‘…you can’t work singular when you’re working with families’: co-creating strategies for fetal alcohol spectrum disorder prevention and support with an Aboriginal and Torres Strait Islander primary healthcare service: a baseline mixed methods study

Background: Community controlled Aboriginal Medical Services (AMS) lead the way in addressing the health needs of Aboriginal and Torres Strait Islander peoples. If appropriately resourced, AMSs are inherently well-placed to address prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorder (FASD). The Strong Start, Bright Future project and a regional AMS co-created culturally-informed approaches to address PAE and FASD. This study reports baseline findings and proposed strategies for the implementation phase of the project. Methods: Using Indigenous and Western mixed methods, this study centred staff and Aboriginal and Torres Strait Islander community voices, knowledges and priorities through yarning. Questionnaires and a chart audit sought broad insights into staff knowledge, attitudes and practices. Yarns were analysed using Dadirri and narrative analysis, and questionnaire and chart audit results were summarised numerically (descriptive statistics). All findings were integrated to produce proposed service-specific implementation strategies. Results: Findings revealed the strengths of Aboriginal and Torres Strait Islander relational and trust-building approaches, particularly within AMS community outreach services that foster connections with Aboriginal and Torres Strait Islander women in the community, facilitating access to PAE and FASD-related knowledge and services. However, clinical staff knowledge gaps, misconceptions, inconsistent practices and unclear diagnostic referral pathways were barriers to service access. Guided by Aboriginal and Torres Strait Islander community and staff knowledge and priorities, proposed strategies were multifaceted, including whole-of-service training, community learning opportunities, family-centred care and culturally safe messaging. Conclusions: The Aboriginal and Torres Strait Islander community and outreach staff knowledge featured in this research highlights the strengths of Aboriginal and Torres Strait Islander approaches for addressing PAE and FASD, and provides essential guidance informing safe and culturally responsive PAE and FASD services for Aboriginal and Torres Strait Islander peoples.