Abstract
BackgroundEvaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments.AimTo describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes.MethodsWe conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles.ResultsFrom 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability.ConclusionThe prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities.Patient or public contributionThis paper is a review of evaluation studies and did not involve patients or the public.
Highlights
Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences
Evaluations of health programmes designed for Indigenous people are not always considered useful when making decisions about the development or future of health programmes, constituting a significant waste in resources.1-3 The focus on Western biomedical measures often means evaluations exclude outcomes that reflect participant experiences providing an incomplete picture of processes that are working well and those that are failing.[1,4]
As qualitative evaluation data on the experiences of Indigenous people with health services grows, it is clear that these data should be given prominence and should be routinely collected and reported in evaluations of health programmes to ensure decision making reflects the needs of Indigenous communities.[1]
Summary
Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. Evaluations of health programmes designed for Indigenous people are not always considered useful when making decisions about the development or future of health programmes, constituting a significant waste in resources.1-3 The focus on Western biomedical measures often means evaluations exclude outcomes that reflect participant experiences providing an incomplete picture of processes that are working well and those that are failing.[1,4] Increasingly, evaluations are using qualitative methods to capture participant experiences; this is often an afterthought or to support quantitative evaluation data and little attention is given to the importance of qualitative data. Evaluations often assess measurable clinical outcomes.[1,4] unlike clinical outcomes, information about how Indigenous participants experience health programmes may help to identify the specific aspects of service delivery influencing service use or engagement which is essential to achieving long-term health outcomes.[6]
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