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Type: Journal article
Title: Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review
Author: Gibson, O.
Lisy, K.
Davy, C.
Aromataris, E.
Kite, E.
Lockwood, C.
Riitano, D.
McBride, K.
Brown, A.
Citation: Implementation Science, 2015; 10(1):71-1-71-23
Publisher: BioMed Central
Issue Date: 2015
ISSN: 1748-5908
Statement of
Odette Gibson, Karolina Lisy, Carol Davy, Edoardo Aromataris, Elaine Kite, Craig Lockwood, Dagmara Riitano, Katharine McBride, Alex Brown
Abstract: BACKGROUND: Access to appropriate, affordable, acceptable and comprehensive primary health care (PHC) is critical for improving the health of Indigenous populations. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. This systematic literature review synthesised international evidence on the factors that enable or inhibit the implementation of interventions aimed at improving chronic disease care for Indigenous people. METHODS: A systematic review using Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed platform), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Excerpta Medica Database (EMBASE), ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online and Primary Health Care Research and Information Service (PHCRIS) databases was undertaken. Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary. RESULTS: Twenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another. CONCLUSIONS: Future interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people.
Keywords: Australia; New Zealand; Canada; United States; Primary health care; Intervention; Chronic disease; Indigenous peoples
Rights: © 2015 Gibson et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
RMID: 0030029466
DOI: 10.1186/s13012-015-0261-x
Appears in Collections:Translational Health Science publications

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