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Table 4 Final list of programme modifications and implementation strategies achieved

From: A Delphi yarn: applying Indigenous knowledges to enhance the cultural utility of SMART Recovery Australia

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”