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Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study

Hengel, Belinda, Guy, Rebecca, Garton, Linda, Ward, James, Rumbold, Alice R., Taylor-Thomson, Debbie M., Silver, Bronwyn J., McGregor, Skye, Dyda, Amalie, Knox, Janet, Kaldor, John, Maher, Lisa and STRIVE Invstigators (2015). Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study. Sexual Health,12(1):4-12.

Document type: Journal Article
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IRMA ID 75039815xPUB833
Title Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study
Author Hengel, Belinda
Guy, Rebecca
Garton, Linda
Ward, James
Rumbold, Alice R.
Taylor-Thomson, Debbie M.
Silver, Bronwyn J.
McGregor, Skye
Dyda, Amalie
Knox, Janet
Kaldor, John
Maher, Lisa
STRIVE Invstigators
Journal Name Sexual Health
Publication Date 2015
Volume Number 12
Issue Number 1
ISSN 1448-5028   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84924491308
Start Page 4
End Page 12
Total Pages 9
Place of Publication Australia
Publisher C S I R O Publishing
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract 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.
Keywords Indigenous
STI screening
DOI http://dx.doi.org/10.1071/SH14080   (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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