Article Text
Abstract
Objectives To examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia.
Design Qualitative study.
Setting Primary health care services serving remote Aboriginal communities in the Northern Territory, Australia.
Participants Seven of the 11 regional sexual health coordinators responsible for supporting the Northern Territory Government Remote Sexual Health Program.
Methods Semi-structured in-depth interviews conducted in person or by telephone; data were analysed using an inductive and deductive thematic approach.
Results Despite uniform availability of CQI tools and activities, sexual health CQI implementation varied across the Northern Territory. Participant narratives identified five factors enhancing the uptake and sustainability of sexual health CQI. At clinic level, these included adaptation of existing CQI tools for use in specific clinic contexts and risk environments (eg, a syphilis outbreak), local ownership of CQI processes and management support for CQI. At a regional level, factors included the positive framing of CQI as a tool to identify and act on areas for improvement, and regional facilitation of clinic level CQI activities. Three barriers were identified, including the significant workload associated with acute and chronic care in Aboriginal primary care services, high staff turnover and lack of Aboriginal staff. Considerations affecting the future sustainability of sexual health CQI included the need to reduce the burden on clinics from multiple CQI programmes, the contribution of regional sexual health coordinators and support structures, and access to and use of high-quality information systems.
Conclusions This study contributes to the growing evidence on how CQI approaches may improve sexual health in remote Australian Aboriginal communities. Enhancing sustainability of sexual health CQI in this context will require ongoing regional facilitation, efforts to build local ownership of CQI processes and management of competing demands on health service staff.
- sexual health
- aboriginal
- australia
- continuous quality improvement
- primary health care
- remote
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Footnotes
Contributors PG, GS, JB and SB designed the study. PG, JB and SB conducted data collection. PG, JB and SB undertook analysis of the data. PG, GS and SB led on drafting of the manuscript. All other authors (LM, RB, JW, RG, AR, NR, CKF, BD, LM, JK) assisted with interpretation of data and review of successive drafts of the manuscript. All authors read and approved the final manuscript.
Funding The STRIVEplus study is funded through a National Health and Medical Research Council Partnership Grant (APP1060471).
Disclaimer The funder played no role in design or implementation of this study.
Competing interests The authors have ongoing involvement in Aboriginal health, sexual health and CQI in Australia, as researchers, clinicians and policymakers.
Ethics approval Approval was obtained from Central Australian Human Research Ethics Committee (HREC 15–298) and the Human Research Ethics Committee of the NT Department of Health and the Menzies School of Health Research (HREC 2015–2374).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Not applicable as this is a qualitative research.
Patient consent for publication Not required.