Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services

Hueiming Liu, Tracey-Lea Laba, L Massi, Stephen Jan, Tim Usherwood, Anushka Patel, Noel Hayman, Alan Cass, AM Eades, Christopher Lawrence, David Peiris

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To identify facilitators and barriers to clinical trial implementation in Aboriginal health services.

    Design: Indepth interview study with thematic analysis.

    Setting: Six Aboriginal community-controlled health services and one government-run service involved in the Kanyini Guidelines Adherence with the Polypill (KGAP) study, a pragmatic randomised controlled trial that aimed to improve adherence to indicated drug treatments for people at high risk of cardiovascular disease.

    Participants: 32 health care providers and 21 Aboriginal and Torres Strait Islander patients.

    Results: A fundamental enabler was that participants considered the research to be governed and endorsed by the local health service. That the research was perceived to address a health priority for communities was also highly motivating for both providers and patients. Enlisting the support of Aboriginal and Torres Strait Islander staff champions who were visible to the community as the main source of information about the trial was particularly important. The major implementation barrier for staff was balancing their service delivery roles with adherence to often highly demanding trial-related procedures. This was partially alleviated by the research team's provision of onsite support and attempts to make trial processes more streamlined. Although more intensive support was highly desired, there were usually insufficient resources to provide this.

    Conclusion: Despite strong community and health service support, major investments in time and resources are needed to ensure successful implementation and minimal disruption to already overstretched, routine services. Trial budgets will necessarily be inflated as a result. Funding agencies need to consider these additional resource demands when supporting trials of a similar nature.

    Original languageEnglish
    Pages (from-to)24-28
    Number of pages5
    JournalMedical Journal of Australia
    Volume203
    Issue number1
    DOIs
    Publication statusPublished - 2015

    Fingerprint

    Pragmatic Clinical Trials
    Health Services
    Community Health Services
    Research
    Guideline Adherence
    Health Priorities
    Budgets
    Health Personnel
    Cardiovascular Diseases
    Randomized Controlled Trials
    Clinical Trials
    Interviews
    Pharmaceutical Preparations
    Therapeutics

    Cite this

    Liu, Hueiming ; Laba, Tracey-Lea ; Massi, L ; Jan, Stephen ; Usherwood, Tim ; Patel, Anushka ; Hayman, Noel ; Cass, Alan ; Eades, AM ; Lawrence, Christopher ; Peiris, David. / Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services. In: Medical Journal of Australia. 2015 ; Vol. 203, No. 1. pp. 24-28.
    @article{21e7bcbf4a1147cfa363e7abeda8d452,
    title = "Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services",
    abstract = "Objective: To identify facilitators and barriers to clinical trial implementation in Aboriginal health services. Design: Indepth interview study with thematic analysis. Setting: Six Aboriginal community-controlled health services and one government-run service involved in the Kanyini Guidelines Adherence with the Polypill (KGAP) study, a pragmatic randomised controlled trial that aimed to improve adherence to indicated drug treatments for people at high risk of cardiovascular disease. Participants: 32 health care providers and 21 Aboriginal and Torres Strait Islander patients. Results: A fundamental enabler was that participants considered the research to be governed and endorsed by the local health service. That the research was perceived to address a health priority for communities was also highly motivating for both providers and patients. Enlisting the support of Aboriginal and Torres Strait Islander staff champions who were visible to the community as the main source of information about the trial was particularly important. The major implementation barrier for staff was balancing their service delivery roles with adherence to often highly demanding trial-related procedures. This was partially alleviated by the research team's provision of onsite support and attempts to make trial processes more streamlined. Although more intensive support was highly desired, there were usually insufficient resources to provide this. Conclusion: Despite strong community and health service support, major investments in time and resources are needed to ensure successful implementation and minimal disruption to already overstretched, routine services. Trial budgets will necessarily be inflated as a result. Funding agencies need to consider these additional resource demands when supporting trials of a similar nature.",
    keywords = "Article, cardiovascular disease, health care personnel, health care planning, health service, high risk patient, human, medical ethics, patient compliance, patient participation, randomized controlled trial (topic), adult, Australia, Cardiovascular Diseases, communication disorder, controlled study, female, health auxiliary, indigenous health care, male, middle aged, Oceanic ancestry group, organization and management, practice guideline, psychology, randomized controlled trial, statistics and numerical data, Adult, Communication Barriers, Community Health Workers, Female, Guideline Adherence, Health Services, Indigenous, Humans, Male, Middle Aged, Oceanic Ancestry Group, Patient Compliance",
    author = "Hueiming Liu and Tracey-Lea Laba and L Massi and Stephen Jan and Tim Usherwood and Anushka Patel and Noel Hayman and Alan Cass and AM Eades and Christopher Lawrence and David Peiris",
    note = "NHMRC (grant numbers 457508, 571281 and 632810)",
    year = "2015",
    doi = "10.5694/mja14.00581",
    language = "English",
    volume = "203",
    pages = "24--28",
    journal = "Medical Journal of Australia",
    issn = "0025-729X",
    publisher = "Australasian Medical Publishing Company",
    number = "1",

    }

    Liu, H, Laba, T-L, Massi, L, Jan, S, Usherwood, T, Patel, A, Hayman, N, Cass, A, Eades, AM, Lawrence, C & Peiris, D 2015, 'Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services', Medical Journal of Australia, vol. 203, no. 1, pp. 24-28. https://doi.org/10.5694/mja14.00581

    Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services. / Liu, Hueiming; Laba, Tracey-Lea; Massi, L; Jan, Stephen; Usherwood, Tim; Patel, Anushka; Hayman, Noel; Cass, Alan; Eades, AM; Lawrence, Christopher; Peiris, David.

    In: Medical Journal of Australia, Vol. 203, No. 1, 2015, p. 24-28.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services

    AU - Liu, Hueiming

    AU - Laba, Tracey-Lea

    AU - Massi, L

    AU - Jan, Stephen

    AU - Usherwood, Tim

    AU - Patel, Anushka

    AU - Hayman, Noel

    AU - Cass, Alan

    AU - Eades, AM

    AU - Lawrence, Christopher

    AU - Peiris, David

    N1 - NHMRC (grant numbers 457508, 571281 and 632810)

    PY - 2015

    Y1 - 2015

    N2 - Objective: To identify facilitators and barriers to clinical trial implementation in Aboriginal health services. Design: Indepth interview study with thematic analysis. Setting: Six Aboriginal community-controlled health services and one government-run service involved in the Kanyini Guidelines Adherence with the Polypill (KGAP) study, a pragmatic randomised controlled trial that aimed to improve adherence to indicated drug treatments for people at high risk of cardiovascular disease. Participants: 32 health care providers and 21 Aboriginal and Torres Strait Islander patients. Results: A fundamental enabler was that participants considered the research to be governed and endorsed by the local health service. That the research was perceived to address a health priority for communities was also highly motivating for both providers and patients. Enlisting the support of Aboriginal and Torres Strait Islander staff champions who were visible to the community as the main source of information about the trial was particularly important. The major implementation barrier for staff was balancing their service delivery roles with adherence to often highly demanding trial-related procedures. This was partially alleviated by the research team's provision of onsite support and attempts to make trial processes more streamlined. Although more intensive support was highly desired, there were usually insufficient resources to provide this. Conclusion: Despite strong community and health service support, major investments in time and resources are needed to ensure successful implementation and minimal disruption to already overstretched, routine services. Trial budgets will necessarily be inflated as a result. Funding agencies need to consider these additional resource demands when supporting trials of a similar nature.

    AB - Objective: To identify facilitators and barriers to clinical trial implementation in Aboriginal health services. Design: Indepth interview study with thematic analysis. Setting: Six Aboriginal community-controlled health services and one government-run service involved in the Kanyini Guidelines Adherence with the Polypill (KGAP) study, a pragmatic randomised controlled trial that aimed to improve adherence to indicated drug treatments for people at high risk of cardiovascular disease. Participants: 32 health care providers and 21 Aboriginal and Torres Strait Islander patients. Results: A fundamental enabler was that participants considered the research to be governed and endorsed by the local health service. That the research was perceived to address a health priority for communities was also highly motivating for both providers and patients. Enlisting the support of Aboriginal and Torres Strait Islander staff champions who were visible to the community as the main source of information about the trial was particularly important. The major implementation barrier for staff was balancing their service delivery roles with adherence to often highly demanding trial-related procedures. This was partially alleviated by the research team's provision of onsite support and attempts to make trial processes more streamlined. Although more intensive support was highly desired, there were usually insufficient resources to provide this. Conclusion: Despite strong community and health service support, major investments in time and resources are needed to ensure successful implementation and minimal disruption to already overstretched, routine services. Trial budgets will necessarily be inflated as a result. Funding agencies need to consider these additional resource demands when supporting trials of a similar nature.

    KW - Article

    KW - cardiovascular disease

    KW - health care personnel

    KW - health care planning

    KW - health service

    KW - high risk patient

    KW - human

    KW - medical ethics

    KW - patient compliance

    KW - patient participation

    KW - randomized controlled trial (topic)

    KW - adult

    KW - Australia

    KW - Cardiovascular Diseases

    KW - communication disorder

    KW - controlled study

    KW - female

    KW - health auxiliary

    KW - indigenous health care

    KW - male

    KW - middle aged

    KW - Oceanic ancestry group

    KW - organization and management

    KW - practice guideline

    KW - psychology

    KW - randomized controlled trial

    KW - statistics and numerical data

    KW - Adult

    KW - Communication Barriers

    KW - Community Health Workers

    KW - Female

    KW - Guideline Adherence

    KW - Health Services, Indigenous

    KW - Humans

    KW - Male

    KW - Middle Aged

    KW - Oceanic Ancestry Group

    KW - Patient Compliance

    U2 - 10.5694/mja14.00581

    DO - 10.5694/mja14.00581

    M3 - Article

    VL - 203

    SP - 24

    EP - 28

    JO - Medical Journal of Australia

    JF - Medical Journal of Australia

    SN - 0025-729X

    IS - 1

    ER -