'Making a difference': A new care paradigm for pregnant and parenting Aboriginal people.

OBJECTIVE To describe community-based stakeholders' views of how safe and responsive care "makes a difference" to health and well-being for pregnant and parenting Aboriginal people. Community-based stakeholders included community members, providers of health and social care, and health care and community leaders. METHODS A postcolonial standpoint, participatory research principles and a case-study design were used to investigate two Aboriginal organizations' experiences improving care for pregnant and parenting Aboriginal people. Data were collected through researcher field notes, exploratory interviews and small group discussions with purposively selected community-based leaders, members and providers. Data were analyzed using an interpretive descriptive method. RESULTS Community participants' views of "making a difference" emphasized: recognizing relevant outcomes of care; acknowledging progress over time; and using a strengths-based approach in which providers appreciate individuals' efforts and the challenges of their contextual circumstances. DISCUSSION "Making a difference" to pregnant and parenting Aboriginal people would facilitate Aboriginal peoples' efforts to tackle the deeply embedded socio-historical determinants of well-being and capacity, and thus shift priorities for care upstream to focus on such determinants. Such a paradigm for care would integrate multiple perspectives on desirable outcomes within local frameworks based on values and priorities of Aboriginal parents, while also incorporating the benefits and wisdom of existing yet further downstream approaches to care. CONCLUSION Design and evaluation of care based on community values and priorities and using a strengths-based approach can improve early access to and relevance of care during pregnancy and parenting for Aboriginal people.