Optimising Healthy Homes and Neighbourhoods (HHAN) Collaborative Research Project

Background

The Optimising Healthy Homes and Neighbourhoods (HHAN) Collaborative Research Project aims to evaluate an intersectoral initiative designed to address the complex health and social needs of families in Sydney facing adverse social determinants of health to reflect HHAN’s holistic approach. Funded by NSW Health and developed by the Sydney Local Health District (SLHD) since 2015, HHAN focuses on breaking cycles of inequity by working with families to address their needs. The initiative particularly serves Aboriginal and Torres Strait Islander families and culturally and linguistically diverse families.

Aim & Research Methodology

The project assesses HHAN's impact and effectiveness against the quintuple aims of healthcare, using the WHO's integrated people-centred health services (IPCHS) framework. It employs multi-method evaluations, including Indigenous research methods and participatory research, to co-design solutions for optimizing service delivery.

Collaborative Group

The project involves investigators from The George Institute for Global Health, University of Sydney, University of New South Wales, SLHD, Central Eastern Sydney Primary Health Network, Health Justice Australia, and NSW Ministry of Health. This diverse team brings expertise in various fields, enriching the evaluation with multiple perspectives, including those of Aboriginal and Torres Strait Islander researchers. It is funded in kind by partners and by the Centre for research excellence for health and social care integration.

Governance and Ethical Conduct

Governance structures ensure best practices in Aboriginal and Torres Strait Islander health research. The project includes an Aboriginal and Torres Strait Islander Advisory Committee and follows guidelines from the Guunu-maana (Heal) program at The George Institute, which emphasizes ethical research and advocacy led by Indigenous ways of knowing, being and doing. There is regular feedback of project progress to the intersectoral HHAN Steering Committee.

The research will be conducted at The George Institute for Global Health and at the site: Sydney Local Health District.

Research and Findings To Date

Since 2015, the initiative has used a Critical Realist Approach and Plan-Do-Study-Act cycles to build research capacity. Key findings include: Enrollment of 591 families by June 2024, with 30% being First Nation families. Decreased hospitalizations and emergency department presentations. Strong therapeutic relationships as a key mechanism for success, though with risks of dependency and staff burnout. Challenges due to historical fragmentation, institutional racism, and limited resources.

Future Work Plan

Building on the research done so far, the next 12- 18 months involve several key activities:

• Surveys, yarns and interviews with stakeholders triangulated with the analysis of program data,
• Linked data evaluation and economic evaluations,
• Underpinned by continuous feedback and optimization of implementation.
• Writing and dissemination of research findings through meetings, academic outputs, and conferences.