Benefits of this Research

Cardiovascular Disease (CVD) is the primary influencing factor in the life expectancy gap between Indigenous and non-Indigenous populations. Ischaemic heart disease alone is reported to account for 24% of the avoidable and preventable gap, with Aboriginal and Torres Strait Islander people being three times more likely to have a major cardiac event. In addition to this, they are more than twice as likely to die in hospital from heart disease, and are more likely to have numerous cardiac risk factors such as smoking, high blood pressure, obesity and diabetes.

Secondary prevention strategies such as cardiac rehabilitation (CR) programs have been implemented in Australian Indigenous populations to improve cardiovascular health. However, there are many barriers to participation. Studies have demonstrated that the main barriers are inadequate access to care, patient misconceptions of purposes and benefits of CR, sub-optimal awareness by practitioners of the national guidelines for the implementation of CR, and inadequate patient–physician communication.

To increase participation in CR for this population a number of strategies have been shown to be successful. CR programs for Australian Indigenous populations should be gender specific, multifactorial in nature, consist of a culturally sensitive program structure, utilise Indigenous Health Workers (IHW), provide transport assistance and provide general education about medication usage.

It is recommended that program delivery should occur within an Aboriginal Medical Service (AMS) but these are not always available in areas of need. This is highlighted in the ‘Close the Gap’ report where 27% of respondents who said they would prefer to go to an AMS, did not have an AMS within their local area. Bainbridge et al (2015) report that accessibility to an AMS is limited (reach and capacity) despite over 140 services Australia-wide. Thus, non-AMS health services must be able to provide culturally competent care.

The purpose of the Indigenous CR program at the University of Canberra’s Faculty of Health Clinics (UC-ICR) is to implement known enablers to overcome common access barriers for participation in CR programs by Aboriginal and Torres Strait Islander people. The feasibility evaluation of a targeted, women's only CR program will support future investigation and implementation. Improving the cultural capability of CR programs can increase utilisation
of CR services for Indigenous Australians, recognising the historical, social and cultural circumstances of Indigenous peoples and how these directly affect their uptake of health services.

The UC-ICR program is based on the success of previous studies which have implemented specific enablers within the Australian Indigenous population to overcome known barriers. Ski et al (2015) found that adopting these enablers, decreased risk factors for CVD such as alcohol and smoking, and increased physical activity. Others found these strategies reduced CVD deaths and blood pressure, and increased CR participation rates.

The evidence strongly indicates that the UC-ICR program at the University of Canberra’s Faculty of Health Clinics will be an appropriate program, aiming to increase participation rates in CR programs for Aboriginal and Torres Strait Islanders. In addition, this project will be informed by data collected in the UC-CIRI project ‘Introducing Restorative Health Practices to give voice, accountability and healing value for Aboriginal and Torres Strait Islander families/ communities in the new University of Canberra Public Hospital’, assisting us to create a culturally safe environment for Indigenous participants by working with, and being led by, Indigenous voices.

This feasibility study will be made available to adult Aboriginal and Torres Strait Islander’s and their families who have CVD (post-acute myocardial infarction, coronary artery bypass graft, coronary angioplasty and/or other cardiovascular disease). It will not only be a secondary prevention program, but will also provide primary prevention for those at risk of CVD. Our aim is to make a tangible difference to local Indigenous communities by enabling Indigenous identity, decreasing risk factors for CVD and overall risk of a cardiac event.