Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners

Odette Pearson; Shwikar Othman; Kate Colmer; Sana Ishaque; Gloria Mejia; Sarah Crossing; David Jesudason; Gary Wittert; Paul Zimmet; Sophia Zoungas; Natalie Wischer; Kim Morey; Jane Giles; Sara Jones; Alex Brown; Saravana Kumar

doi:10.1071/PY23124

REVIEW (Open Access)

Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners

Odette Pearson ^A ^B ^* , Shwikar Othman ^A ^B , Kate Colmer ^C , Sana Ishaque ^C , Gloria Mejia ^D , Sarah Crossing ^A , David Jesudason ^B ^E , Gary Wittert ^B ^F , Paul Zimmet ^G , Sophia Zoungas ^H , Natalie Wischer ^I , Kim Morey ^A ^B , Jane Giles ^C , Sara Jones ^J , Alex Brown ^K ^L and Saravana Kumar ^J

+ Author Affiliations

- Author Affiliations

^A Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia.

^B University of Adelaide, Adelaide, SA 5000, Australia.

^C Flinders University, Adelaide, SA 5042, Australia.

^D Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, SA 5000, Australia.

^E Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.

^F Freemasons Centre for Male Health and Well Being, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia.

^G Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic. 3004, Australia.

^H School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.

^I National Association of Diabetes Centres, Sydney, NSW 2000, Australia.

^J School of Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia.

^K Telethon Kids Institute, Ground Floor, 108 North Terrace, Adelaide, SA 5000, Australia.

^L Australian National University, Canberra, ACT 2601, Australia.

^* Correspondence to: Odette.Pearson@sahmri.com

Australian Journal of Primary Health 30, PY23124 https://doi.org/10.1071/PY23124

Submitted: 3 July 2023 Accepted: 3 April 2024 Published: 3 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation.

Methods

Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria.

Results

Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants’ knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes.

Conclusions

Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.

Keywords: Aboriginal health workers, chronic disease management, chronic diseases, community health workers, indigenous health workers, primary health care setting, scoping review, training programs, workforce.

References

Aboriginal and Torres Strait Islander Health Practice Board (2020) Professional capabilities for registered Aboriginal and Torres Strait Islander Health Practitioners. Available at https://www.atsihealthpracticeboard.gov.au/Codes-Guidelines/Professional-capabilities.aspx

AIHW (2016) Australian burden of disease study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011 – summary report. Australian Institute of Health and Welfare, Canberra.

Amos B, Bailes B, Baxter S, Burgoyne T, Johnson G, King M, Pollard M, Stewart M, Giaretto A, Graham A (2002) Report: an eye health program for Aboriginal health workers in South Australia. Aboriginal and Islander Health Worker Journal 26, 22-24.
| Google Scholar |

Australian Government (2022) HLT40221 – Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice (Release 1). Available at https://training.gov.au/Training/Details/HLT40221#tableUnits

Bainbridge A, Formenti L, West L, Chan AS (2021) ‘Discourses, dialogue and diversity in biographical research: an ecology of life and learning.’ (Brill)

Bernardes CM, Valery PC, Arley B, Pratt G, Medlin L, Meiklejohn JA (2020) Empowering voice through the creation of a safe space: an experience of Aboriginal women in regional Queensland. International Journal of Environmental Research and Public Health 17, 1476.
| Crossref | Google Scholar |

Colleran K, Harding E, Kipp BJ, Zurawski A, MacMillan B, Jelinkova L, Kalishman S, Dion D, Som D, Arora S (2012) Building capacity to reduce disparities in diabetes: training community health workers using an integrated distance learning model. The Diabetes Educator 38, 386-396.
| Crossref | Google Scholar | PubMed |

Colmer K, Kumar S, Jesudason D, Mejia G, Wittert G, Wischer N, Zoungas S, Zimmet P, Brown A, Morey M, Giles J, Jones S, Pearson O (2020) Supporting best practice in the management of chronic diseases in primary health care: a scoping review protocol of training programs for Indigenous health workers/practitioners. Available at https://osf.io/9dh67

Croager EJ, Eades T, Pratt IS, Slevin T (2010) Impact of a short, culturally relevant training course on cancer knowledge and confidence in Western Australia’s Aboriginal Health Professionals. Australian and New Zealand Journal of Public Health 34, S76-S79.
| Crossref | Google Scholar | PubMed |

Cueva M, Kuhnley R, Revels LJ, Cueva K, Dignan M, Lanier AP (2013) Bridging storytelling traditions with digital technology. International Journal of Circumpolar Health 72, 20717.
| Crossref | Google Scholar |

Cueva M, Kuhnley R, Lanier A, Dignan M, Revels L, Schoenberg NE, Cueva K (2016) Promoting culturally respectful cancer education through digital storytelling. International Journal of Indigenous Health 11, 34-49.
| Crossref | Google Scholar | PubMed |

Cueva K, Cueva M, Revels L, Dignan M (2018a) Culturally-relevant online education improves health workers’ capacity and intent to address cancer. Journal of Community Health 43, 660-666.
| Crossref | Google Scholar | PubMed |

Cueva K, Revels L, Cueva M, Lanier AP, Dignan M, Viswanath K, Fung TT, Geller AC (2018b) Culturally-relevant online cancer education modules empower Alaska’s community health aides/practitioners to disseminate cancer information and reduce cancer risk. Journal of Cancer Education 33, 1102-1109.
| Crossref | Google Scholar | PubMed |

Cueva K, Cueva M, Revels L, Hensel M, Dignan M (2019) An evaluation of cancer education webinars in Alaska. Journal of Cancer Education 36, 484-490.
| Crossref | Google Scholar |

Curtis K, Fry M, Shaban RZ, Considine J (2017) Translating research findings to clinical nursing practice. Journal of Clinical Nursing 26, 862-872.
| Crossref | Google Scholar | PubMed |

Davidson PM, Digiacomo M, Abbott P, Zecchin R, Heal PE, Mieni L, Sheerin N, Smith J, Mark A, Bradbery B, Davison J (2008) A partnership model in the development and implementation of a collaborative, cardiovascular education program for Aboriginal Health Workers. Australian Health Review 32, 139-146.
| Crossref | Google Scholar | PubMed |

Doorenbos AZ, Kundu A, Eaton LH, Demiris G, Haozous EA, Towle C, Buchwald D (2011) Enhancing access to cancer education for rural healthcare providers via telehealth. Journal of Cancer Education 26, 682-686.
| Crossref | Google Scholar | PubMed |

Dudgeon P, Ugle K (2014) Communicating and engaging with diverse communities. In ‘Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice’. (Eds PM Dudgeon, H Milroy, R Walker) pp. 257–267. (Australian Government Department of the Prime Minister and Cabinet)

Durey A, Halkett G, Berg M, Lester L, Kickett M (2017) Does one workshop on respecting cultural differences increase health professionals’ confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation. BMC Health Services Research 17, 660.
| Crossref | Google Scholar |

Gibson O, Eltridge F, Luz Z, Stewart H, Westhead S, Zimmet P, Brown A (2016) The South Australian Aboriginal Diabetes Strategy 2017–2021. Wardliparingga Aboriginal Research Theme. South Australian Health and Medical Research Institute, Adelaide.

Glazier RH, Bajcar J, Kennie NR, Willson K (2006) A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care 29, 1675-1688.
| Crossref | Google Scholar | PubMed |

Gomersall JS, Gibson O, Dwyer J, O’Donnell K, Stephenson M, Carter D, Canuto K, Munn Z, Aromataris E, Brown A (2017) What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Australian and New Zealand Journal of Public Health 41, 417-423.
| Crossref | Google Scholar | PubMed |

Grant MJ, Booth A (2009) A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal 26, 91-108.
| Crossref | Google Scholar | PubMed |

Hare MJL, Zhao Y, Guthridge S, Burgess P, Barr ELM, Ellis E, Butler D, Rosser A, Falhammar H, Maple-Brown LJ (2022) Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study. BMJ Open 12(5), e059716.
| Crossref | Google Scholar |

Harfield SG, Davy C, McArthur A, Munn Z, Brown A, Brown N (2018) Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Globalization and Health 14, 12.
| Crossref | Google Scholar | PubMed |

Higgins R, Murphy B, Worcester M, Daffey A (2012) Supporting chronic disease self-management: translating policies and principles into clinical practice. Australian Journal of Primary Health 18, 80-87.
| Crossref | Google Scholar | PubMed |

Iseke J (2013) Indigenous storytelling as research. International Review of Qualitative Research 6, 559-577.
| Crossref | Google Scholar |

Jones A, Barnett B (2006) Guidelines for ethical and effective communication for researchers working in Torres Strait. Report to CRC Torres Strait. p. 106. CRC Reef Research Centre, Townsville, Australia.

Jull J, Hizaka A, Sheppard AJ, Kewayosh A, Doering P, MacLeod L, Joudain G, Plourde J, Dorschner D, Habash M, Graham ID (2019) An integrated knowledge translation approach to develop a shared decision-making strategy for use by Inuit in cancer care: a qualitative study. Current Oncology 26, 192-204.
| Crossref | Google Scholar | PubMed |

King M, Sinn A (1999) An account from five Aboriginal health workers who undertook the Diabetes Educators Course conducted by Flinders University. Aboriginal and Islander Health Worker Journal 23, 19-23.
| Google Scholar |

King M, Munt R, Eastwood A (2007) The impact of a postgraduate diabetes course on the perceptions Aboriginal health workers and supervisors in South Australia. Contemporary Nurse 25, 82-93.
| Crossref | Google Scholar | PubMed |

King C, Goldman A, Gampa V, Smith C, Muskett O, Brown C, Malone J, Sehn H, Curley C, Begay M-G, Nelson AK, Shin SS (2017) Strengthening the role of community health representatives in the Navajo Nation. BMC Public Health 17, 348.
| Crossref | Google Scholar | PubMed |

Kirkpatrick J, Kirkpatrick W (2016) ‘Four levels of training evaluation.’ (ATD Press: USA)

Look MA, Baumhofer NK, Ng-Osorio J, Furubayashi JK, Kimata C (2008) Diabetes training of community health workers serving native Hawaiians and Pacific People. The Diabetes Educator 34, 834-840.
| Crossref | Google Scholar | PubMed |

Martyn J-A, Woolcock A (2020) An appreciative inquiry to identify the continuing education needs of Aboriginal and Torres Strait Islander health practitioners in regional Queensland. The Australian Journal of Indigenous Education 50, 320-330.
| Crossref | Google Scholar |

McDermott RA, Schmidt B, Preece C, Owens V, Taylor S, Li M, Esterman A (2015) Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial. BMC Health Services Research 15, 68.
| Crossref | Google Scholar | PubMed |

McRae M, Taylor S, Swain L, Sheldrake C (2008) Evaluation of a pharmacist-led, medicines education program for Aboriginal health workers. Rural and Remote Health 8, 946.
| Crossref | Google Scholar |

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6, e1000097.
| Crossref | Google Scholar | PubMed |

Moleta CD, Look MA, Trask-Batti MK, Mabellos T, Mau ML (2017) 2016 writing contest graduate winner: cardiovascular disease training for community health workers serving native Hawaiians and other Pacific Peoples. Hawai’i Journal of Medicine & Public Health 76, 190-198.
| Google Scholar | PubMed |

Munn Z, Porritt K, Lockwood C, Aromataris E, Pearson A (2014a) Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Medical Research Methodology 14, 108.
| Crossref | Google Scholar | PubMed |

Munn Z, Porritt K, Aromataris E, Lockwood C, Peters M (2014b) Supporting document for the Joanna Briggs Institute levels of evidence and grades of recommendation. The Joanna Briggs Institute.

National Aboriginal and Torres Strait Islander Health Worker Association (2012) The Aboriginal and Torres Strait Islander Health Worker Professional Practice Framework. ACT. Available at https://www.natsihwa.org.au/aboriginal-and-torres-strait-islander-health-worker-professional-practice-framework

National Aboriginal Community Controlled Health Organisation (NACCHO) (2019) The importance of Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners in Australia’s health system: position statement. Available at https://www.natsihwa.org.au/sites/default/files/position_statmente_importance_aboriginal_torres_strait_islander_hw_hp_in_aust_health_system_aug_2019.pdf

National Rural Health Alliance Inc. (2006) Aboriginal and Torres Strait Islander Health Workers: Position Paper. National Rural Health Alliance Inc., ACT.

NSW Ministry of Health (2018) Aboriginal health worker guidelines for NSW Health. NSW Health, NSW. Available at https://www.health.nsw.gov.au/workforce/aboriginal/Pages/aboriginal-health-worker-guidelines.aspx

Orr AL (1993) Training outreach workers to serve American Indian elders with visual impairment and diabetes. Journal of Visual Impairment & Blindness 87, 336-340.
| Crossref | Google Scholar |

Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, Herrera CA, Rada G, Penaloza B, Dudley L, Gagnon M-P, Garcia Marti S, Oxman AD (2017) Implementation strategies for health systems in low-income countries: an overview of systematic reviews (Review). Cochrane Database of Systematic Reviews 9, CD011086.
| Crossref | Google Scholar |

Peters M, Godfrey C, McInerney P, Munn Z, Tricco A, Khalil H (2020) Chapter 11: Scoping reviews. In ‘JBI manual for evidence synthesis’. (Eds E Aromataris, Z Munn) pp. 407–450. (JBI: Adelaide, SA, Australia) doi:10.46658/JBIMES-20-12

Phillips GL (2017) Dancing with power: Aboriginal health, cultural safety and medical education. PhD Thesis, Monash University. Available at https://doi.org/10.4225/03/58b774b372862

Policicchio JM, Dontje K (2018) Diabetes training for community health workers on an American Indian reservation. Public Health Nursing 35, 40-47.
| Crossref | Google Scholar | PubMed |

Pálsdóttir B, Barry J, Bruno A, Barr H, Clithero A, Cobb N, De Maeseneer J, Kiguli-Malwadde E, Neusy A-J, Reeves S, Strasser R, Worley P (2016) Training for impact: the socio-economic impact of a fit for purpose health workforce on communities. Human Resources for Health 14, 49.
| Crossref | Google Scholar | PubMed |

Ryder C, Mackean T, Coombs J, Williams H, Hunter K, Holland AJA, Ivers RQ (2020) Indigenous research methodology – weaving a research interface. International Journal of Social Research Methodology 23, 255-267.
| Crossref | Google Scholar |

Sebastian S, Thomas DP, Brimblecombe J, Arley B, Cunningham FC (2021) Perceived impact of the characteristics of the Indigenous Queensland B.strong brief intervention training program on uptake and implementation. Health Promotion Journal of Australia 33, 245-256.
| Crossref | Google Scholar |

Smith RL, Devine S, Preston R (2020) Recommended methodologies to determine Australian Indigenous community members’ perceptions of their health needs: a literature review. Australian Journal of Primary Health 26, 95-103.
| Crossref | Google Scholar | PubMed |

Thorpe S, Browne J (2009) Heart health action in Aboriginal communities: translating training into practice: final evaluation report. (Heart FoundationVictorian Aboriginal Community Controlled Health Organisation Inc.: Victoria) Available at https://www.vaccho.org.au/assets/01-RESOURCES/TOPIC-AREA/NUTRITION/Health-Action-in-Aboriginal-Communities-eval-Report-Final-2009-09-18.pdf

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine 169, 467-473.
| Crossref | Google Scholar | PubMed |

Veritas Health Innovation (2018) Covidence systematic review software. Veritas Health Innovation Ltd., Melbourne.

West R, Armao JE, Creedy DK, Saunders V, Rowe Minnis F (2021) Measuring effectiveness of cultural safety education in First Peoples health in university and health service settings. Contemporary Nurse 57, 356-369.
| Crossref | Google Scholar | PubMed |

Wilson AM, Kelly J, Jones M, O’Donnell K, Wilson S, Tonkin E, Magarey A (2020) Working together in Aboriginal health: a framework to guide health professional practice. BMC Health Services Research 20, 601.
| Crossref | Google Scholar | PubMed |

Zeunert S, Cerro N, Boesch L, Duff M, Shephard MD, Jureidini KF, Braun J (2002) Nutrition project in a remote Australian aboriginal community. Journal of Renal Nutrition 12, 102-106.
| Crossref | Google Scholar | PubMed |