Process evaluation of a randomised controlled trial intervention designed to improve rehabilitation services for Aboriginal Australians after brain injury: The Healing Right Way Trial
Publication Details
Katzenellenbogen, J.,
White, J.,
Robinson, M.,
Thompson, S.,
Epstein, A.,
Stanley, M.,
Klobas, J.,
Haynes, E.,
Armstrong, E.,
Coffin, J.,
&
Skoss, R.
(2024).
Process evaluation of a randomised controlled trial intervention designed to improve rehabilitation services for Aboriginal Australians after brain injury: The Healing Right Way Trial.
BMC Health Services Research, 24.
Abstract
Background: Healing Right Way (HRW) aimed to improve health outcomes for Aboriginal Australians with stroke or traumatic brain injury by facilitating system-level access to culturally secure rehabilitation services. Using a steppedwedge randomised controlled trial (RCT) design (ACTRN12618000139279, 30/01/2018), a two-pronged intervention was introduced in four rural and four urban hospitals, comprising 1.Cultural security training (CST) for staf and 2. Training/employment of Aboriginal Brain Injury Coordinators (ABIC) to support Aboriginal patients for 6-months post-injury. Three-quarters of recruited patients lived rurally. The main outcome measure was quality-of-life, with secondary outcomes including functional measures, minimum processes of care (MPC); number rehabilitation occasions of service received, and improved hospital experience. Assessments were undertaken at baseline, 12- and 26-weeks post-injury. Only MPCs and hospital experience were found to improve among intervention patients. We report on the process evaluation aiming to support interpretation and translation of results.
Methods: Using mixed methods, the evaluation design was informed by the Consolidated Framework for Implementation Research. Data sources included minutes, project logs, surveys, semi-structured interviews, and observations. Four evaluation questions provided a basis for systematic determination of the quality of the trial. Findings from separate sources were combined to synthesise the emerging themes that addressed the evaluation questions. Three components were considered separately: the trial process, CST and ABIC.
Results: The complex HRW trial was implemented to a satisfactory level despite challenging setting factors, particularly rural–urban system dynamics. Patient recruitment constraints could not be overcome. The vulnerability of stepped-wedge designs to time efects infuenced recruitment and trial results, due to COVID. Despite relatively
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