Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care

Introduction Adverse pregnancy outcomes are more common among Aboriginal and Torres Strait Islander populations than non-Indigenous populations in Australia. Later in life, most of the difference in life expectancy between Aboriginal and Torres Strait Islander women and non-Indigenous women is due to non-communicable diseases (NCDs). Most Aboriginal and Torres Strait Islander women attend health services regularly during pregnancy. Providing high-quality care within these appointments has an important role to play in improving the current and future health of women and babies. Aim This study engaged stakeholders in a theory-informed process to use aggregated continuous quality improvement (CQI) data to identify 1) priority evidence-practice gaps in Aboriginal and Torres Strait Islander maternal health care, 2) barriers and enablers to high-quality care, and 3) strategies to address identified priorities. Methods Three phases of reporting and feedback were implemented using de-identified CQI data from 91 health services between 2007 and 2014 (4,402 client records). Stakeholders (n = 172) from a range of professions and organisations participated. Results Stakeholders identified four priority areas relating to NCDs: smoking, alcohol, psychosocial wellbeing and nutrition. Barriers or enablers to high-quality care included workforce support, professional development, teamwork, woman-centred care, decision support, equipment and community engagement. Strategies to address the priorities included upskilling staff to provide best practice care in priority areas, advocating for availability of healthy food, housing and local referral options, partnering with communities on health promotion projects, systems to facilitate continuity of care and clear referral pathways. Conclusions This novel use of large-scale aggregate CQI data facilitated stakeholder input on priority evidence-practice gaps in maternal health care in Australia. Evidence-practice gaps relating to NCD risk factors and social determinants of health were prioritised, and stakeholders suggested both healthcare-focussed initiatives and approaches involving the community and the wider health sector. The findings can inform health service planning, advocacy, inter-agency strategies, and future research.


Introduction
Maternal health -Phase 2 ESP Project 1. By Clicking 'Yes' here, you consent to take part in this survey. Your responses will remain confidential. * Yes, I agree to take part in this survey No, I don't want to take part in this survey Name Email address Phone 2. If you would like to receive feedback about this research, please provide your contact details: If you wish to supply your details but not have them linked to your survey response, contact us separately at abcd@menzies.edu.au Section 1 -Background Information Other (please specify) 9. Which of the following roles were represented in the group? (You may select as many as relevant) * The priority evidence-practice gaps in maternal care identified through Phase 1 of the ESP Project, and detailed in the trend data report are: # Enquiry about smoking and delivery of smoking cessation advice in pregnancy # Enquiry about alcohol use and delivery of brief counselling early in pregnancy # Social risk factor assessment in pregnancy and, if evidence of social risk, record of referral to appropriate services # Provision of appropriate follow-up for women identified as at-risk based on emotional wellbeing assessment # Discussion of SIDS prevention and the importance of keeping a safe environment for the baby (postnatal care) # Discussion of diet and nutrition for the mother and baby (postnatal care) # Emotional wellbeing screening for all women during pregnancy # Discussion of smoking and the increased risk of SIDS in babies in a smoking environment (postnatal care) We would like you to reflect on these priority evidence-practice gaps and the trend data when responding to the next section of the survey.

Maternal health -Phase 2 ESP Project
The next sections cover aspects of health centre systems, the broader system environment and staff attributes identified in international and Australian research as having the potential to impact on quality of care in a variety of contexts. The survey seeks your opinion on the extent to which the various items identified may be important in the Aboriginal and Torres Strait Islander primary health care (PHC) context.

Your responses should relate to:
(1) providing best practice maternal health care as relevant to the priority evidence-practice gaps. (

2) reflections on the report 'Priority Evidence-Practice Gaps in Aboriginal and Torres Strait Islander Maternal Health Care (with supporting data: 2007 -2014) -Phase 2 ESP Project'
(3) the PHC system for Aboriginal and Torres Strait Islander people in general rather than to any Section 2: Barriers and Enablers to Addressing Gaps Maternal health -Phase 2 ESP Project specific health centre or service.
Attributes of the health centre or broader health system environment that support best practice in maternal health care.
Please select responses to the following statements.

Strongly disagree
Partly disagree Partly agree Strongly agree Don't know 13. Within the socio-political context, there is sufficient financial support (e.g. from local/regional health authorities, government) to support best practice in maternal health care as relevant to the priority evidence-practice gaps We have asked you to identify barrier, enablers and strategies in one survey, and will feed this information back in one report. (This occurred over two phases of reports and feedback in the earlier ESP Project cycles for child health and chronic illness care).

Section 5: Feedback on this survey
Maternal health -Phase 2 ESP Project 87. Do you have any comments about this changed approach?