A structured systems approach to improving health promotion practice for chronic disease in Indigenous communities

Health promotion strategies have the potential to significantly improve health and reduce health inequities within and between population groups. However, Indigenous health promotion and primary care programs have had varying success. Research suggests that implementation failure is largely attributed to system factors including planning processes, resources, infrastructure and capacity.

Increasingly, systematic, quality improvement methods are being acknowledged and accepted as the primary approach for improving system performance, processes and outcomes of health care. Locally, the continuous quality improvement (CQI) concept appears to be well suited to the Indigenous Australian setting. Experience in using CQI cycles for improving clinical services for the prevention and management of chronic conditions in 12 remote communities in the Top End of the Northern Territory (the ABCD Project), has been of enthusiastic ongoing engagement by health centre staff and health service management and of meaningful measurement of service performance and organisational systems. There is evidence of improvement in health centre systems and in processes and outcomes of care and the process has achieved engagement of Aboriginal Health Workers in the quality improvement cycle and action research process.

The wider health system pressure to monitor and improve performance has led to increasing attention to provide valid and reliable methods for assuring quality and improving health promotion effectiveness. However, the use and effectiveness of quality improvement tools and processes in health promotion has yet to be determined and the team was unable to identify any studies investigating this approach in Indigenous settings.

This research explored the feasibility of quality improvement methods for health promotion by investigating the impact of a continuous quality improvement intervention, similar to the model used in the ABCD (Audit and Best Practice for Chronic Disease) Project. While the ABCD Project had a clinical focus, this research developed and test a number of tools and a range of strategies relevant to quality improvement for health promotion. 

By building on the success of the recently established process for improving systems of clinical care (the ABCD project), this research had the potential to improve the effectiveness of health promotion in Indigenous communities. This project made important contributions to the health promotion field where there is little documented evidence on the use and effectiveness of modern quality approaches. Furthermore, it addressed an area of research which had not been investigated extensively in Australia, and particularly in Indigenous settings.

Related resources:
  • Bailie, R. S., Si, D., Dowden, M., & Lonergan, K. 2007a, Audit and Best Practice for Chronic Disease – Project Final Report, Menzies School of Health Research.
  • Bailie, R. S., Si, D., O’Donoghue, L., & Dowden, M. 2007b, ‘Indigenous Health: effective and sustainable health services through continuous quality improvement’, Medical Journal of Australia, vol. 186(10), pp. 525–7.

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