In the vast and often harsh landscapes of remote Australia, Aboriginal communities face unique health challenges, many woven into a complex tapestry that blends cultural, social, and environmental factors. Among these issues, sexual health remains a significant concern, made even more pressing by the susceptibility to sexually transmissible infections (STIs). In response to this urgent health need, Continuous Quality Improvement (CQI) programs have been deployed across various clinics to enhance sexual health services for Aboriginal communities. But how sustainable are these CQI endeavors? A recent qualitative research study, published in BMJ Open and authored by Praveena Gunaratnam and colleagues, shows a fascinating mix of barriers and facilitators influencing the durability of such programs.
DOI: 10.1136/bmjopen-2018-026679
According to the study, conducted through semi-structured in-depth interviews with seven of the eleven regional sexual health coordinators responsible for supporting the Northern Territory Government Remote Sexual Health Program, sustaining a sexual health CQI programme is contingent upon several elements. At the clinic level, efforts to tailor CQI tools for specific contexts and risks, local ownership of CQI processes, and management support emerged as important facilitators. At a regional level, the positive framing of CQI as an improvement tool, and regional facilitation of clinic-level CQI activities, were also highlighted. However, amidst the favorable factors, daunting barriers stand. The workload tied to acute and chronic care in Aboriginal primary care services, the high staff turnover, and the scarcity of Aboriginal staff pose significant challenges to CQI implementation.
The findings suggest that CQI’s future sustainability in these settings will hinge on reducing the number of competing CQI programmes, enhancing the role and support rendered by regional sexual health coordinators, and improving access to and the usage of high-quality information systems. The authors further propose that addressing these factors is crucial to making enduring improvements in sexual health outcomes within remote Australian Aboriginal communities.
References
1. Gunaratnam, P., Schierhout, G., Brands, J., et al. (2019). Qualitative perspectives on the sustainability of sexual health continuous quality improvement in clinics serving remote Aboriginal communities in Australia. BMJ Open, 9(5), e026679. doi:10.1136/bmjopen-2018-026679
2. Silver, B.J., Guy, R.J., Wand, H., et al. (2015). Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities. Sex Transm Infect, 91, 135–141. doi:10.1136/sextrans-2014-051617
3. Hengel, B., Wand, H., Ward, J., et al. (2017). Patient, staffing and health centre factors associated with annual testing for sexually transmissible infections in remote primary health centres. Sex Health, 14, 274–281. doi:10.1071/SH16123
4. Bailie, R.S., Si, D., O’Donoghue, L., et al. (2007). Indigenous health: effective and sustainable health services through continuous quality improvement. Med J Aust, 186, 525–527.
5. Lau, R., Stevenson, F., Ong, B.N., et al. (2016). Achieving change in primary care–causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci, 11, 40. doi:10.1186/s13012-016-0396-4
Keywords
1. Sexual Health Continuous Quality Improvement
2. Aboriginal Community Health Services
3. Remote Sexual Health Programs
4. Indigenous Health Barriers and Facilitators
5. Sustainable Health Initiatives Remote Communities
The research presented sheds a critical light on the factors that influence the success and sustainability of CQI programs targeting sexual health in remote Aboriginal communities in Australia, underlining the need for a strategic and context-sensitive approach. Recognizing and responding to the intrinsic complexities, from local clinic adaptation and ownership to broader regional support and streamlined CQI efforts, are vital in driving meaningful and lasting improvements in sexual health services. With a diligent focus on these recommendations, health practitioners, policy makers, and program coordinators can optimize their contributions toward the health and well-being of some of the most remote populations in Australia.