Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity

Abstract

Issue addressed: Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity. Methods: A systematic search of peer-reviewed literature was conducted. Articles published between 1990-2014 that focused on a health care-settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included. Results: Twenty-five articles met the inclusion criteria. Qualitative (n = 18) and quantitative (n = 7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities. Conclusions: While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges.So what? Primary healthcare organisations wanting to increase their health promotion capacity can pre-empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review.

Could health information systems enhance the quality of Aboriginal health promotion? A retrospective audit of Aboriginal health programs in the Northern Territory of Australia

“…Moreover, current indicators of Aboriginal health care quality do not monitor and report on Aboriginal participation in health care delivery [ 3 ]. Few research studies of Aboriginal health promotion have assessed quality against indicators of best practice; for those that have done this, it is generally reported at a community-, and not health system level [ 10 , 24 ]. Using a structured data extraction tool designed for health promotion quality improvement purposes, this study provided insight into the scope of health promotion and identified gaps in quality which could be used to target system level changes and improve Aboriginal health promotion efforts.…”

“…Health promotion is an ongoing strategic priority of NT Health [ 18 , 22 ] and a core function in models of comprehensive primary health care [ 21 ]. However, in reality, a range of challenges influence health promotion delivery and its success in the NT, including the burden of acute care in Aboriginal communities, high workforce turnover, low stability and acute-oriented, temporary staffing [ 19 , 23 ] together with the availability of information about, and capacity to report on, health promotion quality and effectiveness [ 10 , 23 , 24 ].…”

“…These have included: (i) a Health Promotion Strategic Framework [ 25 ]; (ii) introduction of the Quality Improvement Program Planning System (QIPPS); and (iii) participation in continuous quality improvement initiatives [ 26 ], including in health promotion specifically [ 27 ]. These initiatives have proved useful in guiding planning and implementation of health promotion programs across the NT’s diverse context, and there is some evidence of impact on health promotion quality [ 10 , 24 ]. Previous assessments, however, have mainly been conducted at a community-level.…”

Skills, systems and supports: An Aboriginal Community Controlled Health Service (Apunipima) approach to building health promotion evaluation capacity of staff

“…Other health promotion capacity building projects report access to ongoing specialist support was important to achieving project milestones . However, little has been published on how health promotion capacity has been developed in an ACCHS . As far as we can determine, the report of this project to increase health promotion evaluation capacity in an ACCHS is unique.…”

Promoting environmental sustainability, equity and health in Victorian Primary Care Partnerships

“…The terminology of “factors that help or challenge” appears more compatible with a focus on practice than “barriers and enablers.” The terminology of “barriers and enablers”, particularly “perceived barriers” is often associated with a focus on individual human actors who are deterred from behaving in a health‐promoting way . Recent literature recognises that barriers and enablers can operate at organisational and societal levels, as well as individual level . The focus, however, still appears to be on human intention.…”