Sarah Louise Larkins

Sarah Louise Larkins
James Cook University · School of Medicine and Dentistry

MBBS, BMedSci, MPH&TM, PhD, FRACGP, FARGP

About

166
Publications
46,248
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,494
Citations
Introduction
I'm an academic General Practitioner, working as Professor of Health Systems Strengthening at the College of Medicine and Dentistry, James Cook University in Townsville, Australia. I am involved in a variety of reserach projects related to health services (with a a focus on primary care services for rural, remote and Indigenous populations), sexual and reproductive health, and social accountability in medical education.
Additional affiliations
August 2008 - present
James Cook University
Position
  • Associate Dean, Research

Publications

Publications (166)
Article
Background Academic health centres (AHCs) are organisations that aim to mobilise knowledge into practice by improving the responsiveness of health systems to emerging evidence. This study aims to explore the population health role of AHCs in Australia and England, where AHCs represent novel organisational forms. Methods A multiple-case study desig...
Preprint
Background There is limited data on system-level factors associated with equitable access to high-quality primary care. We examine whether individual-level socioeconomic variation in general practitioner (GP) quality-of-care varies by area-level organisation of primary healthcare (PHC) services. Methods Baseline data (2006–2009) from the Sax Insti...
Article
Full-text available
Background: Globally, experiences of menarche and subsequent menstruation are embedded in social and cultural beliefs, norms and practices. Menarche is an important developmental milestone in sexual and reproductive health (SRH) for females. Menarche is intertwined with socio-cultural norms, beliefs and practices, which can impact on women's abili...
Article
Full-text available
Background: Research is central to high functioning health services alongside clinical care and health professional training. The impact of embedded research includes delivery of high-quality care and improved patient outcomes. Evaluations of research impact help health service leadership ensure investments lead to the greatest healthcare benefits...
Article
The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems. Traditionally, structural issues with health professional education perpetuate these. COVID-19 has highlighted inequities, but may also be a disruptor, allowing positive responses and system redesign. Examples from health professional schools in high...
Preprint
Background : Lung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer. As part of implementing lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers. Methods : In-depth interv...
Preprint
Background Timely access to primary healthcare and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individuals' socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in GP and specialist use in New South Wales (NSW...
Article
Full-text available
As life expectancy increases for Indigenous populations, so does the number of older adults with complex, chronic health conditions and age-related geriatric syndromes. Many of these conditions are associated with modifiable lifestyle factors that, if addressed, may improve the health and wellbeing of Indigenous peoples as they age. If models of he...
Article
Full-text available
Background This systematic review was undertaken to assist the implementation of the WOmen’s action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women’s group (WG) action to improve maternal and child health (MCH) outcomes. There is now considerable international evidence that WGs improve MCH outco...
Article
Full-text available
Background Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effecti...
Article
Full-text available
Background Many indigenous people have died or been harmed because of inadequately monitored research. Strong regulations in Human Research Ethics (HRE) are required to address these injustices and to ensure that peoples’ participation in health research is safe. Indigenous peoples advocate that research that respects indigenous principles can cont...
Article
Full-text available
The use of contraceptives for family planning improves women’s lives and may prevent maternal deaths. However, many women in low and middle-income countries, including the Pacific region, still die from pregnancy-related complications. While most health centres offer family planning services with some basic contraceptive methods, many people do not...
Article
Full-text available
During the 2016-2017 Solomon Islands dengue outbreak, the National Referral Hospital (NRH) in Honiara was the epicenter for the national response. High-quality nursing care is critical for successful management and this study investigated the factors affecting the quality of nursing care for patients admitted to NRH with dengue. Data were collected...
Article
Full-text available
Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality...
Article
Full-text available
Background A national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector. Aim The liter...
Article
Setting: Surveillance and response workforce in the Indo-Pacific region, including Papua New Guinea (PNG), Solomon Islands, Fiji, Eastern Indonesia and Timor-Leste. Objective: To evaluate the implementation of a modified WHO SORT IT research training programme which included a workplace-based research project. The training was designed for surve...
Article
Full-text available
Background Survivorship care plan (SCP) comprising a treatment summary and plan for follow-up care is recommended by various organizations to address long-term needs of an increasing number of breast cancer survivors. Although there have been previous systematic reviews of SCPs in cancer, none has focused on breast cancer exclusively. This systemat...
Article
Full-text available
Background Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextu...
Article
Full-text available
Background Menarche, the first menstruation, is a significant developmental milestone for females. In Papua New Guinea (PNG), menarche is an important socio-cultural event marking transition from girlhood to womanhood. PNG is a culturally and linguistically diverse nation, with wide-ranging socio-cultural beliefs and practices around menarche. This...
Article
Full-text available
Objectives To (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT. Setting Three Indigenous primary healthcare (PHC) centres in the Northern Terr...
Article
Full-text available
Background Telehealth and teleradiology are increasingly used around the world to facilitate health care provision when the health care provider and clients are separated by distance. The BreastScreen Australia Remote Radiology Assessment Model (RRAM) is an initiative developed to address the challenges of inadequate access to a local radiological...
Article
Full-text available
Background A study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies. Methods/design Applying a constructivist grounded theory methodology, HCP were interviewed about their attitudes towards the provision of resuscitation and intensive...
Article
Introduction Breast cancer is the most commonly diagnosed cancer in Australian women. Given the diverse geography and populations within Australia, the ability to offer a telemedicine-supported breast screening and assessment service may increase access. The aim of this study was to assess clinical outcomes of a telemedicine-based remote radiology...
Article
Full-text available
Breast cancer is the most commonly diagnosed cancer in Australian women. Providing timely diagnostic assessment services for screen-detected abnormalities is a core quality indicator of the population-based screening program provided by BreastScreen Australia. However, a shortage of local and locum radiologists with availability and appropriate exp...
Article
Full-text available
Introduction: Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues...
Article
Full-text available
Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the pr...
Article
Full-text available
Objective: To understand the impact of alcohol consumption on the health utilisation of people with chronic diseases. Methods: A retrospective chart audit was undertaken in two primary care settings in a regional Australian city. Three indicator conditions were selected: type 2 diabetes, chronic obstructive pulmonary disease and chronic kidney dise...
Article
Full-text available
Objective: To better understand the impact of alcohol consumption on the clinical management of chronic diseases in a regional general practice setting. Methods: A retrospective chart audit was undertaken of individual patient records at two large group general practices in Townsville, a regional Australian city. Three common indicator chronic d...
Article
Objective: The James Cook University (JCU) medical school has a mission to produce graduates committed to practising with underserved populations. This study explores the views of final-year students regarding the influence of the JCU medical curriculum on their self-reported commitment to socially-accountable practice, intentions for rural practi...
Article
Objective: Ageing is a time of change that might involve financial, health and social losses. To maintain well-being, older people need to engage a range of resources to cope with these losses. However, national policies mainly focus on financial resources. This study used Folkman and Lazarus's transactional theory to identify coping methods engag...
Article
Full-text available
Introduction: Much of the existing work around implementation of cancer optimal care pathways (OCP) has either focused exclusively on the clinical elements of care or has targeted individual stages in the cancer trajectory, rather than using a patient-centred or service delivery lens to inform the integration of care across the continuum. This revi...
Article
Full-text available
Health systems in the Asia-Pacific region are poorly prepared for pandemic threats, particularly in rural/provincial areas. Yet future emerging infectious diseases are highly likely to emerge in these rural/provincial areas, due to high levels of contact between animals and humans (domestically and through agricultural activities), over-stretched a...
Article
Background: The use of family planning contraceptives helps improve women’s lives and prevent maternal deaths. Globally, maternal mortality has been significantly reduced between 1990 and 2015. However, the gains have not been evenly spread with the majority of deaths still occurring in low- and middle-income countries. Solomon Islands, a low-incom...
Article
Chronic diseases are a major contributor to the burden of disease in Australia. Alcohol consumption is similar in people with chronic disease and the general public, and may contribute to management challenges. In regional Australia, there are limited options for the management of excess alcohol consumption, so most of this burden falls to general...
Article
Full-text available
Background: Extremely preterm babies are at risk of significant mortality and morbidity due to their physiological immaturity. At periviable gestations decisions may be made to either provide resuscitation and intensive care or palliation based on assessment of the outlook for the baby and the parental preferences. Health care professionals (HCP)...
Article
Full-text available
Introduction: In Australia, there have been improvements in Aboriginal and Torres Strait Islander maternal health, however inequities remain. There is increasing international evidence illustrating the effectiveness of Participatory Women's Groups (PWGs) in improving Maternal and Child Health (MCH) outcomes. Using a non-randomized, cluster stepped-...
Article
Full-text available
Background: Health systems in Australia and worldwide are increasingly expected to conduct research and quality improvement activities in addition to delivering clinical care and training health professionals. This study aims to inform a research impact evaluation at a regional Australian Hospital and Health Service by developing a programme theor...
Article
Full-text available
Introduction Community-based Participatory Women’s Groups (PWGs) have proven to be an effective intervention to improve maternal and child health (MCH) outcomes in low/middle-income countries (LMICs). Less is known about how PWGs exert their effects in LMICs and virtually nothing is known about the contextual issues, processes and power relationshi...
Chapter
Appropriate housing, education, access to healthy food and economic, physical and emotional security are all vital determinants of good health. However, access to appropriate health services, ideally close to home, is important in terms of delivering the required preventive and curative health care to maximise the potential of community members for...
Article
Aim: To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis. Methods: CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base p...
Presentation
Summary of abstract What is the impact of research that learnt from high performing Indigenous primary healthcare centres to help striving centres improve their systems and performance? Abstract Title Impact evaluation of a strengths-based approach to improving the delivery of Indigenous primary healthcare Background Chronic disease management...
Article
Objectives: Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professio...
Article
Full-text available
Design A qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopme...
Article
Full-text available
Objectives Improving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a mismatch between interventions and context. This project aimed to understand the successful implementation of CQI initiatives in Aboriginal...
Article
Drawing from Australian Aboriginal and Torres Strait Islander perspectives, we conceptualize the association between community participation and continuous quality improvement (CQI) processes in Indigenous primary health care (PHC) services. Indigenous experiences of community participation were drawn from our study identifying contextual factors a...
Article
Full-text available
Introduction: Generalism in the health workforce has been established as an important strategy to address health workforce maldistribution. Thus, to best serve the medical needs of northern Australia, the James Cook University (JCU) College of Medicine and Dentistry has a mission to produce graduates who both practise in the region and have a gene...
Article
Full-text available
Background Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the numb...
Book
This book examines the mechanisms and strategies farmers in North Australia adopt to manage the setbacks and challenges they face. This social research is based on farmers’ experiences, but also draws on the author’s own experience after his tropical fruit farm was destroyed by two Category 5 cyclones in five years. Through historical analysis, the...
Article
Full-text available
Background Contemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was t...
Article
Full-text available
Background Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the pra...
Article
Aim The Townsville Hospital cares for babies in a large geographical area, many of who are outborn, are of Aboriginal or Torres Strait Islander origin and have families who reside in areas of deprivation. This study examined the outcomes of babies born at all locations in North Queensland to assess the predictors of poor outcomes. Methods A retros...
Article
Full-text available
(1) Background: Studies have shown that older people prefer to continue living in their own home and community as they age; however this is dependent upon available services and social support. In Australia about two thirds of people will age at home. The Australian Government provides home care packages to support ageing in place yet in rural area...
Article
Background: Medical workforce problems still dominate headlines despite considerable investment in education, training and other initiatives. There is little consensus about what Australia's general practice workforce should look like or what training outcomes should be reported. Objective: The aim of this paper was to explore a number of issues...
Article
Full-text available
Problem: Australian Aboriginal women's aspirations for birthing on country (having our babies born on our traditional land) are increasingly being reported in Australian scholarly and policy literature. However given the paucity of publications authored by Aboriginal Australians from remote areas of Australia, how well can the current knowledge ba...
Article
Full-text available
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...
Article
Community participation is increasingly seen as a prerequisite for more acceptable and sustainable health services. It is difficult to evaluate the extent of participation in health planning and implementation of services, and there are limited tools available to assist in evaluating such processes. Our paper reports on community participation as p...
Article
Full-text available
Objectives: To examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians. Design: Mixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and t...
Conference Paper
Full-text available
It is widely acknowledged that people in rural communities experience poorer oral health outcomes than those in larger centres. Further, children and adolescents have been identified as at-risk populations. Effectively engaging them in health promotion has the potential to impact positively on their lifelong general health. Addressing this through...