Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: identifying the gaps.
Indigenous Australians experience a disproportionately greater burden of harm from smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) than the general Australian population. A critical step in further improving efforts to reduce this harm is to review existing efforts aimed at increasing the uptake of evidence-based interventions in Indigenous-specific health-care settings and programs. This study systematically identifies and reviews published Indigenous-specific dissemination studies targeting SNAP interventions. An electronic search of eight databases and a manual search of reference lists of previous literature reviews were undertaken. Eleven dissemination studies were identified for review: six for nutrition and physical activity as a component of diabetes care, three for alcohol and two for smoking. The majority of studies employed continuing medical education (n = 9 studies), suggesting that improving health-care providers' knowledge and skills is a focus of current efforts to disseminate best-evidence SNAP interventions in Indigenous health-care settings. Only two studies evaluated reminder systems, despite their widespread use in Indigenous-specific health-care services, and only one study employed academic detailing, despite its cost-effectiveness at modifying health-care provider behavior. There is a clear need for more Indigenous-specific dissemination research targeting the uptake of secondary prevention and to establish reliable and valid measures of Indigenous-specific health-care delivery, in order to determine which dissemination strategies are most likely to be effective in Indigenous health-care settings and programs.
Clifford
A
A
National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW, Sydney, Australia. a.clifford@unsw.edu.au
Jackson Pulver
L
L
Richmond
R
R
Shakeshaft
A
A
Ivers
R
R
D000437:Alcoholism / Q000208:ethnology; D001315:Australia / Q000453:epidemiology; D004032:Diet / Q000208:ethnology; D055317:Evidence-Based Practice / Q000458:organization & administration*; D015444:Exercise; D015438:Health Behavior / Q000208:ethnology*; D006293:Health Promotion / Q000458:organization & administration; D054624:Health Status Disparities; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D012907:Smoking / Q000208:ethnology