title: Aboriginal health workers and diabetes care in remote community health centres: a mixed method analysis.
abstract: OBJECTIVE
  To assess the effect of employing Aboriginal health workers (AHWs) on delivery of diabetes care in remote community health centres, and to identify barriers related to AHWs' involvement in diabetes and other chronic illness care.
  
  
  METHODS
  Three-year follow-up study of 137 Aboriginal people with type 2 diabetes in seven remote community health centres in the Northern Territory.
  
  
  METHODS
  Delivery of guideline-scheduled diabetes services; intermediate outcomes (glycated haemoglobin [HbA(1c)] and blood pressure levels); number and sex of AHWs at health centres over time; barriers to AHWs' involvement in chronic illness care.
  
  
  RESULTS
  There was a positive relationship between the number of AHWs per 1000 residents and delivery of guideline-scheduled diabetes services (but not intermediate health outcomes). Presence of male AHWs was associated with higher adherence to the guidelines. Barriers to AHWs' involvement in chronic illness care included inadequate training, lack of clear role divisions, lack of stable relationships with non-Aboriginal staff, and high demands for acute care.
  
  
  CONCLUSIONS
  Employing AHWs is independently associated with improved diabetes care in remote communities. AHWs have potentially important roles to play in chronic illness care, and service managers need to clearly define and support these roles.
authors.affiliation: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, Australia. damin.si@menzies.edu.au
authors.forename: Damin
authors.initials: D
authors.lastname: Si
authors.forename: Ross S
authors.initials: RS
authors.lastname: Bailie
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Togni
authors.forename: Peter H N
authors.initials: PH
authors.lastname: d'Abbs
authors.forename: Gary W
authors.initials: GW
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006303:Health Services, Indigenous / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015876:Northern Territory; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D019035:Rural Health Services / Q000706:statistics & numerical data; D012737:Sex Factors; D000078329:Workforce