To describe the co-design of an Aboriginal unintentional child injury prevention programme in partnership with Walgett Aboriginal Medical Service.

An iterative codesign process using Indigenous research methodology and development of a programme logic model was employed with oversight from a panel of injury experts and key stakeholders. Yarning, stakeholder interviews and a codesign approach to programme development, piloting and evaluation were used. Informed by family and community priority setting, an unintentional child injury prevention programme was designed and delivered through a locational supported playgroup in an Aboriginal community-controlled medical service.

Through an Aboriginal-led codesign approach, a comprehensive injury prevention programme and accompanying manual was developed by the community, for the community. Informed and guided by participants, the researcher’s areas of child injury considered of high value within their community were addressed within the developed programme. The key safety areas identified were water safety, road safety and safety around the home. Data collected throughout the iterative design process shaped the delivery of the programme to ensure it met community needs. In addition to the creation of the manuals, the programme included complementary initiatives to support the delivery. Water safety included mums and bubs swim lessons/water familiarisation. Road safety included car restraint fittings. Home safety included a Goonimoo open day collaboration with KidSafe New South Wales with safety promotion information and resources.

Codesigning an injury prevention programme with staff at an Aboriginal Medical Service and injury experts provided a culturally tailored response to the needs of the community and partners. This process and approach has demonstrated the feasibility of the use of codesigned processes for the development of community-based injury prevention programmes.

Data are available on reasonable request.

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Community-led and collaboratively designed public health programmes and approaches yield beneficial results for Aboriginal and Torres Strait Islander (hereafter Aboriginal) people. In fact, the success of public health interventions with Aboriginal communities depends on authentic partnerships and inclusion at all levels of predesign, design and implementation.1–3 Codesign is an approach within research that promotes authentically collaborative practice to ensure that key stakeholders impacted by the research can contribute meaningfully at all stages and at all levels. It is an approach that, if used effectively, can be beneficial in Aboriginal research.3 A codesign approach, recognising and ensuring equal voice, built on trust, respect and commitment to partnership, provides the structure for collaborative public health programme design with Aboriginal communities.4 5

Unintentional injury among children is a significant global issue that requires urgent attention, causing almost 950 000 child deaths each year. Unintentional injuries can occur through a myriad of mechanisms, including traffic injuries, drownings, burns, poisons and falls.6 7 They are a serious concern for Aboriginal children in Australia, with unintentional child injury accounting for 47% of deaths of Aboriginal children aged 1–4 years.8 Of those, drowning accounts for 35% of these deaths.8 The leading cause of death from injuries for Aboriginal children aged 0–14 years was from land transport accidents (31%), followed by drowning (15%).9 Rates of hospitalisation were higher for Indigenous children when compared with non-Indigenous children.9 However, for all children in Australia, remoteness has a significant impact on injury deaths, three times that of urban areas.9 There is evidence that preventative initiatives and programmes grounded in behaviour change (individual and community),10 environmental change and systemic change reduce the risk of unintentional injuries, but such programmes are scarce for Aboriginal children in Australia.

Due to the ongoing impacts of invasion and colonisation of what is now called Australia, Aboriginal peoples and communities experience significant health inequities.11 These are largely due to the complex intersection of the social and cultural determinants of health and their impact on access to primary care, health information and the involvement in the design and implementation of interventions, programmes and solutions.12 The complex nature of the social determinants of health on populations devastatingly impacted by ongoing colonisation means that a decolonising approach to healthcare must be prioritised,13 with Aboriginal groups at the fore. Explicitly, this translates as Aboriginal communities controlling the resources, interventions and outcomes that impact the health and well-being of our communities.

The codesign process described took place in the context of an existing research partnership, called Yuwaya Ngarra-li (YN), between the Dharriwaa Elders Group (DEG) and the University of New South Wales (UNSW) that is built on community priorities identified through years of rigorous community-led collaboration and research. YN was established after invitation from the DEG to UNSW to work together on the Elders’ vision for positive social change in their community of Walgett in north-western NSW, on Gamilaraay country, Australia.14 This collaboration and work are guided by Gamilaraay and Yuwalaraay language and ways of knowing, being and doing.15 16 Through extensive community-led consultations, design and collaboration, YN has established and created clear research protocols and strategic goals for their partnership,14 17 one of which is to improve the health and well-being of Aboriginal peoples in Walgett. YN provided the opportunity and access to place-based expertise that enabled the codesign for this unintentional child injury prevention project.

An important factor in this successful partnership is the leadership from well-established Aboriginal Community Controlled organisations within Walgett itself, namely the Walgett Aboriginal Medical Service (WAMS). WAMS is an Aboriginal Community Controlled Health Organisation (ACCHO) and opened its doors in 1986 following lobbying and organising by founding Aboriginal leaders from Walgett. WAMS is committed to the health and well-being of the community and a leader in Indigenous health. ACCHOs are central to improving and maintaining the health and well-being of Aboriginal communities across this nation. WAMS has many innovative services available for the whole community in Walgett, both Indigenous and non-Indigenous, one of which is the Goonimoo Mobile Children’s Service. Established in 1985, Goonimoo provides curated playgroup programmes to support education and development of children aged 0–5 years and their families. The expertise and knowledge of the Goonimoo team were identified by WAMS and DEG as being a core element of improving the well-being of Aboriginal children and families in Walgett.

Walgett is a rural town and shire in North-Western NSW. According to the most recent (2021) census, the population was 5253 people, of whom 21.2% identify as Aboriginal.18 The majority (95.8%) of Indigenous people in Walgett speak only English at home and 2.2% use an Indigenous language at home. In Walgett, 15.3% of the Aboriginal workforce reported being unemployed, which is greater than the rate of unemployment (12.3%) among the Aboriginal workforce of Australia. In Walgett, the median household weekly income among the Aboriginal population was US$996, compared with US$1507 among the Aboriginal population of Australia. Among Aboriginal people aged 15 years or older in Walgett, 35.9% had completed year 12 or higher education, compared with 48.7% among Aboriginal people aged 15 years or older in Australia.18

A group of UNSW injury researchers was made aware of funding available in Aboriginal child injury prevention, thus began discussions with WAMS and YN. During these exploratory discussions, it was identified that this funding met the existing goals of the DEG, which led to YN extending an invitation for the researchers to collaboratively design a programme, the Child Injury Prevention Programme (CHIPP), developed on the foundation of this partnership. CHIPP, with the Goonimoo Mobile Children’s Service, is a successful playgroup programme housed within WAMS aimed to meet the vision of the DEG Elders Council through its design, implementation and evaluation to ensure that it is a holistic, community-led, culturally connected and strengths-focused programme that will have a lasting contribution for positive social change in Walgett. This paper describes the process of codesigning an unintentional CHIPP to develop a comprehensive manual and programme created by community for community.19 20

While the specific CHIPP project did not have an Aboriginal Advisory Group, it came under the umbrella of the YN governance structure. In addition, the research team included two members of YN at UNSW (Aboriginal and non-Aboriginal), one representative from DEG and two WAMS Aboriginal staff members.

The qualitative research to develop and evaluate the programme was guided by Indigenous research methodology1 2 and codesign principles through an iterative process across a period of 19 months, from June 2019 to January 2022. A decolonising research approach was taken, with research methods and questions collaboratively designed throughout the CHIPP partnership process. Decolonising approaches paired specifically with Indigenist standpoint theories ensure that research with Aboriginal peoples is led by Aboriginal peoples.14 15 17 21 22 The primary data used to codesign the CHIPP were collected from yarning circles with participants and stakeholders, field notes and expert injury knowledge. Research Yarning is a relaxed, conversational, semistructured interview method developed by Aboriginal researchers.22 23 From these data sources, a programme logic and programme content were created, iteratively developed and implemented, all of which created the foundations for what became the CHIPP.

Since its inception, this project has positioned all research and conduct within Indigenist research,21 24 25 privileging and centring the Aboriginal researchers, Aboriginal early childhood educators from Goonimoo/WAMS and Aboriginal participants involved in the project. The privilege of conducting research within an ACCHO such as WAMS with Aboriginal leadership and voices situates this research as Indigenist research. The lead researcher in this project is an Aboriginal woman, a Kooma woman. Her approach to research is centred in her identity as a black woman, which shapes her conduct and how she engages with communities and colleagues, strengthened by her expertise and knowledge as a trained social worker. This approach ensures transparency and accountability to community and research collaborators. The necessity of black leadership within Indigenous Health research has been well identified, and our presence as black academics and professionals within research is more vital than ever to ensure research meets community priorities.26 27

This paper has documented the process of codesigning an unintentional CHIPP with an ACCHO. It has highlighted the importance of flexibility when working with the community in a collaborative way utilising a codesign approach. The iterative nature of codesigning programmes such as CHIPP has provided insight into the necessity of the flexible nature of this approach. The way in which the CHIPP was guided by environmental factors (fires, floods and COVID-19), participant feedback and team development demonstrated the ever-changing nature of codesign, the ability to pivot with changes as they occur.

Initial aims were to codesign a programme with participants, namely Aboriginal parents and families attending the Goonimoo mobile children’s playgroup. However, as the data showed, the true codesign at this formative stage occurred between the broader collaborating group, the Aboriginal early childhood educators employed through WAMS, and the UNSW research team, the lead researcher NPW and injury experts, while integrating feedback from participants gathered through initial yarns and programme feedback. This demonstrated an interesting shift in applying a codesign approach to designing a preventative child injury programme. This shift demonstrates that codesign methods are iterative and must be flexible to ensure that key stakeholders remain active throughout design processes.5 The research skills were complementary to the knowledge and expertise of Goonimoo educators rather than overbearing and directive. This codesign process allowed the vision of Goonimoo educators to be at the forefront of design and delivery. The privilege of working closely with an ACCHO meant that the UNSW CHIPP team members were guided by place-based expertise and knowledges. Working in this way, through codesign, meant that the work was led by the Aboriginal staff at the ACHHO rather than a university-led approach.

During the formative design and implementation stages of the CHIPP, there were several environmental factors that also contributed to the changing dynamic of the team approach: COVID-19, drought, fires and floods. The iterative nature of codesign allowed for CHIPP to pivot strategically to ensure that the voices of participants were still informing the design, while the codesign was occurring not directly between participants and UNSW, but with a broader team privileging the knowledges and leadership of Aboriginal women on the research project. Further, the injury priorities revealed throughout the codesign process were largely aligned with injuries that are prevalent in Aboriginal children in rural and remote settings (road injury, injuries in the home, drowning) as well as community safety and adverse police interaction. This highlights the importance of community voice and lived experience—communities know what impacts them most.28

The resource manuals produced for CHIPP are further evidence of the codesign process between the UNSW and Goonimoo CHIPP teams. The iterative nature in which they were developed demonstrated the strength of WAMS and Goonimoo staff, specifically the way in which their service was able to pivot in times of crisis, COVID-19, floods and fire. It also demonstrates the importance of active Indigenous leadership in community-based research projects. The development of the CHIPP manuals is a testament to the way in which Indigenous knowledges and the experience and expertise within existing programmes, held by Indigenous staff within ACCHO’s, can be used to embed preventative injury information into programmes for the community.

This paper describes the process of codesigning a CHIPP within a research partnership group, specifically with an ACCHO. A genuine collaborative process privileges the knowledges of Aboriginal peoples throughout and at all levels. The first author is an Aboriginal (Kooma) woman and researcher at UNSW. Our codesign process highlights that community-led research and programme design must have active Indigenous leadership throughout and at all levels. The CHIPP project sought to achieve this by utilising a codesign approach shaped by Indigenist and decolonising research methodologies and Indigenous methods of research.21 35

Taking these approaches within contemporary Aboriginal and Torres Strait Islander research settings is of the utmost importance: no longer can researchers or institutions defer to a lack of knowledge or awareness in relation to proper and authentic conduct when proposing or conducting research with Aboriginal and Torres Strait Islander communities or population groups. Ways to work with Aboriginal and Torres Strait Islander peoples have been clearly articulated over 30 years, by Aboriginal peoples from the community and within academia.15 26 35–37

Australia is a colony that has developed through invasion and ongoing colonisation. Due to the lasting impacts of this, there are many complex issues faced by Aboriginal and Torres Strait Islander peoples.11 38 However, through decolonising processes, such as those described here, these issues can be overcome through Aboriginal and Torres Strait Islander led research, programme design and control. Socioecological theory emphasises the contexts and systems within which child injuries occur and thus the different levels at which interventions may be targeted to prevent child injury: children, their family, peer group, community, institutions and organisations and the broader social, political and environmental factors that influence their lives, including culture, belief systems and social norms.38–40

The health of Indigenous peoples is intrinsically linked to the historical and contemporary context in which we, as lead Aboriginal author and research partners, live, work and exist. While chronic health conditions and acute health concerns impact Aboriginal and Torres Strait Islanders and need to be addressed, at the individual and community levels, it is the systems level which presents the greatest challenges.41 Systems shape the way in which care is provided, but are often underlined by racist assumptions and practices that limit the autonomy, choice and self-determination in the healthcare delivered to Indigenous peoples.42–44 Until we can control the health measures that are designed to ‘fix’ our peoples and communities, nothing will change. Without consistency in funding to support Indigenous-led measures, our communities will continue to receive half measures that line the pockets of people and institutions far removed from those they ‘aim to help’.

The social determinants of health underlying the gross health inequities between Aboriginal and non-Aboriginal children are well documented.45 In relation to unintentional child injury, the social determinants help to explain the unequal division of access to services, safe and appropriate housing, and goods that impact the risk of unintentional injuries. However, the solutions for addressing these inequities are still out of reach for most Indigenous children. Preventative interventions in public health, for example, are often shaped by behaviour change models. But changing behaviours also relies on having access to equipment and resources that enable children to be kept safe. The CHIPP directly addresses this issue in a contextually tailored approach in partnership with an ACCHO embedded in a remote community, and in doing so has identified a need and a culturally safe avenue through which unintentional injury prevention can be made accessible for Aboriginal families.

Aboriginal community control is central to Aboriginal success. Aboriginal communities have the demonstrated capacity to identify areas of need and establish the priorities that will yield holistic success.46 Until our communities have complete control over the priorities and funding that drive research, institutions and researchers must commit to community-led and authentically collaborative research projects. This process takes time which needs to be factored into the timeframes of grants.

Partnerships are essential for successful community-led public health interventions. When seeking to understand the importance and breadth of these partnerships, it is often imperative that as a research team, institution or interested stakeholder, there is significant effort to understand what partnerships exist. Simply, it is important to explore existing partnerships and relationships within the community you hope to collaborate with. Fortunately for the CHIPP project, there were many years of partnership building that preceded our project, and we were invited to the community by the DEG through its existing YN partnership.

The process of codesigning the CHIPP project ensured that the intervention design, delivery and outputs were actively controlled by local Indigenous community leadership. The development of the CHIPP provides useful insights into the way in which western safety and injury information can be successfully adapted to ensure that the messages are appropriate for the specific community. It has demonstrated that codesign can be an effective approach in responding to and meeting the needs of community and partners. A one-size-fits-all approach does not work for Aboriginal and Torres Strait Islander communities; we are not homogeneous.

Data are available on reasonable request.

We pay our respects to elders past and present on whose lands this research was conducted—Gamilaraay, Yuwaalaraay, Wiradjuri, Bedegal, Tharawal, Gadigal and Wangal. We would like to acknowledge and thank the people and community that allowed us to conduct this research and design this programme with them. The CHIPP was developed in partnership with the Walgett Aboriginal Medical Service, Dharriiwaa Elders Group, Yuwaya Ngarra-li, UNSW, Kidsafe NSW.