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Introduction Aboriginal and Torres Strait Islander communities of Australia experience poorer health outcomes in the areas of overweight and obesity, diabetes and cardiovascular disease. Contributing to this burden of disease in the Australian community generally and in Aboriginal and Torres Strait Islander communities, is the consumption of sugar-sweetened beverages (SSBs). We have described a protocol for a review to systematically scope articles that document use of SSBs and interventions to reduce their consumption with Aboriginal and Torres Strait Islander people. These results will inform future work that investigates interventions aimed at reducing harm associated with SSB consumption. Methods and analysis This scoping review draws on a methodology that uses a six-step approach to search databases including PubMed, SCOPUS, CINAHL, Informit (including Informit: Indigenous Peoples), Joanna Briggs Institute EBP Database and Mura, between January 1980 and February 2017. Two reviewers will be engaged to search for and screen studies independently, using formulated selection criteria, for inclusion in our review. We will include primary research studies, systematic reviews including meta-Analysis or meta-synthesis, reports and unpublished grey literature. Results will be entered into a table identifying study details and characteristics, summarised using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis chart and then critically analysed. Ethics and dissemination This review will not require ethics committee review. Results will be disseminated at appropriate scientific meetings, as well as through the Aboriginal and Torres Strait Islander community. Refereed/Peer-reviewed

Objective: To synthesise client perceptions of the unique characteristics and value of care provided in Aboriginal Community Controlled Health Organisations (ACCHOs) compared to mainstream/general practitioner services, and implications for improving access to quality, appropriate primary health care for Indigenous Australians. Method: Standardised systematic review methods with modification informed by ethical and methodological considerations in research involving Indigenous Australians. Results: Perceived unique valued characteristics of ACCHOs were: 1) accessibility, facilitated by ACCHOs welcoming social spaces and additional services; 2) culturally safe care; and 3) appropriate care, responsive to holistic needs. Conclusion: Provider-client relationships characterised by shared understanding of clients' needs, Indigenous staff, and relationships between clients who share the same culture, are central to ACCHO clients' perceptions of ACCHOs' unique value. The client perceptions provide insights about how ACCHOs address socio-economic factors that contribute to high levels of chronic disease in Indigenous communities, why mainstream PHC provider care cannot substitute for ACCHO care, and how to improve accessibility and quality of care in mainstream providers. Implications for public health: To increase utilisation of PHC services in Indigenous Australian communities, and help close the gaps between the health status of Indigenous and non-Indigenous Australians, Indigenous community leaders and Australian governments should prioritise implementing effective initiatives to support quality health care provision by ACCHOs. Refereed/Peer-reviewed

Review objective The objective of this review is to: 1.Identify tools used to measure quality of life and well-being in Aboriginal and Torres Strait Islander Australian peoples. 2.Identify and synthesize Aboriginal and Torres Strait Islander peoples’ perceptions of quality of life and well-being. Inclusion criteria As the first objective of this review is to simply identify and report on those tools that have been used to date to measure quality of life and well-being in Aboriginal and Torres Strait Islander Australian peoples rather than synthesise the results of the studies that have used the tools, a detailed PICo has not been presented to directly correspond to this objective. All studies that report on quality of life or well-being in Aboriginal and Torres Strait Islander Australian peoples will be retrieved to identify which tool has been employed. The following PICo elements will be used to address objective two of this review. Types of participants This review will consider studies that include Aboriginal and Torres Strait Islander peoples. Phenomena of interest The phenomena of interest for objective two is how Australian Aboriginal and Torres Strait Islander peoples perceive quality of life and well-being. Context The review will consider studies conducted in Australia.

The specific purpose of this review is to systematically examine the scientific literature in order to examine factors that facilitate and/or inhibit the implementation of interventions aimed at improving primary health care provided to Indigenous patients with chronic disease. More specifically, to fully encompass the factors of interest, the questions asked by this review are: • What attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of Indigenous communities support (facilitators) or inhibit (barriers) the implementation of interventions aimed at improving chronic disease care for Indigenous people within the primary health care setting? • What attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of health care providers support (facilitators) or inhibit (barriers) the implementation of interventions aimed at improving chronic disease care for Indigenous people within the primary health care setting? • What attitudes, beliefs, expectations, understandings, perceptions, experiences and knowledge of policy and decision makers support (facilitators) or inhibit (barriers) the implementation of interventions aimed at improving chronic disease care for Indigenous people within the primary health care setting? Inclusion criteria Types of participants This review will consider studies that have included Indigenous people of any age receiving treatment for chronic disease (cardiovascular disease, chronic kidney disease, chronic respiratory disease, diabetes, depression, HIV/AIDS) in the primary health care setting. Participants of interest in this review include Indigenous people with chronic illness, their family or members of the community, as well as all primary health care providers (e.g. doctors, nurses, administrators, health care workers) and other policy and decision makers in indigenous health. Phenomena of interest The phenomena of interest are the attitudes, beliefs, expectations, understandings and knowledge about chronic disease health care that support or inhibit the implementation of interventions aimed at managing chronic disease. Context The context of the review is the provision of health care in the primary health care/community/outpatient setting.

Background: To describe reported studies of the impact on HbA1C levels, diabetes-related hospitalisations, andother primary care health endpoints of initiatives aimed at improving the management of diabetes in Indigenousadult populations of Australia, Canada, New Zealand and the United States. Method: Systematic literature review using data sources of MEDLINE, Embase, the Cochrane Library, CINHAL andPsycInfo from January 1985 to March 2012. Inclusion criteria were a clearly described primary care intervention,model of care or service, delivered to Indigenous adults with type 2 diabetes reporting a program impact on atleast one quantitative diabetes-related health outcome, and where results were reported separately for Indigenouspersons. Joanna Briggs Institute critical appraisal tools were used to assess the study quality. PRISMA guidelineswere used for reporting. Results: The search strategy retrieved 2714 articles. Of these, 13 studies met the review inclusion criteria. Three levels ofprimary care initiatives were identified: 1) addition of a single service component to the existing service, 2) system-levelimprovement processes to enhance the quality of diabetes care, 3) change in primary health funding to support betteraccess to care. Initiatives included in the review were diverse and included comprehensive multi-disciplinary diabetes care,specific workforce development, systematic foot care and intensive individual hypertension management. Twelve studiesreported HbA1C, of those one also reported hospitalisations and one reported the incidence of lower limb amputation.The methodological quality of the four comparable cohort and seven observational studies was good, and moderate forthe two randomised control trials. Conclusions: The current literature provides an inadequate evidence base for making important policy and practicedecisions in relation to primary care initiatives for Indigenous persons with type 2 diabetes. This reflects a very smallnumber of published studies, the general reliance on intermediate health outcomes and the predominance ofobservational studies. Additional studies of the impacts of primary care need to consider carefully research design and thereporting of hospital outcomes or other primary end points. This is an important question for policy makers and furtherhigh quality research is needed to contribute to an evidence-base to inform decision making. Refereed/Peer-reviewed

Thesis (PhD)--University of South Australia, 2013. Includes bibliographical references (leaves 201-222) Aboriginal and Torres Strait Islander people suffer disproportionately from type 2 diabetes and its related co-morbidities, compared to the mainstream Australian population. In isolated north Queensland communities, populated by Aboriginal and Torres Strait Islander people, type 2 diabetes is managed in partnership with the local State government operated primary health care service. In 2001 these primary health care services moved to an evidence-based approach to managing chronic diseases. As a consequence the State and Commonwealth governments have invested in the primary health care workforce and infrastructure. The aim of this thesis is to generate further understanding of the relationship between community-level primary health care resourcing and hospitalisation of Aboriginal and Torres Strait Islander people in north Queensland with type 2 diabetes.

Refereed/Peer-reviewed

Background: Primary health care is recognised as an integral part of a country's health care system. Measuring hospitalisations, that could potentially be avoided with high quality and accessible primary care, is one indicator of how well primary care services are performing. This review was interested in the association between chronic disease related hospitalisations and primary health care resourcing. Conclusion: Seven of 12 measures of the relationship between PHC resourcing and ACSC hospitalisations had a significant inverse association. As a collective body of evidence the studies provide inconclusive support that more PHC resourcing is associated with reduced hospitalisation for ACSC. Characteristics of improved or increased PHC access showed inverse significant associations with fewer ACSC hospitalisations after adjustment for health status. The varied measures of hospitalisation, PHC resourcing, and health status may contribute to inconsistent findings among studies and make it difficult to interpret findings. Methods: Studies were included if peer reviewed, written in English, published between 2002 and 2012, modelled hospitalisation as a function of PHC resourcing and identified hospitalisations for type 2 diabetes as a study outcome measure. Access and use of PHC services were used as a proxy for PHC resourcing. Studies in populations with a predominant user pay system were excluded to eliminate patient financial barriers to PHC access and utilisation. Articles were systematically excluded based on the inclusion criteria, to arrive at the final set of studies for review. Results: The search strategy identified 1778 potential articles using EconLit, Medline and Google Scholar databases. Ten articles met the inclusion criteria and were subject to review. PHC resources were quantified by workforce (either medical or nursing) numbers, number of primary care episodes, service availability (e.g. operating hours), primary care practice size (e.g. single or group practitioner practice-a larger practice has more care disciplines onsite), or financial incentive to improve quality of diabetes care. The association between medical workforce numbers and ACSC hospitalisations was mixed. Four of six studies found that less patients per doctor was significantly associated with a decrease in ambulatory care sensitive hospitalisations, one study found the opposite and one study did not find a significant association between the two. When results were categorised by PHC access (e.g. GPs/capita, range of services) and use (e.g. n out-patient visits), better access to quality PHC resulted in fewer ACSC hospitalisations. This finding remained when only studies that adjusted for health status were categorised. Financial incentives to improve the quality of diabetes care were associated with less ACSC hospitalisations, reported in one study. Refereed/Peer-reviewed

Background To develop an instrument that predicts diabetes-related vascular disease severity using routinely collected data on Australian Aboriginal and Torres Strait Islander adults with type 2 diabetes, in the absence of diabetes duration. Methods A complex diabetes severity classification system was simplified and adapted for use with an Australian Aboriginal and Torres Strait Islander adult population with type 2 diabetes in north Queensland. Detailed vascular health risks and morbidities were mapped to routinely collected measures. Individual–level health screening, hospital separation and mortality data were linked and used to plot mean monthly in-patient hospital cost and percent mortality by disease severity as defined by the newly developed instrument, to test construct validity. Results The revised instrument consists of four combined diabetes-related microvascular and macrovascular stages that range from least severe (stage 1) to severe irreversible vascular impairment (stage 4). When applied to data of an Aboriginal and Torres Strait Islander Australian population the instrument showed good construct validity, predicting higher hospital cost and mortality as vascular disease severity increased. Conclusions This instrument discriminates between levels of diabetes-related vascular disease severity, displays good construct validity by predicting increased hospital cost and mortality with worsening severity and can be populated with routinely collected data. It may assist with future health service research and its use could be extended to practice settings for health care planning for diabetes management programs and monitoring vascular disease progression.

Background Access to appropriate, affordable, acceptable and comprehensive primary health care (PHC) is critical for improving the health of Indigenous populations. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. This systematic literature review synthesised international evidence on the factors that enable or inhibit the implementation of interventions aimed at improving chronic disease care for Indigenous people. Methods A systematic review using Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed platform), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Excerpta Medica Database (EMBASE), ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online and Primary Health Care Research and Information Service (PHCRIS) databases was undertaken. Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary. Results Twenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another. Conclusions Future interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0261-x) contains supplementary material, which is available to authorized users.