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This may be the author’s version of a work that was submitted/acceptedfor publication in the following source:
Parker, Elizabeth, Meiklejohn, Beryl, Patterson, Carla, Edwards, Ken,Preece, Cecelia (Cilla), Shuter, Patricia, & Gould, Patricia(2006)Our Games Our Health: A Cultural Asset for Promoting Health in Indige-nous Communities.Health Promotion Journal of Australia, 17 (2), pp. 103-108.
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Our Games Our Health
1
This is author version of article published as:
Parker, Elizabeth A. and Meiklejohn, Beryl M. and Patterson, Carla M. and Edwards, Kenneth D. and Preece, Cilia
and Shuter, Patricia E. and Gould, Trish (2006) Our games our health: a cultural asset for promoting health in
indigenous communities . Health Promotion Journal of Australia 17(2):pp. 103-108.
Copyright 2006 Australian Health Promotion Association
Our Games Our Health.
A Cultural Asset for Promoting Health in Indigenous Communities
Elizabeth Parker1
Beryl Meiklejohn1
Carla Patterson1
Ken Edwards1
Cilla Preece2
Patricia Shuter1
Trish Gould1
Contact:
Dr Elizabeth Parker
Senior Lecturer
School of Public Health
Queensland University of Technology
Victoria Park Rd
Kelvin Grove 4059
Phone: (07) 3864 3371
Fax: (07) 3864 3369
Email: e.parker@qut.edu.au
1 Queensland University of Technology
2 The George Institute for International Health
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Abstract
Issue addressed: Indigenous Australians have higher morbidity and mortality rates
than do non-Indigenous Australians. Until recently, few health promotion
interventions have had more than limited success in Indigenous populations.
Methods: This community-based health promotion initiative introduced traditional
Indigenous games into schools and community groups in Cherbourg and Stradbroke
Island (Queensland, Australia). A joint Community Forum managed the project;
and the Indigenous community-based Project Officers coordinated training in
traditional games, and undertook community asset audits and evaluations.
Results: The games have been included in the activities of a range of community
organisations in Cherbourg and Stradbroke Island. A number of other organisations
and communities in Australia have included them in their projects. A games video
and manual were produced to facilitate the initiative’s transferability and
sustainability.
Conclusions: Conventional approaches to health promotion generally focus on
individual risk factors, and often ignore a more holistic perspective. This project
adopted a culturally appropriate, holistic approach; embracing a paradigm that
concentrated on the communities’ cultural assets and contributed to sustainable and
transferable outcomes. There is a need for appropriate evaluation tools for time-
limited community engagement projects.
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Key words: Community capacity building, health promotion, Indigenous health,
traditional games.
So what?
This project illustrates a health promotion approach that strengthens ties within
communities rather than endangering them; therefore, reinforcing the factors that
support the wellbeing of communities and individuals. Additionally, the enthusiastic
uptake of the initiative by other communities indicates its potential for
transferability. The games are still played in the schools, demonstrating the
initiative’s sustainability.
Introduction
Globally, the disintegration of Indigenous communities because of historical events
has negatively impacted on their social and cultural systems.1-6 This has had
adverse consequences for the social, spiritual, psychological and physical health of
Indigenous, or First Nations, peoples.2,3,5,6,7,8 Like Indigenous peoples in Canada,
USA and New Zealand,7-9 Indigenous Australians have a poorer quality of life than
do their non-Indigenous counterparts.1,10,11 Moreover, vis-à-vis health status,
Indigenous Australians are one of the most disadvantaged populations in the
developing and developed world.12 Non-communicable diseases such as
cardiovascular disease and type 2 diabetes contribute to an Indigenous life
expectancy dramatically less than that of the non-Indigenous population.10,12
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Despite the widespread awareness of Indigenous health status and the increasing
research into risk factors, the gap between Indigenous and non-Indigenous health
persists .1,3,13 Few interventions designed to reduce disease incidence, mortality
and morbidity, have been effective, particularly at a population level.3,13,14
One of the reasons for such disappointing outcomes is the focus on modifying
disease risk factors through individual behaviour change, without considering the
social, political and cultural context of health in Indigenous populations.15
Additionally, there has traditionally been a top down approach to health
interventions, with a disregard for the Indigenous communities’ ‘ownership’,15 and
naivety about culture. A significant challenge for health promotion is how to
develop and implement effective, appropriate, and sustainable initiatives for
Indigenous peoples. Despite some commonalities in their health status, interests
and needs, Indigenous Australian groups are not homogenous;16,17 consequently, it
is crucial that interventions are coordinated with the specific self-identified needs,
values and aspirations of the discrete communities.18 Reflecting on past failures,
projects directed at the individual, rather than the family and community, act to
threaten values esteemed by Indigenous communities.19 Although well intentioned,
interventions that jeopardize the connections between the individual and the wider
social fabric, present health risks for Australian Indigenous communities.3
It is at this point, then, that there might be a valuable convergence between the
lessons learnt from the failure of past interventions, the identification of more
appropriate and effective interventions, and our increased understanding and
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respect for cultural factors central to Indigenous life and health. Indigenous
Australians, like the NZ Maori and the Canadian and US First Nations Peoples, view
disease as an imbalance in their lives, and a consequence of the destruction of their
way of life since first contact.2,4,7,8,20,21 This perspective is incongruent with the
models used as a basis for public health and health promotion practice that attribute
responsibility for disease to individuals.14
Central to the Australian Indigenous view of health is the concept of the individual
as one part of the whole community.3,22 Actions that are seen to disconnect the
individual from family and community are regarded as shameful.22 Evidence
suggests that interventions that incorporate the cultural dimension as a vehicle for
community participation and exercise, for the benefit of the wider community or to
reinforce group participation, are more likely to succeed than individual exercise
programs.3,22
Our Games, Our Health
“Our Games, Our Health” was developed with two discrete Indigenous communities
in Queensland, Stradbroke Island and Cherbourg. The application for funding was
submitted jointly through the two communities and Queensland University of
Technology (QUT). The QUT team members were known to both communities
through previous initiatives; and collaborated with them to determine the priorities
for action, through meetings with various community groups prior to the funding
submission. The project was underpinned by the holistic context in which
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Indigenous communities view health, one centred on connectedness at three levels
– family, community and society;14 and emphasised the centrality of
relationships.16,23 Using the analogy of the traditional Indigenous games as a
‘cultural thread’ the project drew together the communities’ own resources to
develop and integrate the project to enhance physical activity in a meaningful way.
Prior to this project, traditional Indigenous games have been played in schools, but
to our knowledge have not been utilised to mobilise Indigenous communities.
However, the revival of traditional games encourages people to contemplate their
origins; this may initiate new activities that have a positive effect on building
community capacity;24 and sport is an important ‘community building instrument’
that can encourage social cohesion and address many of the issues impacting on
Indigenous Australians.25
The aim of the project was to develop, implement and evaluate a community-based,
multi-strategy health promotion intervention that focussed on men’s and older
people’s health in the Cherbourg and Stradbroke Island communities. However, as
the project progressed it was found to be more efficacious to redirect the focus to
school children. This was due to the difficult personal circumstances of some
members of the men’s and elders’ groups, whereas with the support of the
Community Project Officers and the schools, the children’s participation was more
consistent. The Cherbourg School is an Indigenous school, while the Stradbroke
Island School has a high proportion of Indigenous children; there are Indigenous
and non-Indigenous teachers at both Schools.
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The specific objectives were to:
• consolidate the Community Forum to manage the project;
• conduct a family-based health promotion intervention;
• collaborate with Indigenous Sport and Recreation Officers
• develop action research/evaluation skills;
• evaluate the project;
• build sustainable activities throughout the project through community
ownership.
Methods
The project was structured through three interlocking stages, with each stage being
enriched by the previous, so that knowledge and skills development opportunities
were integrated into as many aspects of the project as possible. The stages were
community engagement, community mobilisation and capacity building. The project
operated between March 2001 and July 2002.
Community engagement
A Community Forum was established, comprising 10 members of both the
Cherbourg and Stradbroke Island communities, who met alternately in each
community. Traditional games were held at each forum, allowing members to learn
about the games, be physically active and become acquainted. Indigenous
Community Project Officers were employed in each community to coordinate
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training in traditional games and undertake community asset audits. A short course
in health promotion was conducted for staff.
Community mobilisation
Two ‘asset audit’ audit workshops were conducted in each community, where
existing strengths and gaps were identified and actions on physical activity priorities
were mapped. Strengths included, for example, ‘cultural activities in schools’ and
‘satisfactory roads’, while gaps include ‘insufficient recreational facilities’ and ‘no
good walking path’. ‘Train the trainer’ games workshops were held to transfer skills
to community leaders and engage regional Indigenous Sport and Recreation
Officers. These were held at QUT, as it was closer to both communities than they
were to each other. A project newsletter was distributed throughout the two
communities to encourage the ‘adoption’ of the intervention, as someone
considering change may be influenced by observing the results of the adoption of an
innovation by others.26 The newsletters included, for example, comments from
students regarding their participation in the games, updates from the Community
Project Officers, and information on the benefits of physical activity.
The games used for the project are from the book Choopadoo: games from the
dreamtime (Table 1).27 This is one of the few resources available describing
Australian traditional Indigenous games, and the most comprehensive. The games
derive from most areas of Australia, including the Torres Strait Islands. They are
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suitable for a range of age groups and include cooperative and competitive games.
The duration of the games is 10-30 minutes.
Table 1 about here
Community capacity building
A video and manual (owned by QUT) were produced for project sustainability. The
video features an introduction to traditional Indigenous games and shows children
from Cherbourg and Stradbroke Island playing some of the games; the manual
outlines the games’ history and rules. The video was distributed to communities
involved in the project, in addition to other interested communities. The activities
of the video are available on the Australian Sports Commission website. Currently
unavailable, the updated edition of Choopadoo is due out in 2006. Grant
applications to extend the project were written collaboratively with the
communities. Successful grants from the Telstra Community Development Fund
have allowed the transfer of the project to Weipa, Charleville and Cunnamulla
(Queensland). In addition, the children demonstrated the games at the Croc
Eistedfodd, Weipa (2002).
Results and Evaluation
Over 200 children from two primary schools participated in the 16 month project,
through organised carnivals, and traditional physical activity integrated into the
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curricula. Furthermore, the games became part of the daily physical education and
cultural curricula at both schools. The games were taught by community members,
who had attended training days. The first training day involved a demonstration
and try-out of some games, the second and third involved practising familiar games
and learning new ones. The Community Forum met six times and hosted the two
asset audit workshops.
Process evaluations were conducted at key points throughout the project and the
resulting information was used to develop and improve it on an ongoing basis.
These key points included the Community Forum, training days and asset audit
workshops. The process evaluations used written questionnaires and focus groups,
and included questions about satisfaction levels and the quality of information. In
summary, most people ‘agreed’ or ‘strongly agreed’ that these were satisfactory.
Feedback from community members included:
Today was satisfactory
I would like to be on the forum
Everything seems to be going all right at this point in time
Feedback from the 109 children surveyed included:
I like them all
I played when at school
I played with my cousins, brothers and sisters
It was great, it was friendly
Limitations
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The original objective of using the participatory action research design as a
framework for the evaluation encountered difficulties. While many community
members attended the training, it was difficult to integrate them into the Evaluation
Group because of long travel distances, and the limited available time due to their
work and family commitments. While this model is ideal in theory, the difficulties
identified in its application in Indigenous community-based research highlighted the
need to develop alternative methods of measuring social capital and networking.
Indicators with potential in tool development, identified during the project, include
consistent attendance, communication with others about information arising from
the Forum, numbers of distribution channels targeted with promotional materials
and collaboration with other members at venues. However, limited time and funds
prevented these methods from being fully explored; as the funding available to the
project was considerably less than that applied for.
Problems were encountered in addressing the issue of a formal impact evaluation of
the project; these included a limited timeframe. Difficulties with similar projects are
well documented; however, research into appropriate strategies is underway.28-30
The limited value of currently available tools for use in evaluating community
development projects within Indigenous communities has also been recognised.31,32
The literature on social capital tool measurement was searched33,34 and a number of
tools were trialled, particularly a modified version of a tool for measuring social
networks by Hawe et al.33 The tool was administered at three Community Forum to
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acquire insight into the perceived capacity of the Forum as a ‘network’ between and
across services and sectors. This was abandoned because the Forum members had
carried out extensive evaluation exercises as part of the comprehensive process
evaluation and were experiencing an evaluation ‘overload’. Furthermore, time and
funding constraints meant that only a limited evaluation could be undertaken. More
funding could have ensured a more robust pre-post test evaluation was utilised, in
addition to assessing various impact measures.
At first glance, it may seem inconsistent that the program was extended to other
communities when a comprehensive evaluation could not be conducted. However,
the project demonstrated significant potential, as considerable interest has been
shown in the games, both within the participating communities, as well as outside
communities. In addition, the project team are still fielding inquiries regarding the
Games from communities Australia-wide.
Conclusions
Consistent with the ‘NHMRC Road Map’ criteria,35 this project highlights three key
principles crucial in improving Indigenous health. The first is the focus on the
Communities’ strengths, identified in the asset audits, rather than their deficits or
disease-centred risk factors. Instead, the developers adopted a ‘positive Indigenous
health promotion paradigm’. The second is community control, where the
communities participated in the planning and decision-making from the outset. The
third is the facilitation of cultural exchanges between two geographically distant
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Indigenous communities; which has the potential to enrich capacity by extending
networks and enabling the communities to learn from each other, thus enhancing
outcomes.
The preoccupation with formal impact evaluation in a multi-dimensional project with
the goal of community development, somewhat contradicts the theoretical concepts
that underpin such projects. The postulated capacity building would extend beyond
the project implementation and increase the sustainability of the project and, by
definition, challenge the concept of impact evaluation. Cognisant of this, and the
key role of evaluation in developing effective health promotion projects, it was
decided that a flexible application of a formative process evaluation consisting of
complimentary qualitative and quantitative data collection was appropriate.29
Sport plays a role in the life of many Australians and its significance in Indigenous
Australian societies should not be underestimated. The use of games to increase
physical activity allowed the Indigenous communities to re-establish a part of their
cultural identity; thus enhancing the project’s effectiveness and sustainability. This
project, which was driven by, and targeted, the whole community, is in keeping with
the Indigenous holistic approach to health. The approach of building on community
strengths worked well in this modest project; and the philosophy of eschewing the
standard ‘disease’ deficit-model of health promotion that underpinned the project
enabled active community engagement in the asset audits of physical, health and
social infrastructure and the actions that arose from these.
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This project provides evidence that the theory of ‘social capital’ and ‘community
capacity building’ can be translated into practice. The capacity of the communities
has been developed to the point where they have collectively identified a priority for
action and demonstrated the will to make this happen. The social capital that has
accumulated will help to restore the essential balance in the Indigenous cultural
view of health; it strengthens the connectedness to community and family. To a
point, the ‘ties that bind’ have been re-established through the cultural thread that
symbolises this project. Through these ties the protective factors central to the
Indigenous view of health and underpinned by current research, have begun to be
restored within these communities. The games provided a culturally appropriate
activity that combined physical activity and opportunities for social interactions with
the possibility for a revitalisation of one facet of Indigenous Australian cultural
identity.
Ethics
The QUT Human Research and Ethics Committee granted approval for this project in
February 2001. Informed consent for interviews was gained from all participants in
the games project, and from the parents of participating students.
Acknowledgements
During the preparation of this paper, Dr Carla Patterson passed away. Carla
provided invaluable input into the asset audit in this project. Carla will be sadly
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missed by all her colleagues. The authors thank the people of the Cherbourg and
Stradbroke Island communities for their generous contribution and support; the
community-based Project Officers, Amanda Coombs (formerly Stradbroke Island)
and Richard Coleman (Cherbourg) for their invaluable advice and assistance; Health
Promotion Queensland – Queensland Health for funding this project; and Julie
Appleton for the final evaluation.
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Table 1: Some examples of Traditional Games used in Our Games Our Health
Games Description of Games Ball Games Kai Keentan
Teams hit the ball up in the air with hands, while trying to keep it from touching the ground Running, passing and catching. Players on opposite team try to intercept ball when thrown.
Ball Rolling Juluhya Koolchee
Players roll a marble down a tube, the players whose marble appears first is the winner. Teams roll balls towards each other, aiming to hit the opposing team’s balls.
Disc Game Gorri
One player rolls a ball or disc towards a marked area, the other players attempt to hit it with their balls or discs
Throwing Games Wana Boomerang
A player tries to deflect balls thrown by all the other players at a target, which she/he must defend. Players attempt throw the boomerang in such a way that it returns to them.
Dodging Game Taktyerra
Teams throw balls at each other, and attempt to dodge the balls being thrown at them.
Hitting Game Kalq
One player throws a ball to the player next to them in a circle, who must then hit it on to the next person.
Finding Object Game Luka-pul Pul
One player hides an object, another player attempts to find it, if unsuccessful, the first player gives clues to guide the searcher.
Imitation Game Beejan Eejar
Players act out cooking, eating and storing food, making camp etc (As a part of role-playing for adult life)
Tag Game Puuny
A blindfolded player tries to catch one of the other players, the player caught takes the place of the blindfolded player.
Running Games Tarnambai
Players start at different distances depending on ability. They run as fast as possible, but try and finish together
Guessing Games Wabbyn
Players attempt to guess what another player has seen. Clues may be given. (Similar to ‘animal, vegetable or mineral?’ game)
Dance/Corroboree Yongar Ngardongin
An acting contest, one player acts as the kangaroo the other as the hunter.
See Choopadoo: Games from the Dreamtime (1999) by Ken Edwards, for more information about the origins, history and rules of the games.