Yadav Uday Narayan, Thottunkal Stefan, Agostino Jason, Sinka Victoria, Wyber Rosemary, Hammond Belinda, Butler Danielle C, Belfrage Mary, Freeman Kate, Passey Megan, Walke Emma, Smith Matthew, Jones Benjamin, Lovett Raymond, Douglas Kirsty A
Yardhura Walani, National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, The Australian National University, Canberra, ACT, Australia.
International Centre for Future Health Systems, University of New South Wales, Sydney, Sydney, NSW, Australia.
Health Res Policy Syst. 2025 May 27;23(1):70. doi: 10.1186/s12961-025-01325-9.
Chronic disease is the leading cause of morbidity and mortality among Aboriginal and Torres Strait Islander peoples in Australia. A comprehensive health assessment is available as an annual health check (HC) to Aboriginal and Torres Strait Islander peoples through the Medicare Benefits Schedule in primary health care settings. This review aims to systematically identify contextual and mechanistic factors that contribute to the success or failure of implementing effective HCs in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australian primary health care (PHC).
We systematically searched for peer-reviewed and grey literature, including policy reports, theses, and guidelines, between 1 November 1999 and 30 June 2023, using a combination of keywords and subject headings related to "health checks", "chronic disease", and "Aboriginal and Torres Islander peoples" in seven databases. The extracted data were summarized using a content analysis approach, applying strength-based approaches.
In total, 16 peer-reviewed articles and five grey literature that met the inclusion criteria were used for evidence synthesis that identified several contextual and mechanistic factors that influenced the implementation of HCs. Barriers included resource constraints driven by complexities in administrative, workforce and policy domains that significantly impeded the implementation of HCs. Within PHC, physical space constraints, competing demands and a focus on acute care over preventive measures hindered HC implementation. In addition, inconsistent identification of Aboriginal and Torres Strait Islander status, negative attitudes of PHC staff towards HC efficacy and patients' fear of stigma or confidentiality breaches were barriers. Patients reported HCs as failing to address holistic health needs. To improve HC implementation, enablers included strong clinical leadership, recruitment of culturally competent non-Indigenous and Aboriginal and Torres Strait Islander staff, Indigenous partnership and community engagement and incentives for participation. Effective electronic records, transport provision and flexible scheduling also increased accessibility.
Our findings suggest that future implementation research must adopt a more comprehensive and holistic approach across different models of PHC, with clearly identified contextual and mechanistic factors linked to people-reported and service outcomes, to guide the implementation and evaluation of HCs. While undertaking future research, it is crucial to implement policy and practice reforms as identified in this review to create a culturally safe service at the PHC level required to drive the uptake of quality HCs that aligns with community priorities and aspirations for the prevention and early detection of chronic diseases.
慢性病是澳大利亚原住民和托雷斯海峡岛民发病和死亡的主要原因。通过初级卫生保健机构的医疗保险福利计划，可为原住民和托雷斯海峡岛民提供全面健康评估作为年度健康检查（HC）。本综述旨在系统地确定在澳大利亚初级卫生保健（PHC）中，有助于在原住民和托雷斯海峡岛民中成功或失败实施有效健康检查以预防和早期发现慢性病的背景因素和机制因素。
我们在1999年11月1日至2023年6月30日期间，使用七个数据库中与“健康检查”、“慢性病”和“原住民和托雷斯岛民”相关的关键词和主题词组合，系统地搜索了同行评审文献和灰色文献，包括政策报告、论文和指南。提取的数据采用基于优势的内容分析方法进行总结。
总共16篇同行评审文章和5篇符合纳入标准的灰色文献用于证据综合，确定了几个影响健康检查实施的背景因素和机制因素。障碍包括行政、劳动力和政策领域的复杂性导致的资源限制，这严重阻碍了健康检查的实施。在初级卫生保健机构内部，物理空间限制、相互竞争的需求以及对急性护理而非预防措施的关注阻碍了健康检查的实施。此外，对原住民和托雷斯海峡岛民身份的识别不一致、初级卫生保健机构工作人员对健康检查效果的负面态度以及患者对耻辱感或保密性被侵犯的担忧都是障碍。患者报告健康检查未能满足整体健康需求。为了改善健康检查的实施，促进因素包括强有力的临床领导、招聘具有文化能力的非原住民和原住民及托雷斯海峡岛民工作人员、原住民伙伴关系和社区参与以及参与激励措施。有效的电子记录、交通提供和灵活的时间表也提高了可及性。
我们的研究结果表明，未来的实施研究必须在不同的初级卫生保健模式中采用更全面和整体的方法，明确确定与人们报告的结果和服务结果相关的背景因素和机制因素，以指导健康检查的实施和评估。在进行未来研究时，实施本综述中确定的政策和实践改革至关重要，以便在初级卫生保健层面创建一个文化安全的服务，以推动采用符合社区预防和早期发现慢性病优先事项和愿望的高质量健康检查。
