Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: A qualitative study in remote aboriginal communities in Australia

Belinda Hengel*, Stephen Bell, Linda Garton, James Ward, Alice Rumbold, Debbie Taylor-Thomson, Bronwyn Silver, Skye McGregor, Amalie Dyda, Janet Knox, Rebecca Guy, Lisa Maher, John Martin Kaldor, Robyn McDermott, Steven Skov, John Boffa, Donna Ah Chee, Mathew Law, Christopher Fairley, Basil DonovanDavid Glance

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: Young people living in remote Australian Aboriginal communities experience high rates of sexually transmissible infections (STIs). STRIVE (STIs in Remote communities, ImproVed and Enhanced primary care) was a cluster randomised control trial of a sexual health continuous quality improvement (CQI) program. As part of the trial, qualitative research was conducted to explore staff perceptions of the CQI components, their normalisation and integration into routine practice, and the factors which influenced these processes. Methods: In-depth semi-structured interviews were conducted with 41 clinical staff at 22 remote community clinics during 2011-2013. Normalisation process theory was used to frame the analysis of interview data and to provide insights into enablers and barriers to the integration and normalisation of the CQI program and its six specific components. Results: Of the CQI components, participants reported that the clinical data reports had the highest degree of integration and normalisation. Action plan setting, the Systems Assessment Tool, and the STRIVE coordinator role, were perceived as adding value to the program, but were less readily integrated or normalised. The remaining two components (dedicated funding for health promotion and service incentive payments) were seen as least relevant. Our analysis also highlighted factors which enabled greater integration of the CQI components. These included familiarity with CQI tools, increased accountability of health centre staff and the translation of the CQI program into guideline-driven care. The analysis also identified barriers, including high staff turnover, limited time involved in the program and competing clinical demands and programs. Conclusions: Across all of the CQI components, the clinical data reports had the highest degree of integration and normalisation. The action plans, systems assessment tool and the STRIVE coordinator role all complemented the data reports and allowed these components to be translated directly into clinical activity. To ensure their uptake, CQI programs must acknowledge local clinical guidelines, be compatible with translation into clinical activity and have managerial support. Sexual health CQI needs to align with other CQI activities, engage staff and promote accountability through the provision of clinic specific data and regular face-to-face meetings. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12610000358044. Registered 6/05/2010. Prospectively Registered.

Original languageEnglish
Article number230
JournalBMC Health Services Research
Issue number1
Publication statusPublished - 2 Apr 2018
Externally publishedYes

Bibliographical note

Funding Information:
Australian National Health and Medical Research Council (NHMRC), Grant ID: 568806. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed in this publication are those of the authors and do not reflect the views of NHMRC. John Kaldor, Rebecca Guy, Alice Rumbold, Basil Donovan and Lisa Maher are supported by NHMRC fellowships.

Funding Information:
1Apunipima Cape York Health Council, PO Box 12045, Earlville, Cairns, Qld 4870, Australia. 2Kirby Institute, UNSW Sydney, Wallace Wurth Building, Kensington, NSW 2052, Australia. 3NT Department of Health, Sexual Health and Blood Borne Virus Unit, Casuarina, NT 0811, Australia. 4South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia. 5Menzies School of Health Research, Darwin, NT 0810, Australia. 6Robinson Research Institute, University of Adelaide, Adelaide, SA 5006, Australia. 7Lismore Sexual Health Service, NSW Health, Sydney, NSW 2480, Australia. 8Flinders University, Adelaide, SA 5000, Australia. 9Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia. 10Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia. 11Central Australian Aboriginal Congress, Alice Springs, NT 0870, Australia.

Publisher Copyright:
© 2018 The Author(s).


  • Aboriginal
  • Continuous quality improvement
  • Normalisation process theory
  • Sexual health


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