| | Enablers | Barriers | References |
| | Proximal level | | | Health literacy (demand) | Awareness in risk perception, trust, information and empowerment, peer-led health promotion, social interaction, self-awareness, and informing perceived benefit. | Low-risk perception of disease, perceived shame, little confidence, lack of familiarity, inadequate information, misperceptions, poor trust, conflicting messages, literacy gaps, and lack of prior medical history. | [28, 45, 48, 49, 51, 54–59, 63–66, 73, 78, 79, 84, 90, 98–109, 119, 139–141]. | | Sociocultural factors (D) | Adaption with two cultural identities, informed choice, rights-based approaches, identity disclosure, users’ engagement, rust-building, and breaking cultural stereotypes. | Lack of cultural safety, confidentiality, stigma, stereotypes, social isolation, lack of male involvement, lost connection to culture, inadequate discussion on STIs, sociocultural and religious influence, and social isolation of people with HIV. | [15, 28, 30, 45, 66, 69, 72–74, 78–81, 102–104, 137, 138] | | Language and communication (D) | Cultural sensitivity to overcome stereotypes, informal talk, homogenous backgrounds, cross-cultural workers, and understanding of culture. | Failure to understand language, lack of fluency and confidence, and high expectations of migrants. | [15, 28, 30, 55–58, 62, 66, 72, 90, 102, 104, 112, 119, 137, 138, 142]. | | Reaching to HFs (D) | Distance to HFs, availability of transportation facilities, maternity units in hospitals, affordable services, early health care visits in pregnancy, short travel time, timely and early testing at point of care. | High OOP expenditure and costly drugs, financial constraints, billing, payment issues without Medicare, high direct and indirect costs, poor access to transportation, long travel time, high care costs, lack of accommodation, high transport mobility. | [15, 45–49, 51, 53–58, 68, 70, 71, 78, 86–92, 94–106, 109, 142]. | | Provider’s behaviours and communication (S) | Overcoming fears/shame/negative experiences, improved trust, engagement, and coordination, expanded roles of Indigenous providers, understanding participants’ language, use of interpreters, use of culturally sensitive language, ensuring privacy and confidentiality, cultural representation, minimise shame, willingness to self-educate for minorities, practitioners’ nonjudgemental approach and inclusive language, trust, knowledge to reduce stigma. | Language barriers, lack of culturally appropriate skills, inadequate social skills in exchanging information, lack of confidentiality, insufficient cultural competency, cultural disengagement, and social isolation. | [15, 30, 48, 49, 51, 54, 57, 59, 60, 65, 66, 71, 72, 74, 75, 77–85, 100–102, 105, 107–110, 117, 137, 143, 144] | | Quantity and quality of workforce (S) | Dedicated clinical time, multidisciplinary team, local workforce, cultural sensitivity to overcome stereotypes, trusted relationships, responsiveness and shared cultural backgrounds, Indigenous providers, access to information to non-Indigenous providers, young GPs, the inclusion of psychologists and social workers, bilingual community educators. | High staff turnover, lack of capacity-building opportunities, inadequate technical skills and experiences, follow-up reminders, clinical complexity, shortage of Indigenous workers, inadequate engagement of providers with users, lack of clarity on provider roles, lack of interpreters or inconsistent services, lack of reminder calls, lack of respect of migrants’ beliefs and cultural safety, insufficient training, providers’ inadequate understanding, competing for clinical priorities, limited roles of PHC workers on NCDs. | [27, 44–49, 51, 55–59, 61–64, 67, 68, 72, 74–77, 79, 90, 98, 101–105, 107, 109, 112, 116, 117, 119, 121, 125, 126, 138, 139, 142, 143] | | Provision of services at HFs (S) | Culturally safe and continuity of midwifery care, timely family-centred service package care, reduced cost in flexible hours, package at HFs, closer to home or outreach, and home visits, welcoming and nonjudgemental attitudes of providers, follow-up service recalls to HIV patients, reminder systems, frequent care, services provided by the preferred gender, prearranged group appointments, community radio, ethnic newspapers and posters in the dissemination of pretravel health information. | Closure of rural maternity units/shifts, unavailability of and difficulties in operating after-hours services, lack of rapid referral, insufficient training and capacity-building opportunities, inadequate knowledge and experience, logistical barriers, lack of care coordination, poor understanding of the practical realities, minimal attention on health promotion interventions. | [27, 28, 47–49, 51, 53, 55, 57, 58, 62, 63, 65–71, 82, 84, 88, 96, 100, 101, 105, 107, 111–117, 121, 123, 125, 127, 128, 135, 136, 142] |
| | Intermediate level | | | Community engagement and participation (D) | Community interaction with local and Aboriginal people, interpersonal communication with providers, contextual adaptation, community engagement, community representation, women empowerment, embedded relation of providers, partnerships and engagement with the governments, partnerships for collaboration within the Medicare Locals model and community-level work, use of bilingual community educators. | Lack of targeted community involvement, limited health resources for refugees, lack of resources and logistics, poor communication and information, insufficient understanding of contexts, lack of effective partnerships and collaboration with users, and disjointed and fraught providers’ relationships. | [15, 27, 28, 30, 48, 49, 54, 57, 59–65, 74–77, 90, 98, 100–102, 105, 107, 108, 110–112, 129, 130, 137, 142, 144] | | Programs and models of care (S) | Community-controlled health services, midwifery-led continuity of care, strong regional collaborations between PHNs and local organisations, understanding the difference between primary care and public health, involvement of local governments, service coordination and quality improvement initiatives, clinical networks and planned terms of references, team-based primary care, and care coordination framework. | Discontinuity and short-term programs, challenges in program evaluation in mainstream PHC programs, lack of alternative models of care, nonfunctioning health hardware, health system lacks of clinician or practice choices to address the needs of sexual minorities, unclear roles and responsibilities overlap between public health and primary care, lack of a national policy on catch-up vaccination, medically centred model of care, ambiguities in the federal/state divided responsibilities for PHC, medico centricity and privatisation, unclear accountability mechanisms, and high bureaucracy. | [13, 15, 30, 49, 53, 55, 58, 62, 67, 69–71, 80, 81, 85, 86, 88, 90, 96, 97, 102, 104, 105, 110, 113, 115, 116, 118, 119, 125, 128, 133, 135–137, 145–152] | | Financial resources (S) | Targeted copayment, bulk billing, primary care incentives and commissioning of services, blended payment methods, single fundholding arrangements, and monitoring OOP, technology effectively generated data for informed intelligence and decision-making, flexibility in regional and funding for Indigenous people, Mandatory Integrated Public and Private Health Insurance incentives, reduction in copayment cap, better access to prescription medications. | High care costs in multimorbidity (lack of insurance), insufficient funding, competing priorities in resource allocations, a lack of national programs on chronic conditions, fragmentation of funding and services, lack of financial incentives, had no support for high taxpayer priority access. | [13, 27, 47, 50, 51, 68, 69, 73, 78, 79, 83, 84, 89, 91–93, 96–99, 109, 118, 126, 130–136, 148, 151, 153] | | Health workforce management (S) | Partnership with universities for Indigenous midwives and Aboriginal people, regional maternity care workers and increased Indigenous midwives, quality supervision, supervised GP training, professional development program attitudinal training attracted and enhanced the retention of the GPs. | Administrative burden, direct remuneration and opportunity costs (e.g., GP services in RACFs), poor trust and burnout, tension of roles of the workforce, inequitable distribution, lack of skills and experience, shortages of staff and high turnover, complex and overwhelming workload, a lack of understanding of administrative management functions, and inadequate skill experience. | [13, 27, 48, 57, 59, 60, 62, 71, 73, 75, 80, 82–85, 96, 105, 110–117, 133, 148, 154] | | Evidence use in planning and monitoring (S) | Standard setting, benchmarking using reliable and comparable data, tailoring and prioritising practices, monitoring and surveillance, priority-based resource allocation in planning, timely collection of consistent and quality data from multiple sources and collation, creating visual indicators and prioritising, board training, accreditation requirements, research, practitioner-informed implementation and national quality and performance framework, tailored community-driven, bottom-up health planning using codesign principles, surveillance, reporting, use of records of care and quality indicators. | Inadequate quality data, poor understanding sensitivity in surveillance, complexity of use of technology, lack of comparable information, lack of audit tools and data on quality of care, inadequate evidence-based planning, missing link of translation of evidence into practice, unavailability of quality data and inadequacy to identify problems, poor coordination of health planning, inadequate funding of PHNs, performance and regulatory requirements. | [13, 15, 30, 46, 51, 55, 60–62, 70, 73, 76, 85–89, 96, 98, 106, 107, 113, 114, 117–120, 127, 136, 137, 143, 144, 148, 153, 154] |
| | Distal level | | | Socioeconomic and diversities (S and D) | Provision of Medicare | Lack of full-time work, economic hardship, systematic racial discrimination, dominant culture at HFs that inadequately captured Indigenous knowledge, values and culture, experiences of stigma and discrimination in employment. | [6, 15, 30, 63, 64, 66, 72, 79, 84, 96, 102, 104, 109, 130, 137, 138, 140, 142] |
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