Abstract
BackgroundHealth promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. The development and implementation of step-by-step guides, instruments, packages, frameworks or resources has provided a feasible and low-resource strategy for strengthening evidence-informed health promotion practice. Yet there has been little assessment of where and how these tools are implemented or their effectiveness. This paper reviews the characteristics, implementation and effects of Indigenous health promotion tools.MethodsIndigenous health promotion tools were identified through a systematic literature search including a prior scoping study, eight databases, references of other reviews and the authors’ knowledge (n = 1494). Documents in the peer reviewed and grey literature were included if they described or evaluated tools designed, recommended or used for strengthening Indigenous Australian health promotion. Eligible publications were entered into an Excel spreadsheet and documented tools classified according to their characteristics, implementation and effects. Quality was appraised using the Dictionary for Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Program (CASP) tools for quantitative and qualitative studies respectively.ResultsThe review found that Indigenous health promotion tools were widely available. Of 74 publications that met inclusion criteria, sixty (81%) documented tools developed specifically for the Indigenous Australian population. All tools had been developed in reference to evidence; but only 22/74 (30%) publications specified intended or actual implementation, and only 11/74 (15%) publications evaluated impacts of the implemented tools. Impacts included health, environmental, community, organisational and health care improvements. The quality of impact evaluations was strong for only five (7%) studies.ConclusionsThe small number and generally moderate quality of implementation and evaluation studies means that little is known about how tools work to strengthen Indigenous health promotion practice. The findings suggest that rather than continuing to invest in tool development, practitioners, policy makers and researchers could evaluate the implementation and effects of existing tools and publish the results. There is a need for long-term investment in research to review the current use of health promotion tools and the factors that are likely to enhance their implementation.
Highlights
Health promotion by and with Aboriginal and Torres Strait Islander Australians is critically important given a wide gap in health parity compared to other Australians
Inclusion criteria Documents were included in the review if they described or evaluated Indigenous-specific or non-Indigenous specific tools that were designed, recommended or used to plan, implement or evaluate an Indigenous Australian health promotion program
Characterising health promotion tools The review found 74 publications that described or evaluated tools designed to enhance Indigenous health promotion practice. They included 60/74 (81%) Indigenous Australian-specific tools; five non-Indigenous specific tools that were tailored for Indigenous Australians, nine tools that were non-Indigenous specific and not tailored, and one Canadian Indigenous tool
Summary
Health promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. There is considerable scope for improvements in the implementation of health promotion efforts targeting Aboriginal and Torres Strait Islander (hereafter Indigenous) individuals, families, organisations and communities. Pat Anderson, the Chairperson of Australia’s Indigenous health research centre, the Lowitja Institute, recently argued that the breadth of health promotion efforts needed to be expanded. She stated: “attempts to prevent physical health issues are not enough from our perspective – prevention needs to operate across all these other domains as well. In 2002, a consensus statement by key health promotion representatives from all Australian states and territories acknowledged that Indigenous health issues are complex and health improvement requires inter-sectoral strategies [5]
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