Journal article
A workforce enhancement model for Australian remote community Primary Health Care services: implementation of a stepped-wedge cluster randomised trial (SW-CRT)
BMC Health Services Research, Vol.26(1), pp.1-15
2026
PMID: 41612286
Appears in Thompson Institute Research Collection
Abstract
Background
First Nations people in Australia continue to experience a high level of socio-economic disadvantage, driven by the ongoing injustices of colonisation. In remote communities in the Northern Territory (NT) First Nations children experience early onset and persistence of middle ear infections (otitis media), preventable conductive hearing loss and developmental delay, which contribute to a trajectory of further disadvantage, particularly in education and employment. Health services are not resourced to deliver adequate care for these children. This trial of First Nations workforce enhancement is the first to address these issues.
Methods
This open cohort stepped-wedge cluster randomised trial of on-country training and new job creation was implemented in 2 pilot and 18 randomised remote communities. Governance of all aspects was co-designed, and First Nations led. Qualified trainers delivered three Certificate II units in Aboriginal Primary Health Care (2 weeks), and competency training in ear and hearing health, otoscopy, tympanometry, and hearScreen® (4 weeks). Community residents were eligible for training if they met criteria for NT Government employment. Here we report baseline characteristics and intervention implementation outcomes.
Results
On-country training commenced in April 2020 and completed in November 2023. A new job description was approved for Ear Health Facilitators. Two randomised communities declined participation. The COVID-19 pandemic caused direct and long-term disruptions. From 167 expressions of interest, 53 of 89 (60%) enrolled participants completed all training. Lack of services interrupted attendance, whereas Liaison Assistants, meals, and payment were enablers. English language and numeracy were barriers. Trainee self-evaluations showed substantial increases in confidence, knowledge, and skills. Trainers assessed performance against 38 competencies, identifying strengths and areas for training modification. Trainees requested more flexibility and catch-up opportunities, more time for two-way learning, and to practice ear assessments. Thirteen communities employed 15 Ear Health Facilitators.
Conclusions
This trial of a remote health workforce enhancement model demonstrated feasibility and preference for on-country work-readiness and technical training with harmonised job creation. This has the potential to improve effectiveness and sustainability of priority health services – in this case, ear and hearing health care. Infrastructure to support development of this workforce was a major barrier. Evaluation of workplace integration, sustainability, and impact on ear and hearing services will be reported separately.
Trail registration
This trial was registered on clinicaltrials.gov on 16 April 2019, ID NCT03916029.
Details
- Title
- A workforce enhancement model for Australian remote community Primary Health Care services: implementation of a stepped-wedge cluster randomised trial (SW-CRT)
- Authors
- Amanda J Leach (Corresponding Author) - Menzies School of Health ResearchAmelia McCullough - Menzies School of Health ResearchEmily Websdale - Menzies School of Health ResearchJiunn-Yih Su - Menzies School of Health ResearchVictor Oguoma (Author) - University of the Sunshine Coast, Queensland, Thompson InstitutePeter Stanley Morris - Charles Darwin UniversitySean Taylor - Menzies School of Health ResearchSandra Nelson - Northern Territory Health ServicesKelvin Kong - John Hunter Children's HospitalJohn Paterson - Aboriginal Medical Services Alliance of the Northern Territory (Australia)Jody Dixon - Northern Territory Department of EducationAlan Cass - Charles Darwin University
- Publication details
- BMC Health Services Research, Vol.26(1), pp.1-15
- Publisher
- BioMed Central Ltd.
- Date published
- 2026
- DOI
- 10.1186/s12913-025-13743-0
- ISSN
- 1472-6963
- PMID
- 41612286
- Copyright note
- This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
- Data Availability
- The datasets generated and/or analysed during the current study are not publicly available due to potential for re-identification of communities and individuals, but are available from the corresponding author on reasonable request including approval from the above Ethics committees and community.
- Grant note
- The Hearing for Learning Initiative was funded by The Balnaves Foundation, The Northern Territory Government and the Australian Federal Government.
- Organisation Unit
- Thompson Institute
- Language
- English
- Record Identifier
- 991200950402621
- Output Type
- Journal article
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