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Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services

Liu, Hueming, Laba, Tracey-Lea, Massi, Luciana, Jan, Stephen, Usherwood, Tim, Patel, Anushka, Hayman, Noel E., Cass, Alan, Eades, Anee-Marie, Lawrence, Chris and Peiris, David P. (2015). Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services. Medical Journal of Australia,203(1):24-28.

Document type: Journal Article
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IRMA ID 75039815xPUB933
Title Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services
Author Liu, Hueming
Laba, Tracey-Lea
Massi, Luciana
Jan, Stephen
Usherwood, Tim
Patel, Anushka
Hayman, Noel E.
Cass, Alan
Eades, Anee-Marie
Lawrence, Chris
Peiris, David P.
Journal Name Medical Journal of Australia
Publication Date 2015
Volume Number 203
Issue Number 1
ISSN 0025-729X   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84936745631
Start Page 24
End Page 28
Total Pages 5
Place of Publication Australia
Publisher Australasian Medical Publishing Company Pty. Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Objective:
 To identify facilitators and barriers to clinical trial implementation in Aboriginal health services.

Design:
Indepth interview study with thematic analysis.

Setting:
Six Aboriginal community-controlled health services and one government-run service involved in the Kanyini Guidelines Adherence with the Polypill (KGAP) study, a pragmatic randomised controlled trial that aimed to improve adherence to indicated drug treatments for people at high risk of cardiovascular disease.

Participants:
32 health care providers and 21 Aboriginal and Torres Strait Islander patients.

Results:
A fundamental enabler was that participants considered the research to be governed and endorsed by the local health service. That the research was perceived to address a health priority for communities was also highly motivating for both providers and patients. Enlisting the support of Aboriginal and Torres Strait Islander staff champions who were visible to the community as the main source of information about the trial was particularly important. The major implementation barrier for staff was balancing their service delivery roles with adherence to often highly demanding trial-related procedures. This was partially alleviated by the research team's provision of onsite support and attempts to make trial processes more streamlined. Although more intensive support was highly desired, there were usually insufficient resources to provide this.

Conclusion:
Despite strong community and health service support, major investments in time and resources are needed to ensure successful implementation and minimal disruption to already overstretched, routine services. Trial budgets will necessarily be inflated as a result. Funding agencies need to consider these additional resource demands when supporting trials of a similar nature.
DOI http://dx.doi.org/10.5694/mja14.00581   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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