Abstract
BackgroundChronic diseases account for over 70% of health gaps between Aboriginal people and the rest of the Australian population. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW).ObjectiveThis study aimed to evaluate the feasibility and acceptability of a community-based chronic disease screening program for Aboriginal people.MethodsIn 2015, the program was enhanced to include an iPad app for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in 9 NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and Web portal usage, and key informant interviews was conducted.ResultsOverall, 1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 640 (61.19%) female, 957 (91.49%) Aboriginal or Torres Strait Islander). High chronic disease rates were observed (231 [22.08%] participants at high cardiovascular disease (CVD) risk, 173 [16.54%] with diabetes, and 181 [17.30%] with albuminuria). A minority at high risk of CVD (99/231 [42.9%]) and with diabetes (73/173 [42.2%]) were meeting guideline-recommended management goals. Overall, 297 participants completed surveys (response rate 37.4%) with 85.1% reporting satisfaction with event organization and information gained and 6.1% experiencing problems with certain screening activities. Furthermore, 21 interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties (eg, time delays in processing blood test results) impeded smooth processing of information. Only 51.43% of participants had a medical review recorded postevent with wide intersite variability (10.5%-85.6%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered highly resource intensive to implement and support from a central coordinating body and integration with existing operational processes was essential.Conclusions1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no previous knowledge of these issues. Strategies to improve linkage to primary care could enhance the program’s impact on reducing chronic disease burden.
Highlights
Studies of cardiovascular disease (CVD) risk management in Australian general practice and Aboriginal Community Controlled Health Service (ACCHS) settings demonstrated that 50% of routinely attending adults lacked sufficient recorded information to comprehensively evaluate vascular risk [6]
The 1 Deadly Step program was developed in partnership with New South Wales (NSW) Health and the Australian Rugby League to address the high prevalence of chronic diseases in NSW Aboriginal communities
A total of 1046 people were screened between April 2015 and April 2016 at 9 events in NSW
Summary
Chronic diseases, including cardiovascular disease (CVD), diabetes, chronic kidney disease (CKD), chronic respiratory disease and cancer, account for over 70% of health gaps between Aboriginal people and the rest of the Australian population [1]. Studies of CVD risk management in Australian general practice and Aboriginal Community Controlled Health Service (ACCHS) settings demonstrated that 50% of routinely attending adults lacked sufficient recorded information to comprehensively evaluate vascular risk [6]. For those identified at high vascular risk, only around 40% were prescribed guideline-indicated medicines. The 1 Deadly Step program was developed in partnership with New South Wales (NSW) Health and the Australian Rugby League to address the high prevalence of chronic diseases in NSW Aboriginal communities. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW). Strategies to improve linkage to primary care could enhance the program’s impact on reducing chronic disease burden
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