' Achievement , pride and inspiration ' : outcomes for volunteer role models in a community outreach program in remote Aboriginal communities

Introduction: There is growing support for the prosocial value of role modelling in programs for adolescents and the potentially positive impact role models can have on health and health behaviours in remote communities. Despite known benefits for remote outreach program recipients, there is limited literature on the outcomes of participation for role models. Methods: Twenty-four role models participated in a remote outreach program across four remote Aboriginal communities in the Northern Territory, Australia (100% recruitment). Role models participated in semi-structured one-on-one interviews. Transcripts were coded and underwent thematic analysis by both authors. Results: Cultural training, Indigenous heritage and prior experience contributed to general feelings of preparedness, yet some role models experienced a level of culture shock, being confronted by how disparate the communities were to their home communities. Benefits of participation included exposure to and experience with remote Aboriginal peoples and community, increased cultural knowledge, personal learning, forming and building relationships, and skill development. Conclusions: Effective role model programs designed for remote Indigenous youth can have positive outcomes for both role models and the program recipients. Cultural safety training is an important factor for preparing role models and for building their cultural competency for implementing health and education programs in remote Indigenous communities in Australia. This will maximise the opportunities for participants to achieve outcomes and minimise their culture shock.


Introduction
Youth mentoring programs are known to provide intervention and support to at-risk youth 1 ; however, relatively little literature exists on the outcomes of mentoring programs with remote Indigenous youth 2 , with no known studies outlining the outcomes for mentors or role models delivering the programs.Various elements combine to promote successful health promotion programs among Indigenous youth in remote communities.Employment of Indigenous workers, longevity beyond 1 year 3 , community involvement 4 , and respect for local social systems, culture and knowledge 5 are all elements needed for effective programs.
In many programs, sport at the community level has been advocated as a mechanism to promote a socially cohesive society 6 , encourage strong community bonds, reduce crime rates, and offer access to positive mentors and role models 7 .There is growing support for the value of role modelling, especially for those adolescent populations that are from socially and culturally disadvantaged backgrounds and/or considered 'at-risk' of engaging in unhealthy behaviours and educational disengagement 8 .Evidence shows that having a role model, one known to the adolescent, has been linked to higher academic performance, increased levels of physical activity, decreased substance use and fewer behavioural problems in school 9,10 .Further, evaluation of an outreach program in remote Northern Territory communities found that utilising role models motivated youth to develop a diversity of skills, encouraged resilience, self-esteem and healthy choices, built relationships and embodied facets of mentoring 11 .
The potential positive outcomes of role model programs for remote Indigenous youth have been outlined, but there is little research that explores the outcomes for external role models or mentors who are involved in remote programs.Various urban studies have confirmed that the benefits of role modelling or mentor programs for Indigenous youth extend beyond youth, to include improved knowledge of Indigenous Australian culture and youth issues, enhanced personal development and self-esteem, sense of achievement and pride, development of strong relationships with students, and the opportunity and ability to challenge assumptions and stereotypes for mentors 12 .These outcomes may exist in an urban context, but for external people who spend time in remote communities there are many cross-cultural contexts with many cultural complexities 13 .These people should attain some cultural understanding or training prior to visiting remote communities to ensure cultural sensitivity, appropriateness and respect 14 .This study will examine whether positive outcomes similar to those found in urban contexts are present for role models in a remote context.
The purpose of this study was to determine the outcomes for volunteer role models (both Indigenous and non-Indigenous) delivering an outreach program through schools in four remote Aboriginal communities in Northern Territory, Australia.The findings of this study have implications for the design and justification of other remote outreach programs.
In Australia, the term 'Indigenous' refers to Aboriginal and Torres Strait Islander peoples.The communities included in this study are Aboriginal communities only.

Sample and location
In October 2013, 24 role models participated in a remote outreach program across four remote Aboriginal communities in the Northern Territory, Australia, with 100% (n=24) consenting to participate in the study.Fiftyfour percent of the role models were female, with a mean age of 29.1 years.Twenty-five percent (25%) of the role models identified as Indigenous.It was the first remote community visit for nine role models (38%).The populations of the four remote Northern Territory communities visited ranged from approximately 200 residents to 700 residents and were located up to four hours' drive from the nearest regional centre of Alice Springs, which has a population of approximately 28,000.

Program aims and overview
An Aboriginal community organisation has run the outreach program three times per year in various remote Aboriginal communities since 1995.Role models volunteer and are selected based on their experience, skills or specific capabilities (eg athletics, writing, teaching).The intention is that they are exemplary, worthy of imitation and will reflect critical aspects of psychosocial, physical and educational functioning.The role models work collaboratively with the schools and communities to provide inspiration, encouragement and support for students at school; enhance students' self-esteem and self-confidence as Aboriginal young people; help students develop life skills, knowledge and social capital; encourage participation in sport and recreation activities for healthy and positive lifestyles; and strengthen school and community partnerships.
Before visiting the communities, the role models participate in training sessions, which contain elements of 'cultural awareness', 'cultural competence' and 'cultural respect' that are frequently used in Australia when training health workers 15 .In the current format, the training consists of a session with a local Elder, who explains cultural elements (eg kinship systems) and ways of being respectful while in communities.This training aims to increase participant awareness of cultural factors applying specifically to the Aboriginal peoples and communities participating in the program 15,16 .

Methodology and instruments
Based on the limited existing research in the field, a grounded theory approach was used: the authors had a topic for investigation (outcomes for role models), conducted the research, and then analysed the data to explain findings 17 .Both researchers were present during the delivery of the program in one community and met participants several times prior to conducting interviews, developing rapport between researchers and participants.Hence, researchers gained an understanding of the participants' experiences, definitions, values, adaptations and understandings 17 .Semistructured interviews focused on role models' knowledge, skills and preparedness, and the benefits gained and challenges faced during the program.The interviews were conducted following the implementation of the program in the four communities and duration was 15-40 minutes.

Data analysis and trustworthiness
The data were transcribed verbatim, category labels were allocated to each piece of text to reflect meaning, and relationships between categories were examined.Categories were then examined in light of the research questions.Both members of the research team were involved in data analysis and conducted independent analyses for all transcripts to ensure credibility in the qualitative data analyses procedures.These were followed by collaborative discussions to finalise data coding and the thematic layout of data descriptions 18 .The authors made minor refinements to coding and groupings.

Limitations
Despite 100% participation, the study includes a relatively small sample size.To address this limitation, a larger scale study is currently being conducted.

Ethics approval
Ethics approval was granted from The University of Sydney Human Research Ethics Committee (2013/717) and the Northern Territory Department of Education.The research observes the values and ethics in Indigenous health research outlined by the National Health and Medical Research Council 19 .Participants have been de-identified.

Results
Various themes emerged in the interviews (Table 1), including influences on feelings of preparedness, the perceived reciprocity of the program (benefits for the participants and for the volunteer role models), the cultural learning derived from participation, the challenges encountered during the program and the associated personal development, and the suggestions for improvement that would reduce the challenge or increase the benefit.The focus of this article is the outcomes for volunteer role models, hence the predominant themes of 'benefits' and 'learning for role models' are elaborated.

Benefits and learning for role models
The role models espoused many personal benefits gained through their participation in the program, coupled with perceived benefits for the program participants 20 .These include forming and building relationships in the community and with each other, and learning gains that facilitated increased cultural competence through experience of Aboriginal culture and community.
For the returning role models, the focus was on reestablishing and building upon the relationships they had formed previously: … I have built some great relationships and believe that through regular contact, these relationships can be lifelong.I also feel … I have a responsibility to continually participate.(role model X) Continuity was perceived as important for enhancing trust and respect among role models, community members and students.Building and maintaining these relationships also served as motivation to return: I wanted to keep building relationships with the kids and community … keep coming back as much as I could … (role model W) An increase in cultural awareness, knowledge, skills and competence was a benefit that all role models attributed to their participation in the program.The biggest learning gain the role models derived from the program was the exposure to and awareness of Aboriginal culture and the inequities that are faced by Aboriginal people in remote areas.This 'exposure' was recognised as having provided the opportunity to learn: … so much knowledge about Indigenous culture …and how life is in a remote community … about the different communities … the history and people … (role model W) Consequently, the role models recognised challenges inherent in this learning, such as experiencing a level of culture shock being confronted by the daily struggles, living conditions and health disparities experienced by the community: Seeing the kids with different health issues is tough.(role model A) Despite some culture shock, the majority of participants felt well prepared for the experience and expressed learning and development.This was derived from the cultural training that was part of the preparation for the program, as well as developed through experience in the community.Consequently, some of the role models indicated pride in the personal growth they experienced and believed that the outreach program and their contributions as role models, coupled with continued cultural learning, would make a difference in the remote community and to Aboriginal inequality in remote regions:

Sense of achievement, pride, inspiration, feeling like you can make a difference. (role model M)
One role model highlighted that this learning was important for all non-Indigenous Australians because the knowledge would: … reach more people and improve people's understanding of Aboriginal culture … There'd be a greater understanding and appreciation for the Aboriginal culture in this country, making it easier for future generations to take pride in and value the original custodians of the land.(role model B) The challenges varied based on participant preparedness or prior experience.Participants were able to overcome challenges using various strategies which led to them suggesting improvements for the program that would minimise the challenges in future and enhance the benefits for all participants (improvement suggestions reported elsewhere: ref. 20).
'I believe as a nation we fail to recognise the disadvantages that Indigenous community faces, and that it is a complex situation, and there is no simple solution.'(role model X) '… it can be quite intimidating coming into a community where you are somewhat of a stranger to everyone.'(role model B) Participants expressed that their experience prompted them to advocate on behalf of these communities and Aboriginal peoples, particularly regarding reconciliation efforts.This indicates that a sustainable outcome of their experience as participation in the program is: … providing people who may not have ordinarily been exposed to Aboriginal culture with a very unique experience and new found appreciation for the situation currently faced within Aboriginal communities, which we can pass onto others.(role model D)

Discussion
There is mounting evidence of the importance of role modelling in youth development and health promotion 2 , but few investigations of the benefits and learning for those role models involved in such programs 21 .The findings suggest that involvement in the remote outreach program offers a symbiosis of sorts, whereby the role models feel they are contributing positively to health promotion and education for Aboriginal youth in remote communities, but also benefiting from the exposure and experience with Aboriginal culture and community.This indicates that this particular remote outreach program embeds the notion of reciprocity that is outlined by the NHMRC as essential when engaging with Indigenous peoples 19 .Building relationships was a perceived benefit for the role models, which mirrors urban research suggesting that programs with mentors for Indigenous youth 'facilitate connections' and 'offer a sense of community' for both mentors and mentees 22 .
The disparities between home communities and the remote communities visited presented a level of culture shock for the new role models, a recognised challenge for many non-Indigenous people visiting remote communities 23 .Cultural training, Indigenous cultural background and relevant prior experience contributed to feelings of preparedness, and are important components to promote culturally appropriate behaviour among the role models while in the community and to maximise the outcomes for the role models during the program.Research suggests that the most effective cultural training shifts the focus of training away from trying to teach about Indigenous culture, and toward analysing processes of power imbalance and identity 15,24 .This cultural safety model appears to be the best option for delivering effective Indigenous cultural training.Utilising the cultural safety model with this remote outreach program, particularly related to analysing policies, systems and programs in reference to Indigenous communities and people, could alleviate the culture shock experienced by the new role models and would better prepare and guide the role models for their time in the community (and beyond).
Similar to those of other studies, the current suggest that both Indigenous and non-Indigenous people's knowledge, learning and cultural competency of Indigenous culture and identity increases as a result of implementing and participating in remote and rural Indigenous programs 3,12,25 .Schinke et al 26 call this phronesis: 'the practical wisdom gained through experience'.This wisdom and profound learning has similarly been described elsewhere, whereby mentoring Indigenous youth had 'extended [the mentors] personally and opened up possibilities to explore aspects of the self …' 22 .
The generally positive responses and benefits derived from participation expressed by the role models in this study are unsurprising, given that altruism is known to provide a 'helpers' high' 27 and enhance social, emotional and physical wellbeing.The sense of achievement and pride expressed by the role models in this remote study corroborates the findings of urban mentoring programs, where mentors had experienced 'accomplishment and pride from being involved' 22 and experienced benefits categorised as altruistic, social, cognitive and personal 21 .Many of the comments of the participants align with the ideals surrounding 'making the world a better place' 27 , specifically in their resultant ability to contribute to reconciliation efforts, and reduce prejudice and racism in their own professions and lives.This suggests that role modelling or mentoring programs can be beneficial for both program deliverers and recipients, with benefits that are potentially applicable across urban, rural and remote contexts.

Conclusions
Effective role modelling programs designed for remote Indigenous youth can have positive outcomes for both role models and the program recipients.Cultural safety training is an important factor for preparing role models and for building their cultural competency for implementing health and education programs in remote Indigenous communities in Australia to maximise the outcomes and minimise culture shock.Sustainable outreach programs can provide opportunities for Australians to understand and experience Indigenous culture and contribute to national efforts to promote health and education among remote Indigenous youth.

Table 1 :
Summary of participant response categoriesFeelings of preparedness were influenced by having enough, or not enough of the listed sub-categories.Predominantly, the participants felt prepared, which could reflect the selection process in that role models are selected based on relevant skills and experience.Others expressed becoming prepared through learning 'on the ground' during the program.Provision of more community specific information would have better prepared new role models and those with limited prior experience with Indigenous peoples and culture.