Using Aboriginal participatory action research within a mixed methods study exploring COVID-19 vaccination uptake in Aboriginal women: a methodological framework for co-design.

The COVID-19 pandemic evidenced the critical role of vaccination in reducing the severity of illness and the risk of infection. Despite the policies and efforts of governments to increase vaccination uptake, COVID-19 immunization among Australian Aboriginal pregnant women is lower compared to vaccine uptake of non-Indigenous pregnant women. To date, there have been no national Aboriginal Participatory Action Research (APAR) co-designed Aboriginal-led studies exploring the factors influencing uptake of COVID-19 vaccination in Aboriginal women of childbearing age. This Aboriginal-led research was conducted with Aboriginal women of childbearing age and non-Aboriginal mothers of Aboriginal children in the Great Southern region of Western Australia (WA). The study aimed to explore the factors influencing COVID-19 vaccine knowledge, confidence, and uptake and was conducted in consultation with Aboriginal Elders and health service partners in the region. This research employed an explanatory sequential mixed methods design, with co-design principles embedded at every stage of the study. Using Western quantitative methods and Indigenous qualitative methodologies, the research completed 110 surveys and conducted 5 Yarning Circles. Participants reported safety and trust as key factors influencing vaccination decision making. Although the vaccine mandate increased vaccine uptake, the study found a decline in vaccination following the end of the mandate. Participants also reported ongoing challenges following the COVID-19 pandemic as lack of engagement and access to health information and services. The findings underscore the importance of cultural legitimacy in research and the need for sustained partnerships between Indigenous communities and health researchers to foster trust and promote health equity. This paper outlines the methodological framework implemented in the Ngarngk Koolangka Moorditj Yarning Project (NKMY) conducted in Australia (2022-2024).