Author: Carole Reeve
Reeve, Carole, 2016 Translating research evidence into health service delivery, Flinders University, School of Medicine
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This thesis by published work investigates a population health approach to improving health outcomes of Aboriginal and Torres Strait Islander people in rural and remote Australia. In Chapter 1, I describe the current poor health status for Aboriginal and Torres Strait Islander people living in remote Australia and the importance of the research question and this thesis. I also provide a commentary on the literature around the development of a population health approach to reducing health inequities. Chapter 2 provides an outline of my own epistemology, the methodology and the program logic model used to evaluate the series of case studies. The Community Health service Evaluation Framework (CHEF) tool is developed using the program logic model and enables a consistent and systematic analysis of each case study. Chapters 3 to 6 describe each of the programs implemented and presents them each as a case study. These case studies are arranged to progress from a single clinical intervention through to health service re-orientation. The CHEF tool analysis of each intervention case was used to identify common themes and effective attributes across the case series.
This thesis, identifies attributes of effective population health interventions implemented in remote Australia:
• Test evidence-based assumptions in context
• Maximise the population impact
• Address the social determinants of health using multiple-level strategies
• Integrate with existing services
• Align implementation epistemology, theory and evaluation methodology to ensure accountability for outcomes and
• Empower the community.
This complexity requires a systems approach to planning, monitoring and evaluation. The CHEF tool was presented as a conceptual tool for evaluating population health interventions in the context of remote Aboriginal and Torres Strait Islander health. Finally, I draw these findings together into a proposed comprehensive evaluation framework that brings together both change theory and systems theory when improving health outcomes in the rural and remote context. Change theory challenges us to consider how we can adapt the structure of the health system in order to enable the processes required to achieve the outcomes of the intervention. Systems theory informs the importance of taking into account the context as well as the many components of the complex system to achieve sustainability and improve effectiveness.
The papers in this thesis demonstrated that improvements in health outcomes for rural and remote Aboriginal and Torres Strait Islander people are possible with a comprehensive population health approach. The thesis contributes to the literature by developing an analysis tool that identifies common themes and attributes across the case studies.
Policy and practice implications
Strong local leadership can maximise the opportunities to translate evidence into improvements in health service delivery. Key factors:
• Importance of planning to align the intervention, theoretical model and evaluation in partnership with the local community
• Monitoring to inform the adaption to context and integration with existing services for efficiency and sustainability and
• Embedding research and evaluation in health service delivery to ensure the appropriate data is collected for the effective evaluation of both the process and the impact.
Keywords: Research translation, Evaluation, Aboriginal health, Inequality, Access to health services, Appropriateness of health services
Subject: Health Service Management thesis, Primary Health Care thesis, Public Health thesis
Thesis type: Doctor of Philosophy
Completed: 2016
School: School of Medicine
Supervisor: Prof Lucie Walters