Abstract
BackgroundIn Australia’s north, Aboriginal peoples live with world-high rates of rheumatic heart disease (RHD) and its precursor, acute rheumatic fever (ARF); driven by social and environmental determinants of health. We undertook a program of work to strengthen RHD primordial and primary prevention using a model addressing six domains: housing and environmental support, community awareness and empowerment, health literacy, health and education service integration, health navigation and health provider education. Our aim is to determine how the model was experienced by study participants.MethodsThis is a two-year, outreach-to-household, pragmatic intervention implemented by Aboriginal Community Workers in three remote communities. The qualitative component was shaped by Participatory Action Research. Yarning sessions and semi-structured interviews were conducted with 14 individuals affected by, or working with, ARF/RHD. 31 project field reports were collated. We conducted a hybrid inductive-deductive thematic analysis guided by critical theory.ResultsAboriginal Community Workers were best placed to support two of the six domains: housing and environmental health support and health navigation. This was due to trusting relationships between ACWs and families and the authority attributed to ACWs through the project. ACWs improved health literacy and supported awareness and empowerment; but this was limited by disease complexities. Consequently, ACWs requested more training to address knowledge gaps and improve knowledge transfer to families. ACWs did not have skills to provide health professionals with education or ensure health and education services participated in ARF/RHD. Where knowledge gain among participant family members was apparent, motivation or structural capability to implement behaviour change was lacking in some domains, even though the model was intended to support structural changes through care navigation and housing fixes.ConclusionsThis is the first multi-site effort in northern Australia to strengthen primordial and primary prevention of RHD. Community-led programs are central to the overarching strategy to eliminate RHD. Future implementation should support culturally safe relationships which build the social capital required to address social determinants of health and enable holistic ways to support sustainable individual and community-level actions. Government and services must collaborate with communities to address systemic, structural issues limiting the capacity of Aboriginal peoples to eliminate RHD.
Highlights
In northern Australia, Aboriginal peoples suffer the highest documented burden of acute rheumatic fever (ARF) in the world with an age-standardised rate of initial ARF of 71.9 per 100,000 population among Indigenous Australians, compared with 0.60 per 100,000 for non-Indigenous Australians between 2015 and 2017 [1]
Community-led programs are central to the overarching strategy to eliminate rheumatic heart disease (RHD)
Government and services must collaborate with communities to address systemic, structural issues limiting the capacity of Aboriginal peoples to eliminate RHD
Summary
In northern Australia, Aboriginal peoples suffer the highest documented burden of acute rheumatic fever (ARF) in the world with an age-standardised rate of initial ARF of 71.9 per 100,000 population among Indigenous Australians, compared with 0.60 per 100,000 for non-Indigenous Australians between 2015 and 2017 [1]. This largely preventable disease has been linked to disparities grounded in colonial practices which disadvantage Indigenous peoples through restricted access to culturally safe healthcare, housing and education [2,3,4,5]. Our aim is to determine how the model was experienced by study participants
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