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Conte KP, Laycock A, Bailie J, Walke E, Onnis LA, Feeney L, Langham E, Cunningham F, Matthews V, Bailie R. Producing knowledge together: a participatory approach to synthesising research across a large-scale collaboration in Aboriginal and Torres Strait Islander health. Health Res Policy Syst 2024; 22:3. [PMID: 38172892 PMCID: PMC10765661 DOI: 10.1186/s12961-023-01087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Despite that stakeholder participation in evidence synthesis could result in more useful outcomes, there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage diverse stakeholders as equal partners in knowledge co-production. The aims of this paper are to describe an innovative participatory process of synthesising a large body of academic research products and compare the findings of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review. METHODS First, a rapid synthesis of all research outputs (n = 86) was conducted by researchers with in-depth knowledge of the collaboration's research. Second, a team of researchers and service providers conducted a structured synthesis of seventy-eight peer-reviewed articles and reports generated by the collaboration. Fifty-five publications were brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value added by the participatory method by comparing findings generated across the three synthesis approaches. RESULTS Twelve researchers and 11 service providers/policy partners-8 self-identified as Aboriginal and/or Torres Strait Islander-participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The process explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrepancies did not contradict but gave deeper insights into statements created by the other methods. The participatory synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key messages for practice. CONCLUSION The participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising a large body of evidence in a relatively short time. The participatory approach produced findings comparable to traditional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who, ultimately, are the end users of the research. This process will interest other large-scale research collaborations seeking to engage stakeholders in evidence synthesis.
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Affiliation(s)
- Kathleen P Conte
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia.
- Oregon Health Sciences University-Portland State University School of Public Health, Portland State University, Portland, USA.
| | - Alison Laycock
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Emma Walke
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Leigh-Ann Onnis
- College of Business, Law and Governance, James Cook University, Cairns, Australia
| | - Lynette Feeney
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Erika Langham
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia
| | - Frances Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Ross Bailie
- Sydney Medical School, The University of Sydney, Camperdown, Australia
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Cullen J, Childerhouse P, Jayamaha N, McBain L. Developing a model for primary care quality improvement success: a comparative case study in rural, urban and Kaupapa Māori organisations. J Prim Health Care 2023; 15:333-342. [PMID: 38112700 DOI: 10.1071/hc23046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/10/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Primary care is under pressure to achieve accessible, equitable, quality health care, while being increasingly under resourced. There is a need to understand factors that influence quality improvement (QI) to support a high-performing primary care system. Literature highlights the impact of context on QI but there is little primary care research on this topic. Aim This qualitative case study research seeks to discover the contextual factors influencing QI in primary care, and how the relationships between contextual factors, the QI initiative, and the implementation process influence outcomes. Methods The Consolidated Framework for Implementation Research was used to frame this qualitative study exploring primary care experiences in depth. Six sites were selected to provide a sample of rural, urban and Kaupapa Māori settings. Qualitative data was collected via semi-structured interviews and compared and contrasted with the organisational documents and data provided by participants. Results Cases reported success in achieving improved outcomes for patients, practices, and staff. Strong internal cultures of 'Clan' and 'Adhocracy' typologies supported teamwork, distributed leadership, and a learning climate to facilitate iterative sensemaking activities. To varying degrees, external network relationships provided resources, knowledge, and support. Discussion Organisations were motivated by a combination of patient/community need and organisational culture. Network relationships assisted to varying degrees depending on need. Engaged and distributed leadership based on teamwork was observed, where leadership was shared and emerged at different levels and times as the need arose. A learning climate was supported to enable iterative sensemaking activities to achieve success.
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Affiliation(s)
- Jane Cullen
- Massey University, Palmerston North, New Zealand
| | | | | | - Lynn McBain
- Department of Primary Care, University of Otago, Wellington, New Zealand
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Mateo‐Arriero I, Lalovic A, Dowden G, Markey L, Cox KL, Flicker L, Bessarab D, Thompson S, Kickett C, Woods D, Pestell CF, Edgill P, Etherton‐Beer C, Smith K. Co-design of dementia prevention program for Aboriginal Australians (DAMPAA). Alzheimers Dement 2023; 19:4564-4571. [PMID: 36933191 PMCID: PMC10955769 DOI: 10.1002/alz.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Dementia is highly prevalent in older Aboriginal Australians, with several modifiable risk factors. Currently, there is limited evidence on how to prevent cognitive decline in Aboriginal Australians. METHODS Based on our Theory of Change (ToC) framework, we co-developed the Dementia risk management and prevention program for Aboriginal Australians (DAMPAA) aged over 45 years in partnership with Aboriginal community-controlled organizations (ACCOs) and Elders. Qualitative data were collected through ACCO staff workshops, Elders yarning, and governance groups to inform the protocol. Additionally, we conducted a small pilot study. RESULTS Expected DAMPAA ToC outcomes are: (1) improved daily function, (2) better cardiovascular risk management, (3) falls reduction, (4) improved quality of life, and (5) reduced cognitive decline. Attendance enablers are social interaction, environment, exercise type/level, and logistics. DISCUSSION Findings suggest that ToC is an effective collaborative approach for co-designing Aboriginal health programs.
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Affiliation(s)
- Irene Mateo‐Arriero
- Centre for Aboriginal Medical and Dental HealthUniversity of Western AustraliaPerthWAAustralia
| | - Alexander Lalovic
- Centre for Aboriginal Medical and Dental HealthUniversity of Western AustraliaPerthWAAustralia
| | - Glennette Dowden
- Centre for Aboriginal Medical and Dental HealthUniversity of Western AustraliaPerthWAAustralia
| | - Lesley Markey
- Centre for Aboriginal Medical and Dental HealthUniversity of Western AustraliaPerthWAAustralia
| | - Kay L. Cox
- Centre for Aboriginal Medical and Dental HealthUniversity of Western AustraliaPerthWAAustralia
- West Australian Centre for Health and AgeingUniversity of Western AustraliaPerthWAAustralia
| | - Leon Flicker
- West Australian Centre for Health and AgeingUniversity of Western AustraliaPerthWAAustralia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental HealthUniversity of Western AustraliaPerthWAAustralia
| | - Sandra Thompson
- Western Australian Centre for Rural HealthUniversity of Western AustraliaGeraldtonWAAustralia
| | | | - Deborah Woods
- Geraldton Regional Aboriginal Medical ServiceGeraldtonWAAustralia
| | - Carmela F. Pestell
- School of Psychological ScienceUniversity of Western AustraliaPerthWAAustralia
| | - Paula Edgill
- Derbarl Yerrigan Health ServiceEast PerthWAAustralia
| | | | - Kate Smith
- Centre for Aboriginal Medical and Dental HealthUniversity of Western AustraliaPerthWAAustralia
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Cullen J, Childerhouse P, McBain L. Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice. J Prim Health Care 2022; 14:179-186. [PMID: 35771707 DOI: 10.1071/hc22012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/04/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction The impact of contextual factors on primary health-care quality improvement is significant. In-depth research is required to identify the key contextual factors that influence quality improvement initiatives to develop high-performing primary health-care systems. Aim This research seeks to answer two questions; what are the contextual factors influencing primary care improvement initiatives?; and how do contextual factors, the quality improvement initiative and the implementation process influence one another and the overall improvement outcomes? Methods A multi-case study methodology was used to explore the complexities of the phenomena in situ . Three sites where successful quality improvement had occurred were selected by purposeful theoretical sampling to provide a sample of rural, urban and Kaupapa Māori general practice settings typical of the New Zealand environment. Semi-structured interviews were conducted with team members and triangulated with secondary data provided by the organisations. Results The quality improvement topic and the approach taken were intrinsically linked to context. Sites reported success in achieving the desired outcomes benefitting the patients, practice and staff. Teams did not use formal improvement methods, instead relying on established relationships and elements of change management methods. The culture in all three cases was a large component of why and how these initiatives were successful. Discussion Intrinsic motivation was generated by community connections and networks. This combined with a learning climate generated by distributed leadership and teamwork enabled success. Iterative reflection and sensemaking processes were able to deliver quality improvement success in primary care without the use of formal improvement methods.
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Affiliation(s)
- Jane Cullen
- Massey University, Palmerston North, New Zealand
| | - Paul Childerhouse
- Massey University, Palmerston North, New Zealand; and Department of Supply Chain Management, College of Business and Law, RMIT, Melbourne, Australia
| | - Lynn McBain
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Redman-MacLaren M, Turner Anmatyerre/Jaru NN, Taylor J, Laycock A, Vine K, Thompson Gurindji Q, Larkins S, Carlisle K, Thompson S, Bailie R, Matthews Quandamooka V. Respect Is Central: A Critical Review of Implementation Frameworks for Continuous Quality Improvement in Aboriginal and Torres Strait Islander Primary Health Care Services. Front Public Health 2021; 9:630611. [PMID: 34336752 PMCID: PMC8322579 DOI: 10.3389/fpubh.2021.630611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context. Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia. Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level; meso (health service) level; and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff-engendering trusting relationships with community enacted through respect. Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context.
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Affiliation(s)
| | | | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | - Alison Laycock
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Kristina Vine
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | | | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | - Sandra Thompson
- Western Australia Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
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Cox R, Molineux M, Kendall M, Tanner B, Miller E. Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review. BMJ Qual Saf 2021; 31:134-146. [PMID: 34253682 PMCID: PMC8784995 DOI: 10.1136/bmjqs-2020-012729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Internationally, patient and public involvement (PPI) is core policy for health service quality improvement (QI). However, authentic QI partnerships are not commonplace. A lack of patient and staff capability to deliver successful partnerships may be a barrier to meaningful QI collaboration. OBJECTIVES The research questions for this scoping review were: What is known regarding the capabilities required for healthcare staff and patients to effectively partner in QI at the service level?; and What is known regarding the best practice learning and development strategies required to build and support those capabilities? METHODS A six-stage scoping review was completed. Five electronic databases were searched for publications from January 2010 to February 2020. The database searches incorporated relevant terms for the following concepts: capabilities for PPI in healthcare QI; and best practice learning and development strategies to support those capabilities. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS Forty-nine papers were included. Very little peer-reviewed literature focused explicitly on capabilities for QI partnerships and thus implicit paper content was analysed. A Capability framework for successful partnerships in healthcare quality improvement was developed. It includes knowledge, skills and attitudes across three capability domains: Personal Attributes; Relationships and Communication; and Philosophies, Models and Practices, and incorporates 10 capabilities. Sharing power and leadership was discussed in many papers as fundamental and was positioned across all of the domains. Most papers discussed staff and patients' co-learning (n=28, 57.14%). Workshops or shorter structured training sessions (n=36, 73.47%), and face-to-face learning (n=34, 69.38%) were frequently reported. CONCLUSION The framework developed here could guide individualised development or learning plans for patient partners and staff, or could assist organisations to review learning topics and approaches such as training content, mentoring guidelines or community of practice agendas. Future directions include refining and evaluating the framework. Development approaches such as self-reflection, communities of practice, and remote learning need to be expanded and evaluated.
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Affiliation(s)
- Ruth Cox
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia .,Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Queensland, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Queensland, Australia
| | - Melissa Kendall
- School of Health Sciences and Social Work, Griffith University, Queensland, Queensland, Australia.,Acquired Brain Injury Outreach Service and Transitional Rehabilitation Program, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Bernadette Tanner
- Consumer Co-Researcher C/O Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Elizabeth Miller
- Consumer Co-Researcher C/O Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
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Carlisle K, Matthews Quandamooka V, Redman-MacLaren M, Vine K, Turner Anmatyerre/Jaru NN, Felton-Busch Yangkaal/Gangalidda C, Taylor J, Thompson S, Whaleboat Meriam Le D, Larkins S. A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services. BMC Health Serv Res 2021; 21:431. [PMID: 33957914 PMCID: PMC8101223 DOI: 10.1186/s12913-021-06383-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement. Methods A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case. Results A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce). Conclusions These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06383-7.
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Affiliation(s)
- Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia. .,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.
| | | | - Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, Cairns, Nguma-bada Campus, QLD, Australia
| | - Kristina Vine
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | | | - Catrina Felton-Busch Yangkaal/Gangalidda
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Murtupuni Centre for Rural & Remote Health, James Cook University, Mt Isa, QLD, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | - Sandra Thompson
- Western Australia Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Donald Whaleboat Meriam Le
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, QLD, Australia
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Ramanathan SA, Larkins S, Carlisle K, Turner N, Bailie RS, Thompson S, Bainbridge R, Deeming S, Searles A. What was the impact of a participatory research project in Australian Indigenous primary healthcare services? Applying a comprehensive framework for assessing translational health research to Lessons for the Best. BMJ Open 2021; 11:e040749. [PMID: 33622941 PMCID: PMC7907854 DOI: 10.1136/bmjopen-2020-040749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT. SETTING Three Indigenous primary healthcare (PHC) centres in the Northern Territory, Australia; project coordinating centre distributed between Townsville, Darwin and Cairns and the broader LFTB learning community across Australia. PARTICIPANTS LFTB research team and one representative from each PHC centre. PRIMARY AND SECONDARY OUTCOME MEASURES Impact reported as (1) quantitative metrics within domains of benefit using a modified Payback Framework, (2) a cost-consequence analysis given a return on investment was not appropriate and (3) a narrative incorporating qualitative evidence of impact. Data were gathered through in-depth stakeholder interviews and a review of project documentation, outputs and relevant websites. RESULTS LFTB contributed to knowledge advancement in Indigenous PHC service delivery; enhanced existing capacity of health centre staff, researchers and health service users; enhanced supportive networks for quality improvement; and used a strengths-based approach highly valued by health centres. LFTB also leveraged between $A1.4 and $A1.6 million for the subsequent Leveraging Effective Ambulatory Practice (LEAP) Project to apply LFTB learnings to resource development and creation of a learning community to empower striving PHC centres. CONCLUSION Retrospective application of FAIT to LFTB, although not ideal, was feasible. Prospective application would have allowed Indigenous community perspectives to be included. Greater appreciation of the full benefit of LFTB including a measure of return on investment will be possible when LEAP is complete. Future assessments of impact need to account for the limitations of fully capturing impact when intermediate/final impacts have not yet been realised and captured.
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Affiliation(s)
- Shanthi Ann Ramanathan
- Health Research Economics, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Nalita Turner
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Ross Stewart Bailie
- The University of Sydney, University Centre for Rural Health, Lismore, New South Wales, Australia
| | - Sandra Thompson
- University of Western Australia, Western Australian Centre for Rural Health, Geraldton, Western Australia, Australia
| | - Roxanne Bainbridge
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Central Queensland University, Cairns, Queensland, Australia
| | - Simon Deeming
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andrew Searles
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Hunter B, Biezen R, Alexander K, Lumsden N, Hallinan C, Wood A, McMorrow R, Jones J, Nelson C, Manski-Nankervis JA. Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach. BMJ Open 2020; 10:e040228. [PMID: 33371024 PMCID: PMC7751202 DOI: 10.1136/bmjopen-2020-040228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To codesign an electronic chronic disease quality improvement tool for use in general practice. DESIGN Service design employing codesign strategies. SETTING General practice. PARTICIPANTS Seventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne. INTERVENTIONS Codesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform. RESULTS Participants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners. CONCLUSION Study participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.
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Affiliation(s)
- Barbara Hunter
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ruby Biezen
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karyn Alexander
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Lumsden
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Western Health Chronic Disease Alliance, Sunshine Hospital, Western Health, Footscray, Victoria, Australia
| | - Christine Hallinan
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anna Wood
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rita McMorrow
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Jones
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Western Health Chronic Disease Alliance, Sunshine Hospital, Western Health, Footscray, Victoria, Australia
| | - Craig Nelson
- Western Health Chronic Disease Alliance, Sunshine Hospital, Western Health, Footscray, Victoria, Australia
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Bradley K, Smith R, Hughson JA, Atkinson D, Bessarab D, Flicker L, Radford K, Smith K, Strivens E, Thompson S, Blackberry I, LoGiudice D. Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial. BMC Health Serv Res 2020; 20:208. [PMID: 32164678 PMCID: PMC7069169 DOI: 10.1186/s12913-020-4985-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3-5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment. METHODS/DESIGN The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families. DISCUSSION The Let's CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment. TRIAL REGISTRATION ACTRN12618001485224. Date of registration: 04 of September 2019.
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Affiliation(s)
- Kate Bradley
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Robyn Smith
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Jo-anne Hughson
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - David Atkinson
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Dawn Bessarab
- The University of Western Australia, M303, 35 Stirling Highway, Perth, 6009 Australia
| | - Leon Flicker
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Kylie Radford
- Neuroscience Research Australia, 139 Barker Street, Sydney, NSW 2031 Australia
- The School of Medical Sciences, University of New South Wales, Sydney, NSW Australia
| | - Kate Smith
- University of Western Australia, 35 Stirling Highway, Perth, 6009 Australia
| | | | - Sandra Thompson
- The University of Western Australia, 167 Fitzgerald St, Geraldton, WA 6530 Australia
| | | | - Dina LoGiudice
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
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Kildea S, Roe Y. Research complexity in the remote Australian Indigenous context: a way forward. Lancet Glob Health 2019; 7:e1474-e1475. [PMID: 31607451 DOI: 10.1016/s2214-109x(19)30403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Sue Kildea
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, 4000 QLD, Australia.
| | - Yvette Roe
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, 4000 QLD, Australia
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12
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Laycock A, Bailie J, Matthews V, Bailie R. Using developmental evaluation to support knowledge translation: reflections from a large-scale quality improvement project in Indigenous primary healthcare. Health Res Policy Syst 2019; 17:70. [PMID: 31324251 PMCID: PMC6642555 DOI: 10.1186/s12961-019-0474-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Developmental evaluation is a growing area of evaluation practice, advocated for informing the adaptive development of change initiatives in complex social environments. The utilisation focus, complexity perspective and systems thinking of developmental evaluation suggest suitability for evaluating knowledge translation initiatives in primary healthcare. However, there are few examples in the literature to guide its use in these contexts and in Indigenous settings. In this paper, we reflect on our experience of using developmental evaluation to implement a large-scale knowledge translation research project in Australian Aboriginal and Torres Strait Islander primary healthcare. Drawing on principles of knowledge translation and key features of developmental evaluation, we debate the key benefits and challenges of applying this approach to engage diverse stakeholders in using aggregated quality improvement data to identify and address persistent gaps in care delivery. DISCUSSION The developmental evaluation enabled the team to respond to stakeholder feedback and apply learning in real-time to successfully refine theory-informed research and engagement processes, tailor the presentation of findings to stakeholders and context, and support the project's dissemination and knowledge co-production aim. It thereby contributed to the production of robust, useable research findings for informing policy and system change. The use of developmental evaluation appeared to positively influence stakeholders' use of the project reports and their responses to the findings. Challenges included managing a high volume of evaluation data and multiple evaluation purposes, balancing facilitative sense-making processes and change with task-focused project management, and lack of experience in using this evaluation approach. Use of an embedded evaluator with facilitation skills and background knowledge of the project helped to overcome these challenges, as did similarities observed between features of developmental evaluation and continuous quality improvement. CONCLUSION Our experience of developmental evaluation confirmed our expectations of the potential value of this approach for strengthening improvement interventions and implementation research, and particularly for adapting healthcare innovations in Indigenous settings. In our project, developmental evaluation successfully encompassed evaluation, project adaptation, capacity development and knowledge translation. Further work is warranted to apply this approach more widely to improve primary healthcare initiatives and outcomes, and to evaluate implementation research.
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Affiliation(s)
- Alison Laycock
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia. .,The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia.
| | - Jodie Bailie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia
| | - Veronica Matthews
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia
| | - Ross Bailie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW, 2480, Australia
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