"Putting the power back into community": A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia's Northern Territory

Kelly Hosking; Teresa De Santis; Emily Vintour-Cesar; Phillip Merrdi Wilson; Linda Bunn; George Garambaka Gurruwiwi; Shiraline Wurrawilya; Sarah Mariyalawuy Bukulatjpi; Sandra Nelson; Cheryl Ross; Kelly-Anne Stuart-Carter; Terese Ngurruwuthun; Amanda Dhagapan; Paula Binks; Richard Sullivan; Linda Ward; Phoebe Schroder; Jaclyn Tate-Baker; Joshua S Davis; Christine Connors; Jane Davies; Hep B PAST partnership

doi:10.1371/journal.pone.0288577

"Putting the power back into community": A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia's Northern Territory

PLoS One. 2024 Jan 24;19(1):e0288577. doi: 10.1371/journal.pone.0288577. eCollection 2024.

Authors

Kelly Hosking^{1

2

3}, Teresa De Santis³, Emily Vintour-Cesar^{1

2}, Phillip Merrdi Wilson³, Linda Bunn³, George Garambaka Gurruwiwi², Shiraline Wurrawilya³, Sarah Mariyalawuy Bukulatjpi⁴, Sandra Nelson³, Cheryl Ross², Kelly-Anne Stuart-Carter⁵, Terese Ngurruwuthun⁴, Amanda Dhagapan⁴, Paula Binks², Richard Sullivan^{2

6}, Linda Ward², Phoebe Schroder⁷, Jaclyn Tate-Baker⁸, Joshua S Davis^{2

9}, Christine Connors^{1

3}, Jane Davies^{2

8}; Hep B PAST partnership

Affiliations

¹ Public Health Directorate, Office of the Chief Health Officer, Northern Territory Health, Northern Territory, Australia.
² Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
³ Population and Primary Health Care Branch, Top End Health Service, Northern Territory Health, Northern Territory, Australia.
⁴ Miwatj Aboriginal Health Corporation, Nhulunbuy, East Arnhem Land, Northern Territory, Australia.
⁵ Centre for Disease Control, Northern Territory Health, Alice Springs, Northern Territory, Australia.
⁶ UNSW School of Clinical Medicine, St George & Sutherland Campus, Jannali, NSW, Australia.
⁷ Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, NSW, Australia.
⁸ Department of Infectious Diseases, Royal Darwin and Palmerston Hospital, Northern Territory Health, Darwin, Northern Territory, Australia.
⁹ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.

Abstract

Background: Chronic hepatitis B (CHB) is endemic in the Aboriginal and Torres Strait Islander population of Australia's Northern Territory. Progression to liver disease can be prevented if holistic care is provided. Low health literacy amongst health professionals is a known barrier to caring for people living with CHB. We co-designed and delivered a culturally safe "Managing hepatitis B" training course for the Aboriginal health workforce. Here, we present an evaluation of the course.

Objectives: 1. To improve course participants CHB-related knowledge, attitudes, and clinical practice. 2. To evaluate the "Managing hepatitis B" training course. 3. To enable participants to have the skills and confidence to be part of the care team.

Methods: We used participatory action research and culturally safe principles. We used purpose-built quantitative and qualitative evaluation tools to evaluate our "Managing hepatitis B" training course. We integrated the two forms of data, deductively analysing codes, grouped into categories, and assessed pedagogical outcomes against Kirkpatrick's training evaluation framework.

Results: Eight courses were delivered between 2019 and 2023, with 130 participants from 32 communities. Pre- and post-course questionnaires demonstrated statistically significant improvements in all domains, p<0.001 on 93 matched pairs. Thematic network analysis demonstrated high levels of course acceptability and significant knowledge acquisition. Other themes identified include cultural safety, shame, previous misinformation, and misconceptions about transmission. Observations demonstrate improvements in post-course engagement, a deep understanding of CHB as well as increased participation in clinical care teams.

Conclusions: The "Managing hepatitis B" training course led to a sustained improvement in the knowledge and attitudes of the Aboriginal health workforce, resulting in improved care and treatment uptake for people living with CHB. Important non-clinical outcomes included strengthening teaching and leadership skills, and empowerment.

Copyright: © 2024 Hosking et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Australian Aboriginal and Torres Strait Islander Peoples
Education, Medical, Continuing*
Health Services, Indigenous*
Health Workforce
Hepatitis B, Chronic*
Humans
Northern Territory

Grants and funding

The Australian National Health and Medical Research Council (NHMRC) supported this work. This research is part of the Hep B PAST project, which receives an NHMRC partnership grant, GNT1151837. KH is undertaking a PhD and has an NHRMC scholarship, GNT1190918. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.