NHMRC Research Fellow, Dr Nikki Percival, is a health services researcher passionate and deeply committed to achieving Indigenous health equality and undertaking research that makes a real difference to people’s lives.
Throughout her career, Nikki has focused on redesigning and strengthening the health system so that it works better for Aboriginal and Torres Strait Islander peoples. She has been involved in developing, implementing and evaluating quality improvement initiatives alongside Indigenous primary health care services, including developing Australia’s first quality improvement tools to assist health services achieve best practice in Indigenous health promotion.
Nikki has trained and worked in the health promotion field since 1994 and has made significant contributions to Indigenous health promotion in research and evaluation, policy and practice. She has been an investigator on research grants totalling >$2.1M, including competitive NHMRC funding; and >$8.6M total consultancy funding. She has won numerous awards for her pioneering work in health promotion quality improvement and has been invited to speak at national and international events including from the World Health Organisation – Western Pacific Region, and for other events in Australia, New Zealand and Canada.
Prior to starting a research career, Nikki was employed in government and non-government organizations in practice and senior policy roles, including the Manager of the Health Promotion Strategy Unit, Northern Territory Department of Health. Her policy and practice experience has influenced her research interests and approach to research translation and implementation.
Her current research (NHMRC Early Career Fellowship) combines quality improvement methods and implementation science to understand effective ways to link clinical preventive services and community based health promotion programs. The Fellowship provides a unique opportunity to utilise Nikki's policy-practice-research experience to investigate effective ways to improve service delivery and impact of chronic disease prevention initiatives in Indigenous communities.
- NHMRC Early Career Fellowship (Award)
- Australian Health Promotion Association (member)
- Public Health Association of Australia (member)
- International Union for Health Promotion and Education (member)
- 15th World Congress on Public Health (Scientific Committee)
- 10th Health Services and Policy Research Conference (Organising Committee)
- Frontiers in Public Health, Public Health Policy (Review Editor)
- Peer Reviewer: BMC Public Health, BMC Health Services Research, PLOS ONE, Global Health Promotion, Australian Journal of Primary Health and the Australian and New Zealand Journal of Public Health
Can supervise: YES
- health promotion
- Indigenous health
- primary health care
- qualitative research
- implementation science and knowledge translation
- quality improvement
- Evaluating complex interventions
- systems approaches
- health services and policy research
- chronic disease
- health promotion and education
- Indigenous health
- Primary health care
- Program planning, implementation and evaluation
- Social determinants of health
Dzidowska, M, Lee, KSK, Wylie, C, Bailie, J, Percival, N, Conigrave, JH, Hayman, N & Conigrave, KM 2020, 'A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement.', BMC family practice, vol. 21, no. 1.View/Download from: Publisher's site
BACKGROUND:Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements. METHODS:We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes. RESULTS:Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved scree...
Stoneham, M & Percival, N 2020, 'More than words: ANZJPH declares an urgent call for manuscripts that focus on Indigenous health', Australian and New Zealand Journal of Public Health.
Laycock, AF, Bailie, J, Percival, NA, Matthews, V, Cunningham, FC, Harvey, G, Copley, K, Patel, L & Bailie, R 2019, 'Wide-scale continuous quality improvement: A study of stakeholders' use of quality of care reports at various system levels, and factors mediating use', Frontiers in Public Health, vol. 6, no. JAN.View/Download from: Publisher's site
© 2019 Laycock, Bailie, Percival, Matthews, Cunningham, Harvey, Copley, Patel and Bailie. 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 coul...
Robinson, S 2019, 'Selected research from the 10th Health Services Research Association "Shifting priorities: balancing acute and primary care services"', Journal of Health Organization and Management, vol. 33, no. 1, pp. 2-4.View/Download from: Publisher's site
Laycock, A, Harvey, G, Percival, N, Cunningham, F, Bailie, J, Matthews, V, Copley, K, Patel, L & Bailie, R 2018, 'Application of the i-PARIHS framework for enhancing understanding of interactive dissemination to achieve wide-scale improvement in Indigenous primary healthcare.', Health research policy and systems, vol. 16, no. 1, pp. 117-117.View/Download from: Publisher's site
BACKGROUND:Participatory research approaches improve the use of evidence in policy, programmes and practice. Few studies have addressed ways to scale up participatory research for wider system improvement or the intensity of effort required. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to analyse implementation of an interactive dissemination process engaging stakeholders with continuous quality improvement (CQI) data from Australian Indigenous primary healthcare centres. This paper reports lessons learnt about scaling knowledge translation research, facilitating engagement at a system level and applying the i-PARIHS framework to a system-level intervention. METHODS:Drawing on a developmental evaluation of our dissemination process, we conducted a post-hoc analysis of data from project records and interviews with 30 stakeholders working in Indigenous health in different roles, organisation types and settings in one Australian jurisdiction and with national participants. Content-analysed data were mapped onto the i-PARIHS framework constructs to examine factors contributing to the success (or otherwise) of the process. RESULTS:The dissemination process achieved wide reach, with stakeholders using aggregated CQI data to identify system-wide priority evidence-practice gaps, barriers and strategies for improvement across the scope of care. Innovation characteristics influencing success were credible data, online dissemination and recruitment through established networks, research goals aligned with stakeholders' interest in knowledge-sharing and motivation to improve care, and iterative phases of reporting and feedback. The policy environment and infrastructure for CQI, as well as manager support, influenced participation. Stakeholders who actively facilitated organisational- and local-level engagement were important for connecting others with the data and with the externally located research team. Develop...
McCalman, J, Bailie, R, Bainbridge, R, McPhail-Bell, K, Percival, N, Askew, D, Fagan, R & Tsey, K 2018, 'Continuous quality improvement and comprehensive primary healthcare: a systems framework to improve service quality and health outcomes', Frontiers in Public Health, vol. 6.View/Download from: Publisher's site
Percival, NA, McCalman, J, Armit, C, O'Donoghue, L, Bainbridge, R, Rowley, K, Doyle, J & Tsey, K 2018, 'Implementing health promotion tools in Australian Indigenous primary health care', Health Promotion International, vol. 33, no. 1, pp. 92-106.View/Download from: Publisher's site
In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services.
Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model.
An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing.
The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools.
Williams, HM, Percival, NA, Hewlett, NC, Cassady, RBJ & Silburn, SR 2018, 'Online scan of FASD prevention and health promotion resources for Aboriginal and Torres Strait Islander communities', HEALTH PROMOTION JOURNAL OF AUSTRALIA, vol. 29, no. 1, pp. 31-38.View/Download from: Publisher's site
de Witt, A, Cunningham, FC, Bailie, R, Percival, N, Adams, J & Valery, PC 2018, '"It's just presence," the contributions of aboriginal and Torres Strait Islander health professionals in cancer care in Queensland', Frontiers in Public Health, vol. 6, no. DEC.View/Download from: Publisher's site
© 2018 de Witt, Cunningham, Bailie, Percival, Adams and Valery. Objectives: The aim of this research was to explore health professionals' perspectives on the provision of follow-up cancer care for Aboriginal and Torres Strait Islander patients in Queensland. Methods: Semi-structured interviews were conducted with Indigenous and non-Indigenous health professionals who had experience providing care for Indigenous cancer patients in the primary health care and hospital setting. Results: Participants were recruited from six Aboriginal Community Controlled Health Services (n = 17) and from a tertiary hospital (n = 9) across urban, regional, and remote geographical settings. Culturally safe care, psychological support, determining patient needs, practical assistance, and advocating for Indigenous health were identified as enablers to support the needs of Indigenous patients when accessing cancer care, and Indigenous health professionals were identified as the key enabler. Conclusion: Indigenous health professionals significantly contribute to the provision of culturally competent follow-up cancer care by increasing the accessibility of follow-up cancer care services and by supporting the needs of Indigenous cancer patients. All health professionals need to work together and be sufficiently skilled in the delivery of culturally competent care to improve the Indigenous cancer journey and outcomes for Indigenous people. Effective organizational policies and practices are crucial to enable all health professionals to provide culturally competent and responsive cancer care to Indigenous Australians.
Laycock, A, Bailie, J, Matthews, V, Cunningham, F, Harvey, G, Percival, N & Bailie, R 2017, 'A developmental evaluation to enhance stakeholder engagement in a wide-scale interactive project disseminating quality improvement data: study protocol for a mixed-methods study', BMJ OPEN, vol. 7, no. 7.View/Download from: Publisher's site
Garvey, G, Percival, N, Izquierdo, L, Moodie, D & Moore, S 2016, 'Big data in an indigenous health context: Opportunities and obstacles', Cancer Forum, vol. 40, no. 2, pp. 110-114.
The ability of health researchers to unearth previously unsuspected health risks, trends and commonalities at a population level through matching information across different datasets is well attested. However, as more of this type of research is conducted, the spotlight is being shone on the barriers to accessing these data. Less well known are the complexities experienced by researchers working with datasets in an Aboriginal and Torres Strait Islander health context. We present the insights of a number of researchers, clinicians and public sector representatives who have extensive experience of data linkage in the Aboriginal and Torres Strait Islander health sector, on key issues and practical and ethical implications of utilising big datasets. Obstacles are further highlighted in the experiences of a national multicentre cancer cervical screening study. While researchers must at all times respect the individuals whose information is contained within these datasets, and abide by the legislative structures governing their use, measures to streamline data linkage processes are required. Realising the potential of existing health data that previously has not been available may underpin significant improvements in indigenous health and ultimately life expectancy.
McCalman, J, Bainbridge, R, Percival, N & Tsey, K 2016, 'The effectiveness of implementation in Indigenous Australian healthcare: an overview of literature reviews', INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH, vol. 15.View/Download from: Publisher's site
Percival, N, O'Donoghue, L, Lin, V, Tsey, K & Bailie, RS 2016, 'Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care', Frontiers in Public Health, vol. 4, pp. 1-9.View/Download from: Publisher's site
Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.
Bailie, J, Schierhout, G, Laycock, A, Kelaher, M, Percival, N, O'Donoghue, L, McNeair, T & Bailie, R 2015, 'Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians', BMJ OPEN, vol. 5, no. 11.View/Download from: Publisher's site
Tretheway, R, Taylor, J, O'Hara, L & Percival, N 2015, 'A missing ethical competency? A review of critical reflection in health promotion', HEALTH PROMOTION JOURNAL OF AUSTRALIA, vol. 26, no. 3, pp. 216-221.View/Download from: Publisher's site
Bailie, J, Schierhout, GH, Kelaher, MA, Laycock, AF, Percival, NA, O'Donoghue, LR, McNeair, TL, Chakraborty, A, Beacham, BD & Bailie, RS 2014, 'Follow-up of Indigenous-specific health assessments - a socioecological analysis', MEDICAL JOURNAL OF AUSTRALIA, vol. 200, no. 11, pp. 653-657.View/Download from: Publisher's site
McCalman, J, Tsey, K, Bainbridge, R, Rowley, K, Percival, N, O'Donoghue, L, Brands, J, Whiteside, M & Judd, J 2014, 'The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: a systematic literature search', BMC PUBLIC HEALTH, vol. 14.View/Download from: Publisher's site
O'Donoghue, L, Percival, N, Laycock, A, McCalman, J, Tsey, K, Armit, C & Bailie, R 2014, 'Evaluating Aboriginal and Torres Strait Islander health promotion activities using audit and feedback', AUSTRALIAN JOURNAL OF PRIMARY HEALTH, vol. 20, no. 4, pp. 339-344.View/Download from: Publisher's site
Bailie, R, Si, D, Connors, C, Weeramanthri, T, Clark, L, Dowden, M, O'Donohue, L, Condon, J, Thompson, S, Clelland, N, Nagel, T, Gardner, K & Brown, A 2008, 'Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project', BMC HEALTH SERVICES RESEARCH, vol. 8.View/Download from: Publisher's site
Clelland, N, Gould, T & Parker, E 2007, 'Searching for Evidence: What works in Indigenous Mental Health Promotion', Health Promotion Journal of Australia, vol. 18, no. 3.View/Download from: Publisher's site
Percival, N 2018, 'Strengthening systems and collaborations for chronic disease prevention in Indigenous communities', Prevention and Public Health Conference: We can do more and we must, Sydney Boulevard Hotel.
Percival, N, Strobel, N, McCalman, J, Matthews, V, Bailie, J, Bailie, R & Burgess, P 2019, 'Do Primary HealthCare linkages with community improve preventive care for Indigenous adults?', Public Health Prevention Conference 2019: Smashing the Silos, Melbourne, Australia.
Laycock, A, Bailie, J, Percival, N, Harvey, G, Cunningham, F, Matthews, V, Copley, K, Patel, L & Bailie, R 2018, 'Wide-scale continuous quality improvement: Stakeholders' use of quality of care reports', Primary Health Care Research Conference, Melbourne.
Percival, N & Boucher, P 2018, 'Community Participation: Closing the Gap in Indigenous Health Promotion', Prevention and Public Health Conference: We can do more and we must, Sydney Boulevard Hotel.
Percival, N, O'Donoghue, L, Laycock, A, Bailie, J & Bailie, R 2017, 'Improving Implementation of Indigenous health promotion: Lessons from a place-based evaluation of the Indigenous chronic disease package', 15th World Congress on Public Health, Melbourne.
Laycock, A, Bailie, J, Matthews, V, Cunningham, F, Harvey, G, Percival, N & Bailie, R 2017, 'Driving system-wide primary healthcare improvement: Stakeholder perspectives and actions following a CQI data sharing and analysis project', 6th Annual NHMRC Symposium on Research Translation, Brisbane.
Percival, N, Cassady, R, Hannah, C, Hefler, M, Williams, H & Hewlett, N 2017, 'Navigating the ethics of a large scale health promotion project in an Indigenous health context', 15th World Congress on Public Health, Melbourne.
Williams, H & Percival, N 2016, 'Tailoring local-level service delivery models for widespread implementation', 3rd Biennial Australasian Implementation Conference, Melbourne.
Bailie, J, Schierhout, G, Laycock, A, Kelaher, M, Percival, N, O'Donoghue, L & Bailie, R 2014, 'Enhancing implementation through evaluation: reflections on an innovative evaluation of a national chronic disease program', Third Global Symposium on Health Services Research, Global Symposium on Health Services Research, Cape Town, South Africa.
Percival, N 2012, 'Indigenous health promotion quality improvement'.
Percival, N, O'Donoghue, L & Bailie, R 2011, 'Using Continuous Quality Improvement Techniques to Improve Health Promotion in Indigenous Primary Health Care: A feasibility study', 7th Health Services and Policy Research Conference, Health Services and Policy Research Conference (HSRAANZ), Adelaide, Australia.
Percival, N, O'Donoghue, L, Lin, V & Bailie, R 2011, 'The Principles seem obvious but applying them in practice is not easy – Health Promotion Quality Evaluation in Indigenous Primary Health Care', Australasian Evaluation Society 2011 International Conference.
Bailie, R University Centre for Rural Health, University of Sydney 2018, Parlimentary Inquiry submission to 'Closing the Gap Refresh', Sydney.
Percival, N 2017, Fetal Alcohol Spectrum Disorder Prevention and Health Promotion Resources Project: Final Report. Prepared by Menzies School of Health Research., Canberra.
Bailie, R, Griffin, J, Kelaher, M, McNeair, T, Percival, N, Alison, L & Schierhout, G 2013, Sentinel Sites Evaluation: Summary Report. Report prepared by Menzies School of Health Research, Canberra.
Bailie, R, Griffin, J, Kelaher, M, McNeair, T, Percival, N, Laycock, A & Schierhout, G 2013, Sentinel Sites Evaluation: Final Report. Prepared by Menzies School of Health Research, Canberra.