Screening and brief intervention in Aboriginal Primary Health Care: towards evidence-based practice

Abstract

Background: While the disproportionately high burden of Smoking, poor Nutrition, Alcohol misuse and Physical inactivity (SNAP risk factors) related harm borne by Indigenous Australian communities has been documented over many years; attempts to redress this imbalance appear to have been inadequate to date. Therefore, there is a clear need for well controlled intervention and dissemination efforts in this area. Given the evidence that brief intervention is effective at modifying health risk behaviours among non-Indigenous Australians, its feasibility and effectiveness for Indigenous Australians should be determined. Implementing brief intervention into Aboriginal Community Controlled Health Services (ACCHSs), as an evidence-based strategy using established resources, would appear a logical and critical step before evaluating its effectiveness for reducing SNAP related-harm in the Indigenous Australian community. Aims: Examine the process of implementing and adapting an intervention to enhance delivery of evidence-based screening and brief intervention for SNAP risk factors in ACCHSs. Methods: Action Research using qualitative methods in an emergent and developmental manner in one regional and one rural ACCHS. Results: Qualitative findings and an examination of the literature informed the development of a multi-component intervention comprising training, provision of brief intervention materials, influential colleagues, educational outreach, and audit and feedback. Of the five intervention strategies, training and the provision of brief intervention materials were effectively implemented in both ACCHS. The effective implementation of educational outreach in one ACCHS facilitated the involvement of health professionals in tailoring preventive health care screening items, checklists and prompts, and increased the involvement of Aboriginal health workers (AHWs) in delivering the Adult Health Check. Less than optimal Information Technology (IT) systems in both ACCHSs presented a major barrier to auditing preventive health care processes, and providing timely and accurate feedback of preventive health care performance to health professionals. Conclusion: ACCHSs can implement significant changes in their practice environments to facilitate evidence-based screening and brief intervention. Crucial components for creating change in ACCHSs participating in this study were systems tailoring, educational outreach and influential colleagues. This study produced subjective benefits to participating ACCHSs as well as a worked-up multi-component intervention that can now be more widely tested.