Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
Shopping Cart: ( empty )
You are here: Home > Journals > PY > PY25048
RESEARCH ARTICLE (Open Access)
Contents Vol 31(4)

Carer and staff preferences for characteristics of health services delivery for Aboriginal and Torres Strait Islander children: a best–worst scaling study

Shingisai Chando https://orcid.org/0000-0003-4521-3491 A B * , Martin Howell C D , Janice Nixon E , Simone Sherriff B , Kym Slater F , Natalie Smith G , Laura Stevenson H , Michelle Dickson B , Allison Jaure A C , Jonathan C. Craig I , Sandra J. Eades J Kirsten Howard D
+ Author Affiliations
- Author Affiliations

A Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.

B Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW, Australia.

C Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia.

D Leeder Centre for Health Policy, Economics and Data, University of Sydney, Sydney, NSW, Australia.

E Sax Institute, Sydney, NSW, Australia.

F Tharawal Aboriginal Corporation, Airds, NSW, Australia.

G Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, NSW, Australia.

H Orange Aboriginal Medical Services, Orange, NSW, Australia.

I College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.

J Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia.

* Correspondence to: Shingisai.Chando@sydney.edu.au

Australian Journal of Primary Health 31, PY25048 https://doi.org/10.1071/PY25048
Submitted: 11 March 2025  Accepted: 1 July 2025  Published: 17 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Prioritising the characteristics of health services delivery can guide improvements to the quality of care for Aboriginal and Torres Strait Islander children and their carers. The aim of this study was to estimate the relative importance of 20 health services delivery characteristics for Aboriginal and Torres Strait Islander children.

Methods

From May 2022 to November 2023, best–worst scaling surveys were distributed in person and online to carers of Aboriginal and Torres Strait Islander children and staff who work at health services used by Aboriginal and Torres Strait Islander children. Preference scores (0–1) were calculated using multinomial logit regression models. Interaction terms were added to a regression model to examine preference heterogeneity.

Results

A total of 109 surveys were completed. Most participants identified as Aboriginal and Torres Strait Islander (81%), and were aged ≥30 years (77%), female (83%) and either worked or used health services at an Aboriginal Community Controlled Health Organisation (84%). For the combined sample of carers and staff, the most important attribute was ‘Treatment options are explained, and the carer is involved in decisions about the child’s care’, followed by ‘Clinical staff ask carer about their concerns for their child and respond to them’ and ‘Clinical staff provide carers with the skills to manage their child’s health at home’.

Conclusions

Our study identified that communication characteristics related to shared decision-making and empowerment are considered the most important characteristics of health services delivery for Aboriginal and Torres Strait Islander children.

Keywords: Aboriginal and Torres Strait Islander, best-worst scaling, child health services delivery, children, health policy, health service preferences, health services, Indigenous health.

References

Australian Government (2016) National framework for the health services for Aboriginal and Torres Strait Islander children and families. Department of Health, Canberra.

Campbell MA, Hunt J, Scrimgeour DJ, Davey M, Jones V (2018) Contribution of Aboriginal community-controlled health services to improving Aboriginal health: an evidence review. Australian Health Review 42, 218-226.
| Crossref | Google Scholar | PubMed |

Chando S, Craig JC, Burgess L, Sherriff S, Purcell A, Gunasekera H, Banks S, Smith N, Banks E, Woolfenden S (2020) Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMC Pediatrics 20, 13.
| Crossref | Google Scholar |

Chando S, Howell M, Young C, Craig JC, Eades SJ, Dickson M, Howard K (2021a) Outcomes reported in evaluations of programs designed to improve health in Indigenous people. Health Services Research 56, 1114-1125.
| Crossref | Google Scholar |

Chando S, Tong A, Howell M, Dickson M, Craig JC, Delacy J, Eades SJ, Howard K (2021b) Stakeholder perspectives on the implementation and impact of Indigenous health interventions: a systematic review of qualitative studies. Health Expectations 24, 731-743.
| Crossref | Google Scholar |

Chando S, Dickson M, Howell M, Tong A, Craig JC, Slater K, Smith N, Nixon J, Eades SJ, Howard K (2022) Delivering health programs for Aboriginal and Torres Strait Islander children: carer and staff views on what’s important. Health Promotion Journal of Australia 33, 222-234.
| Crossref | Google Scholar | PubMed |

Chando S, Howell M, Dickson M, Jaure A, Craig JC, Eades SJ, Howard K (2024) Factors informing funding of health services for Aboriginal and Torres Strait Islander children: perspectives of decision-makers. Australian Journal of Primary Health 30, PY24054.
| Crossref | Google Scholar |

Coombs D (2023) Future-proofing Indigenous self-determination in health: Goals, tactics, and achievements of Aboriginal community controlled health organisations in New South Wales, Australia. In ‘Public policy and Indigenous futures’. (Eds N Moodie, S Maddison) pp. 73–93. (Springer)

Ellis LA, Dammery G, Gillespie J, Ansell J, Wells L, Smith CL, Wijekulasuriya S, Braithwaite J, Zurynski Y (2024) Public perceptions of the Australian health system during COVID-19: findings from a 2021 survey compared to four previous surveys. Health Expectations 27, e14140.
| Crossref | Google Scholar |

Elvidge E, Paradies Y, Aldrich R, Holder C (2020) Cultural safety in hospitals: validating an empirical measurement tool to capture the Aboriginal patient experience. Australian Health Review 44, 205-211.
| Crossref | Google Scholar | PubMed |

Gomersall JS, Gibson O, Dwyer J, O’Donnell K, Stephenson M, Carter D, Canuto K, Munn Z, Aromataris E, Brown A (2017) What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Australian and New Zealand Journal of Public Health 41, 417-423.
| Crossref | Google Scholar | PubMed |

Graham B, Kruger E, Tennant M, Shiikha Y (2023) An assessment of the spatial distribution of bulk billing-only GP services in Australia in relation to area-based socio-economic status. Australian Journal of Primary Health 29, 437-444.
| Crossref | Google Scholar | PubMed |

Harfield SG, Davy C, Mcarthur A, Munn Z, Brown A, Brown N (2018) Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Globalization and Health 14, 12.
| Crossref | Google Scholar |

Hollin IL, Paskett J, Schuster ALR, Crossnohere NL, Bridges JFP (2022) Best-worst scaling and the prioritization of objects in health: a systematic review. PharmacoEconomics 40, 883-899.
| Crossref | Google Scholar | PubMed |

Larkins S, Carlisle K, Turner N, Taylor J, Copley K, Cooney S, Wright R, Matthews V, Thompson S, Bailie R (2019) ‘At the grass roots level it’s about sitting down and talking’: exploring quality improvement through case studies with high-improving Aboriginal and Torres Strait Islander primary healthcare services. BMJ Open 9, e027568.
| Crossref | Google Scholar |

Louviere JJ, Flynn TN, Marley AAJ (2015) ‘Best-worst scaling: theory, methods and applications.’ (Cambridge University Press)

Lungu EA, Guda Obse A, Darker C, Biesma R (2018) What influences where they seek care? Caregivers’ preferences for under-five child healthcare services in urban slums of Malawi: a discrete choice experiment. PLoS ONE 13, e0189940.
| Crossref | Google Scholar |

Mühlbacher AC, Kaczynski A, Zweifel P, Johnson FR (2016) Experimental measurement of preferences in health and healthcare using best-worst scaling: an overview. Health Economics Review 6, 2.
| Crossref | Google Scholar |

O’Sullivan BG, Kippen R, Hickson H, Wallace G (2022) Mandatory bulk billing policies may have differential rural effects: an exploration of Australian data. Rural and Remote Health 22, 7138.
| Crossref | Google Scholar |

Pearson O, Schwartzkopff K, Dawson A, Hagger C, Karagi A, Davy C, Brown A, Braunack-Mayer A, on behalf of the Leadership Group guiding the Centre for Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE) (2020) Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia. BMC Public Health 20, 1859.
| Crossref | Google Scholar |

Ride J, Goranitis I, Meng Y, LaBond C, Lancsar E (2024) A reporting checklist for discrete choice experiments in health: the DIRECT checklist. PharmacoEconomics 42, 1161-1175.
| Crossref | Google Scholar | PubMed |

Sherwood J (2013) Colonisation – it’s bad for your health: the context of Aboriginal health. Contemporary Nurse 46, 28-40.
| Crossref | Google Scholar | PubMed |

Wittenberg E, Bharel M, Bridges JFP, Ward Z, Weinreb L (2016) Using best-worst scaling to understand patient priorities: a case example of Papanicolaou tests for homeless women. The Annals of Family Medicine 14, 359-364.
| Crossref | Google Scholar | PubMed |