Facilitators and barriers to the implementation of Primary Health Care Interventions for Aboriginal and Torres Strait Islander people with Chronic Diseases: A systematic review protocol

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Abstract

Review question/objective

This systematic review seeks to:

Review question/objective

1. Identify and synthesise relevant international evidence on the factors or facilitators that support the implementation of interventions aimed at improving chronic disease (CD) care for Indigenous people within the primary health care (PHC) setting; and

Review question/objective

2. Identify and synthesise relevant international evidence on the factors or obstacles that inhibit the implementation of interventions aimed at improving CD care for Indigenous people within the PHC setting.

Review question/objective

The specific purpose of this review is to systematically examine the scientific literature in order to examine factors that facilitate and/or inhibit the implementation of interventions aimed at improving primary health care provided to Indigenous patients with chronic disease. More specifically, to fully encompass the factors of interest, the questions asked by this review are:

Review question/objective

• What attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of Indigenous communities support (facilitators) or inhibit (barriers) the implementation of interventions aimed at improving CD care for Indigenous people within the PHC setting?

Review question/objective

• What attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of health care providers support (facilitators) or inhibit (barriers) the implementation of interventions aimed at improving CD care for Indigenous people within the PHC setting?

Review question/objective

• What attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of policy and decision makers support (facilitators) or inhibit (barriers) the implementation of interventions aimed at improving CD care for Indigenous people within the PHC setting?

Background

The poor health status of the Aboriginal and Torres Strait Islander population is well documented,1 with the life-expectancy gap between Indigenous and non-Indigenous people one of contemporary Australia's most enduring health divides.2 Most Indigenous populations in colonized countries experience poor health outcomes relative to their non-Indigenous counterparts.3 Among the Australian Indigenous population CDs are the largest contributors to these health disparities.4 For example, cardiovascular disease (CVD) is the single leading cause of death among Aboriginal and Torres Strait Islander communities,2 diabetes remains at epidemic proportions,5 and rates of chronic kidney disease (CKD) are also disproportionately higher.6 Collectively, these conditions account for up to 50% of the life expectancy gap between Aboriginal and Torres Strait Islander, and non-Indigenous people in Australia.7

Background

Access to appropriate, affordable and acceptable comprehensive primary health care (PHC) is critical for improving the health of Aboriginal and Torres Strait Islanders8 and Indigenous populations world-wide. A recent study, for example, has shown that better access to primary health care9 that is responsive to the needs of Aboriginal and Torres Strait Islander people,10 reduces the rates of avoidable hospitalization. Similarly, a study of a Canadian reservation-dwelling Aboriginal population showed that poor access and ineffective primary health care services were directly related to increased procedure utilization and hospital admissions.11 While there are inter and intra-country differences, there are also a number of common lessons which relate to the provision of appropriate primary health care services for all Indigenous people.12

Background

Specifically, the success of primary health care services does not only rely on the provision of sufficient resources. While appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for Indigenous people.13 Poor or racist treatment afforded to some Indigenous patients, for example, continues to discourage people from accessing services in all but the most serious situations.14, 15 Likewise, even well-meaning messages which appear overly negative and/or contradict the world-view of the Indigenous patient may discourage people from engaging with health services.16,17

Background

Instead, the success of a primary health care service depends upon health providers understanding and accounting for the beliefs, expectations and experiences of Indigenous people. Rather than solely emphasising the implementation of evidence based treatment methods, research suggests that health care providers need to also understand health from the perspective of the Indigenous patient, appreciate the importance of establishing long term relationships with the community, provide an Indigenous space where patients feel comfortable and cared for, and respect the strong ties that Indigenous people have to family and their land.18 Health care providers who do not have an awareness of these issues and an understanding of cultural norms, struggle to understand why Indigenous communities refuse to engage or re-engage with health care services.19, 20

Background

The proposed systematic review will focus on the attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of both Indigenous people as well as health care practitioners, in order to better understand what supports (facilitators) or inhibits (barriers) the implementation of interventions aimed at improving CD care for Indigenous people within a PHC setting. In particular, this systematic literature review will focus on care for six CDs which have been found to be more common in Aboriginal and Torres Strait Islanders, in comparison to non-Indigenous populations - namely CVD,

Background

CKD, chronic respiratory disease (CRD), type 2 diabetes mellitus (T2DM), depression and HIV/AIDS. While a number of literature reviews have already identified a range of factors which impact upon the implementation of care in the general community for example,21, 22, 23 a preliminary search of the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Library, CINAHL, PubMed and PROSPERO has revealed that there is not currently a systematic review (either published or underway) that considers this from the perspective of interventions which are designed to improve health care for Indigenous people living with a CD.

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