Applying what works: a systematic search of the transfer and implementation of promising Indigenous Australian health services and programs

Abstract

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.

A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand

“…Few study designs employed a control group and none employed randomisation. These findings are consistent with previous reviews of Indigenous intervention research [46,47], and provide an opportunity for researchers to improve the quality of evaluations of Indigenous suicide prevention interventions through the application of more rigorous study designs. Encouragingly, data collection methods were generally moderate to strong: seven of the nine studies used a previously tested or validated measure.…”

Does Indigenous health research have impact? A systematic review of reviews

“…Publication bias11. Conflict of interestMcDonald E, Bailie R, Brewster D and Morris P [33]○●●●◐●●●●○●Arnold M, Moore SP, Hassler S, Ellison-Loschmann L, Forman D and Bray F [55]○○●●◐●○●○○●Azzopardi PS, Kennedy EC, Patton GC, Power R, Roseby RD, Sawyer SM and Brown AD [56]○○●●◐●●●○○●McCalman J, Tsey K, Wenitong M, Wilson A, McEwan A, James YC and Whiteside M [28]○○●●◐●○○●◐●Gould GS, Munn J, Watters T, McEwen A and Clough AR [22]○●◐○◐●●●●◐●Shah PS, Zao J, Al-Wassia H and Shah V [24]○◐●●◐●●●●◐●Chang AB, Taylor B, Masters IB, Laifoo Y and Brown Alexander DH [43]●●●●●●●●●◐●McCalman J, Tsey K, Bainbridge R, Rowley K, Percival N, O’Donoghue L, Brands J, Whiteside M and Judd J [23]●◐●●◐●●●○◐●Clifford AC, Doran CM and Tsey K [26]○●●●◐●●●NA◐●McCalman J, Tsey K, Clifford A, Earles W, Shakeshaft A and Bainbridge R [27]○●●●◐●●●NA○…”

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

“…We limited our review to the five year period preceding the point of data collection as our aim was to describe current evaluation practice. In this study, we considered interventions to include any ‘systematic actions and approaches taken to address an identified Indigenous health need’ 2 . Given that Indigenous perspectives of health are holistic, we included studies related to physical, mental, social and emotional wellbeing.…”

“…We also assessed whether the primary outcome measured in the study was a health or a health risk factor outcome versus a health service delivery or process outcome (i.e. assessing utilisation, reach, satisfaction, quality, and implementation) 2 . The type of organisation that led the evaluation, based on the first author's affiliation, was categorised as research institution/university, government, health service, NGO or commercial consultancy provider.…”