Table 4 Final list of programme modifications and implementation strategies achieved
Implementation strategies accepted after Round 3 | ||
|---|---|---|
Key programme modification | Accepted strategy | Panellists’ quotes |
1. Composition of a separate facilitator and group member handbook | 1. Is no more than 15 pages | “Keep it simple, 10–15 pages max” |
2. Has space for writing, drawing, and working through activities | “If it’s a handbook for participants then make it about them. [it needs to be] long enough to convey [the programme] concepts, provide workspace and be short enough to not be overwhelming to use” | |
3. Use Indigenous designed and/or developed recovery resources | “Aboriginal validated and designed resources should be used” | |
4. Have a minimal amount of written text (higher ratio of artwork and imagery) | “I think it should be easy to read and follow without huge chunks of text” | |
5. Convey the core programme tools and techniques using artwork and imagery | “The language is clinical and unfamiliar for many Aboriginal and Torres Strait Islander mob, especially those for who English is a 3rd language. Use pictures to convey ideas where possible and ensure it is written in the right voice and style. Add a glossary for those terms that cannot be substituted to explain meanings | |
6. Contains testimonials of Indigenous people who have recovered attending SMART Recovery groups | “[It would be helpful to] share testimonies of facilitators or an Aboriginal person who has [recovered by using] the programme and has moved forward to a point of no longer being an addict, or have an addiction or if so has ways of managing it well with the right supports in place through key Elders etc.” | |
2. Culturally appropriate language, terminology, and literacy level | 7. Reflects the voice of Aboriginal and Torres Strait Islander peoples | “When we talk about terms like 'meetings' or 'program tools' it does not apply to our ontology, terms to need to define in our way of knowing, being and doing” |
8. Is clearly written | “Any piece of writing that is simple and concise will be able to communicate it's intended message across easier” | |
9. Is strengths based, | “Strength based wording would hopefully give people a sense of empowerment” | |
10. Is empowering | “I would love to see the shame taken out of recovery and empower participants to own their story and their journey wherever they may be on it.” | |
11. Is engaging | “The attendee workbook must be written in language that conveys the voice and perspective of ATSI peoples or we won’t engage with it” | |
3. Culturally meaningful programme activities | 12. That can strengthen connections to community and country | “Healing happens at the community level” |
13. That strengthen cultural identities | “[there needs to be] activities where attendees could be culturally immersed and promote their own cultural wellbeing” | |
14. That encourage positive social, family and community support networks | “It is proven that Aboriginal people confront and tackle serious issues/problems collectively, the reason for this is so we can add identity, family kinship and culture to everything we do” | |
15. Promote holistic concepts of health and wellbeing | “What we were doing was running fitness programmes for the clients as they progress this helps them deal with their cravings and urges etc.” | |
4. Create supplementary storytelling resources | 16. Co-created with a range of different community ambassadors | “I would like to see the [new] handbook be co-created by consumers on how they view the world, which would inform the language that should be used. I find it interesting that we talk about consumer-centred care but when we develop intervention strategies it neglects the voice of the consumer who live their experience and that intervention strategies should be about facilitation of change not a forceful direction of change” |
17. Narratives reflect diverse culture and community groups | “[this would make the handbook more meaningful for group members] because they know that the book has cultural values [and contains] an Aboriginal perspective not a western world mind set” | |
18. Map onto the handbooks in such a way that they reinforce learning of tools and techniques (e.g. a story would be created to exemplify how to use urge surfing) | “[It would be more helpful if the handbook used] examples of local programs or people, or even a case study that uses local language and terms” | |
19. Promote holistic concepts of health and wellbeing | “This would help participants identify with the content. I don't seem to see this in the current [handbook]” | |
20. Address the broader social and historical determinants of recovery, health, and wellness | “because we are constantly being bombarded with negative views of our people” | |
21. Complemented by imagery depicting a range of different skin types, genders, and ages | “I suggest a range of gender expression, ages and skin colour. Aboriginality isn’t about colour so we need to stay away from stereotypes full stop” | |
22. Depict a progressive journey of how people recover attending SMART Recovery groups | “[the handbook needs] a storyline that conveys a progressive but cultural storyline. [this] cultural storyline would provide attendees the opportunity to nurture their cultural spirituality and their own self-narrative” | |
5. Customisation for diverse community contexts | 23. Provided facilitators with a master shell during or after SMART facilitator training | “[this would allow] the facilitator to reword to suit the audience” |
24. Each facilitator would be responsible for customising the handbook according to their groups context and needs | “The facilitator should be able to reword to suit the audience” | |
25. Customisations would include use of local language/terminology (i.e., rugby vs football), local artwork, imagery, and symbolism and, a personalised acknowledgement of Country | “If region specific resources are prepared, language will be easily localised. If language is not localised you risk excluding participants. It [may not always be a matter of] translating into each of the local languages, but maybe using terms and examples that are locally relevant” | |
26. Content is tailored to each community's primary substance(s) use and/or problematic behaviour(s) of concern | “This issue is very difficult to achieve, it would be great to design a handbook that relates to each community however trying to accommodate everyone is nearly impossible but would be fantastic” | |
27. Customisation includes acknowledgement of Country | “[need to] localize the images and artwork, even the acknowledgment of country where the groups are run should be aligned’ | |
Implementation strategy rejected after Round 3 | Panellists alternative suggestions | |
|---|---|---|
Prepare handbooks as generic templates with no artwork or imagery and simple language | 1. Create a customised handbook during facilitator training 2. SMART Recovery practical and financial support for facilitators to create a handbook on return to their communities after facilitator training |
Strategies that were added after reaching consensus in Round 3 | Participant quotes | |
|---|---|---|
1. Creating an audio version of the handbook(s) would be useful for some people/communities | “Having an audio version would be fantastic and especially if in different Aboriginal languages. People retain and learn information in different ways. Most people [Indigenous or not] need a variety of learning tools” | |
2. The handbook should have the capacity for each community to use locally relevant scenarios and symbolisms as examples of applying SMART tools and techniques | “I think it's vital people from different communities can connect with the materials regardless of where they are from” |