Health Promotion International Advance Access published online on November 3, 2009
Health Promotion International, doi:10.1093/heapro/dap039
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Perspectives |
Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: identifying the gaps
1National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW, Sydney, Australia, 2Muru Marri Indigenous Health Unit, Faculty of Medicine, UNSW, Sydney, Australia, 3School of Public Health and Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia, 4Graduate School of Medicine, UOW, Wollongong, Australia and 5Illawarra Aboriginal Medical Service, Wollongong, Australia
* Corresponding author. E-mail: a.clifford{at}unsw.edu.au
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Abstract |
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Indigenous Australians experience a disproportionately greater burden of harm from smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) than the general Australian population. A critical step in further improving efforts to reduce this harm is to review existing efforts aimed at increasing the uptake of evidence-based interventions in Indigenous-specific health-care settings and programs. This study systematically identifies and reviews published Indigenous-specific dissemination studies targeting SNAP interventions. An electronic search of eight databases and a manual search of reference lists of previous literature reviews were undertaken. Eleven dissemination studies were identified for review: six for nutrition and physical activity as a component of diabetes care, three for alcohol and two for smoking. The majority of studies employed continuing medical education (n = 9 studies), suggesting that improving health-care providers’ knowledge and skills is a focus of current efforts to disseminate best-evidence SNAP interventions in Indigenous health-care settings. Only two studies evaluated reminder systems, despite their widespread use in Indigenous-specific health-care services, and only one study employed academic detailing, despite its cost-effectiveness at modifying health-care provider behavior. There is a clear need for more Indigenous-specific dissemination research targeting the uptake of secondary prevention and to establish reliable and valid measures of Indigenous-specific health-care delivery, in order to determine which dissemination strategies are most likely to be effective in Indigenous health-care settings and programs.
Key words: Aboriginal health; dissemination; intervention; risk factors