Supporting reorientation of health services in Indigenous Australian communities: the health promotion systems assessment tool.

Summary: Few tools and mechanisms exist to assist the reorientation of health services, especially in the Indigenous Australian health context; where improving health status and life expectancy is a priority. We developed a health promotion systems assessment tool (HPSAT) to provide health services with the information and support they need to drive health system change. Tool development occurred using a participatory, iterative approach that included a literature review, expert input by Indigenous and non-Indigenous stakeholders and annual group workshops in four Indigenous Australian primary health care (PHC) services. Four health system components: (i) organizational environment; (ii) service delivery systems; (iii) information systems and decision support; and (iv) adaptability and integration, form the framework of the tool. A scoring system monitors system change over time. The HPSAT provides a constructive framework to support health services to collectively assess and support reorientation in Indigenous Australian PHC services. Participation of key stakeholders with an intimate knowledge about the local context was pivotal in developing a user-friendly and fit-for-purpose tool. Maximum benefits of the tool are likely to be gained when used as part of a continuous quality improvement intervention. Lay Summary: Primary health care services are important providers of health promotion approaches. In Australia, the health status and life expectancy of Indigenous peoples is much lower than that of the general population. Meeting Indigenous peoples' acute and chronic care needs can influence PHC service delivery models. Few tools and mechanism are available to support the reorientation of Indigenous Australian PHC services from an acute and chronic care model to a more comprehensive model, with greater emphasis on health promotion and prevention. This article describes the development and trialling of a tool providing Indigenous Australian PHC services with the information and support they need to reorient their health systems towards health promotion. The health promotion systems assessment tool provides a useful framework to facilitate collective appraisal of service delivery models and to identify opportunities for health system reorientation in Indigenous Australian PHC context. The tool has the potential to benefit many other health services seeking to reorient their systems towards health promotion. [ABSTRACT FROM AUTHOR]