Implementation and evaluation of co-designed strategies with Aboriginal and Torres Strait Islander women aiming to reduce diabetes-related risks before, during and after pregnancy

A multi-component program co-designed with Aboriginal and Torres Strait Islander women, communities and health services, conducted across three sites. Intervention components include: 1. Face-to-face group health education sessions with women, facilitated by an Aboriginal or Torres Strait Islander woman with a guest 'expert' relevant to the topic. Topics are tailored to each study site, having been nominated by co-design participants in the formative phase of this study, and include topics relating to diabetes (what is diabetes, managing diabetes, preventing diabetes, understanding intergenerational diabetes), healthy eating, pregnancy planning and contraception, healthy infant feeding, postpartum support, sexual health, and social and emotional wellbeing. Group education sessions will be delivered in a community space (i.e. not in a clinical setting), with the specific space being determined by stakeholders in each site. Education sessions in each region will occur monthly for 2-3 hours. Facilitators will have all completed a culturally appropriate short course in facilitation either prior to or in the early phase of implementation. Attendance logs will be kept, and session facilitators will debrief after sessions to discuss how the session was run, including adherence to pre-planned session goals and structure. 2. Supporting community members to produce locally-made videos to share health promotion messages relating to diabetes in pregnancy in local languages. Research staff will provide support to produce short (less than 3 minute) live action videos. Health promotion messages, languages and dissemination strategies will be determined by video participants, although based on formative work it is anticipated dissemination will include through social media. 3. Advocacy with communities and in partnership with other key stakeholders regarding food security; specific components of this will be determined by an action group of community and agency stakeholders brought together within the first month of implementation, and may include: a. The facilitating of the action group itself, comprising community and agency stakeholders b. Development or distribution of existing health promotion materials and promoting these through a community campaign, e.g. review of existing health promotion materials by action group members and study staff; identification of gaps where development of new resources may be required; identification of contextually appropriate dissemination methods and support from study staff and action group members to implement these c. Working with stores to maximise the potential of store as health promoting environments, e.g. modifications to product placement and pricing, sales promotions on healthy foods and water 4. Enhancing the knowledge and confidence of healthcare professionals to support women with diabetes in pregnancy by providing information, research updates and networking opportunities, such as through the : a. Diabetes in Pregnancy Clinical Reference Group (quarterly online meetings) - one hour meeting providing updates of recent contextually relevant research findings, feedback from reference group members regarding relevance of findings to clinical practice and policies, and input from reference group members regarding any additional concerns/priority areas which could be addressed through research/quality improvement projects b. Dissemination of policy and practice briefs (twice per year, distributed by email) to health services and clinicians across the Northern Territory and Far North Queensland, including summaries of relevant research findings and implications for policy and practice c. Annual Diabetes Across the Lifecourse; Northern Australia Partnership Educational Symposium (in-person and online) - full-day educational meeting with multiple presentations from local and national/international guest speakers on topics relevant to diabetes care, with dedicated time for networking and interactive component for attendees to discuss relevance of presentations to practice Attendance lists, dissemination logs and minutes will be reviewed to monitor adherence 5. Improving access to physical activity through monthly water fitness activities, e.g. aquarobics, facilitated by an experienced physiotherapist with plan to build the capacity of local community members to continue delivery of the physical activity program through training interested local members to be facilitators Intervention components will be delivered over a 12 months period. The specific components implemented in each site are determined by co-design participants, i.e. it is anticipated that not all components will be implemented in every site. Implementation of program components will be conducted in each region as a collaboration between study staff and staff of partner organisations such as the participating Aboriginal Community Controlled Health Service. Implementation and evaluation of activities in each region will be supported by a working group, comprising study staff, Aboriginal and Torres Strait Islander women and representatives from local stakeholder organisations.