Table 4 Implications for practice

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.