BackgroundThe transfer and implementation of acceptable and effective health services, programs and innovations across settings provides an important and potentially cost-effective strategy for reducing Indigenous Australians' high burden of disease. This study reports a systematic review of Indigenous health services, programs and innovations to examine the extent to which studies considered processes of transfer and implementation within and across Indigenous communities and healthcare settings.MethodsMedline, Informit, Infotrac, Blackwells Publishing, Proquest, Taylor and Francis, JStor, and the Indigenous HealthInfoNet were searched using terms: Aborigin* OR Indigen* OR Torres AND health AND service OR program* OR intervention AND Australia to locate publications from 1992–2011. The reference lists of 19 reviews were also checked. Data from peer reviewed journals, reports, and websites were included. The 95% confidence intervals (95% CI) for proportions that referred to and focussed on transfer were calculated as exact binomial confidence intervals. Test comparisons between proportions were calculated using Fisher's exact test with an alpha level of 5%.ResultsOf 1311 publications identified, 119 (9.1%; 95% CI: 7.6% - 10.8%) referred to the transfer and implementation of Indigenous Australian health services or programs, but only 21 studies (1.6%; 95% CI: 1.0% - 2.4%) actually focused on transfer and implementation. Of the 119 transfer studies, 37 (31.1%; 95% CI: 22.9 - 40.2%) evaluated the impact of a service or program, 28 (23.5%; 95% CI: 16.2% - 32.2%) reported only process measures and 54 were descriptive. Of the 37 impact evaluation studies, 28 (75.7%; 95% CI: 58.8% - 88.2%) appeared in peer reviewed journals but none included experimental designs.ConclusionWhile services and programs are being transferred and implemented, few studies focus on the process by which this occurred or the effectiveness of the service or program in the new setting. Findings highlight a need for partnerships between researchers and health services to evaluate the transfer and implementation of Indigenous health services and programs using rigorous designs, and publish such efforts in peer-reviewed journals as a quality assurance mechanism.
This investigation of reform of Western Australian community services problematises assumptions about the enabling state. The investigation is distinctive by virtue of its attention to the departure points as well as the destinations in pathways of policy change and its unpacking of three modes of public provision into their three constituent policy elements (funder‐provider mix; the nature of agreements between policy actors; and the type of funding relationships). We find first that government had long adopted some aspects of the model of governance associated with the enabling state. Second, we find some path dependency in policy change towards marketisation. Third, we find highly nuanced policy outcomes combining government exploitation of its authority, market innovations and the maintenance of basic network features of the programs.
This article illustrates the potential of clinical data mining (CDM) for exploring families' engagement with integrated early intervention and prevention (EIP) service systems. New approaches to EIP under the Communities for Children program seek to achieve systemic change towards more integrated service provision in an area. To date, program monitoring has focused on contacts by families with individual services, not necessarily engagement across an emerging system. As part of an evaluative capacity-building (ECB) process, practitioners asked the question: What can we learn about users' engagement with the service system from existing records of use? The approach taken drew from CDM methodology. EIP does not usually involve significant user database systems as the work entails community development methodologies and users can be variously the community, groups, families and individuals. A partial dataset, from routinely recorded contacts, was available for one area. The dataset relied on a family number system created as a membership club for consciousness-raising on child-friendly communities. The de-identified dataset was mined for ‘connection’ with, and ‘movement’ within, the service system. There was evidence beyond the intuitive knowing of practitioners that the contractual obligation to engage families and children with services across a system was achieved. CDM provided a means to demonstrate this within a broader evaluative capacity-building process.
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