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

    Research output: Contribution to journalArticleResearchpeer-review

    15 Downloads (Pure)

    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

    Fingerprint

    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.
    @article{10c3bab5be58446a8fede8b0dc043eff,
    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.",
    keywords = "adult, Article, Australian Aborigine, clinical article, clinical practice, comprehension, controlled study, cultural factor, diagnostic test, female, health care, health care delivery, health center, health personnel attitude, health program, human, indigenous people, male, primary health care, qualitative research, randomized controlled trial, sexual health, sexually transmitted disease, staff training, teamwork, total quality management",
    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",
    year = "2015",
    doi = "10.1071/SH14080",
    language = "English",
    volume = "12",
    pages = "4--12",
    journal = "Sexual Health",
    issn = "1448-5028",
    publisher = "CSIRO Publishing",
    number = "1",

    }

    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

    TY - JOUR

    T1 - Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities

    T2 - results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study

    AU - Hengel, Belinda

    AU - Guy, Rebecca

    AU - Garton, Linda

    AU - Ward, James

    AU - Rumbold, Alice

    AU - Taylor-Thomson, Debbie

    AU - Silver, Bronwyn Joy

    AU - McGregor, Skye

    AU - Dyda, Amalie

    AU - Knox, Janet

    AU - Kaldor, John

    AU - Maher, Lisa

    PY - 2015

    Y1 - 2015

    N2 - 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.

    AB - 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.

    KW - adult

    KW - Article

    KW - Australian Aborigine

    KW - clinical article

    KW - clinical practice

    KW - comprehension

    KW - controlled study

    KW - cultural factor

    KW - diagnostic test

    KW - female

    KW - health care

    KW - health care delivery

    KW - health center

    KW - health personnel attitude

    KW - health program

    KW - human

    KW - indigenous people

    KW - male

    KW - primary health care

    KW - qualitative research

    KW - randomized controlled trial

    KW - sexual health

    KW - sexually transmitted disease

    KW - staff training

    KW - teamwork

    KW - total quality management

    U2 - 10.1071/SH14080

    DO - 10.1071/SH14080

    M3 - Article

    VL - 12

    SP - 4

    EP - 12

    JO - Sexual Health

    JF - Sexual Health

    SN - 1448-5028

    IS - 1

    ER -