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Abstract
Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.
Highlights
The disparities between the health status of Aboriginal and Torres Strait Islander people (Australia’s Indigenous populations) and that of other Australians is unacceptable
In the Northern Territory (NT), the title Aboriginal health workers (AHWs) is regulated in recognition of the specific scope of work practices, clinical work, ensuring that work is carried out without risk to public safety.) With the exception of one health service, staff employed in these health centers were not specialist health promotion practitioners
Our study showed that the introduction of structured and facilitated quality improvement cycles can improve health center systems and quality of health promotion activities in Indigenous primary health care (PHC) centers
Summary
The disparities between the health status of Aboriginal and Torres Strait Islander people (Australia’s Indigenous populations) and that of other Australians is unacceptable. There have been improvements in some social and health indicators [2], chronic diseases, Health Promotion Quality Improvement such as cardiovascular disease, diabetes, and renal disease, remain significant contributors to premature and excess mortality and morbidity among Indigenous Australians. International experience has shown the positive effect of health systems based on equity, disease prevention, and health promotion in narrowing health inequities [6] and in reducing Indigenous health inequities. Access to an integrated and comprehensive primary health care (PHC) system, with a strong primary and preventive focus, has been critical in delivering better health for Native Americans and the Maori people of New Zealand [7]
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