Open Access Highly Accessed Research article

The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: a systematic literature search

Janya McCalman1*, Komla Tsey1, Roxanne Bainbridge1, Kevin Rowley2, Nikki Percival3, Lynette O’Donoghue4, Jenny Brands3, Mary Whiteside5 and Jenni Judd6

Author Affiliations

1 The Cairns Institute, James Cook University, McGregor Rd, Smithfield, PO Box 6811, 4870, QLD 4878, Cairns, Australia

2 Onemda VicHealth Koori Health Unit and Centre for Health and Society, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, 3010 Melbourne, VIC, Australia

3 Menzies School of Health Research, Level 1, 147 Wharf Street, 4000 Spring Hill, QLD, Australia

4 Menzies School of Health Research, PO Box 41096, 0811 Casuarina, NT, Australia

5 Department of Social Work & Social Policy, School of Allied Health, Faculty of Health Sciences, La Trobe University, 3068 Bundoora, VIC, Australia

6 Faculty of Medicine, Health and Molecular Sciences, Anton Brienl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD 4811, Australia

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BMC Public Health 2014, 14:712  doi:10.1186/1471-2458-14-712

Published: 11 July 2014



Health promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. The development and implementation of step-by-step guides, instruments, packages, frameworks or resources has provided a feasible and low-resource strategy for strengthening evidence-informed health promotion practice. Yet there has been little assessment of where and how these tools are implemented or their effectiveness. This paper reviews the characteristics, implementation and effects of Indigenous health promotion tools.


Indigenous health promotion tools were identified through a systematic literature search including a prior scoping study, eight databases, references of other reviews and the authors’ knowledge (n = 1494). Documents in the peer reviewed and grey literature were included if they described or evaluated tools designed, recommended or used for strengthening Indigenous Australian health promotion. Eligible publications were entered into an Excel spreadsheet and documented tools classified according to their characteristics, implementation and effects. Quality was appraised using the Dictionary for Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Program (CASP) tools for quantitative and qualitative studies respectively.


The review found that Indigenous health promotion tools were widely available. Of 74 publications that met inclusion criteria, sixty (81%) documented tools developed specifically for the Indigenous Australian population. All tools had been developed in reference to evidence; but only 22/74 (30%) publications specified intended or actual implementation, and only 11/74 (15%) publications evaluated impacts of the implemented tools. Impacts included health, environmental, community, organisational and health care improvements. The quality of impact evaluations was strong for only five (7%) studies.


The small number and generally moderate quality of implementation and evaluation studies means that little is known about how tools work to strengthen Indigenous health promotion practice. The findings suggest that rather than continuing to invest in tool development, practitioners, policy makers and researchers could evaluate the implementation and effects of existing tools and publish the results. There is a need for long-term investment in research to review the current use of health promotion tools and the factors that are likely to enhance their implementation.

Health promotion; Indigenous; Tools; Guides; Instruments; Packages; Frameworks; Resources; Implementation; Evaluation