Effectiveness of an Aboriginal and
Torres Strait Islander Cultural Respect
Program in General Practice - Protocol
for a Cluster Randomised Control Trial
BACKGROUND
AIM
Sixty percent of Aboriginal people are urban dwellers, who
often have poor access to appropriate health care. General
practices, Aboriginal communities and the community
health sector must work together to address this issue.
We have developed a Toolkit and care partnership strategy
– ‘Ways of Thinking and Ways of Doing’ (WoTWoD) to
assist general practices to provide culturally and clinically
appropriate health care to Aboriginal people.The WoTWoD
is a whole-of-practice clinical re-design process to embed
cultural respect in general practice. This poster describes
the study protocol to evaluate the WoTWoD program in
Sydney and Melbourne.
To conduct a cluster randomised control trial (RCT) to examine whether the WoTWoD improves
cultural respect and delivery of culturally and clinically appropriate care to Aboriginal patients in
Australian general practice.
METHODS
This multi-centre RCT will be conducted in 58 general practices in Sydney and Melbourne, through
Medicare Locals (MLs), Aboriginal communities and the community health sector. The practices
will be randomised into intervention or control groups. For intervention practices, practice staff
will implement the WoTWoD program and be supported by the ‘Closing the Gap’ team from the
MLs and Aboriginal cultural mentors. For control practices, WoTWoD will be implemented at the
conclusion of the intervention phase. The flow chart summarises the study protocol.
WoTWoD STUDY PROTOCOL
OUTCOME MEASURES
Recruitment of 58
general practices
Pre-Evaluation of all practices
» Conduct cultural quotient evaluation with practice staffa
» Conduct clinical audit of practice
b
Primary
Secondary
Improved clinical care of
Aboriginal patients
(Use of MBS Item #715)
Number of Aboriginal
patients shared with
community health sectors
Improved cultural respect
among practice staff
(Cultural Quotient Score)
Culturally appropriate health
care as assessed
by patient satisfaction
Cultural mentor and practice
perceptions on the appropriateness
of embedding WoTWoD
into routine practice
Randomisation of all practices
29 Intervention Practices
29 Control Practices
(12 months)
(12 months)
» Staff attend training workshop
» Usual care and practice
Clinically appropriate health
care as measured by
adherence to Aboriginal specific
clinical guidelines
» Staff implement WoTWoD with
guidance from cultural mentors
Post-Evaluation
Post-Evaluation
b
» Conduct clinical audit of practices
» Conduct clinical audits of practice
b
Authors
[above] Painting by Ashley Firebrace (2014)
Prof Siaw-Teng Liaw1, 2
Prof Mark Harris1
Prof Lisa Jackson Pulver2, 3
A/Prof Margaret Kelaher4
A/Prof John Furler5
Dr Rosa Canalese6
Dr Phyllis Lau5
Ms Vicki Wade7
Dr Iqbal Hasan1
» Interview cultural mentors, practice
staff and selected patientsc
Analysis of data from intervention
and control practices
» Predictive factors for self-identification, conduct of health checks and
CQ examined using a multivariate analysis approach
» Interview data thematically analysed using a directed content analysis
approach
1. Research Centre for Primary Health Care and
Equity (CPHCE), UNSW Australia
a
A 54-item instrument that measures ability to engage in a culturally diverse setting;
b
Includes practice profile, number of Aboriginal patients and their identification processess, clinical
issues of Aboriginal patients attending and use of Aboriginal-specific and relevant MBS items;
c
Cultural mentors and practice staff will be asked about their views of the impact WoTWoD on their
health care.
2. School of Public Health and Community
Medicine, UNSW Australia
3. Muru Marri Indigenous Health Unit, UNSW
Australia
4. Melbourne School of Population and Global
Health, University of Melbourne
5. General Practice and Primary Health Care
Academic Centre, University of Melbourne
6. GP Synergy, New South Wales
7. Aboriginal Health Unit, National Heart Foundation
FOR MORE INFORMATION FOR MORE INFORMATION FOR MORE INFORMATION
Dr Phyllis Lau
Chief Investigator and Project
Coordinator (Melbourne)
T: +61 3 8344 9042
E: [email protected]
Dr Iqbal Hasan
Project Coordinator (Sydney)
T: +61 2 9616 8520
E: [email protected]
Prof Siaw-Teng Liaw
Principal Investigator
T: +61 2 9616 8520
E: [email protected]
FUNDING AND STUDY PERIOD
The study is funded by NHMRC and will be conducted during the period between April 2014 and March 2017.