Introduction
The CDC has developed a dedicated model for assessing program strategies in healthcare and disease prevention. This model includes six steps and is based on utility, feasibility, propriety, and accuracy (“A framework for program evaluation,” 2021). These steps include engaging stakeholders, describing the program, focusing on the evaluation design, gathering credible evidence, justifying conclusions, ensuring use, and sharing lessons (“A framework for program evaluation,” 2021). The current report presents the program strategy and the need for its evaluation to benefit indigenous Australians. Another purpose is to increase the percentage of people in this group who have received COVID-19 vaccines.
The evaluation model implies integrating the six steps to ensure the adequate implementation or revision of the program strategy. The current report utilizes the CDC framework, starting with the engagement of the stakeholders, namely, the Australian Government Department of Health and the Queensland Government. This framework proved to be a comprehensive tool for vaccination and immunization programs (Wilder et al., 2018).
The program description includes the program goals and objectives and the program strategies and target groups. Further, credible evidence on why the program should be implemented and evaluated is presented. The justification is provided, featuring the official international frameworks and guidelines for the program implementation and evaluation. The existing programs addressing the issue and the logic model are also presented to provide a base for the mode detailed and specific program implementation.
Engaging Stakeholders
Vaccinating indigenous Australians against the COVID-19 virus is critical to a successful vaccination campaign nationwide. At this stage, there is no programmatic strategy to vaccinate the indigenous Australian population in Queensland. Therefore, such a strategy should be developed and evaluated following measures of efficiency and quality. The Australian Government Department of Health (AGDH) is responsible for addressing the health issues in Australia on an equal opportunity basis. AGDH must also ensure adequate access to health services for all population groups.
Therefore, AGDH must direct the Queensland Government to develop a programmatic vaccination strategy for indigenous Australians. So far, there is only a general vaccination strategy for Queensland residents. At the same time, the statistics for the reports provide separate information for various groups, including indigenous Australians, among whom the vaccination rate is significantly lower than among the rest of the population. Program evaluations should be conducted for the benefit of the indigenous Australian population.
Table 1. Engaging stakeholders.
Describing the Program Plan
Indigenous Australians faced severe threats to their health and lives during the pandemic. In typical settings, this group is underrepresented in receiving adequate health care services. In a pandemic situation, the health risks of this group are exacerbated. Risk factors include quality of life as well as social determinants, including behavioural and environmental factors. Living conditions for indigenous Australians are different from those of most Australians (Seale et al., 2021). This group may experience problems due to the lack of fresh water and water for hygiene and sanitation purposes. As a consequence, the risk of contracting coronavirus increases significantly. Personal protective equipment against the virus may also be in short supply for this group. Low levels of health education and awareness of self-prophylaxis of diseases are another significant risk factor.
Risk factors have several critical determinants; the first determinant is poor communication between health workers and indigenous Australians. The second important determinant of risk factors is the geographic distance of indigenous Australians (Horwood et al., 2019). The third factor is their tendency to live in closed dorms; the fourth factor is distrust of officials due to past aggressive assimilation policies. The fifth factor is the need to develop specific strategies and initiatives to work with this population group, which leads to less rapid progress towards the wellbeing and health of this group.
Goals and objectives of the program
Goals
To reduce the incidence of coronavirus disease among indigenous Australians in Queensland.
Objectives
Table 2. Objectives.
Program strategies and target groups
At this stage, the Australian Government Department of Health is vaccinating indigenous Australians on a general basis. Therefore, it is necessary to develop new strategies for working with this population group (Meder et al., 2020). In particular, a plan should be drawn up for a vaccination program for indigenous Australians in Queensland. This plan should include the involvement of those responsible for purchasing vaccines and other resources needed to change the quality of life of the indigenous Australian communities. Medical workers of local healthcare institutions will participate in the implementation of the plan.
The strategic work on vaccination will be carried out following the plan focused on the target group of indigenous Australians in Queensland. It will be carried out within the framework of the Theory of Health Behavioural Change (Ng et al., 2020). As a result of the implementation of vaccination measures, it is possible to achieve maximum coverage of the population belonging to this group. Further, within three months, 100% vaccination of indigenous Australians in Queensland can be achieved. Strategic activities should also include training lectures on vaccine safety, coronavirus threats, and prevention.
Given the problems with obtaining medical services for this population, and higher rates in various areas of health, lectures will include recommendations for a healthy lifestyle and the prevention of other diseases. A continuation of the coronavirus vaccination strategy could be a program to control the immunization of indigenous Australians against other diseases, such as hepatitis B and human papillomavirus.
Considering the need for subsequent re-vaccination, it is necessary to carry out repeated measures six months after the program start. During the re-vaccination, all the activities from the first part of the program, including lectures on disease prevention and healthy lifestyles should be carried out. As part of the program, it is necessary to address common environmental issues to change the quality of life of indigenous Australians. It is necessary to ensure an uninterrupted supply of water and food to communities in need (some communities live near rivers with clean water and do not need water supplies).
A constant supply of disinfectants and hygiene products should be organised as well. These goods should be offered free of charge, as in the modern world, there should be no shortage of essential goods, and they should be an inalienable human right. In addition, ignoring problems with food, water, or personal protective equipment in any community leads to health problems among the inhabitants of these communities. As a result, the state spends incomparably substantial resources on treating people.
Evidence to support the program
Indigenous Australian populations and Torres Strait residents are more likely to be exposed to disease hazards that are curable and successfully prevented by the country’s health care facilities, which is a primary determinant for the needs of this group. Queensland or Western Territory is the most populous state with indigenous Australians and Torres Strait residents. This population group requires special attention from the executive branch, including state and local community leaders. The Australian Government Department of Health also has a stake in wellbeing and makes many efforts to ensure the health of all people in the country.
Immunising indigenous Australians and Torres Strait residents of all ages have significant potential to prevent diseases such as hepatitis B, human papillomavirus, pneumococcal virus, influenza, and other conditions, and meet the needs of this group in increased access to the medical services. Vaccination of this population group is critical in the context of the COVID-19 pandemic, given the high risks for indigenous Australians due to quality of life, behavioural, environmental, and other risks, so this need should be met as well.
There are severe risks and dangers after the onset of illness due to the logistical problems of providing immediate medical attention. Despite this, only 15% of indigenous Australians and Torres Strait residents received their first dose of coronavirus vaccine, and another 7% received two doses (“WA’s indigenous population has lowest,” 2021). These rates are at least half the rate for Queensland residents, 54% of whom received one dose; another 28.5% received two doses of the vaccine (“COVID-19 vaccine roll-out,” 2021). Experts point out that indigenous Australians should have priority in obtaining vaccines due to the many risk factors for the spread of the virus (“WA’s indigenous population has the lowest,” 2021). Therefore, it is necessary to develop a health vaccination program for indigenous people in Queensland, Australia, and Torres Strait.
Indigenous vaccination programs in Australia have proven to be effective. It is evidenced by many scientific studies about diseases such as pneumococcal infection, human papillomavirus, hepatitis B, and others. In particular, Takashima et al. (2019) note that indigenous Australians have a higher rate of invasive pneumococcal infection than the general population, whereas re-vaccination has been ineffective.
McGregor et al. (2018) found higher cervical cancer rates among indigenous Australian women; this trend can be reversed by vaccination against HPV. Brotherton et al. (2019) note that HPV vaccine coverage among indigenous Australians is high, but insufficient among adolescent girls who are less likely to complete their course. Hanson et al. (2020) note that vaccination of indigenous Australians against hepatitis B has dramatically changed the incidence rate in just one generation. However, not all representatives of the target group receive a vaccine. This trend indicates the need to develop new vaccination programs.
Beard and Clark (2019) argue for the need to increase the participation of indigenous Australian women in cervical screening programs, which is inadequate due to socio-cultural and health system-related barriers. Kabir et al. (2021) conducted a study, the results of which indicate insufficient coverage of vaccination of indigenous Australian children with pneumococcal conjugate vaccine. Finally, McHugh et al. (2019) state that influenza and pertussis infections are significantly higher among indigenous Australian women, which necessitates a vaccination campaign during pregnancy.
The Australian Government Department of Health notes that government medicine should ensure that indigenous Australians are vaccinated against diseases such as COVID-19 (“Vaccination for Aboriginal and Torres Strait Islander people,” 2018). Therefore, early implementation and evaluation of the vaccination program for indigenous people in Queensland, Australia, and Torres Strait are needed and should be implemented within the Theory of Health Behavioural Change.
Justification for the program
Ottawa Charter and Jakarta Declarations address necessary activities, programs, and strategies that should be implemented to promote health. The Jakarta declaration introduces the concept of health determinants, including peace, shelter, education, social security and relations, food, income, empowerment of women, a stable ecosystem, social justice, and equity (“The Jakarta Declaration,” 1997). This Declaration also promotes addressing the diseases related to urbanisation, behavioural and biological changes brought by the modern world. Jakarta Declaration claims that strategies set out in the Ottawa Charter for health promotion guarantee success through building healthy public policy, strengthening community action, and reorientation of the health services (“Ottawa Charter for health promotion,” 1986).
The Declaration introduces the priorities of health promotion in the 21st century, namely: promoting social responsibility for health, increasing investments for health development, consolidating partnerships for health, increasing community capacity, empowering individuals, and securing the infrastructure for health promotion. Therefore, the ethical considerations regarding the priority of vaccinating particular groups are supported by these official documents (Rogozea et al., 2021; Fielding et al., 2021). The Declaration and Charter correlate with the Theory of Health Behavioural Change as they promote the positive changes in the behaviour of the target population.
Links to current policies and frameworks
Australian Government Department of Health and Queensland Government have programs and frameworks regarding the COVID-19 vaccination for indigenous Australians in Queensland. The Queensland Government provides detailed guidelines for vaccinating Australians 12, 18, and 60 years of age with Pfizer and Astra Zeneca vaccines (“Vaccination for Aboriginal,” 2018). Unfortunately, the resource does not present a specific strategy for vaccinating indigenous Australians and does not discuss this topic. The Australian Government Department of Health has two immunisation and vaccination websites for Aboriginal and Torres Strait Islander people, presented below.
Table 3. Current policies and frameworks.
Program logic
The program logic will be based on the PRECEDE model, describing the process of developing a strategic plan, which includes preliminary evaluation, process implementation, and post-factum evaluation. This model is quite popular among healthcare workers, and is conventionally used to develop, implement and evaluate strategic healthcare programs (Handyside et al., 2021; Alizadeh-Siuki et al., 2020; Jeihooni et al., 2021).
During the preliminary assessment, on phases 1 and 2, behavioural and risk factors are evaluated. These are quality of life, health issues of the community, genetics, behaviour, and environment. Then, Phase 3 considers the determinants of behaviour and environmental risk factors. Here, the program is implemented through predisposing, reinforcing, and enabling the target population. In phase 4 the appropriate strategies are developed to impact the determinants; these may be educational and policy regulation strategies.
Concerning the goals and objectives of the indigenous Australian vaccination program in Queensland, the model relates as follows. During phases 1 and 2, responsible parties assess the quality of life and health issues in the community. In particular, the rates of COVID-19 vaccinated people; the associated behavioural risks should be assessed during this phase. Phase 3 is dedicated to assessing determinants of behaviour, and environmental risk factors, including adherence to rules to prevent the spread of the virus in the community. Phase 4 corresponds to the development of specific strategies to change the situation. Phase 5 is the strategy implementation, and phases 6, 7, and 8 provide an opportunity to assess the impact and quality of strategy implementation.
Conclusion
The presented plan of the program strategy for vaccinating indigenous Australians living in Queensland will enable a broader Australian vaccination strategy to be implemented and updated for this group. Given the low rates and less accessible medical services for this population group, it needs immediate attention from the official stakeholders. The goals and objectives of the program include education on the prevention of infection with the virus and vaccination of all comers during retreat sessions, managed by the Queensland governmental bodies, and implemented by the local medical workers. During the training, a plan will be implemented to improve the quality of life and health determinants in this group. A change in the situation is needed now, given the effectiveness of vaccines and the absence of any special programs for indigenous Australians.
The Jakarta Declaration and Ottawa Charter are international documents that call on states to ensure equal opportunities for access to health services for all groups of the population. The presented program will make it possible to implement the tasks within the framework of the strategies prescribed in these documents. Several frameworks and guidelines for immunisation and vaccination of Indigenous Australians now exist in Australia, and these documents can help implement the program. A unique logical model, the PRECEDE, will help structure the implementation and subsequent evaluation of a vaccination strategy for indigenous Australians.
In general, if this strategy is implemented, the state will receive many positive changes associated with improvements in health indicators in this group. The program implementation process will be carried out following the PRECEDE model, which will facilitate the assessment of each stage. Education of indigenous Australians on the prevention of infection with the COVID-19, and other dangerous viruses, and on-site vaccination for everyone, will change the attitude of indigenous Australians to the disease and the spread of the virus. As part of the field vaccination, educational training will be held on healthy lifestyles and the benefits of immunisation against other curable but dangerous diseases that are more common among this group. As a result, the implementation of the strategy will change the overall health, behaviour, and environment of indigenous Australians.
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