Improving health promotion in indigenous primary health care
: is a continuing quality improvement approach feasible?

  • Nicole Ann Percival

    Student thesis: Doctor of Philosophy (PhD) - CDU


    Indigenous primary health care (PHC) centres across Australia are achieving improvements in the quality of systems, processes and outcomes in clinical health care by applying a continuous quality improvement (CQI) approach known as Audit
    and Best Practice for Chronic Disease (ABCD). Using mixed methods and drawing on principles of participatory action research, this thesis investigates the feasibility of the ABCD CQI approach in health promotion.

    This thesis addresses a series of incremental and interconnected research objectives to: (1) develop quality indicators and audit tools in health promotion; describe and assess (2) the scope and quality of health promotion activities; and (3) the status of health centre system support for health promotion; and (4) determine the impact of the CQI approach on health promotion over two years. Indicators were developed and used to determine adherence to evidence-based practice and level of health
    centre system support for health promotion. Baseline findings showed significant evidence-practice gaps in the quality of health promotion activities and sub-optimal systems development for supporting health promotion. Following the introduction of the CQI approach, there were improvements in some aspects of health centre systems and in the quality of health promotion activities. These findings demonstrate that the ABCD CQI approach is both acceptable and feasible in health promotion.

    This study identified a number of constraints that may inhibit further improvements in health promotion. Sustained improvements in health promotion quality may be achieved by specifically addressing system barriers in organisational and policy environments and through more effective engagement of management, community people and other organisations in the quality improvement process. Future research should include an examination of how CQI in health promotion can be transferred to other settings and the requirements to support implementation in routine practice.
    Date of AwardJun 2014
    Original languageEnglish
    SupervisorRoss Stewart Bailie (Supervisor) & David Thomas (Supervisor)

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