Background Despite that stakeholder participation in evidence synthesis could result in more useful outcomes, there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage diverse stakeholders as equal partners in knowledge co-production. The aims of this paper are to describe an innovative participatory process of synthesising a large body of academic research products and compare the findings of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review. Methods First, a rapid synthesis of all research outputs ( n = 86) was conducted by researchers with in-depth knowledge of the collaboration’s research. Second, a team of researchers and service providers conducted a structured synthesis of seventy-eight peer-reviewed articles and reports generated by the collaboration. Fifty-five publications were brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value added by the participatory method by comparing findings generated across the three synthesis approaches. Results Twelve researchers and 11 service providers/policy partners—8 self-identified as Aboriginal and/or Torres Strait Islander—participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The process explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrepancies did not contradict but gave deeper insights into statements created by the other methods. The participatory synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key messages for practice. Conclusion The participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising a large body of evidence in a relatively short time. The participatory approach produced findings comparable to traditional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who, ultimately, are the end users of the research. This process will interest other large-scale research collaborations seeking to engage stakeholders in evidence synthesis.

Background From 2014 to 2019, the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI) was evaluated as an innovation platform focusing on continuous quality improvement in Indigenous Australian primary healthcare. Although social network analysis (SNA) is a recognized method for evaluating the functioning, collaboration and effectiveness of innovation platforms, applied research is limited. This study applies SNA to evaluate the CRE-IQI’s functioning as an innovation platform. Methods Two surveys (2017, 2019) were conducted using social survey and network methods. Survey items covered respondent characteristics, their perceptions of the CRE-IQI’s performance, and its impact and sociometric relationships. Members’ relationship information was captured for the CRE-IQI at three time points, namely start (retrospectively), midpoint and final year, on three network types (knew, shared information, collaborated). SNA software was used to compute standard network metrics including diameter, density and centrality, and to develop visualizations. Survey and network results were addressed in a workshop held by members to develop improvement strategies. Results The response rate was 80% in 2017 and 65% in 2019 ( n = 49 and 47, respectively). Between 2017 and 2019, respondents’ mean ratings of the CRE-IQI’s functioning and achievements in meeting its goals were sustained. They perceived the CRE-IQI as multidisciplinary, having effective management and governance, and incorporating Indigenous research leadership, representation and ways of working. Respondents recognized high levels of trust amongst members, rated “good communication and coordination with participants” highly, and “facilitating collaboration” as the CRE’s most strongly recognized achievement. In collaboration and information-sharing networks, average path length remained low in 2017 and 2019, indicating good small-world network properties for relaying information. On average, respondents shared information and collaborated with more CRE members in 2017 than 2019. However, in both 2017 and 2019 there were new collaborations and information-sharing outside of direct collaborations. CRE-IQI outcomes included: evidence generation; knowledge transfer and skills development in quality improvement; research capacity-building, career development; mentoring; grant support; development of new projects; health service support; and policy impact. Conclusions This study shows the utility of network analysis in evaluating the functioning, and collaboration, at the individual, organizational and health system levels, of an innovation platform, and adds to our understanding of factors enabling successful innovation platforms.

ISSUES ADDRESSED:Little research has been conducted on the impact of Aboriginal and Torres Strait Islander brief intervention training programs on health staff participants' own health behaviours. Through the Queensland B.strong program (2017-2020), brief intervention training in smoking cessation, nutrition and physical activity was provided to the Aboriginal and Torres Strait Islander health workforce and other health and community professionals. This study examined the program's impact on participants' own health behaviours. METHODS:Data were collected through four surveys (pre- and post-training workshop, and 3-month and 6-month follow-up) of the 1131 participants in B.strong training workshops from June 2017 to August 2019. Surveys included items on participants' own health behaviours. Pre- and post-workshop surveys were paper-based, and follow-up surveys were completed online. For the analysis of data reported in this paper, paired-samples t tests were used to assess changes between pre-workshop and 3-month follow-up. RESULTS:Statistically significant improvements were found between pre-workshop and 3-month follow-up in the number of serves of vegetables or legumes/beans eaten per day, the number of serves of fruit eaten per day, and in time spent in physical activity. However, there was: no statistically significant change in smoking status, with baseline rates being relatively low; a statistically significant increase in consumption of sugary drinks, and of takeaway foods; a nonsignificant increase in consumption of snack foods; and no significant change in sedentary behaviour of participants. CONCLUSION:While some positive changes in participants' own health behaviours in nutrition and physical activity were associated with the B.strong program, there was no change in their smoking behaviour. SO WHAT?: This study found that some improvements in participants' own health behaviours were associated with the B.strong program. This research may inform future Indigenous brief intervention training programs and health services on how to promote healthy behaviours for health staff themselves.

BACKGROUND:Despite the proliferation of learning collaborations such as innovation platforms, the factors contributing to their success or failure are rarely documented. The Agency for Healthcare Research and Quality learning collaboratives taxonomy provides a framework for understanding how such collaborations work in different settings according to four primary elements: innovation, communication, time, and social systems. This study applied the taxonomy to assess an innovation platform and the utility of applying the taxonomy.METHODS:The study focus was a five-year national research collaboration operating as an innovation platform to strengthen primary health care quality improvement efforts for Indigenous Australians. The study team analyzed project records, reports and publications, and interviews that were conducted with 35 stakeholders. Data were mapped retrospectively against the taxonomy domains and thematically analyzed.RESULTS:The taxonomy proved useful in understanding how and why the innovation platform generated innovations. It revealed that time was particularly important, both to see innovations through and to establish a social system that enabled interconnectivity between members. However, the taxonomy did not provide useful guidance on identifying the types of innovations from the collaboration or the importance of a culture of continuous adaptation and learning. The study also found that the primary and secondary elements of the taxonomy were not discrete, which meant that it was difficult to align themes with only one element.CONCLUSION:To improve the utility of the taxonomy, several elaborations are proposed, including reconfiguring it to a more dynamic form that recognizes the interconnections and links between the elements.

Objective To identify points for improvements within the health system where Aboriginal and Torres Strait Islander cancer patients may experience a lack of continuity in their cancer care. The optimal care pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) framework was utilised as a tool in this work. Methods Semi-structured interviews were conducted with health professionals at the primary health care (PHC) and hospital setting. Data were categorised into six steps using the OCP framework. Results This study identified multiple time-points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients. In addition, the provision of person-centred care and adequate education tailored to patients' and health professionals' needs can help minimise the likelihood of patients experiencing a lack of continuity in their cancer care. Participants were recruited from an urban hospital (n = 9) and from six Aboriginal Community Controlled Health Services (n = 17) across geographical locations in Queensland. The provision of culturally competent care, effective communication, coordination and collaboration between services along the cancer pathway from prevention and early diagnosis through to end-of-life care were highlighted as important to enhance care continuity for Indigenous Australians. Conclusion The implementation of recommendations outlined in the OCP framework may help with improving cancer care continuity for Indigenous patients with cancer. Aboriginal and Torres Strait Islander people can sometimes find cancer care pathways complex and difficult to navigate. This study identified points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients which could potentially lead to improved outcomes.

Issue addressed Brief interventions (BIs) in primary health care (PHC) settings can be effective in addressing behavioural risk factors of chronic conditions. However, the impact of the characteristics of BI training programs on the uptake of the program and implementation of BIs in Indigenous PHC settings is not fully understood. The B.strong Program was an Indigenous health worker BI training program delivered in Queensland from 2017 to 2020. This study examines the impact of the characteristics of the B.strong Program on its uptake and implementation in PHC settings. Methods Semi-structured interviews were conducted in 2019 and 2020 with 20 B.strong Program trainees and four health service managers from eight purposively sampled Queensland PHC services, and one Queensland Department of Health manager, to collect their perceptions of the implementation of the B.strong Program. The Consolidated Framework for Implementation Research guided data collection. Results Key program characteristics that facilitated both the program uptake and the implementation of BIs were: ensuring the cultural appropriateness of the program from development, to engagement with health services and through to delivery, the applicability of the program to trainees' daily clinical work, program credibility, and its ease of access and availability. Participants preferred face-to-face workshop training for online module training. Conclusions Relevance to practice, easy access, program credibility and measures taken to ensure cultural appropriateness of the B.strong Program in development, in engagement stages with health services, and in program delivery facilitated program uptake and implementation of BIs. Online BI training may be of limited value compared to face-to-face training in this setting. So what? To enhance participation by Indigenous PHC services in health worker BI training programs and implementation of BIs posttraining by health staff, it is important to ensure the cultural appropriateness of the program's characteristics, and its development, engagement and delivery processes.

ObjectivesThough multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time.SettingAustralian CQI research network in Indigenous PHC from 2002 to 2019.ParticipantsAuthors from peer-reviewed journal articles and books published by the network.DesignCoauthor networks across four phases of the network (2002–2004; 2005–2009; 2010–2014; 2015–2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends.ResultsWe identified 128 publications written by 308 individual authors from 79 different organisations. Publications increased in number and diversity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55–0.65). Academic organisations dominated the core structure in all funding phases.ConclusionCollaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship diversity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication diversity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among diverse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.

Introduction Indigenous communities worldwide are leading calls for all research involving Indigenous people to be underpinned by values and principles articulated by them. Many researchers are explicitly adopting these principles to guide what, where, how and when research is undertaken with Indigenous people. With critical reflection to support the implementation of such principles largely absent from published literature, this paper explores both the implementation of, and the outcomes from a set of guiding principles used in a large-scale Australian research collaboration to improve Indigenous health. Methods In this inductive qualitative study, we adopted a principles-focused evaluation approach. Based on interviews with 35 actors in the collaboration and a review of project documents, we generated themes that were then iteratively discussed, refined and categorised into (1) ‘strategies’—activities by which implementation of our guiding principles were recognised; (2) ‘outcomes’—results seen from implementing the principles and (3) ‘conditions’—aspects of the context that facilitated and constrained implementation of the principles. Results Respondents found it difficult to articulate how the guiding principles were actually implemented, and frequently referred to them as part of the fabric of the collaboration. They viewed the set of principles as mutually reinforcing, and as providing a rudder for navigating complexity and conflict. Implementation of the principles occurred through five strategies—honouring the principles; being dynamic and adaptable; sharing and dispersing leadership; collaborating purposefully and adopting a culture of mutual learning. Outcomes included increased Indigenous leadership and participation; the ability to attract principled and values-driven researchers and stakeholders, and the development of trusting and respectful relationships. The conditions that facilitated the implementation of the principles were collaborating over time; an increasing number of Indigenous researchers and taking an ‘innovation platform’ approach. Conclusion Our findings show that principles guiding collaborations are valuable in providing a focus, direction and a way of working together when they are collaboratively developed, hold genuine meaning for all members and are implemented within a culture of continuous critical reflection, learning and adaptation, with ongoing reinterpretation of the principles over time.

ISSUE ADDRESSED The B.strong Program was an Indigenous health worker brief intervention (BI) training program delivered in Queensland from 2017-2020. This study examines the organisational factors of participating Indigenous primary health care (PHC) services that impacted on B.strong's uptake and implementation in those services. METHODS Semi-structured interviews were conducted from 2019-2020 with 20 B.strong Program trainees and four health service managers from eight purposively sampled Queensland PHC services, and one Queensland Department of Health manager, to examine their perceptions of uptake and implementation of the B.strong Program. The Consolidated Framework for Implementation Research was used as a framework for the evaluation. Data analysis was conducted using NVivo 11. RESULTS Although strong PHC service support was evident for the uptake of face-to-face workshop training, it was not available to support trainees to complete online modules or for ongoing BI delivery to clients. Key organisational factors associated with both program uptake and implementation of BIs in PHC services were leadership engagement and implementation climate. Within these themes, embedding B.strong into operational practices of health services, having policies, processes, and consistent administrative support to facilitate implementation, and addressing gaps in knowledge and skills of health workers were identified as needing to be improved. The study identified the lack of application of continuous quality improvement (CQI) processes to BIs at these health services as a barrier to effective implementation. CONCLUSIONS The study supports the establishment of BI specific CQI initiatives in health services and supports better engagement with organisational leadership in BI training to ensure their ongoing support of both the training and implementation of BI. SO WHAT?: To enhance uptake of BI training programs by Indigenous PHC services and implementation of BIs post training by health staff, it is important to ensure the support and involvement of senior leadership at the services. Participating organisations need to be supported to embed BI training into practice and to strengthen their capacity for CQI of BIs.

Queensland’s B.strong brief intervention training program was a complex intervention developed for Aboriginal and Torres Strait Islander health workers to assist clients address multiple health risks of smoking, poor nutrition and physical inactivity. This study evaluates program effectiveness by applying the Kirkpatrick four-level evaluation model: (1) Reaction, participants’ satisfaction; (2) Learning, changes in participants’ knowledge, confidence, attitudes, skills and usual practice; (3) Behaviour, application of learning to practice; and (4) Results, outcomes resulting from training. A retrospective analysis was conducted on data for respondents completing pre-training, post-workshop and follow-up surveys. Changes in domains such as training participant knowledge, confidence, attitudes, and practices between survey times were assessed using paired-samples t-tests. From 2017–2019, B.strong trained 1150 health professionals, reaching targets for workshop and online training. Findings showed statistically significant improvements from baseline to follow-up in: participants’ knowledge, confidence, and some attitudes to conducting brief interventions in each domain of smoking cessation, nutrition and physical activity; and in the frequency of participants providing client brief interventions in each of the three domains. There was a statistically significant improvement in frequency of participants providing brief interventions for multiple health behaviours at the same time from pre-workshop to follow-up. Indigenous Queenslander telephone counselling referrals for smoking cessation increased during the program period. B.strong improved practitioners’ capacity to deliver brief interventions addressing multiple health risks with Indigenous clients.

This paper describes the applicability of the Consolidated Framework for Implementation Research (CFIR) to the qualitative evaluation of the implementation of the Queensland Aboriginal and Torres Strait Islander Brief Intervention Training Program, the B.strong Program. Interviews were conducted with 20 B.strong Program trainees and four health service managers from eight purposively sampled Indigenous primary health care services in Queensland to collect their perceptions of the B.strong Program implementation. The 26 constructs of the CFIR were used to guide data collection and analysis. Additional constructs were developed for two program implementation aspects, “quality improvement” and “cultural suitability.” Findings are presented from the application of the CFIR to the evaluation of the implementation of a brief intervention training program in the Australian Indigenous context. While demonstrating the applicability of the CFIR in this evaluation, this study also highlights that it may require modification, to ensure identification of the different contextual factors that influence program implementation.

Effective efforts to strengthen health systems need diverse, multi-stakeholder networks working together on complex or 'wicked' problems such as prevention and control of chronic diseases, solutions to which go beyond the role and capability of one organisation. The contextual complexities inherent in 'wicked' problems mean that solutions warrant a systems approach that encompasses innovation and new ways of thinking about, facilitating and implementing collective decision-making processes and change practices.Innovation platforms are a mechanism for facilitating communication and collaboration among diverse stakeholders, promoting joint action and stimulating innovation. Developmental evaluation is an approach that is increasingly being used to evaluate innovative and emergent programmes and projects, as it enables evaluators to provide real-time feedback so that evaluation findings can be used to guide development and adaptations. Developmental evaluation emphasises learning and adaptation, and aligns well with the implementation of innovation platforms that have continuous reflection, learning and adaptation as a specific design principle.Here, we outline our rationale for applying a developmental evaluation to enhance the formation, functioning and outcomes of an innovation platform aimed at accelerating and strengthening large-scale quality improvement efforts in Australian Aboriginal and Torres Strait Islander primary healthcare. We provide examples to explain how the developmental evaluation findings were used for adaptation of the innovation platform and assess to what extent our application of developmental evaluation was consistent with, and reflective of, its essential principles.Our evaluation aligned strongly with the principles of developmental evaluation, and the approach we took was well suited to situations with a developmental purpose, innovation niche and complexity such as innovation platforms. As a result, along with the increasing interest in multi-stakeholder platforms (e.g. innovation platforms) and the inherent challenges with evaluating these complex networks, we anticipate our use of this approach being of interest globally.

This paper reviews the literature on evaluations of brief intervention training programs for health professionals which address one or more lifestyle factors of chronic disease to identify factors impacting on development and implementation of programs. A search was conducted of the literature evaluating brief intervention training programs from 2000–2019 in the databases: Medline, CINAHL, Psychinfo, Academic Premier, Science Direct, Ovid (Including EMBASE and Healthstar), Web of Science and Informit. The content analysis and data extraction were aligned to the domains in the Consolidated Framework for Implementation Research (CFIR) to assist in the narrative synthesis. The search identified eight evaluations of programs targeting multiple risk factors, and 17 targeting single risk factors. The behavioural risk factor most commonly addressed was smoking, followed by alcohol and drug use. Programs consisted of face-to-face workshops and/or online or distance learning methods. Facilitators included availability of sustainable funding, adapting the program to suit the organisation’s structural characteristics and adoption of the intervention into routine client care. For Indigenous programs, the use of culturally appropriate images and language, consultation with Indigenous communities, and development of resources specific to the communities targeted were important considerations.

AIM:To explore health professionals' perspectives on communication, continuity and between-service coordination for improving cancer care for Indigenous people in Queensland.METHODS:Semi-structured interviews were conducted in a purposive sample of primary health care (PHC) services in Queensland with Indigenous and non-Indigenous health professionals who had experience caring for Indigenous cancer patients in the PHC and hospital setting. The World Health Organisation integrated people-centred health services framework was used to analyse the interview data.RESULTS:Seventeen health staff from six Aboriginal Community Controlled Services and nine health professionals from one tertiary hospital participated in this study. PHC sites were in urban, regional and rural settings and the hospital was in a major city. Analysis of the data suggests that timely communication and information exchange, collaborative approaches, streamlined processes, flexible care delivery, and patient-centred care and support were crucial in improving the continuity and coordination of care between the PHC service and the treating hospital.CONCLUSION:Communication, collaboration and care coordination are integral in the provision of quality cancer care for Indigenous Australians. It is recommended that health policy and funding be designed to incorporate these aspects across services and settings as a strategy to improve cancer outcomes for Indigenous people in Queensland.

Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.

Introduction: Increasing the use of evidence in healthcare policy and practice requires greater understanding of how stakeholders use evidence to inform policy, refine systems and change practice. Drawing on implementation theory, we have used system-focused participatory research to engage diverse stakeholders in using aggregated continuous quality improvement (CQI) data from Australian Indigenous primary health care settings to identify priority evidence-practice gaps, barriers/enablers and strategies for improvement. This article reports stakeholders' use or intended use of evidence at various levels of the system, and factors mediating use. Material and Methods: Interviews were undertaken with a purposeful sample of 30 healthcare stakeholders in different roles, organization types and settings in one Australian jurisdiction and with national participants, as part of the project's developmental evaluation. Qualitative data were analyzed to identify themes and categories relating to use of evidence. Results: Context-specific aggregated CQI data that were relatable to the diverse professional roles and practices provided an effective starting point for sharing perspectives, generating practice-based evidence and mobilizing evidence-use. Interviewees perceived the co-produced findings as applicable at different levels and useful for planning, policy development, supporting best practice and reflection, capacity strengthening and developing new research. Factors mediating use were commitment to best practice; the credibility of the evidence and its perceived relevance to work roles, contexts and decision needs; report format and language; facilitation and communication; competing work pressures and the organizational environment for change. Conclusions: This study found that primary health care stakeholders used evidence on quality of care for a variety of purposes. This could be linked to the interactive research processes used to engage stakeholders in different roles and settings in interpreting data, sharing and generating knowledge. Findings indicate that system-based participatory research using CQI data and iterative, interactive and systematic CQI-based methods can be applied at scale to support concurrent action for healthcare improvement at different system levels. Factors known to influence implementation should be addressed within the research design to optimize evidence use. Further research is needed to explore the utility of interactive dissemination for engaging healthcare stakeholders in informing policy and system change.

Objective This narrative review aimed to identify and categorize the barriers and facilitators to the provision of brief intervention and behavioral change programs that target several risk behaviors among the Indigenous populations of Australia, Canada, and New Zealand. Methods A systematic database search was conducted of six databases including PubMeD, Embase, CINAHL, HealthStar, PsycINFO, and Web of Science. Thematic analysis was utilized to analyze qualitative data extracted from the included studies, and a narrative approach was employed to synthesize the common themes that emerged. The quality of studies was assessed in accordance with the Joanna Briggs Institute’s guidelines and using the software SUMARI – The System for the Unified Management, Assessment and Review of Information. Results Nine studies were included. The studies were classified at three intervention levels: (1) individual-based brief interventions, (2) family-based interventions, and (3) community-based-interventions. Across the studies, selection of the intervention level was associated with Indigenous priorities and preferences, and approaches with Indigenous collaboration were supported. Barriers and facilitators were grouped under four major categories representing the common themes: (1) characteristics of design, development, and delivery, (2) patient/provider relationship, (3) environmental factors, and (4) organizational capacity and workplace-related factors. Several sub-themes also emerged under the above-mentioned categories including level of intervention, Indigenous leadership and participation, cultural appropriateness, social and economic barriers, and design elements. Conclusion To improve the effectiveness of multiple health behavior change interventions among Indigenous populations, collaborative approaches that target different intervention levels are beneficial. Further research to bridge the knowledge gap in this topic will help to improve the quality of preventive health strategies to achieve better outcomes at all levels, and will improve intervention implementation from development and delivery fidelity, to acceptability and sustainability.

Background: The ABCD National Research Partnership was formed in mid-2010 as a collaboration to harness the expertise, experiences and resources of Aboriginal and Torres Strait Islander community-controlled peak bodies, government and research organisations to improve the quality of Indigenous primary health care. The aim of this study was to apply social network methods to assess collaboration and functioning of the Partnership at two time-points. Methods: A social network analysis (SNA) survey was conducted in early 2013, with a follow-up survey in mid-2014. In the two survey rounds, online surveys were emailed to one senior person of the organisation participating in the Partnership (2013: 14 organisations; 2014: 11 organisations). The surveys collected data on respondent perceptions of the Partnership as well as social network relationship data. Social network methods were used to apply standardised metrics to assess how well the partnership was functioning as a collaborative three years into its operation, and in its fourth year. Results: Most respondents rated the Partnership as successful in progressing toward its goals. Network density and centrality scores show a well-connected partnership spanning different organisational types and states/territories (Northern Territory, Queensland, Western Australia, South Australia, and Far-West New South Wales). High centrality scores reflect high connectivity between key hubs in the network, contributing toward the shared goal of improved Indigenous primary health care. Network diagrams show key structural positions by organisational type, the frequency and intensity of interactions and the strengths and potential vulnerabilities in the partnership network, with comparisons at two time points for the partnership. Conclusions: The study found that the Partnership was effective in securing collaboration across its partners. Partners' contribution of resources reflected their active involvement. There was a high level of agreement on the achievement of the key goals of the Partnership, showing shared sense-making amongst partners. SNA tools assisted with monitoring the network over time to develop strategies supporting connections between partners for sustaining collaborative learning. Study findings identify successful approaches for a research partnership to improve quality of care in Indigenous primary health care and provide encouragement for wider applications for research partnerships and collaborations in Australia and internationally.

Efforts to strengthen health systems require the engagement of diverse, multidisciplinary stakeholder networks. Networks provide a forum for experimentation and knowledge creation, information exchange and the spread of good ideas and practice. They might be useful in addressing complex issues or 'wicked' problems, the solutions to which go beyond the control and scope of any one agency. Innovation platforms are proposed as a novel type of network because of their diverse stakeholder composition and focus on problem solving within complex systems. Thus, they have potential applicability to health systems strengthening initiatives, even though they have been predominantly applied in the international agricultural development sector. In this paper, we compare and contrast the concept of innovation platforms with other types of networks that can be used in efforts to strengthen primary healthcare systems, such as communities of practice, practice-based research networks and quality improvement collaboratives. We reflect on our ongoing research programme that applies innovation platform concepts to drive large-scale quality improvement in primary healthcare for Aboriginal and Torres Strait Islander Australians and outline our plans for evaluation. Lessons from our experience will find resonance with others working on similar initiatives in global health.