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The Moree Aboriginal Healthy Lifestyle Group was initially instigated by Aboriginal health and the Renal Aboriginal Health Education Officer (AHEO) as they were approached by community members to create a program that would support Aboriginal community members in their endeavour to lose weight in a culturally appropriate support group. This is the first Aboriginal Healthy Lifestyle program to be initiated in Moree in partnership with community health, utilising the allied health services.

Many of those who attend the group have chronic diseases, and were seeking support from other community members who have similar conditions and challenges in a culturally sensitive environment. Some had previously tried the commercial healthy weight loss programs, but found them to be expensive and did not have the benefit of education with a dietican, exercise and encouragement of AHEO’s and other group members. At the beginning of the program the participants are asked what topics or activities do they want to discuss that would empower participants to make healthier lifestyles choices.

Aboriginal people have a higher incidence of lifestyle related illness such as Type 2 Diabetes, Cardiovascular disease, Hypertension, Renal Failure, and Obesity than the rest of the Australian population (McMurray, Anne. Community Health and Wellness: a Socioecological Approach. 2000). Whilst the Aboriginal population in Moree is 21% of the population it is of concern that the numbers decline to less than 7% in the over 65 years of age group.  It is well known that personal health awareness is the first step in the promotion of healthy lifestyle, disease prevention and increased longevity.

Aboriginal Health Staff were approached by community members to develop a program which would support them in their endeavours to live a healthier lifestyle. The consultation with the Aboriginal Health Staff, Aboriginal community, Dietician, Diabetes Educator, and Cardiac Rehabilitation Nurse resulted in a culturally appropriate after-hours group program.

Over the last 3 years the program has grown organically according to the needs of the community. The fundamental short term aim of the project is to promote a healthy lifestyle options through education and low impact exercise and to provide participants with the educational tools to sustain a healthy lifestyle in a culturally appropriate manner. Neither of these aims would be possible without the encouragement of self determination, self esteem and ownership of health care to make better healthcare choices. The long term aim of this project is to contribute to a decline in chronic disease and associated risk factors within the community.

In all the health services offered to the Moree Community under 12% of the clients are Aboriginal. Hunter New England (HNE) Health staff, at the request of the community, developed a program to address the disease risk factors in a culturally appropriate manner to engage and educate participants on good health and resources available in their community.

Consultation with each year's members, as well as identification of changes needed lead to a culturally sensitive healthy lifestyle group for Moree, which was deemed the answer to improve nutritional knowledge and make positive changes.

Current Hunter New England Health Service weight loss programs for groups were implemented but proved to be inappropriate for the local community. Adjustments were made to allow for cultural differences, such as flexible starting and finishing times, loosely structured format, tactile aids, and Aboriginal Health workers for cultural support.

• Discussion on the direction of the program included all stakeholders. The decisions included incorporating exercise, cooking classes, and talks from health staff which ensured that participants had variety of activities.
• Moree has excellent cold and hot pool facilities which can be accessed all year round. Due to the town's asset, water aerobics was considered a suitable choice and held twice a week by Aboriginal Health.
• A circuit training class was also conducted by the Cardiac Rehabilitation Nurse, utilising the Moree Community Health exercise equipment. The program alternated classes of circuit training with the health education sessions which focused on nutrition presented by the Dietician.
• A variety of subjects was also provided by the Aboriginal Renal Education Officer and Diabetes Educator.

Encouragement and emphasising the benefits of exercise for a healthier lifestyle was achieved by ensuring exercise was a regular onsite part of the program. Financial and social burdens were minimised.

The first program was trialled in early 2007 as weekly nutrition education sessions at 6pm on Mondays, then with alternating exercise class and nutrition programs. By 2008 the program was reorganised and provided a three month calendar with the Monday health topic and what to bring. The calendar was developed to be put on the fridge as a reminder and also has space for participants to add dates, appointments and birthdays to integrate good health into everyday living.

In the trialling of the program, education on nutrition and health topics were the main focus, however participants wanted the inclusion of an exercise and the fortnightly low impact exercise was included. The first aqua aerobic program was developed in 2007, in partnership with NSW Sport and Recreation and in the following years with Pius X Aboriginal Corporation. At the beginning of this year the group has asked for the inclusion of healthy cooking classes to supplement what they have already learned about nutrition with the Dietican and it is hoped that a cookbook will be developed from recipes supplied from the participants. At all stages of the program the Dietican, Diabetic Educator and AHEO's consult with the participants about future topics and activities as we see it as an integral part of the program's development and success.

Advertisement of the program was via leaflets, word of mouth and Mission Beat. Mission Beat is a one hour program on the local radio station which is hosted by two local Aboriginal men. During that hour song requests and community announcements are played.

This program has empowered the participants to make healthier lifestyle choices giving them knowledge on diabetes, cardiovascular disease, renal disease, foot care, food label reading, strokes, benefits of exercise, weight loss and good nutrition. For many of the participants it has raised their self-esteem and confidence through the discussion groups and exercise programs, knowing that their opinions and experiences are valued and respected by the group. The program has benefited the non-Indigenous staff in providing experience and knowledge of cultural differences and has created an environment for a culturally sensitive service to Aboriginal clients.

The group was developed to have Aboriginals in the community attend the Community Health Centre on a regular basis at a set time each week. This ensures people with Diabetes, Cardiovascular Disease, or Renal disease can access health staff and ask questions in group dynamics. The major outcome is the continual attendance to a lifestyle group.  Building a rapport between Community Health staff and the Moree Aboriginal people is also a factor of the group.

Of the 27 participants who have attended the program since its beginning; 8 were returning members. The group, running since October 2007, comprised of 6 sessions of 8 weeks. The groups consists of 5 diabetics, 1 pre-diabetic, 3 cardiac clients, 6 with co-morbidities and 3 attending as a preventative measure because of poor family health history.

The attendance rate was over 65% for all 8 sessions, with an average waist measurement reduction of 4 cm per person. Reduction in waistline measurements is more significant than weight reduction in Diabetes and Cardiovascular risk (Diabetes Australia). For diabetic clients, waist line reduction reduces complications.  The 27 participants have lost a combined total of 103.9 kilograms. As the average group weight equates to be 89.7 kilograms, the weight loss is greater than 1 participant.

An eight week verbal survey was conducted and results reflect and increased interest in personal health.  Types of comments were: 'that it was good', 'liked the variety of topics' and 'it was good to learn what is happening in their body.'

The Women's Aqua Aerobics, a partnership between HNEH Aboriginal Health and Pius X, had 30 registered participants and an attendance rate 72%. The Men's Aqua Aerobics, a partnership between HNEH Drug & Alcohol Clinical Services and Pius X, had 16 males registered and an attendance rate 62.5%. A small number of participants from both groups have continued to attend the pool and have formed their own informal aqua aerobics group.

Educating the participants has empowered them to have a voice in the health education process. This ownership of  their own health has lead them to request recipe books, a shopping tour, information on incorporating local bush tucker, budgeting advice and skills. As well as requesting changes to ensure participation, such as changing the winter timing to prevent those with lung diseases from being outside in the early winter evening.

Although the Healthy Lifestyle group has been running for a period of time, there remains a need to continue the education and physical activities whilst encouraging new members, particularly males, to attend.

Quality Analyst Clinical Governance, Hunter New England Area Health Service
Phone: 02 4921 4041