“Putting the power back into community”: A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia’s Northern Territory

Abstract

Background Chronic hepatitis B (CHB) is endemic in the Aboriginal and Torres Strait Islander population of Australia’s Northern Territory. Progression to liver disease can be prevented if holistic care is provided. Low health literacy amongst health professionals is a known barrier to caring for people living with CHB. We co-designed and delivered a culturally safe “Managing hepatitis B” training course for the Aboriginal health workforce. Here, we present an evaluation of the course. Objectives 1. To improve course participants CHB-related knowledge, attitudes, and clinical practice. 2. To evaluate the “Managing hepatitis B” training course. 3. To enable participants to have the skills and confidence to be part of the care team. Methods We used participatory action research and culturally safe principles. We used purpose-built quantitative and qualitative evaluation tools to evaluate our “Managing hepatitis B” training course. We integrated the two forms of data, deductively analysing codes, grouped into categories, and assessed pedagogical outcomes against Kirkpatrick’s training evaluation framework. Results Eight courses were delivered between 2019 and 2023, with 130 participants from 32 communities. Pre- and post-course questionnaires demonstrated statistically significant improvements in all domains, p<0.001 on 93 matched pairs. Thematic network analysis demonstrated high levels of course acceptability and significant knowledge acquisition. Other themes identified include cultural safety, shame, previous misinformation, and misconceptions about transmission. Observations demonstrate improvements in post-course engagement, a deep understanding of CHB as well as increased participation in clinical care teams. Conclusions The “Managing hepatitis B” training course led to a sustained improvement in the knowledge and attitudes of the Aboriginal health workforce, resulting in improved care and treatment uptake for people living with CHB. Important non-clinical outcomes included strengthening teaching and leadership skills, and empowerment.

Evaluating a novel model of hepatitis B care, Hep B PAST, in the Northern Territory of Australia: results from a prospective, population-based study

“…Hep B PAST partner services are exceeding national HBV elimination targets. Success factors include: systematic data organisation, 17 regular CQI cycles, a hub and spoke model of care, a trained First Nations and PHC health workforce, 19 , 20 dedicated staffing, outreach access to diagnostic technology and in-language consumer health resources. 22 The Hep B PAST program consists of a diverse, multidisciplinary team that includes researchers, epidemiologists, public health experts, lab scientists, clinical doctors, nurses, Aboriginal health workers, and people living with CHB.…”

“…We co-designed and delivered training for the First Nations health workforce, which led to increased and sustained CHB-related knowledge and engagement. 19 , 20 Ongoing education, mentoring and support were provided to all members of the clinical care teams. Sustained funding has been committed from the NT government to continue to deliver these trainings twice-yearly.…”

“…Delivery of CHB care in PHC clinical care teams was implemented through systematic care planning, PHC workforce education, 19 , 20 CHB identified positions embedded in PHC, availability of ultrasound and FibroScan®, support by the specialist outreach teams 21 and culturally appropriate in-language consumer resources. 22 We have previously reported that having an educational tool in a person's first language is crucial to developing treatment partnerships for First Nations peoples living with CHB.…”