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      “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

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          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.

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          Most cited references62

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          Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

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            Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study

            The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to estimate the national, regional, and global prevalence of HBsAg in the general population and in the population aged 5 years in 2016, as well as coverage of prophylaxis, diagnosis, and treatment.
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              Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity.

              Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: VisualizationRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: VisualizationRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Role: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                24 January 2024
                2024
                : 19
                : 1
                : e0288577
                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
                University of New Mexico Health Sciences Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ¶ The complete membership of the Hep B PAST partnership can be found in the acknowledgments

                Author information
                https://orcid.org/0000-0002-6775-7089
                https://orcid.org/0000-0003-4844-9408
                Article
                PONE-D-23-20121
                10.1371/journal.pone.0288577
                10807824
                38266007
                c9fd267d-9b83-4065-96a8-b61204159332
                © 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.

                History
                : 29 June 2023
                : 20 December 2023
                Page count
                Figures: 2, Tables: 3, Pages: 23
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: GNT1151837
                Funded by: funder-id http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: GNT1190918
                Award Recipient :
                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.
                Categories
                Research Article
                Medicine and health sciences
                Medical conditions
                Infectious diseases
                Viral diseases
                Hepatitis
                Hepatitis B
                Medicine and health sciences
                Gastroenterology and hepatology
                Liver diseases
                Infectious hepatitis
                Hepatitis B
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                Custom metadata
                Ethical and privacy considerations restrict public access to the data collected and analysed in this study. Data may be available for reasonable requests through to the Hep B PAST steering committee, email: Hepbpast@ 123456menzies.edu.au . Course materials and guidelines of use can be requested through the corresponding author.

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