The effectiveness of Ear Nose and Throat outreach programs for Aboriginal and Torres Strait Islander Australians: a systematic review

Background Aboriginal and Torres Strait Islander children experience a higher prevalence of ear, nose, and throat (ENT) diseases than non-Indigenous children. Many programs exist that aim to prevent and treat these diseases. Culturally appropriate and timely specialist outreach services may help improve access, service use, and outcomes but there has been a lack of rigorous evaluation of ENT outreach programs to date. Objective To examine the ability of ENT outreach programs to improve health outcomes among Aboriginal and Torres Strait Islander people Methods We performed a systematic literature search of nine databases (Medline, CINAHLS, PsychINFO, Embase, Cochrane, Scopus, Global health, Informit Rural health database and Indigenous collection) and grey literature sources for primary studies evaluating ENT outreach services for Aboriginal and Torres Strait Islander Australians. Two authors independently evaluated the eligible articles and extracted relevant information. Results Of the 506 studies identified, 15 were included in this review. These 15 studies evaluated eight different programs/activities. Studies were heterogeneous in design so a meta-analysis could not be conducted. Seven studies measured health-related outcomes in middle ear or hearing status; six reported overall positive changes one reported no clinically significant improvements. Five programs/activities and their corresponding studies involved Aboriginal and Torres Strait Islander people and organisations in delivery and evaluation, but involvement in program or study design was unclear. Conclusion While some studies demonstrated improved outcomes, the overall ability of ENT programs/activities to improve health outcomes for Aboriginal and Torres Strait Islander children is unclear. The impact of ENT outreach may be limited by a lack of evidence quality, a lack of coordination of services, and the provision of potentially unsustainable services. Improvements in the quality of evidence, service coordination and sustainability would likely improve health outcomes. Strengths and limitations of this study Studies were identification based on a clearly defined and extensive search strategy based on a priori inclusion and exclusion criteria Study appraisal was performed using a relevant tool for mixed methods studies The involvement of Aboriginal and Torres Strait Islander people in all aspects of programs and their evaluation was examined PROSPERO registration number CRD42019134757