An "All Teach, All Learn" Approach to Research Capacity Strengthening in Indigenous Primary Health Care Continuous Quality Improvement.

Karen Mcphail-Bell,Ross Bailie,Jodie Bailie,Michelle Louise Redman-Maclaren,Roxanne Bainbridge,Deborah Askew,Shanthi Ramanathan,Veronica Matthews

doi:10.3389/fpubh.2018.00107

Abstract

In Australia, Indigenous people experience poor access to health care and the highest rates of morbidity and mortality of any population group. Despite modest improvements in recent years, concerns remains that Indigenous people have been over-researched without corresponding health improvements. Embedding Indigenous leadership, participation, and priorities in health research is an essential strategy for meaningful change for Indigenous people. To centralize Indigenous perspectives in research processes, a transformative shift away from traditional approaches that have benefited researchers and non-Indigenous agendas is required. This shift must involve concomitant strengthening of the research capacity of Indigenous and non-Indigenous researchers and research translators—all must teach and all must learn. However, there is limited evidence about how to strengthen systems and stakeholder capacity to participate in and lead continuous quality improvement (CQI) research in Indigenous primary health care, to the benefit of Indigenous people. This paper describes the collaborative development of, and principles underpinning, a research capacity strengthening (RCS) model in a national Indigenous primary health care CQI research network. The development process identified the need to address power imbalances, cultural contexts, relationships, systems requirements and existing knowledge, skills, and experience of all parties. Taking a strengths-based perspective, we harnessed existing knowledge, skills and experiences; hence our emphasis on capacity “strengthening”. New insights are provided into the complex processes of RCS within the context of CQI in Indigenous primary health care.

Highlights

Indigenous peoples experience significant health disparities [1]
Continuous quality improvement (CQI) methods are key to improving primary health-care service delivery, with an emerging evidence base demonstrating promising results in Indigenous health [5, 6]
Skills, knowledge, and system supports necessary to undertake CQI research in this setting have been largely undefined and fragmented. This raises the question of what is an appropriate model of CQI research capacity strengthening (RCS) in Indigenous primary health care that is of value and benefit to Indigenous Australians?

Summary

INTRODUCTION

Indigenous peoples experience significant health disparities [1]. Aboriginal and Torres Strait Islander (hereafter respectfully referred to as “Indigenous”) Australians experience disparities in health status and poor access to/quality of care when compared to non-Indigenous Australians [2, 3]. CQI-RCS means to enhance capacities to conduct and use CQI research that is valued by and of benefit to Indigenous peoples, in the Indigenous primary healthcare setting, with the specific purpose of supporting integrated quality improvement and building on the collaborative platform of the Centre. In the Indigenous primary health-care context, individual capacities include knowledge, skills, and experience to: conduct and critically assess research; participate in all stages of the research; contribute to research-informed action; maintain respectful relationships; and facilitate culturally safe processes. The development process collectively identified and formalized the CQI-RCS priorities and approach, which provided momentum for power-sharing and involvement of more Indigenous people within the Centre Respectful relationships underpinned these processes and structures, as reflected in the program logic (Figure 1).

LIMITATIONS AND STRENGTHS

CONCLUSION