title: The effectiveness of implementation in Indigenous Australian healthcare: an overview of literature reviews.
abstract: BACKGROUND
  Effective implementation can maximise the beneficial impacts of health services. It is therefore important to review implementation in the context of Indigenous populations, who suffer some of the greatest disadvantage within developed countries. This paper analyses Aboriginal and Torres Strait Islander (hereafter Indigenous) Australian health implementation reviews to examine the research question: What is the effectiveness of implementation, as reported in the Indigenous Australian health implementation literature?
  
  
  METHODS
  Eight databases were systematically searched to find reviews of Indigenous Australian health services and/or programs where implementation was the focus. Search terms included Aborigin* OR Indigen* OR Torres AND health AND service OR program* OR intervention AND implementation (or like terms) AND Australia AND review. Review findings were analysed through the lens of the PARiHS framework which theorises that successful implementation occurs through the interplay of evidence, context and facilitation. The review followed Cochrane methods but was not registered.
  
  
  RESULTS
  Six reviews were found; these encompassed 107 studies that considered health service/program implementation. Included studies described many health services implemented across Australia as not underpinned by rigorous impact evaluation; nevertheless implementers tended to prefer evidence-based interventions. Effective implementation was supported by clearly defined management systems, employment of Indigenous health workers as leaders, community control, partnerships, tailoring for diverse places and settings; and active facilitation methods. Short-term funding meant most studies focused on implementation in one site through pilot initiatives. Only two mentioned cost effectiveness. Indigenous Australian studies incorporated two elements not included in the PARiHS reference guide: the value of community control and equity of service provision across sites.
  
  
  CONCLUSIONS
  Comparison of the Indigenous Australian review findings against the PARiHS reference guide elements suggested a fledgling but growing state of Indigenous implementation research, and considerable scope to improve the effectiveness of implementation. Further research is required to explore Indigenous people's understandings of what is important in healthcare implementation; particularly in relation to the value of community control and equity issues.
authors.affiliation: School of Human Health and Social Sciences, CQUniversity, cnr Abbott and Spence St, Cairns, QLD, 4870, Australia. j.mccalman@cqu.edu.au.|The Cairns Institute, James Cook University, PO Box 6811, Cairns, QLD, 4870, Australia. j.mccalman@cqu.edu.au.
authors.forename: Janya
authors.initials: J
authors.lastname: McCalman
authors.affiliation: School of Human Health and Social Sciences, CQUniversity, cnr Abbott and Spence St, Cairns, QLD, 4870, Australia.|The Cairns Institute, James Cook University, PO Box 6811, Cairns, QLD, 4870, Australia.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Bainbridge
authors.affiliation: Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia.
authors.forename: Nikki
authors.initials: N
authors.lastname: Percival
authors.affiliation: College of Arts, Society and Education, James Cook University, PO Box 6811, Cairns, QLD, 4870, Australia.
authors.forename: Komla
authors.initials: K
authors.lastname: Tsey
mesh_terms: D001315:Australia / Q000208:ethnology; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006303:Health Services, Indigenous / Q000592:standards*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D044382:Population Groups / Q000706:statistics & numerical data*; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal and Torres Strait Islander; Community control; Health equity; Health programs; Health services; Implementation; Indigenous Australian; PARiHS framework; Review