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A protocol for a scoping review to identify cross-sector collaboration and adaptation of processes and products to promote innovation which may apply to aged care

Protocol for a Scoping Review

This is a protocol for a scoping review to identify factors (barriers and enablers) that influence implementation of evidence-based practice and innovations in aged care.

Search strategy. (DOCX 13 kb)

Included studies. (DOCX 16 kb)

Additional file 5.

Additional file 1.

Additional file 5.

Additional file 4.

Additional file 2.

Additional file 4.

Additional file 3.

Additional file 3.

Included studies. (DOCX 16 kb)

Risk of bias in randomised controlled trials. (DOCX 15 kb)

Retrospective Studies. (DOCX 15 kb)

File contains summary of papers included in the framework synthesis. (PDF 197 kb)

File contains summary of papers included in the framework synthesis. (PDF 197 kb)

Search strategy. (DOCX 13 kb)

Appraisal for qualitative research. (DOCX 43 kb)

Risk of bias in randomised controlled trials. (DOCX 15 kb)

Appraisal for qualitative research. (DOCX 43 kb)

Medline Search Strategy. (DOCX 13 kb)

Non-Randomised Control Trials. (DOCX 14 kb)

Description of Chronic Care Models. (DOCX 19 kb)

Search strategy. (DOCX 13 kb)

Included studies. (DOCX 16 kb)

Quality appraisal of Case studies and Case series. (DOCX 44 kb)

Quality appraisal of Case studies and Case series. (DOCX 44 kb)

Description of Chronic Care Models. (DOCX 19 kb)

Non-Randomised Control Trials. (DOCX 14 kb)

Medline Search Strategy. (DOCX 13 kb)

A Masterclass Program was developed to strengthen the research capacity of staff within Aboriginal Community-Controlled Health Organisations (ACCHOs) and featured three Masterclasses delivered across Australia,including Understanding Research, Undertaking Research and Research Evaluation. A mixed-method process and impact evaluation of the Masterclass Program was undertaken. The process evaluation examined the reach of the Program and the impact evaluation comprised an online survey (n = 45) and semi-structured interviews (n = 21) with Masterclass participants. During 2014–17, 27 Masterclasses were delivered to 260 people, including predominantly ACCHO personnel but also Indigenous doctors and research institute staff who work closely with the ACCHO sector. Most survey respondents felt the Masterclasses improved their understanding of research and their willingness to participate in and undertake research. The qualitative analysis confirmed this and suggested that Masterclasses were implemented in a supportive learning environment which led to increased research capacity (increased research awareness, changed perceptions,increased understanding, critical thinking and new confidence) and ultimately enhanced research engagement (willingness to participate, motivating others, empowered critique of research partners and proposals, interest in further research training). Barriers to research engagement and areas for improvement of the Masterclass Program before, during and after Masterclasses were also identified. Refereed/Peer-reviewed

Background Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. Method This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Results Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified – accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. Conclusion While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.

Review objective The objective of this review is to: 1.Identify tools used to measure quality of life and well-being in Aboriginal and Torres Strait Islander Australian peoples. 2.Identify and synthesize Aboriginal and Torres Strait Islander peoples’ perceptions of quality of life and well-being. Inclusion criteria As the first objective of this review is to simply identify and report on those tools that have been used to date to measure quality of life and well-being in Aboriginal and Torres Strait Islander Australian peoples rather than synthesise the results of the studies that have used the tools, a detailed PICo has not been presented to directly correspond to this objective. All studies that report on quality of life or well-being in Aboriginal and Torres Strait Islander Australian peoples will be retrieved to identify which tool has been employed. The following PICo elements will be used to address objective two of this review. Types of participants This review will consider studies that include Aboriginal and Torres Strait Islander peoples. Phenomena of interest The phenomena of interest for objective two is how Australian Aboriginal and Torres Strait Islander peoples perceive quality of life and well-being. Context The review will consider studies conducted in Australia.

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: • What attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of Indigenous communities support (facilitators) or inhibit (barriers) the implementation of interventions aimed at improving chronic disease care for Indigenous people within the primary health care setting? • 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 chronic disease care for Indigenous people within the primary health care setting? • 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 chronic disease care for Indigenous people within the primary health care setting? Inclusion criteria Types of participants This review will consider studies that have included Indigenous people of any age receiving treatment for chronic disease (cardiovascular disease, chronic kidney disease, chronic respiratory disease, diabetes, depression, HIV/AIDS) in the primary health care setting. Participants of interest in this review include Indigenous people with chronic illness, their family or members of the community, as well as all primary health care providers (e.g. doctors, nurses, administrators, health care workers) and other policy and decision makers in indigenous health. Phenomena of interest The phenomena of interest are the attitudes, beliefs, expectations, understandings and knowledge about chronic disease health care that support or inhibit the implementation of interventions aimed at managing chronic disease. Context The context of the review is the provision of health care in the primary health care/community/outpatient setting.

Making information available does not necessarily result in subsequent transfer and utilisation. This paper considers the role of various parties to the information transfer process, proposing that the recipient is the key determinant of its success. All other influences such as source, task, organisational and environmental characteristics are considered to be influential on the recipient rather than the process itself. This subtle yet important distinction in some ways simplifies the process by suggesting that the needs of the recipient must inform all information transfer decisions.

Aim The aim of this research was to understand how health workers in developing countries reach diagnostic and treatment decisions. In developing countries, health workers are often forced to make diagnostic and treatment decisions based on limited knowledge, unhelpful information, infrequent and low technology back-up services and without the support of more senior staff. Yet patients continue to be treated. This paper investigates how primary healthcare workers in such contexts reach these diagnostic and treatment decisions. Method Using a qualitative methodology, 58 primary healthcare workers from the three primary healthcare facilities in Papua New Guinea – aid posts, sub-health centres and health centres – participated in an in-depth interview, in order to investigate how diagnostic and treatment decisions were made. Results Although participants were originally trained in the biomedical model, they lived and worked in a context where other belief systems operated to diagnose and treat illness. This led to the coexistence of at least three models of treatment: the biomedical model, traditional indigenous health practices and Christian beliefs. Thus, a homogenous biomedical understanding of health and well-being was not possible in this setting, and treatment options did not always follow the biomedical recommendations. Conclusions In developing countries where competing medical frame works exist, evidence-based practices may be more difficult to implement. Although the skill and knowledge of the provider and availability of treatment resources are still important, belief in the accuracy of the diagnosis and the potency of the treatment by the patient and the patient's community as well as the health provider may be just as significant.

Research into the use of information by health care professionals has generally been conducted in countries dominated by the biomedical model. In these contexts, illness is considered to have a scientifically identifiable physical cause, and treatment practices within the formal health care sector are prescribed and managed in accordance with this definition. Yet there are also contexts where other belief systems inform and guide the way that people think about their health. In comparison to the biomedical model, these contexts have contributed very little to our understanding of how health professionals develop their knowledge. This research investigates how primary health care workers (PHCWs) in one such context, Papua New Guinea (PNG), develop their knowledge about the health services they provide.In order to discover and understand the differing views of these PHCWs, 69 semi-structured interviews were conducted in three culturally and geographically diverse regions of PNG. In explaining the diagnostic and treatment practices they use, these participants provided insights into not only how PHCWs engage with information but also how it informs their professional practice. These data were analysed, interpreted and discussed using a framework consisting of four, primary but interconnecting aspects: the context in which information was provided, the interactions with the sources of information, the processes by which information was understood, and the outcomes realized as a result of the information being used.Findings indicated that the majority of participants in this study acknowledged, if not incorporated, information pertaining to biomedicine, Christianity and Indigenous belief systems into their diagnostic and treatment practices. Even when these belief systems clearly contradicted each other, PHCWs did not in general feel the need to make a conscious choice between them. From their comments it would appear that four factors contributed to this ability to incorporate diverse and often conflicting ideas into the way that patients were cared for. First, all of the belief systems were considered legitimate by at least one group of people connected to the community in which the PHCW worked. Second, although varying in degrees of availability and accessibility, members of these groups were able to disseminate information pertaining to the belief system they supported. Third, the PHCW had no particular affiliation with any one of these groups but instead regularly interacted with a range of different people. Lastly, the PHCW worked in situations where health practices were not generally well supervised by their employers and therefore they were relatively free to choose between various diagnostic and treatment practices.The qualitative interpretive approach adopted in this thesis contributes to the field of human information behavior by affirming that conflict is in the eye of the beholder. When a number of belief systems coexist and all are considered legitimate, information about them is freely available, and the recipients actions are neither constrained by their own dogma, nor imposed upon by others, individuals may quite comfortably embrace diverse beliefs. These findings may also contribute to a better understanding of health management practices in developing countries by suggesting that health professionals are not merely personifications of a biomedical model. Instead, the study demonstrates that multiple belief systems can be combined by PHCWs, and that in turn this benefits the formal health care sector through increased treatment options that are both appropriate and effective in such circumstances. PhD Doctorate