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Table 4 Implications for practice

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

Practice implications
Design attributes
• Interventions should include a strategy for partnering with the community. This should include employment and training of local people to implement the intervention.
• Interventions should, where possible, be designed to be compatible with existing systems or processes, and/or provide training and support for staff. The intervention should add value to the service, in the form of gained knowledge or improvement in existing processes.
• Interventions must be adequately staffed to enable workers to complete their CD-specific tasks. Delegation of tasks and responsibilities of CD staff and the roles of all staff must be transparent to all workers.
• A strategy for impact evaluation must be proposed in the intervention design phase.
• A positive workplace culture should be fostered through strong leadership, with the presence of champions and change agents.
Chronic disease workforce
• Adequate and feasible training must be provided to staff to effectively implement the CD intervention. Cultural awareness training must be included.
• Indigenous Health Workers must be recruited, trained, employed, and included in all stages of the intervention.
• To mitigate high staff turnover in CD interventions, staff must be supported in their work. Reasonable workloads and adequate living conditions for remote staff should be considered.
Clinical care pathways
• A dedicated referral coordinator should be employed to bridge the gaps in referral processes.
Patient/provider partnerships
• Providers should receive guidance on how to communicate with their patients. Including patients in monitoring their progress and speaking with patients in lay language is important.
Access
• Indigenous health workers should be employed, and Indigenous people should be employed in other roles within PHC services. Where possible, services should be provided and delivered within culturally safe spaces.