JMIR Publications

ABSTRACT

Background:

In the context of a syphilis outbreak in neighbouring states, a multi-faceted systems change to increase testing for sexually transmissible infections (STI) among Aboriginal young people aged 15-29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. Components included electronic medical record (eMR) prompts and automated pathology test sets to increase STI testing in annual routine health assessments, credentialling of nurses and Aboriginal Health Practitioners to conduct STI tests independently, pathology request forms pre-signed by a doctor, and improved data reporting.

Objective:

We aimed to determine if the systems change increased integration of STI testing into routine health assessments; inclusion of syphilis tests in STI testing; and STI testing uptake overall. We also explored understandings of factors contributing to acceptability and normalisation of the systems change among staff.

Methods:

We used a mixed-methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhoea, syphilis, and an internal control (glucose). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semi-structured interviews with ACCHS staff using Normalisation Process Theory.

Results:

Among 2,461 patients, the annual proportion of health assessments that included any STI test increased from 16% in the first year of the study period to 43% after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (Coefficient = 0.22, P<0.01) with no decline for 12 months thereafter. The increase was greater for men with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal Health Practitioner-led testing and pre-signed pathology forms proved more difficult to normalise than electronic prompts and shortcuts. Interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual healthcare in routine practice.

Conclusions:

This study provides evidence for the first time that optimising health assessments electronically is an effective and acceptable strategy to increase and sustain integration and completeness of STI testing among Aboriginal young people attending ACCHS. Future strategies should focus on increasing uptake of health assessments and promote whole-of-service engagement and accountability.