Participatory Action Research Applied to an Ear, Nose, and Throat Specialty Service Redesign in Remote Australia: A Mixed-Methods Study of Key Stakeholder Perspectives

Abstract

This mixed-methods study reports on the key stakeholders’ perspectives on the ear, nose, and throat (ENT) service redesign in remote Australia, using a participatory action research (PAR) approach. A primary health care (PHC) clinician survey was conducted to assess local needs and possible educational gaps in clinical knowledge. This was followed by an internal stakeholder forum and a follow-up survey with Torres and Cape Hospital and Health Service staff to gain their perspectives on current service delivery and table ideas for a new ENT health service model. Qualitative data were analyzed inductively and grouped in emerging themes. Quantitative data were imported into tables and analyzed descriptively. PAR allowed for input from 19 PHC clinicians, 10 face-to-face stakeholders perspectives, and 18 stakeholder follow-up survey respondents. Four themes emerged: 1. Training for health workers in ENT management; 2. Improved local service access; 3. New referral pathways to improve continuity of care; and 4. Introduction of telehealth. PAR engaged key stakeholders, identifying gaps in ENT service delivery, and guided the development of the new service model. The inclusion of stakeholders throughout the service redesign process is likely to create a more sustainable model of care which already has local “buy-in”.

The role of Indigenous Health Workers in ear health screening programs for Indigenous children: a scoping review

“…Projects successfully increased the number of children screened 3,5,7,29,32 and identified telehealth as feasible and relatively accurate for clinical diagnosis and management of OM. 30,35,36,[46][47][48][51][52][53] As documented in the literature, studies consistently reported high levels (ranging from 42% to 64%) of OM among Indigenous children. 26,27,33,42,49 Some included studies reported increased OM knowledge and correct diagnosis resulted in improved child behaviour, 22,31,38,43 school performance, 22,38 family life 22,38 and physical health.…”

“…26,27,33,42,49 Some included studies reported increased OM knowledge and correct diagnosis resulted in improved child behaviour, 22,31,38,43 school performance, 22,38 family life 22,38 and physical health. 43 Three studies primarily focused on strengthening ear health screening skills and confidence for IHWs 9,15,51 and one study stressed the importance of providing specialised training for non-Indigenous Health Workers to generate a better understanding of Indigenous health contexts. 35 Challenges research teams faced in maintaining the success of their screening programs included the resource-intensive nature of programs, 30 high healthcare and teaching staff turnover, 35,40 limited OM knowledge in communities and schools, 39,40 service accessibility 35,39 and limited evaluation methods.…”

“…35 Challenges research teams faced in maintaining the success of their screening programs included the resource-intensive nature of programs, 30 high healthcare and teaching staff turnover, 35,40 limited OM knowledge in communities and schools, 39,40 service accessibility 35,39 and limited evaluation methods. 35,43 Potential solutions to these challenges included supportive infrastructure, 24 funded staff and staff training opportunities, 24,37,51 as well as strategic multi-level collaborations across health, environmental and educational departments, especially in remote areas. 5,28,37,41,44 Authors highlighted the importance of community control and support for successful programs and research 25,41,45 and the importance of engaging in local contexts.…”

“…6,54 IHWs contributed to the development and design of two research projects 23,37 and assisted with research coordination in six studies. 6,25,27,39,46,54 While nine studies included IHWs as participants, 9,28,[38][39][40][41]43,44,51 these studies did not ask the IHWs about their specific involvement in ear health programming, rather they were asked about the impact of hearing loss on family life, perceptions of OM among communities, and to evaluate training or screening programs. Further, in seven out of nine studies that included IHWs as participants, IHWs did not constitute the majority of respondents and the respondents' Indigenous status was not clarified, making it impossible to determine which data reflected IHW perspectives.…”

An Audit of Referrals to the Minor Operating Theater of the Patient Presenting in Otolaryngology OPD with Ear Discharge

“…Primary healthcare can play a role in reducing referrals to tertiary care. So, they should have an improved local service as stated in [13] to reduce the workload of tertiary healthcare centers. The accessibility of primary healthcare makes it the prime cornerstone of the healthcare delivery system.…”