Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence

Lokuge, Kamalini; Thurber, Katherine A; Calabria, Bianca; Davis, Meg; McMahon, Kathryn; Sartor, Lauren; Lovett, Raymond; Guthrie, Jill; Banks, Emily

doi:10.1111/1753-6405.12704

Cited by 28 publications

(25 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The perspectives and insights of Indigenous people accessing mobile clinic services is largely absent. Findings support the need for high quality evaluations of Indigenous health programs which integrate qualitative evidence regarding the views and perspectives of Indigenous people [ 115 ]. An absence of qualitative data around the effectiveness of mobile clinics makes it difficult to know whether mobile clinics have potential to improve the cultural accessibility of primary health care services for Indigenous populations.…”

Section: Discussionmentioning

confidence: 68%

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

Beks

Ewing

Charles

et al. 2020

Int J Equity Health

View full text Add to dashboard Cite

Background Mobile clinics have been used to deliver primary health care to populations that otherwise experience difficulty in accessing services. Indigenous populations in Australia, Canada, New Zealand, and the United States experience greater health inequities than non-Indigenous populations. There is increasing support for Indigenous-governed and culturally accessible primary health care services which meet the needs of Indigenous populations. There is some support for primary health care mobile clinics implemented specifically for Indigenous populations to improve health service accessibility. The purpose of this review is to scope the literature for evidence of mobile primary health care clinics implemented specifically for Indigenous populations in Australia, Canada, New Zealand, and the United States. Methods This review was undertaken using the Joanna Brigg Institute (JBI) scoping review methodology. Review objectives, inclusion criteria and methods were specified in advance and documented in a published protocol. The search included five academic databases and an extensive search of the grey literature. Results The search resulted in 1350 unique citations, with 91 of these citations retrieved from the grey literature and targeted organisational websites. Title, abstract and full-text screening was conducted independently by two reviewers, with 123 citations undergoing full text review. Of these, 39 citations discussing 25 mobile clinics, met the inclusion criteria. An additional 14 citations were snowballed from a review of the reference lists of included citations. Of these 25 mobile clinics, the majority were implemented in Australia (n = 14), followed by United States (n = 6) and Canada (n = 5). No primary health mobile clinics specifically for Indigenous people in New Zealand were retrieved. There was a pattern of declining locations serviced by mobile clinics with an increasing population. Furthermore, only 13 mobile clinics had some form of evaluation. Conclusions This review identifies geographical gaps in the implementation of primary health care mobile clinics for Indigenous populations in Australia, Canada, New Zealand, and the United States. There is a paucity of evaluations supporting the use of mobile clinics for Indigenous populations and a need for organisations implementing mobile clinics specifically for Indigenous populations to share their experiences. Engaging with the perspectives of Indigenous people accessing mobile clinic services is imperative to future evaluations. Registration The protocol for this review has been peer-reviewed and published in JBI Evidence Synthesis (doi: 10.11124/JBISRIR-D-19-00057).

show abstract

Section: Discussionmentioning

confidence: 68%

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

Beks

Ewing

Charles

et al. 2020

Int J Equity Health

View full text Add to dashboard Cite

show abstract

“…When examining first author affiliation for all included citations ( n = 74), 74% ( n = 55) of citations were associated with a university or research institution, with only 9.5% (n = 7) citations associated with an ACCHO or other Aboriginal organisation. A previous review of Aboriginal health programs in Australia also found that the majority of program evaluations (72%) were led by a research institution or university rather than an Aboriginal community organisation [107]. However, first author affiliation with a research institution or university does not necessarily mean that the evaluation did not have significant Aboriginal community input; particularly as 90% ( n = 45) of included programs provided details of collaborating with an ACCHO or other Aboriginal organisation in the development or evaluation of the program.…”

Section: Discussionmentioning

confidence: 99%

“…It is not known what proportion of evaluated chronic disease programs or implemented chronic disease programs have been included; a limitation cited by a similar review [107]. It is also possible that evaluated programs targeting more distal risk factors for chronic disease may have been overlooked.…”

Section: Discussionmentioning

confidence: 99%

Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review

et al. 2019

View full text Add to dashboard Cite

Background Targeted chronic disease programs are vital to improving health outcomes for Indigenous people globally. In Australia it is not known where evaluated chronic disease programs for Aboriginal and Torres Strait Islander people have been implemented. This scoping review geographically examines where evaluated chronic disease programs for Aboriginal people have been implemented in the Australian primary health care setting. Secondary objectives include scoping programs for evidence of partnerships with Aboriginal organisations, and use of ethical protocols. By doing so, geographical gaps in the literature and variations in ethical approaches to conducting program evaluations are highlighted. Methods The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a published protocol. This scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) scoping review methodology. The search included 11 academic databases, clinical trial registries, and the grey literature. Results The search resulted in 6894 citations, with 241 retrieved from the grey literature and targeted organisation websites. Title, abstract, and full-text screening was conducted by two independent reviewers, with 314 citations undergoing full review. Of these, 74 citations evaluating 50 programs met the inclusion criteria. Of the programs included in the geographical analysis ( n = 40), 32.1% were implemented in Major Cities and 29.6% in Very Remote areas of Australia. A smaller proportion of programs were delivered in Inner Regional (12.3%), Outer Regional (18.5%) and Remote areas (7.4%) of Australia. Overall, 90% ( n = 45) of the included programs collaborated with an Aboriginal organisation in the implementation and/or evaluation of the program. Variation in the use of ethical guidelines and protocols in the evaluation process was evident. Conclusions A greater focus on the evaluation of chronic disease programs for Aboriginal people residing in Inner and Outer Regional areas, and Remote areas of Australia is required. Across all geographical areas further efforts should be made to conduct evaluations in partnership with Aboriginal communities residing in the geographical region of program implementation. The need for more scientifically and ethically rigorous approaches to Aboriginal health program evaluations is evident. Electronic supplementary material The online version of this article (10.1186/s12889-019-7463-0) contains supplementary material, which is available to authorized users.

show abstract

“…Design of the HfLI has been informed by a systematic review of models for Indigenous primary health care service delivery, [ 18 ] a qualitative assessment of barriers and enablers to child health care service delivery [ 19 ], and impact of CQI on quality of care for Aboriginal and Torres Strait Islander children [ 20 ]. The systematic review found 62 studies meeting inclusion criteria to answer the question “what are characteristics of successful [Indigenous] PHC service delivery” [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Very few Indigenous health programs are rigorously evaluated. A recent systematic review identified 118 papers describing evaluations of 109 interventions [ 18 ]. Most (36) were before/after comparisons, only 9 used an experimental design of which 3 were cluster-randomised controlled trials.…”

Section: Introductionmentioning

confidence: 99%

A community-based service enhancement model of training and employing Ear Health Facilitators to address the crisis in ear and hearing health of Aboriginal children in the Northern Territory, the Hearing for Learning Initiative (the HfLI): study protocol for a stepped-wedge cluster randomised trial

Kong

Cass

Leach

et al. 2021

Trials

View full text Add to dashboard Cite

Background Almost all Aboriginal children in remote communities have persistent bilateral otitis media affecting hearing and learning throughout early childhood and school years, with consequences for social and educational outcomes, and later employment opportunities. Current primary health care and specialist services do not have the resources to meet the complex needs of these children. Method/design This stepped-wedge cluster randomised trial will allocate 18 communities to one of five 6-monthly intervention start dates. Stratification will be by region and population size. The intervention (Hearing for Learning Initiative, HfLI) consists of six 20-h weeks of training (delivered over 3 months) that includes Certificate II in Aboriginal Primary Health Care (3 modules) and competencies in ear and hearing data collection (otoscopy, tympanometry and hearScreen), plus 3 weeks of assisted integration into the health service, then part-time employment as Ear Health Facilitators to the end of the trial. Unblinding will occur 6 months prior to each allocated start date, to allow Community Reference Groups to be involved in co-design of the HfLI implementation in their community. Relevant health service data will be extracted 6-monthly from all 18 communities. The primary outcome is the difference in proportion of children (0 to 16 years of age) who have at least one ear assessment (diagnosis) documented in their medical record within each 6-month period, compared to control periods (no HfLI). Secondary outcomes include data on sustainability, adherence to evidence-based clinical guidelines for otitis media, including follow-up and specialist referrals, and school attendance. Structured interviews with staff working in health and education services, Ear Health Trainees, Ear Health Facilitators and families will assess process outcomes and the HfLI broader impact. Discussion The impact of training and employment of Ear Health Facilitators on service enhancement will inform the health, education and employment sectors about effectiveness of skills and job creation that empowers community members to contribute to addressing issues of local importance, in this instance ear and hearing health of children. Trial registration ClinicalTrials.gov NCT03916029. Registered on 16 April 2019.

show abstract

Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence

Cited by 28 publications

References 10 publications

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review

A community-based service enhancement model of training and employing Ear Health Facilitators to address the crisis in ear and hearing health of Aboriginal children in the Northern Territory, the Hearing for Learning Initiative (the HfLI): study protocol for a stepped-wedge cluster randomised trial

Contact Info

Product

Resources

About