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Table 2 Meta-aggregated findings and categories

From: Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review

Five meta-aggregated synthesised findings and their categories
Finding: design attributes
• Partnering with Indigenous communities and individuals is critical to inform the design of an intervention in order to ensure the successful implementation and sustainability of the intervention
• Compatibility with systems and processes and adding value to existing services are qualities of a successful intervention
• Multiple funding sources could increase the budget to resource additional initiatives but this also increases reporting requirements. Funding accountability is closely linked to evaluation, which is imperative to build into the design of the intervention
• Local people employed as health workers are instruments for engaging patients
• There is a need for strong organisational and clinical leadership to effect change in chronic disease care through an intervention
• The context in which the intervention is implemented is critical in determining its success and sustainability. Context includes political will and the policy environment, the health service capacity for change and community acceptability
• Planning for sufficient workforce resourcing at the design stage is essential so that staff have the time they need to manage chronic diseases
• Willingness and capacity of existing staff to implement new ways of providing chronic disease care
Finding: chronic disease workforce
• Staff identify the need for cultural awareness training and that current training is not sufficient
• Chronic disease training and development for the primary health care workforce needs to be relevant and feasible
• Indigenous Health Workers are excluded from decision making and have limited support for carrying out their work
• Health care staff need support for their own well-being and to help them provide better care
• High turnover of staff in Indigenous health service provision precludes successful implementation of new initiatives
• Dedicated chronic disease positions with transparent roles and responsibilities will help ensure staff time is spent on chronic disease management
• There is a shortage of Aboriginal health workers in the primary health care workforce
Finding: clinical care pathways
• Lack of knowledge of available referral services prevents appropriate follow-up care
• Seamless referral pathways with a dedicated referral coordinator are important to avoid having patients fall through the gaps and miss out on care
• There are limitations in current clinical (electronic) support systems
Finding: patient/provider partnerships
• People with a chronic disease want to share responsibility for their care. They expect comprehensive information about their condition in lay language from service providers. Health care providers must allow patients to be a partner in their care.
• A role of the provider should be to support and empower patients to share responsibility for their health and health care.
• It is important that service providers can communicate in a culturally safe manner and relate to patients and the community
• It is important that service providers understand the competing demands and priorities of patients
Finding: access
• The presence of Indigenous health workers and/or the provision of health care in Indigenous spaces create a friendly and relaxed atmosphere for patients
• There are peer influences based on traditional or cultural understanding that can either enable or inhibit access to care
• Clients need to be able to consistently access services (i.e. ongoing service availability) and experience continuity of care
• Indigenous Health Workers provide cultural safety for patients
• It is important to consider the role of the family when providing chronic disease care to Indigenous patients and when considering the patient’s ability to manage their chronic disease
• The health care system is complex and requires an organised and coordinated approach to enable patients to navigate through it
• Providing a culturally safe service is an enabling factor for Indigenous patients accessing chronic disease management and must include treating patients and their families with respect and consideration