Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities

results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study

Belinda Hengel, Rebecca Guy, Linda Garton, James Ward, Alice Rumbold, Debbie Taylor-Thomson, Bronwyn Joy Silver, Skye McGregor, Amalie Dyda, Janet Knox, John Kaldor, Lisa Maher

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Abstract

Background: Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. 

Methods: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. 

Results: Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. 

Conclusions: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.
Original languageEnglish
Pages (from-to)4-12
Number of pages9
JournalSexual Health
Volume12
Issue number1
DOIs
Publication statusPublished - 2015

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Sexually Transmitted Diseases
Primary Health Care
Health
Infection
Creativity
Confidentiality
Reproductive Health
Quality Improvement
Randomized Controlled Trials
Interviews
Population

Cite this

Hengel, Belinda ; Guy, Rebecca ; Garton, Linda ; Ward, James ; Rumbold, Alice ; Taylor-Thomson, Debbie ; Silver, Bronwyn Joy ; McGregor, Skye ; Dyda, Amalie ; Knox, Janet ; Kaldor, John ; Maher, Lisa. / Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities : results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study. In: Sexual Health. 2015 ; Vol. 12, No. 1. pp. 4-12.
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title = "Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study",
abstract = "Background: Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. Methods: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. Results: Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. Conclusions: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.",
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author = "Belinda Hengel and Rebecca Guy and Linda Garton and James Ward and Alice Rumbold and Debbie Taylor-Thomson and Silver, {Bronwyn Joy} and Skye McGregor and Amalie Dyda and Janet Knox and John Kaldor and Lisa Maher",
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Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities : results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study. / Hengel, Belinda; Guy, Rebecca; Garton, Linda; Ward, James; Rumbold, Alice; Taylor-Thomson, Debbie; Silver, Bronwyn Joy; McGregor, Skye; Dyda, Amalie; Knox, Janet; Kaldor, John; Maher, Lisa.

In: Sexual Health, Vol. 12, No. 1, 2015, p. 4-12.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Garton, Linda

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AU - Taylor-Thomson, Debbie

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