Implementing health promotion tools in Australian Indigenous primary health care.

BACKGROUND: In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services. METHODS: Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model. RESULTS: An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing. CONCLUSION: The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools.

Online scan of FASD prevention and health promotion resources for Aboriginal and Torres Strait Islander communities.

ISSUE ADDRESSED: Foetal Alcohol Spectrum Disorder (FASD) includes a range of life-long impairments caused by alcohol exposure in utero. Health professionals are vital to preventing FASD but many are hesitant to discuss FASD with clients due to their need for additional resources to aid the conversation. This scan sought to identify the scope and gaps in publicly available FASD prevention and health promotion resources, and assess their cultural appropriateness for use among five key groups of Indigenous Australian people including: (i) pregnant women, (ii) women of childbearing age, (iii) grandmothers and aunties, (iv) men, and (v) health professionals. METHODS: Relevant resources published 1995-2017 were identified through the Australian Indigenous HealthInfoNet, FASD organisation websites, grey literature, Google searches, and field experts. Results were screened by inclusion and cultural appropriateness criteria developed and piloted by the research team, and further screened by health professionals attending FASD training workshops. RESULTS: 115 of the 2146 identified resources were eligible. Relevant resources were found for all five key groups; however, no resources were specifically designed for men, grandmothers or aunties. CONCLUSIONS: A range of high-quality, culturally appropriate resources were identified, however, health professionals attending the training workshops were not aware of their availability. Further resource development is suggested for men, grandmothers and aunties. SO WHAT?: Prioritisation of active dissemination and implementation strategies is suggested to increase awareness and use of future resource developments. The inclusion of a resource trial among health professionals is a recommended strategy to increase awareness and use of newly developed resources.

Follow-up of Indigenous-specific health assessments - a socioecological analysis.

OBJECTIVES: To describe patterns of uptake of Indigenous-specific health assessments and associated follow-up items, and examine the barriers and enablers to delivery and billing of follow-up over the first 3 years of implementation of the Indigenous Chronic Disease Package (ICDP). DESIGN, SETTING AND PARTICIPANTS: We used a socioecological approach to analyse data derived from the Sentinel Sites Evaluation of the ICDP - with data from 24 sites across Australia. Administrative data (1 May 2009 to 30 May 2012) and program data (1 March 2010 to 30 May 2012) were provided by the Department of Health. Data on barriers and enablers to follow-up of health assessments were obtained from community focus groups, in-depth interviews and discussions with key informants (1 November 2010 to 30 December 2012). MAIN OUTCOME MEASURES: Monthly number of Medicare Benefits Schedule items claimed for Indigenous-specific health services and follow-up; qualitative data on enablers and barriers categorised according to patient, patient-health service relationship, health service or organisation, community and policy environment levels or influence. RESULTS: There was an increase in the uptake of health assessments, but relatively limited delivery of follow-up care and billing for Indigenous-specific follow-up items. Follow-up was constrained by factors that operated at various levels: patient, interpersonal, health service, community and policy. Constraints included practitioners' lack of awareness of item numbers, staffing, poor state of clinical information systems, billing against non-Indigenous-specific items or more general follow-up items, emphasis on health assessments with less attention to requirements for follow-up, limited capacity to arrange and facilitate follow-up, and communication and transport challenges for patients. CONCLUSIONS: Work is required across various levels of the system to address barriers to follow-up care. Enhancing follow-up care is vital to achieving health benefits from the large financial and human resource investment in health assessments.

Wide-Scale Continuous Quality Improvement: A Study of Stakeholders' Use of Quality of Care Reports at Various System Levels, and Factors Mediating Use.

Introduction: Increasing the use of evidence in healthcare policy and practice requires greater understanding of how stakeholders use evidence to inform policy, refine systems and change practice. Drawing on implementation theory, we have used system-focused participatory research to engage diverse stakeholders in using aggregated continuous quality improvement (CQI) data from Australian Indigenous primary health care settings to identify priority evidence-practice gaps, barriers/enablers and strategies for improvement. This article reports stakeholders' use or intended use of evidence at various levels of the system, and factors mediating use. Material and Methods: Interviews were undertaken with a purposeful sample of 30 healthcare stakeholders in different roles, organization types and settings in one Australian jurisdiction and with national participants, as part of the project's developmental evaluation. Qualitative data were analyzed to identify themes and categories relating to use of evidence. Results: Context-specific aggregated CQI data that were relatable to the diverse professional roles and practices provided an effective starting point for sharing perspectives, generating practice-based evidence and mobilizing evidence-use. Interviewees perceived the co-produced findings as applicable at different levels and useful for planning, policy development, supporting best practice and reflection, capacity strengthening and developing new research. Factors mediating use were commitment to best practice; the credibility of the evidence and its perceived relevance to work roles, contexts and decision needs; report format and language; facilitation and communication; competing work pressures and the organizational environment for change. Conclusions: This study found that primary health care stakeholders used evidence on quality of care for a variety of purposes. This could be linked to the interactive research processes used to engage stakeholders in different roles and settings in interpreting data, sharing and generating knowledge. Findings indicate that system-based participatory research using CQI data and iterative, interactive and systematic CQI-based methods can be applied at scale to support concurrent action for healthcare improvement at different system levels. Factors known to influence implementation should be addressed within the research design to optimize evidence use. Further research is needed to explore the utility of interactive dissemination for engaging healthcare stakeholders in informing policy and system change.