Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services: Trials that address a priority health issue, have had strong health service engagement and adequate local support seem more likely to succeed

Hueming Liu, Luciana Massi, Stephen Jan, Tim Usherwood, Anushka Patel, Noel E. Hayman, Alan Cass, Anne Marie Eades, Christopher Lawrence, David Peiris, Tracey-Lee Laba

Research output: Contribution to journalArticlepeer-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 - 6 Jul 2015

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