What influences the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australian primary health care? Findings from an Evidence Mapping Review

Abstract

Background: Ongoing impacts of colonisation, including experiences of intergenerational trauma, systemic racism, and systemic exclusion from appropriate health and social care services, contribute to Aboriginal and Torres Strait Islander people in Australia experiencing, in general, higher mortality and morbidity, and the onset of chronic, non-communicable disease at a younger age than non-Indigenous Australians. One health policy initiative available through the Medicare Benefits Schedule and available in primary healthcare settings is a comprehensive health assessment available as an annual health checks(HCs). This review aims to systematically identify contextual and mechanistic factors that contribute to the success or failure of implementing effective HCs in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australian primary health care (PHC). Methods: We systematically searched for peer-reviewed and grey literature, including policy reports, theses, and guidelines, between November 1, 1999, and June 31, 2023, using a combination of keywords and subject headings related to 'Health checks,' 'Chronic Disease,' and 'Aboriginal and Torres Islander peoples’ in seven databases. The extracted data were summarised using a content analysis approach, applying strength-based approaches. Results: 16 peer-reviewed articles and five grey literature articles that met the inclusion criteria were used for evidence synthesis that identified several contextual and mechanistic factors that influenced the implementation of HCs. Barriers included resource constraints driven by complexities in administrative, workforce, and policy domains that significantly impeded the implementation of HCs. Within PHC, physical space constraints, competing demands, and a focus on acute care over preventive measures hindered HC implementation. Additionally, inconsistent identification of Aboriginal and Torres Strait Islander status, negative attitudes of PHC staff towards HC efficacy, and patients' fear of stigma or confidentiality breaches were barriers. Patients reported HCs as failing to address holistic health needs. To improve HC implementation, enablers included strong clinical leadership, recruitment of culturally competent non-Indigenous and Aboriginal and Torres Strait Islander staff, Indigenous partnership and community engagement, and incentives for participation. Effective electronic records, transport provision and flexible scheduling also increased accessibility. Conclusion: Our findings suggest the need for future implementation to deliver HCs and improve health service and patient-reported outcomes research across different PHC models. While undertaking this research, it is crucial to implement policy and practice reforms as identified in this review that align with community priorities and aspirations to drive the uptake of quality HCs for the prevention and early detection of chronic diseases.