Capacity Building in Indigenous Chronic Disease Primary Health Care Research in Rural Australia Final Project Report July 2014 December Alex Brown
A C K N O W L E D G E M E N T S This research is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health. The information and opinions contained in it do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute or the Australian Government Department of Health. Wardliparingga Aboriginal Health Research Unit South Australian Health & Medical Research Institute PO Box 11060 Adelaide SA 5000 Australia T 61 8 8128 4224 E wardliparingga@sahmri.com http://www.sahmri.com P a g e 2
Contents Background... 4 PARTNERS... 4 OBJECTIVES... 4 Methods... 5 Results... 6 PROJECT OUTCOMES... 6 PROJECT OUTPUTS... 7 CAPACITY DEVELOPMENT FOR PRESENTERS... 7 FEEDBACK AND EVALUATION... 7 COLLABORATIONS AND PARTNERSHIPS... 8 Discussion... 9 RECOMMENDATIONS... 9 References... 10 P a g e 3
Background While considerable effort in recent years has seen the numbers of Indigenous people in higher education slowly climb, this has not as yet translated to the number of Aboriginal and Torres Strait Islander people undertaking research as a profession. The strategy for increasing capacity in Indigenous chronic disease research in primary health care settings requires a different approach. The building of research capacity within health service staff at the more senior levels in (Aboriginal Community Controlled Health Organisations) ACCHOs is likely to be a more appropriate and sustainable strategy. The principle of control over the research within Aboriginal organisations is a very important one, and the strategy of working with people currently active in rural ACCHOs ensures that future generations of Aboriginal and Torres Strait Islander researchers are embedded in an environment where research can occur and translation can be immediate. P A R T N E RS This project emerged from negotiations across a number of jurisdiction. These discussions focused on opportunities to build research skills in a cohort of ACCHO staff nationally who will have the capacity to contribute to research which will be of benefit to Aboriginal health services as well as the communities they serve. At the national level, the Australian Indigenous Doctors Association (AIDA) and National Aboriginal Community Controlled Health Organisation (NACCHO) were keen to be involved. At the jurisdictional level, several NACCHO affiliates expressed interest in building their research profile and encouraging and supporting the involvement of their members. OBJECTIVES The objectives of the project were, To identify particular issues and needs for research training and support for the conduct of rural primary health care chronic disease research in Indigenous communities in Australia; To develop and collate resources for people conducting rural primary health care chronic disease research in Indigenous communities in Australia; To develop the skills, knowledge and understanding of how rural primary health care chronic disease research can be conducted ethically, effectively, and in culturally sensitive and safe ways in Indigenous communities; and To develop a network of Indigenous researchers undertaking chronic disease research in rural primary health care settings in Australia. P a g e 4
Methods Short, face-to-face Research Master Classes supported by a range of electronic resources were believed to be the best way of building research capacity. This was important because the collaborating partners believe that staff working within this sector were often too busy to participate in many of the longer educational programs. Dr Carol Davy was appointed to develop the content of the Master Classes. A Project Advisory Committee consisting of the following senior researchers was formed to guide and review the quality of the Master Class content, Professor Alex Brown, Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute Professor Ngiare Brown, National Aboriginal Community Controlled Health Organisation Professor Margaret Cargo, University of South Australia Professor Kerin O Dea, University of South Australia; and Associate Professor James Ward, South Australian Health and Medical Research Institute P a g e 5
Results The Capacity Building in Indigenous Chronic Disease Primary Health Care Research in Rural Australia project developed two Research Master Classes (Understanding Research and Undertaking Research) to build the capacity of staff working in ACCHOs and their peak bodies, in primary healthcare chronic disease research. The two Research Master Classes were designed to be interactive, practical and targeted to individuals research interests. They include the building of practical skills, such as developing research questions, writing ethics and grant applications, and translating and exchanging knowledge in a conscious and integrated manner. It is important to note also that the classes focused on the methods used to conduct research effectively, with ethical and cultural issues at the forefront. P R OJECT OUTCOMES While the original agreement was to facilitate three Master Classes, due to the overwhelming interest in the Research Master Classes in early, SAHMRI requested and APHCRI agreed to extend the length of the project until 31 December. By the end of, twelve Research Master Classes had been facilitated with a total of 126 participants in urban and regional locations across nearly all states (Western Australia, South Australia, Victoria, New South Wales and Queensland) and all territories (Northern Territory, Australian Capital Territory). The table below shows dates, numbers of participants and organisations that participated in the Research Master Classes between July 2014 and December. Table 1: Research Master Class dates, participant numbers and participating organisations Date Number of Participants Participating Organisation 13-14 Aug 11 Australian Indigenous Doctors Association 2014 11-12 Mar 10 Victorian Aboriginal Community Controlled Health Organisation (VIC) 22-23 Apr 12 Aboriginal Health and Medical Research Council (NSW) 6-7 May 9 Victorian Aboriginal Community Controlled Health Organisation (VIC) 4-5 Jun 13 Kimberley Aboriginal Medical Services Council (WA) 15-16 Jun 10 Aboriginal Health Council of Western Australia (WA) 29-30 Jun 7 Australian Indigenous Doctors Association 1-2 Jul 8 Aboriginal Medical Services Association of Northern Territory (NT) 12-13 Aug 9 Tobwabba Aboriginal Medical Service (NSW) 1-2 Oct 12 Apunipima Cape York Health Council (QLD) 4-5 Nov 15 Nunkuwarrin Yunti Inc. (SA) 3-4 Dec 10 Winnunga Nimmityjah Aboriginal Health Service (ACT) Total 126 P a g e 6
Due to the ongoing interest in this capacity building project, the Project Advisory Committee has continued to assist Dr Davy in planning for future Master Classes. This has resulted in not only a commitment to sustain the two original Research Master Classes into the future but also develop an additional Master Class focusing on Evaluation. P R OJECT OU T P U T S In addition to the face-to-face workshops, this project has resulted in the development of the following freely available resources (wardliparingga@sahmri.com), which are accessible from a web-based portal for Research Master Class participants. This portal houses additional resources as they become available, including the following: Presenters Guide Understanding Research Master Class Study Guide Understanding Research Master Class Presenters Guide Introduction to Undertaking Research Master Class Study Guide Introduction to Undertaking Research Master Class Additional resources, including those referenced during the Master Classes Link to online participant feedback survey Poster presented at LIME Connection VI Conference, Townsville QLD, 13 August At the completion of each Research Master Class, all participants were posted a certificate of participation and were emailed an electronic link to the password protected web-based portal from which they could access materials and resources provided during the course. C A P A CITY D E V E L OPMENT FOR PRESENTERS In addition to the number of benefits for attending participants, there are also a number of benefits to the researchers facilitating the Master Classes. The Master Classes are cofacilitated by at least one senior researcher (Aboriginal or non-indigenous) and one early career Aboriginal and Torres Strait Islander research. In particular, early career researchers are provided with an opportunity to strengthen their public presentation and teaching skills within practitioner settings. For this reason, a comprehensive Presenters Guide has been developed for each course, which provides details about course content including examples that can be referred to in order to illustrate the information being provided. F E E D B ACK AND EVALUATION An anonymous online survey was also sent to all participants. Results from these surveys suggest that the Research Master Classes are well received, while anecdotal evidence shows positive long-term outcomes, such as participants who have gone on to successfully apply for post graduate scholarships with the University of Adelaide and fellowships through CREATE. Other past participants are undertaking small studies within their own organisations. However, as it remains unclear whether these examples are isolated incidents, a more formal evaluation is planned in order to better understand the long-term impact of these Research Master Classes. This more formal Research Master Class evaluation draws on Bandura s Social Cognitive Theory (Bandura 1986), which suggests that people are driven to change by both internal and environmental factors. The evaluation has three primary aims: (1) to identify any changes to awareness, understanding or behaviour that have resulted from attending a Master Class; (2) to identify and describe any outcomes that have been influenced by or are a direct result of attending a Research Master Class; and (3) to explore ways in which the provision of future Master Classes and associated resources and support can be improved. P a g e 7
Once appropriate ethical approval has been obtained, all 126 Research Master Class participants will be invited to complete an online survey focusing on the three evaluation aims. At the end of the survey, participants will be asked if they are happy to be contacted to discuss participating in a semi-structured telephone interview. A purposive sample of participants who agree to be contacted will be selected, ensuring a range of ages, roles within the Aboriginal Health Sector and gender. The telephone interview will seek to deepen findings from the survey, not only focusing on the main themes but also any unexpected issues that were raised. The telephone interview will also seek to further explore and document outcomes that were identified as being influenced by or resulting from attending the Research Master Classes. Finally, the telephone interview will be used to explore the environmental factors, including system and service issues, which either supported or inhibited participants from making use of learnings from the Research Master Classes. C OLLABORATIONS AND PARTNERSHIPS One of the primary benefits of the Master Classes has been the networking opportunities both between participants in the workshops and between participants and senior Aboriginal researchers. This has led to a number of associated outcomes including the opportunity to collaborate on research projects. In addition, the Master Classes have allowed Kanyini Vascular Collaboration to strengthen existing relationships with AIDA and NACCHO as well as develop new partnerships with the following ACCHOs and peak bodies, Victorian Aboriginal Community Controlled Health Organisation (Melbourne, VIC peak body) Aboriginal Health and Medical Research Council (Sydney, NSW peak body) Kimberley Aboriginal Medical Services Council (Broome, WA peak body) Tobwabba Aboriginal Medical Service (Forster, NSW health service) Winnunga Nimmityjah Aboriginal Health Service (Canberra, ACT peak body) Aboriginal Health Council of Western Australia (Perth, WA peak body) Apunipima Cape York Health Council (Cairns, QLD peak body) Aboriginal Medical Services Association of Northern Territory (Alice Springs/Darwin, NT peak body) Danila Dilba Medical Service (Darwin, NT service) Nunkuwarrin Yunti Inc (Adelaide, SA service) Importantly, given the unexpected levels of interest in these Master Classes, it is intended that Wardliparingga will continue to offer the Research Master Classes into the future, as well as develop further Master Classes, such as one focusing on Evaluation. P a g e 8
Discussion As well as increasing the research capacity of participants, the Master Class series presents opportunities for Aboriginal Health Sector staff to be mentored by senior researchers, for early career Aboriginal and Torres Strait Islander researchers to increase their presentation skills, and for participants and presenters to broaden their networks. As noted above, the content of the Research Master Classes included a range of practical research skills including how to develop a research question and research proposal, and how to write ethics applications and grant applications. The Research Master Classes have a particular focus on conducting ethical research and translating research findings into practice in order to make a practical difference for Aboriginal and Torres Strait Islander peoples. As part of the courses, participants are provided with comprehensive Study Guides with links to further resources that help them to apply the skills they learn. The partnerships developed through this project were aimed at reducing the gap between research and policy and practice by developing the capacity of healthcare practitioners and health policy makers to understand and more deeply engage with research. While Master Class participants will be offered ongoing research mentoring from senior Aboriginal researchers, it is envisioned that the partnerships that were developed will remain of mutual benefit to all parties by providing opportunities for networking, collaboration and communication that can more closely align research activities with policy priorities. By undertaking a formal evaluation of the completed Research Master Classes, developing an Evaluation Master Class, and continuing to seek feedback regarding further research interests from organisations within the Aboriginal health sector, it is anticipated that the partnerships developed through the Research Master Class program will continue into the future, as well as give rise to further innovative collaborations between researchers and people working within the Aboriginal primary healthcare sector. R E C OMMENDATIONS It is recommended that the potential for short Master Classes be recognised as an appropriate way of strengthening the capacity of staff working in ACCHOs and peak bodies. It is recommended that all staff working within an ACCHO and their peak bodies be supported to participate in the suite of existing and currently under development Master Classes. It is recommended that support is provided to add to the suite of Master Classes in line with the needs of ACCHOs and peak bodies. It is recommended that opportunities be made available for Aboriginal and Torres Strait Islander healthcare service providers to work with senior researchers to increase their presentation skills and to broaden their professional networks and partnerships. P a g e 9
References Bandura, A. (1986). Social foundations of thought and action, Englewood Cliffs, New Jersey: Prentice-Hall. P a g e 10