Gotis-Graham Anna, Macniven Rona, Kong Kelvin, Gwynne Kylie
Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia.
Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia.
BMJ Open. 2020 Nov 26;10(11):e038273. doi: 10.1136/bmjopen-2020-038273.
To examine the ability of ear, nose and throat (ENT) outreach programmes to improve health outcomes among Aboriginal and Torres Strait Islander people.
We conducted a systematic literature search of nine databases (Medline, CINAHLS, PsycINFO, Embase, Cochrane, Scopus, Global health, Informit Rural health database and Indigenous collection) and grey literature sources for primary studies evaluating ENT outreach services for Aboriginal and Torres Strait Islander people. This review included English language studies of all types, published between 2000 and 2018, that supplied ENT outreach services to Aboriginal and Torres Strait Islander Australians and provided data to evaluate their aims. Two authors independently evaluated the eligible articles and extracted relevant information. Risk of bias was assessed using the Mixed Methods Assessment Tool.
Of the 506 studies identified, 15 were included in this review. These 15 studies evaluated eight different programs/activities. Studies were heterogeneous in design so a meta-analysis could not be conducted. Seven studies measured health-related outcomes in middle ear or hearing status; six reported overall positive changes one reported no clinically significant improvements. Five programmes/activities and their corresponding studies involved Aboriginal and Torres Strait Islander people and organisations in delivery and evaluation, but involvement in programme or study design was unclear.
While some studies demonstrated improved outcomes, the overall ability of ENT programmes to improve health outcomes for Aboriginal and Torres Strait Islander children is unclear. The impact of ENT outreach may be limited by a lack of quality evidence, service coordination and sustainability. Community codesign and supporting and resourcing local capacity must be a component of outreach programmes and ongoing evaluation is also recommended. Improvements in these areas would likely improve health outcomes.
CRD42019134757.
探讨耳鼻喉科（ENT）外展项目改善原住民和托雷斯海峡岛民健康状况的能力。
我们对九个数据库（Medline、CINAHLS、PsycINFO、Embase、Cochrane、Scopus、全球健康、Informit农村健康数据库和原住民文献集）以及灰色文献来源进行了系统的文献检索，以查找评估针对原住民和托雷斯海峡岛民的耳鼻喉科外展服务的原始研究。本综述纳入了2000年至2018年期间发表的所有类型的英语研究，这些研究为澳大利亚原住民和托雷斯海峡岛民提供了耳鼻喉科外展服务，并提供了评估其目标的数据。两位作者独立评估了符合条件的文章并提取了相关信息。使用混合方法评估工具评估偏倚风险。
在检索到的506项研究中，有15项纳入了本综述。这15项研究评估了八个不同的项目/活动。研究设计各异，因此无法进行荟萃分析。七项研究测量了中耳或听力状况与健康相关的结果；六项报告总体有积极变化，一项报告无临床显著改善。五个项目/活动及其相应的研究在实施和评估过程中让原住民和托雷斯海峡岛民及组织参与其中，但在项目或研究设计中的参与情况尚不清楚。
虽然一些研究表明有改善的结果，但耳鼻喉科项目改善原住民和托雷斯海峡岛民儿童健康状况的总体能力尚不清楚。耳鼻喉科外展的影响可能因缺乏高质量证据、服务协调和可持续性而受到限制。社区共同设计以及支持和提供当地能力资源必须成为外展项目的一部分，同时也建议进行持续评估。这些领域的改进可能会改善健康状况。
PROSPERO注册号：CRD42019134757。
