Working at the cultural interface to meet the needs of remote Australian Aboriginal caregivers with children progressing through the nutritional period of weaning

Author: Anthea Brand

Brand, Anthea, 2020 Working at the cultural interface to meet the needs of remote Australian Aboriginal caregivers with children progressing through the nutritional period of weaning, Flinders University, College of Medicine and Public Health

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


During my work as a Dietitian, one of the communities I worked with highlighted their fears for their children’s future health. Caregivers told me that more people were becoming unwell with chronic diseases and had to leave their country to access healthcare; they worried that this situation would worsen as the food system and feeding children became more complex. My own practice dilemma arose as I recognised these concerns and questioned why communities were facing an unjust burden of disease. Research indicated that optimising nutrition in the early years of life, particularly during the period of weaning (the period from the introduction of complementary foods into a child’s diet to the complete reliance on these foods for nutrition), offered a window of opportunity to address health inequities. Yet concerns for children’s future health were heightening in the presence of an influx of health service resources and programs that aimed to promote optimal child health and nutrition.

This research is in response to the concerns raised by that community. In this study I sought to understand if the nutrition activities undertaken by non-Aboriginal health professionals working in a remote community of Central Australia met the needs of Aboriginal caregivers whose children were progressing through the period of weaning. I defined that in order to meet caregiver’s needs, activities would have to prioritise the concerns of caregivers and respond to the context of feeding and determinants of feeding practices. As such, health professionals and caregivers would be required to share knowledge, create mutual understandings and collaborate in the development of solutions and actions.

Setting the research in one community, enabled me to work closely with them to deeply explore practices and their determinants in context, at multiple timepoints over the period of the weaning of children. This approach recognises the heterogeneity of context and counteracts the generalised knowledge that is often applied when working with Aboriginal communities. So that I could meet the needs of the community and to ensure accurate representation of their voice, I worked closely with the Aboriginal Community Based Worker (CBW) employed by the local health clinic and community members, including a study reference group throughout the study. I employed critical social research methodology and undertook community focus groups, semi-structured interviews and observations to gain knowledge from both Aboriginal caregivers and non-Aboriginal health professionals. I used cultural interface theory to present this knowledge so that the voices of both groups were represented without judgement or privilege. I then applied critical social theory and postcolonial theories to analyse the interactions and sharing of knowledge between the two groups.

Through the research findings and my own reflexivity during the research process, I contribute to knowledge a model of the current cultural interface. This model demonstrates the presence of social and professional discourses of medicalisation, ‘nutritionism’ and essentialist views of culture that reinforce selective models of primary healthcare. These place the health professional in a position of power, facilitate the privileging of biomedical knowledge and contribute to Othering. This acts to oppress the participation of the caregiver and marginalise caregiver’s knowledge at the cultural interface, which clearly disempowers the caregiver and fails to meet their needs. The model also disempowers the health professional, who is aware that their activities are not meeting the needs of caregivers but experiences tension in their inability to work in different ways.

I propose an innovative model of the optimal cultural interface, supported by a comprehensive and culturally safe primary healthcare system. The model enables health professionals to undertake reflexivity to act on structural factors and oppressive practices, in order to redistribute power to caregivers, so that they can actively collaborate in the sharing of knowledge and development of solutions. The facilitation of this model requires re-orientation of the health system and training of health professionals in pre-requisite knowledge. The training will allow health professionals to respect alternative constructs of health and its determinants, adopt and action a more holistic and contextualised view of health/nutrition and develop trusting relationships with caregivers. These pre-requisites are required to facilitate the meaningful sharing of knowledge and respectful collaboration in solution generation.

Keywords: Australian, Aboriginal, nutrition, infant, child, cultural interface, weaning

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Medicine and Public Health
Supervisor: Melissa Lindeman