Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Health Expect. 2021 Jun;24(3):731-743. doi: 10.1111/hex.13230. Epub 2021 Mar 17.
Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments.
To describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes.
We conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high-income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand-searched reference lists of relevant articles.
From 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long-term programme viability.
The prominence of social, emotional and spiritual well-being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community-level outcomes can improve decision-makers' understanding of the impact that health programmes have on communities.
This paper is a review of evaluation studies and did not involve patients or the public.
评估针对原住民的卫生干预措施很少报告反映参与者和社区对其体验的看法的结果。纳入此类数据可以更全面地了解卫生方案的影响，并提高评估的有用性。
描述利益攸关方对原住民卫生方案实施和影响的看法和经验。
我们对评估旨在为高收入国家原住民社区设计的复杂卫生干预措施的定性研究进行了系统评价。我们检索了 6 个电子数据库（截至 2020 年 1 月）：MEDLINE、PreMEDLINE、Embase、PsycINFO、EconLit 和 CINAHL，并对手头参考资料中的相关文章进行了手工检索。
从涉及 677 名利益攸关方（主要是临床工作人员和参与者）的 28 项研究中，确定了六个主要主题：促进参与、重新获得对健康的控制、改善社会健康和归属感、保护社区和文化、培养对美好生活的希望，以及对长期方案可行性的威胁。
本综述中参与者健康之旅的重要方面是社会、情感和精神健康，这凸显了需要重新构建在原住民社区实施的卫生方案评估，避免使用常用的生物医学措施进行评估。评估人员应与社区协商，始终评估卫生专业人员在方案整个生命周期中满足社区需求和期望的能力。纳入关于参与者和社区层面结果的定性数据的评估可以提高决策者对卫生方案对社区影响的理解。
本文是对评估研究的综述，不涉及患者或公众。
