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Farnbach S, Foley C, Gates P, Seccull A, Henderson A, Zocco A, Farrell M, Shakeshaft A. Enhancing the SUSTAINable uptake of evidence to minimise harms from alcohol and other drugs in New South Wales, Australia. Drug Alcohol Rev 2024. [PMID: 38634165 DOI: 10.1111/dar.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
Although alcohol and other drug use is increasingly the focus of policy and research efforts, there are challenges identifying and applying evidence-based strategies to minimise harms for alcohol and other drugs in health care and community settings. These challenges include limited available research, variability across settings, and lack of 'fit' between research evidence and their intended settings. In this commentary, we describe a novel approach to develop and evaluate tailored, sustainable strategies to enhance the uptake of evidence-based activities into health services and community settings. Our approach involves four key principles: (i) identifying evidence-based alcohol and other drug harm minimisation strategies; (ii) partnering with local experts to identify and tailor strategies; (iii) implementing strategies into existing practice/infrastructure to build in sustainability; and (iv) using sustainable co-designed outcome measures including value-based health-care principles to measure uptake, feasibility and acceptability, health outcomes and economic implications. We propose that this approach offers a way forward to enhance the relevance and suitability of research in health services and community settings and has potential to be applied in other sectors.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Catherine Foley
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Peter Gates
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Alison Seccull
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Alexandra Henderson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Centre for Alcohol and Other Drugs, NSW Ministry of Health, Sydney, Australia
| | - Andrea Zocco
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia
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Gibbs D, Colledge-Frisby S, Farnbach S, Doyle M, Shakeshaft A, Larney S. Associations Between Supported Accommodation and Health and Re-offending Outcomes: a Retrospective Data Linkage Study. J Urban Health 2024; 101:80-91. [PMID: 38349583 PMCID: PMC10897077 DOI: 10.1007/s11524-023-00824-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/28/2024]
Abstract
Following release from prison, housing and health issues form a complex and mutually reinforcing dynamic, increasing reincarceration risk. Supported accommodation aims to mitigate these post-release challenges. We describe the impact of attending Rainbow Lodge (RL), a post-release supported accommodation service for men in Sydney, Australia, on criminal justice and emergency health outcomes. Our retrospective cohort study using linked administrative data includes 415 individuals referred to RL between January 2015 and October 2020. Outcomes of interest were rates of criminal charges, emergency department (ED) presentations and ambulance attendance; and time to first reincarceration, criminal charge, ED presentation and ambulance attendance. The exposure of interest was attending RL; covariates included demographic characteristics, release year and prior criminal justice and emergency health contact. Those who attended RL (n = 170, 41%) more commonly identified as Aboriginal or Torres Strait Islander (52% vs 41%; p = 0.025). There was strong evidence that attending RL reduced the incidence criminal charges (adjusted rate ratio [ARR] = 0.56; 95% confidence interval [CI] 0.340.86; p = 0.009). Absolute rates indicate a weak protective effect of RL attendance on ED presentation and ambulance attendance; however, adjusted analyses indicated no evidence of an association between attending RL and rates of ED presentations (ARR = 0.88; 95% CI = 0.65-1.21), or ambulance attendance (ARR = 0.82; 95% CI = 0.57-1.18). There was no evidence of an association between attending RL and time to first reincarceration, charge, ED presentation or ambulance attendance. Greater detail about reasons for emergency health service contact and other self-report outcome measures may better inform how supported accommodation is meeting its intended aims.
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Affiliation(s)
- Daisy Gibbs
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia.
| | | | - Sara Farnbach
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Michael Doyle
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
- Poche Centre for Urban Indigenous Health, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, Universite de Montreal and Centre de Recherche du CHUM, Montreal, Canada
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Economidis G, Eades AM, Shakeshaft A, Farnbach S. Improving the pragmatic usefulness of the scoring matrix for the Consolidated Framework for Implementation Research (CFIR). A proposal for a more frequency-based approach: The CFIR-f. PLoS One 2023; 18:e0295204. [PMID: 38033094 PMCID: PMC10688659 DOI: 10.1371/journal.pone.0295204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
The Consolidated Framework for Implementation Research (CFIR) is a well-established framework for systematically identifying key factors influencing the implementation of programs. To enhance the classification of existing CFIR definitions, as well as its +2/-2 scoring system, this study incorporated the views of relevant experts to: i) improve how themes are scored; and ii) utilise more information regarding the frequency with which themes are identified. This structured, frequency-based approach to the CFIR's scoring process has been trialled as the CFIR-frequency (CFIR-f). Researchers thematically analysed semi-structured interview data from four groups of policy and program experts (N = 24) delivering two family-based therapies in New South Wales (NSW), Australia. Themes identified by less than 50% were excluded from further analysis. Themes identified by 50% or more of expert participants in the four groups were classified as enablers or barriers using clearly defined criteria. Each theme was allocated a score according to how many experts identified it as an enabler or barrier, and then mapped back onto the latest adaptation of the CFIR comprising 67 constructs. The CFIR-f successfully determined three enablers of, and six barriers to, implementation. Enablers included the family-based therapy programs, therapist training and participant monitoring systems. Barriers included referral, data collection and staffing difficulties, NSW adaptation issues and the suitability and safety of the programs for Aboriginal families. The same enablers and barriers were identified using both the CFIR-f and the original scoring approach, and the identified themes were successfully mapped to almost all CFIR constructs (65/67). This paper proposes a more frequency-based approach to CFIR's scoring process (the CFIR-f). By specifically utilising the frequency with which these barriers and enablers are identified, the CFIR-f engenders a list of ranked themes that service providers and policymakers can use to inform their decisions about program modification and implementation.
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Affiliation(s)
- George Economidis
- Faculty of Medicine, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne-Marie Eades
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Anthony Shakeshaft
- Faculty of Medicine, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health and Behavioural Sciences, Poche Centre for Indigenous Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Sara Farnbach
- Faculty of Medicine, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Gibbs D, Stockings E, Larney S, Bromberg DJ, Shakeshaft A, Farnbach S. The impact of supported accommodation on health and criminal justice outcomes of people released from prison: a systematic literature review. Harm Reduct J 2023; 20:91. [PMID: 37480060 PMCID: PMC10362610 DOI: 10.1186/s12954-023-00832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Supported accommodation intends to address challenges arising following release from prison; however, impact of services, and of specific service components, is unclear. We describe key characteristics of supported accommodation, including program components and outcomes/impact; and distil best-evidence components. METHODS We conducted a systematic review, searching relevant databases in November 2022. Data were synthesised via effect direction plots according to the Synthesis Without Meta-analysis guidelines. We assessed study quality using the McGill Mixed Methods Appraisal Tool, and certainty in evidence using the GRADE framework. RESULTS Twenty-eight studies were included; predominantly cross-sectional. Program components which address life skills, vocational training, AOD use, and mental health appear to positively impact criminal justice outcomes. Criminal justice outcomes were the most commonly reported, and while we identified a reduction in parole revocations and reincarceration, outcomes were otherwise mixed. Variable design, often lacking rigour, and inconsistent outcome reporting limited assessment of these outcomes, and subsequently certainty in findings was low. CONCLUSION Post-release supported accommodation may reduce parole revocations and reincarceration. Despite limitations in the literature, the findings presented herein represent current best evidence. Future studies should clearly define program components and measure their impact; use analyses which reflect the high risk of adverse outcomes, such as time-to-event analyses; and consider outcomes which reflect the range of challenges faced by people leaving prison. REGISTRATION PROSPERO registration CRD42020189821.
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Affiliation(s)
- Daisy Gibbs
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia.
| | - Emily Stockings
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Jane Foss Russel Building, Camperdown, NSW, 2006, Australia
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, Universite de Montreal and Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, 06511, USA
- Center for Interdisciplinary Research On AIDS, Yale University, New Haven, CT, 06511, USA
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
- Poche Centre for Indigenous Health, University of Queensland, Toowong, QLD, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
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Foley C, Allan J, Lappin J, Courtney R, Farnbach S, Henderson A, Shakeshaft A. Utilising the Implementation of Integrated Care to Develop a Pragmatic Framework for the Sustained Uptake of Service Innovations (SUSI). Healthcare (Basel) 2023; 11:1786. [PMID: 37372904 DOI: 10.3390/healthcare11121786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The provision of integrated care (IC) across alcohol and other drug (AOD) and mental health (MH) services represents the best practice, yet the consistent delivery of IC in routine practice rarely occurs. Our hypothesis is that there is no practical or feasible systems-change approach to guide staff, researchers, or consumers through the complex transition that is required for the sustained uptake of IC across diverse clinical settings. To address this gap, we combined clinical and consumer expertise with the best available research evidence to develop a framework to drive the uptake of IC. The goal was to develop a process that is both standardised by the best available evidence and can be tailored to the specific characteristics of different health services. The result is the framework for Sustained Uptake of Service Innovation (SUSI), which comprises six core components that are applied in a specified sequence and a range of flexible activities that staff can use to deliver the core components according to their circumstances and preferences. The SUSI is evidence-based and practical, and further testing is currently underway to ensure it is feasible to implement in different AOD and MH services.
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Affiliation(s)
- Catherine Foley
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Julaine Allan
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
- Rural Health Research Institute, Charles Sturt University (CSU), Orange, NSW 2800, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
- Department of Psychiatry and Mental Health, University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Ryan Courtney
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Alexandra Henderson
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
- Poche Centre for Indigenous Health, University of Queensland (UQ), Toowong, QLD 4066, Australia
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Farnbach S, Henderson A, Allan J, Wallace R, Shakeshaft A. A Cluster-Randomised Stepped-Wedge Impact Evaluation of a Pragmatic Implementation Process for Improving the Cultural Responsiveness of Non-Aboriginal Alcohol and Other Drug Treatment Services: A Pilot Study. Int J Environ Res Public Health 2023; 20:4223. [PMID: 36901233 PMCID: PMC10001979 DOI: 10.3390/ijerph20054223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
There is limited evidence regarding implementing organisational improvements in the cultural responsiveness of non-Aboriginal services. Using a pragmatic implementation process to promote organisational change around cultural responsiveness, we aimed to (i) identify its impact on the cultural responsiveness of participating services; (ii) identify areas with the most improvement; and (iii) present a program logic to guide cultural responsiveness. A best-evidence guideline for culturally responsive service delivery in non-Aboriginal Alcohol and other Drug (AoD) treatment services was co-designed. Services were grouped geographically and randomised to start dates using a stepped wedge design, then baseline audits were completed (operationalization of the guideline). After receiving feedback, the services attended guideline implementation workshops and selected three key action areas; they then completed follow-up audits. A two-sample Wilcoxon rank-sum (Mann-Whitney) test was used to analyse differences between baseline and follow-up audits on three key action areas and all other action areas. Improvements occurred across guideline themes, with significant increases between median baseline and follow-up audit scores on three key action areas (median increase = 2.0; Interquartile Range (IQR) = 1.0-3.0) and all other action areas (median increase = 7.5; IQR = 5.0-11.0). All services completing the implementation process had increased audit scores, reflecting improved cultural responsiveness. The implementation process appeared to be feasible for improving culturally responsive practice in AoD services and may be applicable elsewhere.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
| | - Alexandra Henderson
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Raechel Wallace
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
- Network of Alcohol and Drug Agencies, Woolloomooloo, NSW 2011, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
- Poche Centre for Urban Indigenous Health, University of Queensland, Brisbane, QLD 4072, Australia
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Farnbach S, Fernando J, Coyte J, Simms M, Hackett ML. "I tried to get help about my addiction but he just gave me tablets:" male Aboriginal drug and alcohol rehabilitation clients' experiences and preferences speaking about substance use in primary care. BMC Prim Care 2023; 24:25. [PMID: 36681795 PMCID: PMC9863190 DOI: 10.1186/s12875-023-01983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Primary healthcare (PHC) services are crucial in supporting people who use substances. The aims of this study were to explore the experiences of Aboriginal males in NSW in treatment for substance use about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use. METHODS Semi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group. RESULTS Twenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) speaking up about substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. CONCLUSION This research highlights opportunities to improve access and to better support Aboriginal males who use substances in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre and The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | | | - Joe Coyte
- CEO, The Glen Centre (Ngaimpe), Chittaway Point, Australia
| | - Matthew Simms
- South Coast Medical Service Aboriginal Corporation, Nowra, Australia
| | - Maree L Hackett
- The George Institute for Global Health, UNSW, The University of Central Lancashire, Preston, UK
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Hopkins RE, Degenhardt L, Campbell G, Farnbach S, Gisev N. "Frustrated with the whole system": a qualitative framework analysis of the issues faced by people accessing health services for chronic pain. BMC Health Serv Res 2022; 22:1603. [PMID: 36587208 PMCID: PMC9803895 DOI: 10.1186/s12913-022-08946-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic non-cancer pain (CNCP) is complex and often requires multimodal management comprising of both pharmacological and non-pharmacological treatments. To inform delivery of CNCP management, it is important to understand how current health services providing non-pharmacological treatments are accessed by exploring the experiences of people attempting to access services. In doing so, this study sought to explore the underlying drivers of service access barriers. METHODS This study explored the experiences of Australians accessing services for CNCP using semi-structured telephone interviews undertaken between 01 October 2020 and 31 March 2021. Thematic analysis was guided by Levesque et al.'s 2013 conceptual framework of access to health care, with emerging themes mapped to five dimensions of accessibility and corresponding abilities of consumers: Approachability/Ability to perceive; Acceptability/Ability to seek; Availability and Accommodation/Ability to reach; Affordability/Ability to pay; and Appropriateness/Ability to engage. RESULTS The 26 participants (aged 24-78 years, 22 female) reported accessing a range of services including general practitioners (GP), allied health services, and specialised pain clinics, for a variety of conditions. Three themes were mapped to accessibility dimensions (in brackets): 'GP as guide or gatekeeper' (Approachability); 'Outside of my control' (Availability and Accommodation; Affordability); and 'Services aren't always good enough' (Appropriateness). A fourth identified theme illustrated how participants responded to encountering these barriers: 'Leading my own pain management'. Participant experiences suggest problems with the translation of contemporary pain management principles into practice, including continued application of biomedical health models as opposed to the biopsychosocial model, and demonstrate systemic issues with service delivery, including a lack of benchmarking of specialised services. CONCLUSIONS The identified themes highlight several evidence-to-practice gaps in the delivery of health services for people with CNCP in Australia. To address these gaps, there is a need for improved clinician training, increased investment in specialised pain services, and development of clear primary care pathways for CNCP management for evidence-based multimodal pain management to be accessible and equitable.
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Affiliation(s)
- Ria E. Hopkins
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street Randwick, Sydney, NSW 2031 Australia
| | - Louisa Degenhardt
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street Randwick, Sydney, NSW 2031 Australia
| | - Gabrielle Campbell
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street Randwick, Sydney, NSW 2031 Australia ,grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, Sir Fred Schonell Drive St Lucia, Brisbane, QLD 4072 Australia
| | - Sara Farnbach
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street Randwick, Sydney, NSW 2031 Australia
| | - Natasa Gisev
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street Randwick, Sydney, NSW 2031 Australia
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Talbot B, Farnbach S, Tong A, Chadban S, Sen S, Garvey V, Gallagher M, Knight J. Patient and Clinician Perspectives on the use of Remote Patient Monitoring in Peritoneal Dialysis. Can J Kidney Health Dis 2022; 9:20543581221084499. [PMID: 35340772 PMCID: PMC8941702 DOI: 10.1177/20543581221084499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Numerous factors influence patient recruitment to, and retention on,
peritoneal dialysis (PD), but a major challenge is a perceived
“inaccessibility” to treating clinicians. It has been suggested that remote
patient monitoring (RPM) could be a means of improving such oversight and,
thereby, uptake of PD. Objective: To describe patient and clinician perspectives toward RPM and the use of
applications (Apps) suitable for mobiles, tablets, or computers to support
the provision of PD care. Design: Qualitative design using semi-structured interviews. Setting: All patient participants perform PD treatment at home under the oversight of
an urban PD unit in Sydney, Australia. Patient and clinician interviews were
conducted within the PD unit. Participants: 14 participants (5 clinicians [2 nephrologists, 3 PD nurses] and 9 patients
treated with PD). Methods: Semi-structured interviews were conducted using interview guides tailored for
clinician and patient participants. Transcripts were coded and analyzed by a
single researcher using thematic analysis. Results: Six themes were identified: perceived benefits of RPM implementation
(offering convenience and efficiency, patient assurance through increased
surveillance, more complete data and monitoring adherence), uncertainty
regarding data governance (protection of personal data, data reliability),
reduced patient engagement (transfer of responsibility leading to
complacency), changing patient-clinician relationships (reduced
patient-initiated communication, the need to maintain patient independence),
increased patient and clinician burden (inadequate technological literacy,
overmanagement leading to frequent treatment changes), and clinician
preference influencing patient behavior. Limitations: The interviews were conducted in English only and with participants from a
single urban dialysis unit, which may limit generalizability. Conclusions: For patients and clinicians, advantages from the use of RPM in PD may include
increased patient confidence and assurance, improved treatment oversight,
more complete data capture, and overcoming barriers to data documentation.
Careful patient selection and patient and clinician education may help to
optimize the benefits of RPM, maintain patient independence, and reduce the
risks of patient disengagement. The use of an App may support RPM; however,
participants expressed concerns about increasing the burden on some patients
through the use of unfamiliar technology. Human Research Ethics Committee Approval Number: CH62/6/2019-028
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Affiliation(s)
- Benjamin Talbot
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Clinical School, The University of Sydney, New South Wales, Australia
- Ellen Medical Devices, Sydney, New South Wales, Australia
| | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
| | - Steve Chadban
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Shaundeep Sen
- Concord Clinical School, The University of Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Vincent Garvey
- Ellen Medical Devices, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - John Knight
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, New South Wales, Australia
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Trudgett S, Griffiths K, Farnbach S, Shakeshaft A. A framework for operationalising Aboriginal and Torres Strait Islander data sovereignty in Australia: Results of a systematic literature review of published studies. EClinicalMedicine 2022; 45:101302. [PMID: 35243269 PMCID: PMC8861650 DOI: 10.1016/j.eclinm.2022.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Racial health disparities are only likely to be meaningfully improved by tailoring public health and clinical interventions to the specific needs of Indigenous people and their communities. Accurate tailoring relies on the availability of high-quality Indigenous-specific data. The potential benefits of increased availability of Indigenous data need to be balanced by efforts to ensure those data are collected and used appropriately. This paper identifies characteristics of Indigenous Data Sovereignty (IDS) principles and considers a framework for operationalisation. METHODS A PRISMA compliant search of the literature was undertaken, using methods detailed in the Cochrane Collaboration Handbook on Systematic Reviews of Health Promotion and Public Health Interventions (1). The search strategy comprised two steps: a search of 11 scientific electronic databases and five grey literature sources. The search was limited by date of publication (1 January 2000 to 1 December 2021). The following keywords and subject heading terms were used: (exp Aboriginal and Torres Strait Islander or Aborigin* or Torres Strait Island* or, Oceanic ancestry group) and (exp research or biomedical research or population surveillance or translational medical research or, research design) and (exp data or datasets or data collection or data management or health surveys or information dissemination or, intellectual property) and (exp self-determination or ownership or control or access or possession or OCAP or sovereignty or, ethics) and, (exp Australia). IDS principles: (i) ownership; (ii) control; (iii) accessibility; (iv) custodianship; (v) accountability to Indigenous people; (vi) amplify Community voice; (vii) relevant and reciprocal; and (viii) sustainably self-determining. Using standard data extraction forms, we examined relevant Australian studies to identify key characteristics and frequency with which they cited IDS principles. These findings were consolidated into an operationalisation framework. FINDINGS 34 relevant Australian published studies were identified. The most frequently cited IDS principles were Accountability to Aboriginal and Torres Strait Islander peoples and sustainably self-determining. The least frequently cited principle was Access. A framework to operationalise IDS principles is proposed that is both standardised internationally and able to be tailored to the diverse contexts of Indigenous peoples. INTERPRETATION IDS is emergent in Australia and there is a clear need to establish an agreed set of International IDS principles and a framework for their operationalisation and contextualisation across diverse Indigenous communities and contexts. FUNDING This research project is funded through an Australian Research Council (ARC) Discovery Grant from 2017 to 2022. The National Drug and Alcohol Research Centre (NDARC) is funded by the Australian Government Department of Health. The 1st author (ST) is supported by a scholarship co-funded by NDARC and the Lowitja Institute.
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Affiliation(s)
- Skye Trudgett
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
- Corresponding author.
| | - Kalinda Griffiths
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
- School of Health Sciences, University of Sydney, Sydney, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
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11
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Farnbach S, Allan J, Wallace R, Aiken A, Shakeshaft A. Formative process evaluation of a guideline-driven process for improving the cultural responsiveness of alcohol and drug treatment services. BMC Health Serv Res 2021; 21:352. [PMID: 33858384 PMCID: PMC8051070 DOI: 10.1186/s12913-021-06367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/06/2021] [Indexed: 05/31/2023] Open
Abstract
Background To improve Australian Aboriginal and Torres Strait Islander people’s access to, and experience of, healthcare services, including Alcohol and other Drug (AoD) treatment services, principles and frameworks have been developed to optimise cultural responsiveness. Implementing those principles in practice, however, can be difficult to achieve. This study has five aims: i) to describe a five-step process developed to operationalise improvements in culturally responsive practice in AoD services; ii) to evaluate the fidelity of implementation for this five-step process; iii) to identify barriers and enablers to implementation; iv) to assess the feasibility and acceptability of this approach; and v) to describe iterative adaptation of implementation processes based on participant feedback. Methods Participating services were 15 non-Aboriginal AoD services in New South Wales, Australia. Implementation records were used to assess the implementation fidelity of the project. Structured interviews with chief executive officers or senior management were conducted, and interview data were thematically analysed to identify project acceptability, and the key enablers of, and barriers to, project implementation. Quantitative descriptive analyses were performed on the post-implementation workshop survey data, and responses to the free text questions were thematically analysed. Results A high level of implementation fidelity was achieved. Key enablers to improving culturally responsive practice were the timing of the introduction of the five-step process, the active interest of staff across a range of seniority and the availability of resources and staff time to identify and implement activities. Key barriers included addressing the unique needs of a range of treatment sub-groups, difficulty adapting activities to different service delivery models, limited time to implement change in this evaluation (three months) and the varied skill level across staff. The project was rated as being highly acceptable and relevant to service CEOs/managers and direct service staff, with planned changes perceived to be achievable and important. Based on CEO/management feedback after the project was implemented at the initial services, several improvements to processes were made. Conclusion The operationalisation of the five-step process developed to improve cultural responsiveness was feasible and acceptable and may be readily applicable to improving the cultural responsiveness of a wide variety of health and human services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06367-7.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre UNSW, Sydney, NSW, 2052, Australia
| | - Julaine Allan
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2500, Australia.
| | - Raechel Wallace
- Network of Alcohol and Drug Agencies, Woolloomooloo, NSW, 2011, Australia
| | - Alexandra Aiken
- National Drug and Alcohol Research Centre UNSW, Sydney, NSW, 2052, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre UNSW, Sydney, NSW, 2052, Australia
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12
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Farnbach S, Fernando J, Coyte J, Simms M, Hackett ML. "It's hard for me to tell my story" the experiences of Aboriginal and Torres Strait Islander male clients at a residential drug and alcohol rehabilitation centre using primary health care. Health Promot J Austr 2020; 32 Suppl 2:87-94. [PMID: 33370469 DOI: 10.1002/hpja.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022] Open
Abstract
ISSUE ADDRESSED Aboriginal males who use drug and alcohol may experience unique barriers accessing primary health care. This study explores the perceptions of Aboriginal males in treatment for drug and alcohol use around their experiences accessing primary health care, and barriers to access. METHODS Twenty male Aboriginal clients at a fee-paying residential drug and alcohol rehabilitation centre completed semi-structured interviews about their primary health care experiences before their stay. Interpretative phenomenological analysis was used to inductively develop themes. RESULTS About half the males had regular General Practitioners at a mainstream primary health care service or Aboriginal Medical Service. Positive experiences included having medical needs met or understanding the health information provided; and negative experiences included inefficient health service or system processes or experiencing cultural bias or racism. Barriers included limited access to appointments or to the same GP regularly, long wait times, lack of access to transport, worry or fear about their health or the visit or their complex lives taking priority. CONCLUSION This research showed that the participants sought out health care and identified barriers to accessing care and potential improvements. SO WHAT?: Access to a regular General Practitioner, continuity of care and culturally appropriate and comprehensive communication techniques are important to facilitate access to primary health care by Aboriginal males. Efforts to enhance access may focus on inherent strengths within Aboriginal communities including focusing on relationships between clinicians and families, providing a welcoming environment and encouraging clients to bring a trusted family member to appointments.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre and The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Joe Coyte
- The Glen Centre (Ngampie), Chittaway Bay, Australia
| | - Matthew Simms
- South Coast Medical Service Aboriginal Corporation, Nowra, Australia
| | - Maree L Hackett
- The George Institute for Global Health, UNSW and The University of Central Lancashire, Sydney, Australia.,University of Lancashire, Preston, UK
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Farnbach S, Gee G, Eades AM, Evans JR, Fernando J, Hammond B, Sims M, DeMasi K, Glozier N, Hackett ML. What are the resourcing requirements for an Aboriginal and Torres Strait Islander primary health care research project? Public Health Res Pract 2020; 30:29341911. [PMID: 36823797 DOI: 10.17061/phrp29341911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE To explore the role of resourcing during an Aboriginal and Torres Strait Islander primary health care research project. STUDY TYPE Process evaluation using grounded theory approaches of a national Aboriginal and Torres Strait Islander research project (N = 500) named Getting it Right: the validation study. METHODS Qualitative semistructured interviews with 36 primary health care staff and 4 community members from 9 of 10 primary health care services involved in the research project. Interviews included questions about the resources needed to conduct the research project, including flexible reimbursement to participating services (allocated within services), human resources and reimbursement to research participants (vouchers). Qualitative data were triangulated with participant feedback, study administrative data and field notes kept by the interviewer. RESULTS Three themes were identified: 1) the influence of reimbursement on participating services and the research project; 2) the influence of human resources on the research project at participating services; and 3) the consequences of offering vouchers to reimburse research participants. Reimbursement was allocated to research expenses (human resources and logistics) or non-research expenses (service operations, equipment and conference attendance costs). Most services opted to offer vouchers to compensate participants for their time, which staff considered was appropriate recognition of participants' contributions and facilitated recruitment. Some staff described some potential unintended negative consequences from offering vouchers, including creating a welfare mentality or creating problematic expectations. CONCLUSION Primary health care research should have sufficient resourcing available, including human resource capacity, to achieve research targets. Research planning should include consideration of the existing commitments, priorities and human capacity needs of services and patients.
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Affiliation(s)
- Sara Farnbach
- Neurological and Mental Health Division, The George Institute for Global Health, UNSW Sydney, Australia; University of Sydney, NSW, Australia;
| | - Graham Gee
- Victorian Aboriginal Health Service, Melbourne, Australia; Murdoch Children's Research Institute, University of Melbourne, VIC, Australia
| | - Anne-Marie Eades
- Neurological and Mental Health Division, The George Institute for Global Health, UNSW Sydney, Australia; University of Sydney, NSW, Australia
| | - John Robert Evans
- Faculty of Health, University of Technology Sydney, NSW, Australia; School of Education and Social Work, University of Sydney, NSW, Australia
| | | | | | - Matty Sims
- The Glen Centre (Ngampie), Newcastle, NSW, Australia
| | - Karrina DeMasi
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
| | - Nick Glozier
- Brain and Mind Centre and Central Clinical School, University of Sydney, NSW, Australia
| | - Maree L Hackett
- Neurological and Mental Health Division, The George Institute for Global Health, UNSW Sydney, Australia; University of Central Lancashire, Preston, United Kingdom; University of Sydney, NSW, Australia, on behalf of the Getting it Right Investigators
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14
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Farnbach S, Gee G, Eades AM, Evans JR, Fernando J, Hammond B, Simms M, DeMasi K, Hackett ML. 'We're here to listen and help them as well': a qualitative study of staff and Indigenous patient perceptions about participating in social and emotional wellbeing research at primary healthcare services. BMC Psychiatry 2019; 19:294. [PMID: 31590642 PMCID: PMC6781305 DOI: 10.1186/s12888-019-2263-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/29/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Research can inform culturally-appropriate care to strengthen social and emotional wellbeing (SEWB) among Aboriginal and Torres Strait Islander (hereafter, the term 'Indigenous Peoples' is respectfully used and refers to all Aboriginal and/or Torres Strait Islander Peoples of Australia). We acknowledge the cultural diversity of Australia's Indigenous First Peoples and they do not represent a homogenous group.) (hereafter Indigenous) Peoples. We explore the perspectives of primary healthcare staff and Indigenous patients about their willingness to and experiences participating in SEWB research. METHOD Process evaluation using grounded theory approaches of Getting it Right: The validation study, a national validation designed Indigenous SEWB research project (N = 500). Primary healthcare staff (n = 36) and community members (n = 4) from nine of ten primary healthcare services involved with the research project completed qualitative semi-structured interviews. Interview data were triangulated with participant feedback (responses to structured questions and free-text feedback collected during Getting it Right), study administrative data (participant screening logs, communication logs, study protocol, deviation logs and ethics correspondence) and interviewer field notes. RESULTS Three themes about staff, patient and community perspectives concerning research participation developed: (1) considering the needs, risk, preferences and impact of participation in research for staff, patients and community; (2) building staff confidence speaking to patients about research and SEWB problems and (3) patients speaking openly about their SEWB. Some staff described pressure to ensure patients had a positive experience with the research, to respond appropriately if patients became upset or SEWB problems were identified during interviews, or due to their dual role as community member and researcher. Patients and staff reported that patients were more likely to participate if they knew the staff outside of the service, especially staff with a shared cultural background, and they perceived SEWB as a community priority. Staff reported their skills speaking to patients about the research and SEWB improved during the research, which built their confidence. Contrary to staff preconceptions, staff and patients reported that many patients appreciated the opportunity to speak about their SEWB and contributing to research that may eventually enhance SEWB in their community. CONCLUSION Our research project was considered acceptable by most staff and patients. The positive outcomes reported by staff and feedback from patients highlights the importance of providing opportunities for people to speak about their SEWB and for research-informed SEWB PHC care. TRIAL REGISTRATION Getting it Right is registered on ANZCTR12614000705684 .
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW, 2050, Australia. .,University of New South Wales, Sydney, 2052, Australia. .,The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Graham Gee
- grid.439127.aVictorian Aboriginal Health Service, 186 Nicholson St, 3065, Fitzroy, VIC 3072 Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Melbourne, VIC 3000 Australia
| | - Anne-Marie Eades
- 0000 0001 1964 6010grid.415508.dThe George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050 Australia ,0000 0004 4902 0432grid.1005.4University of New South Wales, Sydney, 2052 Australia ,0000 0004 1936 834Xgrid.1013.3The University of Sydney, Sydney, NSW 2006 Australia
| | - John Robert Evans
- 0000 0004 1936 834Xgrid.1013.3The University of Sydney, Sydney, NSW 2006 Australia ,0000 0004 1936 7611grid.117476.2The University of Technology, 15 Broadway, Ultimo, NSW 2007 Australia
| | - Jamie Fernando
- The Glen Centre (Ngampie), 50 Church Rd, Chittaway, NSW 2261 Australia
| | - Belinda Hammond
- Nunkuwarrin Yunti of South Australia, Adelaide, South Australia 5000 Australia
| | - Matty Simms
- The Glen Centre (Ngampie), 50 Church Rd, Chittaway, NSW 2261 Australia
| | - Karrina DeMasi
- Aboriginal Medical Services Alliance Northern Territory, Moonta House 43 Mitchell Street, Darwin City, Northern Territory 0801 Australia
| | - Maree L. Hackett
- 0000 0001 1964 6010grid.415508.dThe George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050 Australia ,0000 0004 4902 0432grid.1005.4University of New South Wales, Sydney, 2052 Australia ,0000 0001 2167 3843grid.7943.9The University of Central Lancashire, Preston, PR1 2HE UK
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15
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Farnbach S, Gee G, Eades AM, Evans JR, Fernando J, Hammond B, Simms M, DeMasi K, Glozier N, Brown A, Hackett ML. Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9. BMC Public Health 2019; 19:1270. [PMID: 31533670 PMCID: PMC6749631 DOI: 10.1186/s12889-019-7569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022] Open
Abstract
Background The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Methods Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Results Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Conclusion Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. Trial registration Australian New Zealand Clinical Trial Registry ANZCTR12614000705684, 03/07/2014.
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, The University of New South Wales, PO Box M201, Missenden Road, Sydney, New South Wales, 2050, Australia. .,University of New South Wales, Sydney, New South Wales, 2052, Australia. .,University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Graham Gee
- Victorian Aboriginal Health Service, Melbourne, Victoria, 3065, Australia.,University of Melbourne, Melbourne, Victoria, 3000, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia
| | - Anne-Marie Eades
- The George Institute for Global Health, The University of New South Wales, PO Box M201, Missenden Road, Sydney, New South Wales, 2050, Australia.,University of New South Wales, Sydney, New South Wales, 2052, Australia.,University of Sydney, Sydney, New South Wales, 2006, Australia
| | - John Robert Evans
- The University of Technology, Sydney, New South Wales, 2006, Australia.,The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Jamie Fernando
- The Glen Centre (Ngampie), Chittaway Point, New South Wales, 2261, Australia.,The University of Newcastle, Newcastle, New South Wales, 2308, Australia
| | - Belinda Hammond
- Nunkuwarrin Yunti of South Australia, Adelaide, South Australia, 5000, Australia
| | - Matty Simms
- The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Karrina DeMasi
- Aboriginal Medical Services Alliance Northern Territory, Darwin, 0801, Australia
| | - Nick Glozier
- Brain and Mind Centre and Central Clinical School University of Sydney, Sydney, New South Wales, 2052, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Maree L Hackett
- The George Institute for Global Health, The University of New South Wales, PO Box M201, Missenden Road, Sydney, New South Wales, 2050, Australia.,University of New South Wales, Sydney, New South Wales, 2052, Australia.,University of Sydney, Sydney, New South Wales, 2006, Australia.,The University of Central Lancashire, Preston, PR1 2HE, UK
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16
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Hackett ML, Teixeira‐Pinto A, Farnbach S, Glozier N, Skinner T, Askew DA, Gee G, Cass A, Brown A. Getting it Right: validating a culturally specific screening tool for depression (
aPHQ
‐9) in Aboriginal and Torres Strait Islander Australians. Med J Aust 2019; 211:24-30. [DOI: 10.5694/mja2.50212] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/28/2019] [Indexed: 01/25/2023]
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17
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Carcel C, Farnbach S, Essue BM, Li Q, Glozier N, Jan S, Lindley R, Hackett ML. Returning to Unpaid Work after Stroke: The Psychosocial Outcomes in Stroke Cohort Study. Cerebrovasc Dis 2019; 47:1-7. [PMID: 30654379 DOI: 10.1159/000496399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While returning to paid work is a crucial marker of stroke recovery, little is known about the differences in unpaid work by sex following stroke. We aimed to determine the sex differences in participation in unpaid work 12 months after stroke. METHODS Psychosocial outcomes in stroke were a prospective, multicentre observational study that recruited individuals, 18-64 years, within 28 days of stroke from New South Wales, Australia. Unpaid work was defined as ≥5 h per week of one or more of: unpaid domestic work for the household; unpaid care of others; looking after own children without pay or looking after someone else's children without pay. Data was collected before stroke, 28 days (baseline), 6 and 12 months follow-up. RESULTS Eighty per cent of women and 52% of men engaged in ≥5 h per week of unpaid work before stroke. At 12 months after, 69% of women and 53% of men completed ≥5 h of unpaid work per week. For women, there was a significant association between participation in unpaid work at 12 months and having financially dependent children (OR 2.67; 95% CI 1.08-6.59). A return to unpaid work in men was associated with participation in unpaid work before stroke (OR 3.74; 95% CI 2.14-6.53). CONCLUSIONS More women are engaged in unpaid work before and at 12 months after stroke, but there is a reduction in the proportion of women returning to unpaid work at 12 months not seen in men. Consideration may need to be given to the development of rehabilitation strategies targeted at the specific needs of stroke survivors.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia, .,The University of Sydney, Sydney School of Public Health, Sydney Medical School, Sydney, New South Wales, Australia, .,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia,
| | - Sara Farnbach
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The University of Sydney, Sydney School of Public Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Beverley M Essue
- The University of Sydney, Sydney School of Public Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nick Glozier
- The University of Sydney, Sydney School of Public Health, Sydney Medical School, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The University of Sydney, Sydney School of Public Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Richard Lindley
- The George Institute for Global Health and Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The University of Sydney, Sydney School of Public Health, Sydney Medical School, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, United Kingdom
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18
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Farnbach S, Eades AM, Gwynn JD, Glozier N, Hackett ML. The conduct of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review. Public Health Res Pract 2018; 28:27451704. [PMID: 29925085 DOI: 10.17061/phrp27451704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives and importance of study: Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (Values and ethics) describes key values that should underpin Aboriginal and Torres Strait Islander (Indigenous)-focused health research. It is unclear how research teams address this document in primary health care research. We systematically review the primary health care literature focusing on Indigenous social and emotional wellbeing (SEWB) to identify how Values and ethics and community preferences for standards of behaviour (local protocols) are addressed during research. STUDY TYPE Systematic review in accordance with PRISMA Guidelines and MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. METHODS We searched four databases and one Indigenous-specific website for qualitative, quantitative and mixed-method studies published since Values and ethics was implemented (2003). Included studies were conducted in primary health care services, focused on Indigenous SEWB and were conducted by research teams. Using standard data extraction forms, we identified actions taken (reported by authors or identified by us) relating to Values and ethics and local protocols. RESULTS A total of 25 studies were included. Authors of two studies explicitly mentioned the Values and ethics document, but neither reported how their actions related to the document's values. In more than half the studies, we identified at least three actions relating to the values. Some actions related to multiple values, including use of culturally sensitive research processes and involving Indigenous representatives in the research team. Local protocols were rarely reported. CONCLUSION Addressing Values and ethics appears to improve research projects. The academic community should focus on culturally sensitive research processes, relationship building and developing the Indigenous research workforce, to facilitate acceptable research that affects health outcomes. For Values and ethics to achieve its full impact and to improve learning between research teams, authors should be encouraged to report how the principles are addressed during research, including barriers and enablers that are encountered.
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, UNSW Sydney, Australia; School of Medicine, University of Sydney, NSW, Australia,
| | - Anne-Maree Eades
- The George Institute for Global Health, UNSW Sydney, Australia; School of Medicine, University of Sydney, NSW, Australia; Murdoch University, Perth, Western Australia
| | - Josephine D Gwynn
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia; Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, NSW, Australia; Central Clinical School, University of Sydney, NSW, Australia
| | - Maree L Hackett
- The George Institute for Global Health, UNSW Sydney, Australia; School of Medicine, University of Sydney, NSW, Australia; Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Farnbach S, Evans J, Eades AM, Gee G, Fernando J, Hammond B, Simms M, DeMasi K, Hackett M. Process evaluation of a primary healthcare validation study of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people: study protocol. BMJ Open 2017; 7:e017612. [PMID: 29102990 PMCID: PMC5722089 DOI: 10.1136/bmjopen-2017-017612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Process evaluations are conducted alongside research projects to identify the context, impact and consequences of research, determine whether it was conducted per protocol and to understand how, why and for whom an intervention is effective. We present a process evaluation protocol for the Getting it Right research project, which aims to determine validity of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people. In this process evaluation, we aim to: (1) explore the context, impact and consequences of conducting Getting It Right, (2) explore primary healthcare staff and community representatives' experiences with the research project, (3) determine if it was conducted per protocol and (4) explore experiences with the depression screening tool, including perceptions about how it could be implemented into practice (if found to be valid). We also describe the partnerships established to conduct this process evaluation and how the national Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research is met. METHODS AND ANALYSIS Realist and grounded theory approaches are used. Qualitative data include semistructured interviews with primary healthcare staff and community representatives involved with Getting it Right. Iterative data collection and analysis will inform a coding framework. Interviews will continue until saturation of themes is reached, or all participants are considered. Data will be triangulated against administrative data and patient feedback. An Aboriginal and Torres Strait Islander Advisory Group guides this research. Researchers will be blinded from validation data outcomes for as long as is feasible. ETHICS AND DISSEMINATION The University of Sydney Human Research Ethics Committee, Aboriginal Health and Medical Research Council of New South Wales and six state ethics committees have approved this research. Findings will be submitted to academic journals and presented at conferences. TRIAL REGISTRATION NUMBER ACTRN12614000705684.
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, Camperdown, New South Wales, Australia
- University of New South Wales, Sydney, New SouthWales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - John Evans
- The University of Technology and The University of Sydney, Sydney, New South Wales, Australia
| | - Anne-Marie Eades
- The George Institute for Global Health, Camperdown, New South Wales, Australia
- University of New South Wales, Sydney, New SouthWales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
- Murdoch University, Western Australia, Australia
| | - Graham Gee
- Victorian Aboriginal Health Service, Victoria, Australia
| | | | - Belinda Hammond
- Nunkuwarrin Yunti of South Australia, South Australia, Australia
| | - Matty Simms
- The Glen Centre (Ngampie), New South Wales, Australia
| | - Karrina DeMasi
- Danila Dilba Health Service, Northern Territory, Australia
| | - Maree Hackett
- The George Institute for Global Health, Camperdown, New South Wales, Australia
- University of New South Wales, Sydney, New SouthWales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, Lancashire, UK
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Farnbach S, Eades AM, Fernando JK, Gwynn JD, Glozier N, Hackett ML. The quality of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review. Public Health Res Pract 2017; 27:27341700. [PMID: 29114717 DOI: 10.17061/phrp27341700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives and importance of the study: Primary health care research focused on Aboriginal and Torres Strait Islander (Indigenous) people is needed to ensure that key frontline services provide evidence based and culturally appropriate care. We systematically reviewed the published primary health care literature to identify research designs, processes and outcomes, and assess the scientific quality of research focused on social and emotional wellbeing. This will inform future research to improve evidence based, culturally appropriate primary health care. STUDY TYPE Systematic review in accordance with PRISMA and MOOSE guidelines. METHODS Four databases and one Indigenous-specific project website were searched for qualitative, quantitative and mixed-method published research. Studies that were conducted in primary health care services and focused on the social and emotional wellbeing of Indigenous people were included. Scientific quality was assessed using risk-of-bias assessment tools that were modified to meet our aims. We assessed community acceptance by identifying the involvement of community governance structures and representation during research development, conduct and reporting. Data were extracted using standard forms developed for this review. RESULTS We included 32 articles, which reported on 25 studies. Qualitative and mixed methods were used in 18 studies. Twelve articles were judged as high or unclear risk of bias, four as moderate and five as low risk of bias. Another four studies were not able to be assessed as they did not align with the risk-of-bias tools. Of the five articles judged as low risk of bias, two also had high community acceptance and both of these were qualitative. One used a phenomenological approach and the other combined participatory action research with a social-ecological perspective and incorporated 'two-way learning' principles. Of the 16 studies where a primary outcome was identified, eight aimed to identify perceptions or experiences. The remaining studies assessed resources, or evaluated services, interventions, programs or policies. We were unable to identify primary outcomes in eight studies. CONCLUSION Conducting Indigenous-focused primary health care research that is scientifically robust, culturally appropriate and produces community-level outcomes is challenging. We suggest that research teams use participatory, culturally sensitive approaches and collaborate closely to plan and implement high-quality research that incorporates local perspectives. Research should result in beneficial outcomes for the communities involved.
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, UNSW Sydney, Australia; School of Medicine, University of Sydney, NSW, Australia,
| | - Anne-Maree Eades
- The George Institute for Global Health, UNSW Sydney, Australia; School of Medicine, University of Sydney, NSW, Australia
| | - Jamie K Fernando
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Josephine D Gwynn
- Poche Centre for Indigenous Health, University of Sydney, NSW, Australia; Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, NSW, Australia; Central Clinical School, University of Sydney, NSW, Australia
| | - Maree L Hackett
- The George Institute for Global Health, UNSW Sydney, Australia; School of Medicine, University of Sydney, NSW, Australia; Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Whalan S, Farnbach S, Volk L, Gwynn J, Lock M, Trieu K, Brimblecombe J, Webster J. What do we know about the diets of Aboriginal and Torres Strait Islander peoples in Australia? A systematic literature review. Aust N Z J Public Health 2017; 41:579-584. [PMID: 28898509 DOI: 10.1111/1753-6405.12721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To provide an overview of published research on the dietary intake of Aboriginal and Torres Strait Islander peoples. METHODS Peer-reviewed literature from 1990 to October 2016 was searched to identify studies that measured the dietary intake of Australian Aboriginal and Torres Strait Islander populations. Study quality was assessed using a purposely devised quality appraisal tool. Meta-analysis was not possible due to the heterogeneity in dietary intake assessment methods. A narrative synthesis of study findings, where key themes were compared and contrasted was completed. RESULTS Twenty-five articles from twenty studies with outcome measures related to dietary intake were included. Dietary intake was assessed by electronic store sales, store turnover method, 24-hour dietary recall, food frequency questionnaire and short questions. Consistent findings were low reported intakes of fruit and vegetables and high intakes of total sugar and energy-dense, nutrient-poor food and beverages. CONCLUSIONS While differences between studies and study quality limit the generalisability of the findings, most studies suggest that the diets of Aboriginal and Torres Strait Islander peoples are inadequate. Implications for public health: A more concerted approach to understanding dietary patterns of Aboriginal and Torres Strait Islander peoples is required to inform policy and practice to improve diet and nutrition.
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Affiliation(s)
- Sarah Whalan
- Menzies School of Health Research, Northern Territory
| | - Sara Farnbach
- The George Institute for Global Health, New South Wales
| | - Lena Volk
- The George Institute for Global Health, New South Wales
| | - Josephine Gwynn
- Faculty of Health Sciences, University of Sydney, New South Wales
| | - Mark Lock
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Kathy Trieu
- The George Institute for Global Health, New South Wales
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Hackett ML, Farnbach S, Glozier N, Skinner T, Teixeira-Pinto A, Askew D, Gee G, Cass A, Brown A. Getting it Right: study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people. BMJ Open 2016; 6:e015009. [PMID: 27927669 PMCID: PMC5168627 DOI: 10.1136/bmjopen-2016-015009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9). METHODS AND ANALYSIS Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid. ETHICS AND DISSEMINATION Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community. TRIAL REGISTRATION NUMBER ACTRN12614000705684.
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Affiliation(s)
- Maree L Hackett
- Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
- University of Central Lancashire, Preston, Lancashire, UK
| | - Sara Farnbach
- Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nick Glozier
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Skinner
- Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Queensland Health, Brisbane, Queensland, Australia
- Discipline of General Practice, The University of Queensland, Brisbane, Queensland, Australia
| | - Graham Gee
- Victorian Aboriginal Health Service, Fitzroy, Victoria, Australia
| | - Alan Cass
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Farnbach S, Eades AM, Hackett ML. Australian Aboriginal and Torres Strait Islander-focused primary healthcare social and emotional wellbeing research: a systematic review protocol. Syst Rev 2015; 4:189. [PMID: 26719082 PMCID: PMC4697316 DOI: 10.1186/s13643-015-0180-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research with a focus on Aboriginal and Torres Strait Islander Australian's (hereafter referred to as Indigenous(1)) needs is crucial to ensure culturally appropriate evidence-based strategies are developed to improve health. However, concerns surrounding this research exist, arising from some previous research lacking community consultation, resulting in little community benefit or infringing on important cultural values. Values and Ethics: Guidelines for Ethical conduct in Aboriginal and Torres Strait Islander Health Research (hereafter referred to as Values and Ethics), developed by The National Health and Medical Research Council of Australia in 2003, is the ethical standard for Indigenous-focused health research. Researchers must address its Values in research design and conduct. However, its impact on research processes is unclear. Local Protocols should also be considered. This review aims to systematically examine practices related to Values and Ethics, Local Protocols and the processes of conducting Indigenous-focused primary healthcare research in collaboration with external researchers. METHODS The following electronic databases and grey literature will be searched (2003 to current): MEDLINE, EMBASE, CINAHL, Informit and HealthInfoNet--an Indigenous-specific research and program website. Indigenous-focused research will be included. Research must be conducted in one or more primary healthcare services, in collaboration with external researchers and with a focus on social and emotional well being. One reviewer will review titles and abstracts to remove obviously irrelevant research articles. Full-text research articles will be retrieved and independently examined by two reviewers. Data and quality assessment will be completed by one reviewer and verified by a second reviewer. Quality will be assessed using modified versions of established quality assessment tools. DISCUSSION This review will provide information on research processes and the impact of Values and Ethics on Indigenous-focused primary healthcare research, informing communities and primary healthcare staff around research practices, and researchers and policy makers of strengths and weaknesses of practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015024994.
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Affiliation(s)
- Sara Farnbach
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, New South Wales, Australia. .,The University of Sydney, Sydney, New South Wales, Australia.
| | - Anne-Marie Eades
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, New South Wales, Australia. .,The University of Sydney, Sydney, New South Wales, Australia.
| | - Maree Lisa Hackett
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, New South Wales, Australia. .,The University of Sydney, Sydney, New South Wales, Australia.
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