An “All Teach, All Learn” Approach to Research Capacity Strengthening in Indigenous Primary Health Care Continuous Quality Improvement

Abstract

In Australia, Indigenous people experience poor access to health care and the highest rates of morbidity and mortality of any population group. Despite modest improvements in recent years, concerns remains that Indigenous people have been over-researched without corresponding health improvements. Embedding Indigenous leadership, participation, and priorities in health research is an essential strategy for meaningful change for Indigenous people. To centralize Indigenous perspectives in research processes, a transformative shift away from traditional approaches that have benefited researchers and non-Indigenous agendas is required. This shift must involve concomitant strengthening of the research capacity of Indigenous and non-Indigenous researchers and research translators—all must teach and all must learn. However, there is limited evidence about how to strengthen systems and stakeholder capacity to participate in and lead continuous quality improvement (CQI) research in Indigenous primary health care, to the benefit of Indigenous people. This paper describes the collaborative development of, and principles underpinning, a research capacity strengthening (RCS) model in a national Indigenous primary health care CQI research network. The development process identified the need to address power imbalances, cultural contexts, relationships, systems requirements and existing knowledge, skills, and experience of all parties. Taking a strengths-based perspective, we harnessed existing knowledge, skills and experiences; hence our emphasis on capacity “strengthening”. New insights are provided into the complex processes of RCS within the context of CQI in Indigenous primary health care.

Chronic disease self‐management programs for Aboriginal and Torres Strait Islander people: Factors influencing participation in an urban setting

“…These focus groups were undertaken by two non‐Indigenous researchers employed by IUIH over a 2‐month period in August and September 2016. Qualitative research was informed by a strengths‐based approach that draws on existing knowledge, skills and resources to improve delivery of health services . As opposed to problem‐based questions, the focus group guide consisted of prompts to ask the participants about the main things that helped or supported them attending the program, with the overarching question “What helps or supports you to attend Work It Out?” These prompts were informed by the literature and included: Location of the program Frequency and length of the program Exercise component versus the yarning (education) component Participating in a group (size, dynamics, support) Workforce issues (staff knowledge of chronic disease, cultural awareness, turnover, support) Transport, money Family Other priorities …”

Protocol for the Yapatjarrathati project: a mixed-method implementation trial of a tiered assessment process for identifying fetal alcohol spectrum disorders in a remote Australian community

“…The project began in 2018 and will continue to 2020. The first 6 months represented the engagement phase during which relationships with the community were developed following an ‘all teach, all learn’ philosophy [12] and the local stakeholders’ group was established. Following the engagement phase, the assessment process was co-designed with the community.…”

“…As a First Nations rural general practitioner, one of the authors (MP) was instrumental in creating a culturally safe space for the research team to connect with local Elders. Using an ‘all teach, all learn approach [12], Elders travelled to the urban center to meet the research team, and the research team visited the remote community to learn more about First Nations’ worldview. Time was set aside to create space for two-way learning between First Nations and non-First Nations researchers [12].…”

“…Using an ‘all teach, all learn approach [12], Elders travelled to the urban center to meet the research team, and the research team visited the remote community to learn more about First Nations’ worldview. Time was set aside to create space for two-way learning between First Nations and non-First Nations researchers [12]. For example, through yarning or story-telling, and cooking food ‘on country’, local community members and Elders provided cultural competence training to the research team.…”

Using developmental evaluation to support knowledge translation: reflections from a large-scale quality improvement project in Indigenous primary healthcare

“…The team acquired knowledge and skills in research translation through interactions with stakeholders, and lessons learnt were shared through ESP reports and processes. The co-creation principle aligns with our ‘All teach, All learn’ research capacity strengthening approach in Indigenous PHC CQI [69]. Timely feedback : Evaluative questions were included in ESP phase surveys from the outset and influenced early change decisions.…”