Eliminating chronic hepatitis B in the northern territory of Australia through a holistic care package delivered in partnership with the community

Davies, Jane; Davis, Joshua S.; Hosking, Kelly; Binks, Paula; Gargan, Catherine Rose Connolly; Greenwood-Smith, Belinda; Bukulatjpi, Sarah Mariyalawuy; Ngurruwuthun, Terese; Dhagapan, Amanda; Wilson, Phillip Merrdi; Santis, Teresa De; Fuller, K.; McKinnon, Melita; Mobsby, Mikaela; Vintour-Cesar, Emily

doi:10.1016/s0168-8278(22)00850-9

Cited by 8 publications

(8 citation statements)

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Section: Methodsmentioning

confidence: 99%

“…This study is part of the Hep B PAST program is a partnership approach to sustainably eliminate CHB from the Aboriginal and Torres Strait Islander population of the NT [ 40 ]. This participatory action research (PAR) project aims to improve CHB-related health literacy, clinical care, and the cascade of care for people living with CHB [ 40 ]. A key component is building the capacity of primary health care professionals through the delivery of CHB education for doctors, nurses, and the Aboriginal health workforce.…”

Section: Methodsmentioning

confidence: 99%

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“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

Hosking,

De Santis,

Vintour-Cesar

et al. 2024

PLoS ONE

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“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

Hosking,

De Santis,

Vintour-Cesar

et al. 2024

PLoS ONE

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Section: Study Design and Processmentioning

confidence: 99%

“…This study is part of a larger Participatory Action Research (PAR) project, Hep B PAST, a partnership approach to sustainability eliminate CHB from the Aboriginal and Torres Strait Islander population of the NT (32). The project aims to improve CHB-related health literacy, clinical care and the cascade of care for people living with CHB (32). A key component to support primary health care to manage CHB is capacity building of health professionals through the delivery of CHB education for doctors, nurses, and the Aboriginal health workforce.…”

Section: Study Design and Processmentioning

confidence: 99%

“…Parallels and examples were drawn to other chronic conditions to increase utility and transferability of skills learnt and to assist in making links to a chronic conditions model of care. The course utilised the Hep B Story app, developed to improve health literacy about CHB by providing education in a person's rst language (35), currently available in nine NT Aboriginal languages (32).…”

Section: Developmentioning

confidence: 99%

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“The most culturally safe training I’ve ever had.” The co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia

Hosking

Santis

Vintour-Cesar

et al. 2023

Preprint

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Background The Aboriginal health workforce provide responsive, culturally safe health care. We aimed to co-design a culturally safe course with and for the Aboriginal health workforce. We describe the factors which led to the successful co-design, delivery, and evaluation of the “Managing hepatitis B” course for the Aboriginal health workforce.Methods A Participatory Action Research approach was used, involving ongoing consultation to iteratively co-design and then develop course content, materials, and evaluation tools. An Aboriginal and Torres Strait Islander research and teaching team received education in chronic hepatitis B and teaching methodologies. Pilot courses were held, in remote communities of the Northern Territory, using two-way learning and teach-back methods to further develop the course and assess acceptability and learnings. Data collection involved focus group discussions, in-class observations, reflective analysis, and use of co-designed and assessed evaluation tools.Results Twenty-six participants attended the pilot courses. Aboriginal and Torres Strait Islander facilitators delivered a high proportion of the course. Evaluations demonstrated high course acceptability, cultural safety, and learnings. Key elements contributing to success and acceptability were acknowledging, respecting, and integrating cultural differences into education, delivering messaging and key concepts through an Aboriginal and Torres Strait Islander lens, using culturally appropriate approaches to learning including storytelling and visual teaching methodologies. Evaluation of culturally safe frameworks and findings from the co-design process led to the creation of a conceptual framework, underpinned by meeting people’s basic needs, and offering a safe and comfortable environment to enable productive learning with attention to the following: sustenance, financial security, cultural obligations, and gender and kinship relationships.Conclusions Co-designed education for the Aboriginal health workforce must embed principles of cultural safety and meaningful community consultation to enable an increase in knowledge and empowerment. The findings of this research can be used to guide the design of future health education for First Nations health professionals and to other non-dominant cultures. The course model has been successfully transferred to other health issues in the Northern Territory.

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“Talking about something no one wants to talk about”—navigating hepatitis B-related work in remote Australian Aboriginal communities: a decade of learning and growth

Binks,

Gurruwiwi,

Dhurrkay

et al. 2024

Discov Health Systems

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Background Chronic hepatitis B (CHB) is one of the leading causes of liver cirrhosis and liver cancer globally. In Australia, Aboriginal and Torres Strait Islander people of the Northern Territory (NT) have the highest prevalence of CHB (6%) and are six times more likely than non-Aboriginal people to be diagnosed with liver cancer. In 2010, a “liver one-stop shop” model of specialised care and research was initiated to address this disparity. Despite many challenges, the program was accepted in NT Aboriginal communities. This study aimed to identify the key elements linked to this success. Methods We conducted a retrospective case study using Stake’s methodology to understand the hepatitis B phenomenon. A constructivist approach allowed a holistic understanding from the real-life perspectives of those involved in the hepatitis B work. Information was sourced from the Aboriginal workforce, patients of remote clinics, interested community members and service providers. Results We identified six elements critical to the successful conduct of our hepatitis B program, which included the essential role of the local Aboriginal workforce, providing health education in a patient’s preferred language, addressing shame and stigma, respecting culture, taking time, and building trust in the community. Conclusions Commitment over the long term was crucial for the success of our hepatitis B program. Adhering to the identified elements was essential to create a culturally safe environment and engage more Aboriginal people in clinical care and research. This study provides powerful lessons and insights that can be applied to other programs and comparable settings worldwide.

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Eliminating chronic hepatitis B in the northern territory of Australia through a holistic care package delivered in partnership with the community

Cited by 8 publications

References 0 publications

“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

“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

“The most culturally safe training I’ve ever had.” The co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia

“Talking about something no one wants to talk about”—navigating hepatitis B-related work in remote Australian Aboriginal communities: a decade of learning and growth

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