Types of participants
Individual participants are not a feature of the scoping review and therefore will not be considered in the study selection.
The concepts of interests are the characteristics (values, principles, components and suggested practical applications) of models of service delivery implemented within an Indigenous health service.
Within the literature a number of different terms such as service delivery models of care and service frameworks have been used interchangeably to articulate the way in which services are or should be operationalized. For the purposes of this review a service delivery model includes all factors involved in the delivery of care. Including, but not limited, to:
- The vision, values and strategies that underpin the delivery of care
- The healthcare services and programs available to clients
- Governance and leadership
- Workforce organization and supply
- Infrastructure and other resources.
For the purpose of this review all characteristics of a model of service delivery, either in part or as a whole, will be considered.
The context is settings where primary health care services are provided predominantly to Indigenous peoples. Indigenous peoples are defined as26 (para1):
"Indigenous populations are communities that live within, or are attached to, geographically distinct traditional habitats or ancestral territories, and who identify themselves as being part of a distinct cultural group, descended from groups present in the area before modern states were created and current borders defined. They generally maintain cultural and social identities, and social, economic, cultural and political institutions, separate from the mainstream or dominant society or culture."
Primary health is defined as27 (para3):
"…socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems with a suitably trained workforce comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives priority to those most in need and addresses health inequalities; maximizes community and individual self-reliance, participation and control; and involves collaboration and partnership with other sectors to promote public health. Comprehensive primary health care includes health promotion, illness prevention, treatment and care of the sick, community development, and advocacy and rehabilitation."
Types of sources
All qualitative, quantitative, economic and mixed methods studies will be considered for inclusion. In addition reviews and systematic literature reviews of programs that meet the inclusion criteria will also be retrieved. Grey (unpublished) literature will also be included. Conference papers will not be included.
The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of PubMed and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. In addition, academics from universities with expertise in Indigenous health services will be contacted and asked to identify literature (particularly grey literature) that meets the review inclusion criteria.
Articles will be assessed for inclusion based on the previously mentioned inclusion criteria examining them by title and abstract. Full text of the articles will be retrieved if it meets the inclusion criteria or if further examination is required before excluding the article. Two reviewers will independently confirm if the full text article meets the inclusion criteria. Any disagreements will be decided by a third reviewer. Multiple articles from the same program/project will be linked and treated as one for the purposes of data extraction and presenting the results.
Studies published in English will be considered for inclusion in this review, and studies published from September 1978 will be considered for inclusion in this review. September 1978 is the date that the Declaration of Alma Ata was adopted at the International Conference on Primary Health Care,26 and subsequently the growth of primary health care internationally.
Databases to be searched
The initial search terms include: Aboriginal, Aborigine, Indigenous, first nation, Maori, Inuit, American Indian, primary health care, comprehensive primary health care, medical service, health service, community care, community health care, model.
Charting the results
The results of each study (including qualitative, quantitative and other study types) will be extracted by at least two independent reviewers with the assistance of QSR International's NVivo 10 software, a qualitative analysis software package.27 QSR International's NVivo 10 software will assist with charting of results, and for sorting and clarifying of data. Data that cannot be recorded in NVivo 10 software will be recorded in a separate charting table (Appendix I). To prevent bias, publications of which one of the reviewers has a conflict of interest will have the data extracted by two other reviewers. The reviewers involved in charting the results will meet as a group to review and pilot the extract of data from two to five studies using NVivo 10 software before reviewers independently extract data.
Presenting the results
Results will be presented as a map of the data extracted from the included papers, to be further refined by the reviewers toward the end of the review process, when there is greater awareness of the contents of the included studies. It is expected however that the key overarching characteristic of the service delivery models identified will be presented and described within the results section of the review.
Conflicts of interest
In accordance with the Conflicts of interest and Cochrane Reviews manual (2.2.4), any included studies in this scoping review that were authored by one of the review authors will be assessed for quality and have the data extracted and checked by the other reviewers, limiting any bias that may occur.28
The authors would like to acknowledge the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) leadership group, comprising national representatives of the Aboriginal Health Sector who provide advice and guidance on CREATE's program of work and are supportive of this review.
This research was supported by National Health and Medical Research Council (NHMRC) Grant No 1061242. The published material is solely the responsibility of the individual authors and do not reflect the views of NHMRC.
1. Peters M, Godfrey C, McInerney P, Baldini SC, Khalil H, Parker D. Methodology for JBI scoping reviews. In: Aromataris E, ed. The Joanna Briggs Institute Reviewers' Manual 2015. Adelaide (Australia): The Joanna Briggs Institute 2015.
2. Peters M, Godfrey C, McInerney P, Khalil H, Parker D, Baldini Soares C. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141-6.
3. Gracey M, King M. Indigenous
health part 1: determinants and disease patterns. Lancet. 2009;374(9683):65-75.
8. Ellison-Loschmann L, Pearce N. Improving access to health care among New Zealand's Maori
population. Am J Public Health. 2006;96(4):612-7.
9. Lurie N. Measuring disparities in access to care. In: Swift EK, ed. Guidance for the National Healthcare Disparities Report. Washington, D. C.: The National Academies Press 2002:99-148.
16. First Nations Health Authority (CA). About us 2015 [Internet]. [cited 13/05/2015]; Available from: http://www.fnha.ca/about
23. Comino E, Harris M, Haas M et al. Optimizing access to best practice primary health care
: a systematic review. Canberra, Australia: APHCRI; 2010.
24. Shah BR, Gunraj N, Hux JE. Markers of access to and quality of primary care for Aboriginal
people in Ontario, Canada. Am J Public Health. 2003;93(5):798-802.
25. Thomas SL, Zhao Y, Guthridge SL, Wakerman J. The cost-effectiveness of primary care for Indigenous
Australians with diabetes living in remote Northern Territory communities. Med J Aust. 2014;200(11):658-62.
27. QSR International Pty Ltd. NVivo qualitative data analysis software. 10 ed 2012.
Appendix I: Charting table