Applied professional practice in public health: promoting equitable health services delivery through evaluation and research

Abstract

Research and evaluation studies can be applied to promote equitable health services delivery, through identifying disparities in health services delivery between different population groups, and recommending strategies to address these disparities. This thesis reports on four applied research studies which explore these issues, undertaken through the NSW Public Health Officer Training Program. The first study is an evaluation of the NSW Early Childhood Oral Health Program, a program designed to improve the oral health of infants and young children in NSW. The evaluation shows that models of shared responsibility for oral health have been established which facilitate prevention and early intervention for early childhood caries, however additional strategies targeting vulnerable populations are required for more equitable access and outcomes. In the second study eye health services for Aboriginal people in western NSW are reviewed through observational visits, key stakeholder consultation and service provision data analysis. The findings indicate that eye health services are not equitably available and accessible for Aboriginal people in this region. Strategies recommended to address this disparity include improved collaborative practice, improved cultural competence, and routine monitoring of service uptake by Aboriginal people. The third study involves a component of “The health of Aboriginal people of NSW: Report of the Chief Health Officer 2012”, which reports on the performance of mainstream health services at the local level in providing effective, equitable, and culturally competent services to Aboriginal people. Health services achieve differential outcomes in key performance indicators for Aboriginal and non- Aboriginal people, and it is anticipated that enhanced reporting of performance in Aboriginal health may increase awareness and precipitate action at a local level to address this disparity. The fourth study investigates issues related to influenza vaccination during pregnancy in central and south western Sydney. Influenza during pregnancy poses significant risks to pregnant women, and although the influenza vaccine is safe, effective, and recommended in guidelines, uptake is low and providers do not routinely recommend it. Understanding the perspectives of pregnant women and antenatal care providers towards the vaccine will enable targeted strategies to address their concerns in order to improve uptake of the vaccine and mitigate the risks of influenza during pregnancy.