LAUSR

There are many challenges in health services research, particularly for people working in Aboriginal and Torres Strait Islander (Indigenous) health. The randomised trial of the Ways of Thinking and Ways of Doing program reported in this issue of the Journal by Liaw and his coauthors1 reflects these challenges. The aims of the program were to improve the rates of Indigenous health checks and recording of health risk factors, and to increase cultural respect in the participating urban general practices. The intervention was guided by cultural mentors, and included workshops, care system redesign, and organisational partnerships for facilitating community engagement. It was implemented after years of developmental work, and its primary outcome measures were rates of Medical Benefits Schedule (MBS) item 715 billing (Indigenous health checks) and of the documentation of risk factors, and changes in a measure of cultural competency of clinic staff over 12 months. The program did not achieve significant changes in any of these outcomes. Nevertheless, the investigators identified important elements for improving care for Indigenous Australians and adopted a systems approach to implementing them in a real world setting. It joins other interventions targeting Indigenous Australian populations that have not significantly improved outcomes, often because of implementation failure,2 highlighting the need to accompany complex interventions with robust process evaluation.3