Abstract
Despite growing acknowledgement of the socially determined nature of health disparities among Aboriginal people, how to respond to this within health promotion programs can be challenging. The legacy of Australia’s assimilation policies have left profound consequences, including social marginalisation, limited educational opportunities, normalisation of premature death, and entrenched trauma. These social determinants, in conjunction with a reluctance to trust authorities, create barriers to accessing healthcare services for the prevention, treatment, and rehabilitation of chronic disease. The Heart Health program is a culturally sensitive cardiac rehabilitation program run at the local Aboriginal Medical Service in Perth, Western Australia that has since moved beyond cardiac education to provide a holistic approach to chronic disease management. A participatory action research framework was used to explore Heart Health participant and service provider perspectives on the barriers, enablers, and critical success factors to program participation and behaviour change. Thematic analysis of interview transcripts was undertaken, and through yarning (Aboriginal storytelling) sessions, many participants made unprompted reference to the impacts of white settlement, discrimination, and the forced fracturing of Aboriginal families, which have been explored in this paper reiterating the need for a social determinants lens to be taken when planning and implementing Aboriginal health promotion programs.
Highlights
Cardiovascular disease, diabetes, and other chronic lifestyle diseases are starkly over-represented in Aboriginal and Indigenous populations around the world, including Australia [2]
This is by no means a new revelation to Aboriginal people, but the influence of these distal factors on health behaviours and health service engagement is often not adequately taken into account in programs ostensibly designed for Aboriginal people [34]
This research and photovoice project began with the question, “what is it about the Heart Health program that sets it apart from other health promotion programs that seek to engage Aboriginal people?” In exploring this question with participants and program staff, two dominant and inter-related themes emerged
Summary
Cardiovascular disease, diabetes, and other chronic lifestyle diseases are starkly over-represented in Aboriginal and Indigenous populations around the world, including Australia [2]. These preventable diseases have ravaged Aboriginal and Torres Strait Islander (Aboriginal) communities across Australia, contributing to the decade difference in life-expectancy between Aboriginal and non-Aboriginal. Australians [3,4]. The prevailing inequalities in Aboriginal health results from a constellation of. Res. Public Health 2018, 15, 1514; doi:10.3390/ijerph15071514 www.mdpi.com/journal/ijerph
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