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Background: The concepts and standard practices of implementation, largely originating in developed countries, cannot necessarily be simply transferred into diverse cultural contexts. There has been relative inattention in the implementation science literature paid to the implementation of interventions targeting minority Indigenous populations within developed countries. This suggests that the implementation literature may be bypassing population groups within developed countries who suffer some of the greatest disadvantage. Within the context of Aboriginal Australian health improvement, this study considers the impact of political and cultural issues by examining the transfer and implementation of the Family Wellbeing program across 56 places over a 20-year period. Methods: A theoretical model of program transfer was developed using constructivist-grounded theory methods. Data were generated by conducting in-depth interviews with 18 Aboriginal and non-Aboriginal research respondents who had been active in transferring the program. Data were categorised into higher order abstract concepts and the core impetus for and process of program transfer were identified. Results: Organizations transferred the program by using it as a vehicle for supporting inside-out empowerment. The impetus to support inside-out empowerment referred to support for Aboriginal people's participation, responsibility for and control of their own affairs, and the associated ripple effects to family members, organizations, communities, and ultimately reconciliation with Australian society at large. Program transfer occurred through a multi-levelled process of embracing relatedness which included relatedness with self, others, and structural conditions; all three were necessary at both individual and organizational levels. Conclusions: Similar to international implementation models, the model of supporting inside-out empowerment by embracing relatedness involved individuals, organizations, and interpersonal and inter-organizational networks. ...

In this paper, capacity strengthening will be pragmatically explored in response to two key questions: what enabling approaches are accessible for Aboriginal and Torres Strait Islander Australian (hereafter Indigenous) organisations to effectively make governance decisions; and what approaches can facilitate partnership processes between communities and governments for improving Indigenous Australian organisational governance. In particular, it will consider 1) the need to strengthen both hard capacities such as resources, technical skills, functions, structures, equipment and so forth; and soft capacities such as values, morale, engagement, motivation, incentives and staff wellbeing; and 2) one strategy that has successfully been used to facilitate partnership between Indigenous organisations and governments - reflective participatory approaches. It will draw from reflective short case study examples in which the authors have participated to demonstrate how, where and when capacity strengthening principles have been adopted. Given the paucity of well-designed evaluations, key principles and practices that appear to work to strengthen capacity will be discussed. Key amongst these are community ownership of governance improvement, collaborative development approaches that are context-dependent and long-term partnerships between government agencies and Indigenous communities built on trust and respect. Capacity-strengthening must have a clear notion of what type of capacity is being strengthened, for whom, and how the effectiveness will be measured.

"Foreword" -- "Preface" -- "Contents" -- "Chapter 1: Introduction" -- "1.1 Cultural Competence Defined" -- "1.2 Cultural Competence-Related Terms" -- "1.3 The Historical Development of Cultural Competence" -- "1.4 What Does Cultural Competence Encompass" -- "1.5 A Multilevel Framework for Cultural Competence in Healthcare" -- "1.6 The Purpose of This Book" -- "1.7 The Objectives of This Book" -- "1.8 Structure of the Book" -- "1.8.1 Chapter 2: The Drivers of Cultural Competence" -- "1.8.2 Chapter 3: Methods" -- "1.8.3 Cultural Competence: A Multilevel, Systematic Scoping Review" -- "1.8.4 Chapter 4: Health Workforce Development Interventions to Improve Cultural Competence" -- "1.8.5 Chapter 5: Cultural Competence Education and Training Interventions for Health and Medical Students" -- "1.8.6 Chapter 6: Programs and Services to Improve Cultural Competence in Healthcare" -- "1.8.7 Chapter 7: Health Organisation and System Cultural Competence Interventions" -- "1.8.8 Chapter 8: Cultural Competence Strengths, Weaknesses and Future Directions" -- "1.8.9 Chapter 9: Multilevel Cultural Competence Intervention Implementation and Evaluation Framework" -- "References" -- "Chapter 2: The Drivers of Cultural Competence" -- "2.1 Introduction: The Conceptual Underpinnings of Cultural Competence" -- "2.1.1 Pathway 1: Cultural or Sociocultural Differences" -- "2.1.2 Pathway 2: Healthcare Disparities" -- "2.2 Pathway 1: Culture and Sociocultural Differences" -- "2.2.1 What Is Culture?" -- "2.2.2 Sociocultural Differences and Healthcare Appropriateness" -- "2.2.3 Conflating Culture with Ethnicity and Race" -- "2.2.4 Worldviews, Language and Healthcare Appropriateness" -- "2.2.5 Increasing Population Diversity" -- "2.3 Pathway 2: Disparities in Healthcare Treatment and Quality" -- "2.3.1 The Role of Bias in Healthcare Disparities

Background: The aim of health service integration is to provide a sustainable and integrated health system that better meets the needs of the end user. Yet, definitions of health service integration, methods for integrating health services, and expected outcomes are varied. This review was commissioned by Queensland Health, the government department responsible for health service delivery in Queensland, Australia, to inform efforts to integrate their mental health services. This review reports on the characteristics, reported outcomes, and design quality of studies included in systematic reviews of health service integration research. Method: The review was developed by systematically searching nine electronic data-bases to find peer-reviewed Australian and international systematic reviews with a focus on health service integration. Reviews were included if they were in the English language and published between 2000 and 2015. A standardized assessment tool was used to analyze the study design quality of included reviews. Data relating to the integration types, methods, and reported outcomes of integration were synthesized. Results: Seventeen publications met the inclusion criteria. Eleven (65%) reviews were published during the past 5 years, which may indicate a trend for increased awareness of the need for service integration. The majority of reviews were published by researchers in the UK (8/47%), USA (3/18%), and Australia (3/18%). Included reviews focused on a variety of integration types, including integrated care pathways, governance models, integration of interventions, collaborative/integrated care models, and integration of different types of health care. Most (53%) of the reviews reported on the cost-effectiveness of service integration, e.g., positive results, no effect, or inconclusive. Only one of the reviews reported on the importance of consumer involvement. The overall design of 70% of the reviews was high, 18% medium, and 12% low. Conclusion: There is no "one size fits all" approach to health ...

This resource sheet reviews the evidence on improving Indigenous community governance through strengthening Indigenous and government organisational capacity. It outlines what works, what doesn't, and what further research is needed on capacity-strengthening programs.

"Those of us who have worked on the frontline of Aboriginal health for any length of time know that beneath the surface reality of Aboriginal people's poor health outcomes sits a deeper truth. It is about the importance of social and emotional wellbeing, and how this flows from a sense of control over one's own life. Where this is lacking, as it is in so many Aboriginal families and communities, there is instead indifference and despair and a descent into poor lifestyle choices and self-destructive behaviours. Our medical professionals do a great job of prescribing medicines and devising treatment programs but, to fix the root causes of ill-health, we need something more. As Aboriginal people we need to have a sense of agency in our lives, that we are not stray leaves blowing about in the wind. In a word, we need empowerment". Dr. Pat Anderson, Chairperson, the Lowitja Institute, Australia's National Institute for Aboriginal and Torres Strait Islander Health Research.

Introduction: In recent years, Australian government policies have promoted access to secondary education through boarding schools for Aboriginal and Torres Strait Islander (hereafter respectfully termed Indigenous) students from remote communities. These students experience the poorest health of any Australian adolescent group. This exploratory study examines how boarding schools across Queensland promote and manage healthcare and wellbeing support for Indigenous students. Methods: Qualitative grounded theory methods were used to sample and collect data from the healthcare and wellbeing support staff of eight Queensland boarding schools using semi-structured interviews. Data were coded using NVIVO software and compared to identify the context, conditions, core process, strategies and outcomes of boarding schools' healthcare and wellbeing support. Preliminary findings were fed back to school staff and students' family members for discussion and response at an annual Schools and Communities meeting. Results: Boarding school health staff support Indigenous student-centred healthcare and wellbeing by weaving a relational network with students, families, school staff and external healthcare providers. Either through on-site or school-linked centres, they provide students with access to healthcare services, support wellbeing, and offer health education. Through these strategies, they enable students' participation in education and learning, receive quality healthcare improvement, "move to a better head space", and become responsible for their own healthcare. Enabling conditions are the professional and cultural capabilities of school staff, school leadership and commitment, compatibility of intersectoral systems and resourcing of healthcare and wellbeing support. Conclusions: Boarding schools are doing considerable work to improve the promotion and management of healthcare and wellbeing support for Indigenous students, but there is considerable variation across schools, impacts are not formally monitored or reported, ...

Introduction: Spreading proven or promising Aboriginal health programs and implementing them in new settings can make cost-effective contributions to a range of Aboriginal Australian development, health and wellbeing, and educational outcomes. Studies have theorised the implementation of Aboriginal health programs but have not focussed explicitly on the conditions that influenced their spread. This study examined the broader political, institutional, social and economic conditions that influenced negotiations to transfer, implement, adapt and sustain one Aboriginal empowerment program - the Family Wellbeing (FWB) program - to at least 60 geographical sites across Australia over 24 years. Material and Methods: A historical account of the spread of the FWB Program was constructed using situational analysis, a theory-methods package derived from a post-structural interpretation of grounded theory methods. Data were collected from published empirical papers, evaluation reports and project papers, and interviews with 18 key actors in the spread of FWB. Social worlds and arenas maps were used to determine the organisations and their representative agents who were involved in FWB spread, and to analyse the enabling and constraining conditions. Results: The program was transferred through three interwoven social arenas: employment and community development; training and capacity development; and social and emotional wellbeing promotion and empowerment research. Program spread was fostered by three primary conditions: government policies and the availability and Aboriginal control of funding and support; Aboriginal leadership, associated informal networks and capability; and research evidence that built credibility for the program. Discussion and conclusion: The continued demand-driven transfer of empowerment programs requires policies that enable Aboriginal control of funding and Aboriginal leadership and networks. Flexible and sustained coordination of program delivery is best leveraged through regional innovation hubs ...

Background: Aboriginal and Torres Strait Islander Australians (hereafter respectfully Indigenous Australians) claim that they have been over-researched without corresponding research benefit. This claim raises two questions. The first, which has been covered to some extent in the literature, is about what type(s) of research are likely to achieve benefits for Indigenous people. The second is how researchers report the impact of their research for Indigenous people. This systematic review of Indigenous health reviews addresses the second enquiry. Methods: Fourteen electronic databases were systematically searched for Indigenous health reviews which met eligibility criteria. Two reviewers assessed their characteristics and methodological rigour using an a priori protocol. Three research hypotheses were stated and tested: (1) reviews address Indigenous health priority needs; (2) reviews adopt best practice guidelines on research conduct and reporting in respect to methodological transparency and rigour, as well as acceptability and appropriateness of research implementation to Indigenous people; and (3) reviews explicitly report the incremental impacts of the included studies and translation of research. We argue that if review authors explicitly address each of these three hypotheses, then the impact of research for Indigenous peoples' health would be explicated. Results: Seventy-six reviews were included; comprising 55 journal articles and 21 Australian Government commissioned evidence review reports. While reviews are gaining prominence and recognition in Indigenous health research and increasing in number, breadth and complexity, there is little reporting of the impact of health research for Indigenous people. This finding raises questions about the relevance of these reviews for Indigenous people, their impact on policy and practice and how reviews have been commissioned, reported and evaluated. Conclusions: The findings of our study serve two main purposes. First, we have identified knowledge and ...

BACKGROUND: Pandemics such as COVID-19 are a serious public health risk for Australian Aboriginal and Torres Strait Islander communities, yet primary healthcare systems are not well resourced to respond to such urgent events. At the start of the COVID-19 pandemic, a federal government advisory group recommended a rapid, tailored Indigenous response to prevent predicted high morbidity and mortality rates. This paper examines the efforts of one ACCHO, which in the absence of dedicated funding, pivoted its operations in response to COVID-19. Gurriny Yealamucka Health Service (Gurriny) is the only primary healthcare service in the discrete Indigenous community of Yarrabah, Far North Queensland. METHODS: The research was conducted at the request of the Chief Executive Officer of Gurriny. Using grounded theory methods, thirteen Gurriny staff and five Yarrabah and government leaders and community members were interviewed, transcripts of these interviews and 59 documents were imported into NVIVO-12 and coded, and key concepts were compared, organised into higher order constructs, then structured into a theoretical framework. RESULTS: Gurriny responded to COVID-19 by leading with local solutions to keep Yarrabah safe. Four key strategies were implemented: managing the health service operations, realigning services, educating and supporting community, and working across agencies. These strategies were enabled or hindered by five conditions: the governance and leadership capacity of Gurriny, relying on the health taskforce, locking the door, "copping it", and (not) having resources. A year after the first case was experienced in Australia and on the eve of vaccine rollout to Indigenous communities, there have been no COVID-19 cases in Yarrabah. DISCUSSION: The success of the locally led, holistic, comprehensive and culturally safe response of Gurriny suggests that such tailored place-based approaches to pandemics (and other health issues) are appropriate, but require dedicated resourcing. Key challenges were the fragmented ...

BACKGROUND: Aboriginal Community Controlled Health Services (ACCHSs) play a critical role in providing culturally appropriate, accessible primary healthcare (PHC) for Aboriginal and Torres Strait Islander peoples in Australia. The success of many ACCHSs has led to increased policy support for their growth and development, including the transition of state government administered PHC services to Aboriginal community control in select communities. However, there is minimal published literature available which evaluates such transitions. This paper reports on an evaluation of one ACCHS (Gurriny Yealamucka Health Service)'s experience of transitioning local PHC services to community control in Yarrabah, Queensland, with a focus on the processes and strategies which were implemented to achieve successful transition. METHODS: Data was collected from interviews with key personnel involved in the transition and organisational documents from the evaluation period. Face-to-face or telephone interviews were conducted with 14 key stakeholders, audio-recorded and transcribed with written consent. Historical organisational documents were provided by Gurriny. All interview transcripts and documents were imported into NVIVO, coded and analysed using grounded theory methods. RESULTS: Gurriny's journey of achieving community control of PHC in Yarrabah entailed an almost 30 year process of building and demonstrating organisational capacity. The first stage (1986 to 2004) was focused on establishing and developing a community-controlled health service and the second stage (2005–14) on preparing for the transition. Formal handover occurred in June 2014. Stage one strategies included: addressing community social and emotional wellbeing; consulting the community; collaborating with researchers; and, strategically building services, organisation capacity and stakeholder trust. Stage two strategies were: communicating and engaging with stakeholders; ensuring strong governance; planning and developing the services and workforce; assuring ...

Introduction: Consistent with the aspirations of First Nations Australians for community control of healthcare services, 123/196 (63%) of Australia's First Nations-specific primary health care services are community-controlled. Yet despite policy commitment over 30 years, the transition of government-run First Nations' primary healthcare services to First Nations community control has been slow. This paper identifies the barriers and enablers to transitioning the delivery of primary healthcare services from Queensland Health to Gurriny Yealamucka community-controlled health service in Yarrabah. Methods: Grounded theory methods were used to select 14 Gurriny and Queensland Health (QH) personnel involved in the transition for interview and to analyse these interview transcripts and 88 Gurriny organisational documents. Results: Barriers and enablers to transition were identified at three levels: those internal factors within Gurriny, external factors directly related to the government handover, and broader structural and policy factors outside the control of either Gurriny or QH. Barriers at the Gurriny organisational level were an internal lack of experience and capacity, and varying levels of community confidence; enablers were leadership stability and capacity, community mandate, relationships with partner organisations, and ability to provide service continuity. Barriers in Gurriny's relationship with QH were a lack of certainty, transparency and prioritisation of the transition process; systemic racism; difficulties obtaining and maintaining the necessary workforce; limited resources including insufficient, unstable and inappropriate funding support; and problems with information sharing; enablers were performance frameworks to keep transition progress on track. Barriers in broad policy environment were an unsupportive Queensland government policy environment; government bureaucracy; and delays, conflicts and divisions; enablers were high-level government support and commitment. Conclusions: The evaluation of ...