Belinda Hengel1, Rebecca Guy2, Linda Garton3, James Ward4, Alice Rumbold5, Debbie Taylor-Thomson5, Bronwyn Silver5, Skye McGregor2, Amalie Dyda2, Janet Knox6, John Kaldor2, Lisa Maher2. 1. Apunipima Cape York Health Council, Cairns, PO Box 12045, Earlville, Qld 4870, Australia. 2. Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia. 3. NT Department of Health, Sexual Health and Blood Borne Virus Unit, Darwin, NT 0810, Australia. 4. Baker IDI, PO Box 1294, Alice Springs, NT, 0871, Australia. 5. Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. 6. Lismore Sexual Health Service, NSW Health, Sydney, NSW 2480, Australia.
Abstract
UNLABELLED: Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. METHODS: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. RESULTS: Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. CONCLUSIONS: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.
UNLABELLED: Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. METHODS: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. RESULTS:Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. CONCLUSIONS: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.
Authors: Barbara Nattabi; Veronica Matthews; Jodie Bailie; Alice Rumbold; David Scrimgeour; Gill Schierhout; James Ward; Rebecca Guy; John Kaldor; Sandra C Thompson; Ross Bailie Journal: BMC Infect Dis Date: 2017-02-15 Impact factor: 3.090
Authors: Ben B Hui; James S Ward; Rebecca Guy; Matthew G Law; Richard T Gray; David G Regan Journal: Open Forum Infect Dis Date: 2022-03-09 Impact factor: 3.835
Authors: Stephanie M Topp; Josslyn Tully; Rachel Cummins; Veronica Graham; Aryati Yashadhana; Lana Elliott; Sean Taylor Journal: BMJ Glob Health Date: 2021-07
Authors: Belinda Hengel; Stephen Bell; Linda Garton; James Ward; Alice Rumbold; Debbie Taylor-Thomson; Bronwyn Silver; Skye McGregor; Amalie Dyda; Janet Knox; Rebecca Guy; Lisa Maher; John Martin Kaldor Journal: BMC Health Serv Res Date: 2018-04-02 Impact factor: 2.655