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Mccalman, JR orcid:0000-0002-3022-3980 ; 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.

 Aboriginal and Torres Strait Islander people strongly assert that health research has contributed little to improving their health, in spite of its obvious potential.  The health concerns of Aboriginal and Torres Strait Islander people were largely ignored in early research published in the MJA, which ref ected broader colonial history and racial discourses. This began to change with the demise of scientific racism, and changed policies and political campaigns for equal treatment of Indigenous people after the Second World War.  In response to pressure from Aboriginal and Torres Strait Islander people and organisations, in parallel to broader political struggles for Indigenous rights since the 1970s, there have been signif cant and measurable changes to Aboriginal and Torres Strait Islander health research. Many of these changes have been about the ethics of health research.  Increasingly, Aboriginal and Torres Strait Islander researchers, communities and organisations are now controlling and decolonising health research to better meet their needs, in collaboration with non-Indigenous researchers and research organisations. ; Associated Grant:Australian Research Council Discovery Indigenous Award.

Kinchin, I orcid:0000-0003-0133-2763; Mccalman, JR orcid:0000-0002-3022-3980 ; 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. ; Associated Grant:this review was supported in part by National Health and Medical Research Council Early Career Fellowship ; Associated Grant Code:APP1113392

Mccalman, JR orcid:0000-0002-3022-3980 ; Strengthening the two-way organisational capacity of both Indigenous and government organisations is critical to raising the health, wellbeing and prosperity of Indigenous Australian communities. A review of the Indigenous Australian literature across seven databases using multiple search terms suggested that improving governance processes is likely to require incremental strengthening of Indigenous and government organisational values, goals, structuresand arrangements that influence employees' and clients' behaviour and wellbeing. Involvement of Indigenous people in leading decision-making about their own development was critical. The literature cited effective approaches as tailored to specific situations, utilising existing community capacity and based on Indigenous community ownership of governance-improvement. Similarly, there is evidence for collaborative approaches between Indigenous people and governments that strengthen existing capacity through long-term partnering. What is important is that capacity strengthening programs have clarity of purpose; being explicit about their intent to strengthen capacity for what and for whom, and how we know their effects? In contrast, the literature cites detrimental approaches for governance including programs that do not reflect community priorities, attempts to improve Indigenous governance structures, such as through amalgamation, without attending to governance processes, fragmented, rapidly changing, ad hoc and poorly coordinated government processes, and multiple accountability requirements (red tape).

Mccalman, JR orcid:0000-0002-3022-3980 ; 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 theorized the implementation of Aboriginal health programs but have not focused 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. Materials and methods: A historical account of the spread of the FWB Program was constructed using situational analysis, a theory-methods package derived from a poststructural interpretation of grounded theory methods. Data were collected from published empirical articles, evaluation reports and project articles, and interviews with 18 key actors in the spread of FWB. Social worlds and arenas maps were used to determine the organizations and their representative agents who were involved in FWB spread and to analyze 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 that can work with partner organizations to tailor the program to local end-user needs. Associated research is also needed to evaluate, continually improve program quality, and build program credibility through evidence. © 2018 McCalman, Bainbridge, Brown, Tsey and Clarke. ; Associated Grant:The study was funded by a Postgraduate Research Scholarship from James Cook University. It is an in kind contribution to the Lowitja Institute project Sustainable implementation of Indigenous early childhood family support programs that work: a Family Wellbeing case-study; Project 1391.

© 2017 The Author(s).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 methodological gaps in documenting Indigenous health research impact that can be addressed by researchers and policy makers. Second, the findings provide the justification for developing a framework allowing researchers and funding bodies to structure future Indigenous health research to improve the reporting and assessment of impact over time. ; Associated Grant:Australian Research Council (ARC) Discovery Indigenous Grant ; Associated Grant Code:(ID: IN150100011)

Mccalman, JR orcid:0000-0002-3022-3980 ; Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. ; Associated Grant:National Health and Medical Research Council Early Career Fellowship: Developing a Service Integration Toolkit to improve the quality of adolescent mental health promotion services in Cape York: a program of mixed methods research; An Innovation Platform for Systems-Wide Improvement in Indigenous Primary Health Care ; Associated Grant Code:APP1113392; APP 1078927

Judd, JA orcid:0000-0001-8441-5008; Mccalman, JR orcid:0000-0002-3022-3980 ; Background: Health promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. The development and implementation of step-by-step guides, instruments, packages, frameworks or resources has provided a feasible and low-resource strategy for strengthening evidence-informed health promotion practice. Yet there has been little assessment of where and how these tools are implemented or their effectiveness. This paper reviews the characteristics, implementation and effects of Indigenous health promotion tools. Methods. Indigenous health promotion tools were identified through a systematic literature search including a prior scoping study, eight databases, references of other reviews and the authors' knowledge (n = 1494). Documents in the peer reviewed and grey literature were included if they described or evaluated tools designed, recommended or used for strengthening Indigenous Australian health promotion. Eligible publications were entered into an Excel spreadsheet and documented tools classified according to their characteristics, implementation and effects. Quality was appraised using the Dictionary for Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Program (CASP) tools for quantitative and qualitative studies respectively. Results: The review found that Indigenous health promotion tools were widely available. Of 74 publications that met inclusion criteria, sixty (81%) documented tools developed specifically for the Indigenous Australian population. All tools had been developed in reference to evidence; but only 22/74 (30%) publications specified intended or actual implementation, and only 11/74 (15%) publications evaluated impacts of the implemented tools. Impacts included health, environmental, community, organisational and health care improvements. The quality of impact evaluations was strong for only five (7%) studies. Conclusions: The small number and generally moderate quality of implementation and evaluation studies means that little is known about how tools work to strengthen Indigenous health promotion practice. The findings suggest that rather than continuing to invest in tool development, practitioners, policy makers and researchers could evaluate the implementation and effects of existing tools and publish the results. There is a need for long-term investment in research to review the current use of health promotion tools and the factors that are likely to enhance their implementation. © 2014 McCalman et al.; licensee BioMed Central Ltd. ; Associated Grant:Cooperative Research Centre for Aboriginal and Torres Strait Islander Health (CRCATSIH). The Cooperative Research Centres program is an Australian Government Initiative