A Culturally Responsive Indigenous Health Worker Spirometry Training and Mentoring Programme (IHWS) Increases Quantity and Quality of Spirometry Performed in Primary Care

Abstract

OBJECTIVE: Evaluate the impact on spirometry quality of a culturally responsive Indigenous Health Worker Spirometry Training and Mentoring programme (IHWS). METHODS: Participation in two-day face-to-face IHWS including post-training telehealth mentoring DESIGN: Submission of spirometry reports before training (T1), after training (T2) and after telehealth mentoring (T3). SETTING: Urban, rural and remote primary healthcare services in Queensland Australia. PARTICIPANTS: Primarily Australian First-Nations Health Workers. MAIN OUTCOME MEASURES: Two raters used nine-point quality criteria to score spirometry at T1, T2 and T3. Inter-rater reliability was assessed using Cohen's original kappa. Reports submitted at a minimum of two time-points were included in the analysis. A linear mixed model analysis and post hoc analysis assessed differences in total scores across different timepoints. RESULTS: Between 2011 and 2018, 360 participants (75.5% Indigenous) attended 43 workshops. Of the 284 participants attending workshops #1-#34, 56.7% (161/284) hadn't performed spirometry before IHWS and were excluded from comparative analysis because spirometry reports could be submitted at only one timepoint (T2). Introduction of telehealth mentoring sessions from workshop #35, increased spirometry submission for assessment at T2 from 9.9% (28/284) to 68.4% (52/76). Thirty-six participants submitted reports at two timepoints or more. Spirometry quality improved across all timepoints (p < 0.001). Inter-rater reliability was good or very good (0.83-0.91). CONCLUSION: Two-day F2F culturally responsive IHWS training increases the quality of spirometry testing. Further increases in quality occur after telehealth mentoring. This model could be adapted to teach spirometry to First-Nation's health workers of other nations.