Academic journal article Australian Health Review

'I Don't Know Why They Don't Come': Barriers to Participation in Cardiac Rehabilitation

Academic journal article Australian Health Review

'I Don't Know Why They Don't Come': Barriers to Participation in Cardiac Rehabilitation

Article excerpt


The health disparities of Indigenous people around the world are a global public health issue. In Australia, Aboriginal and Torres Strait Islander peoples are more likely to have cardiovascular disease and suffer more fatal coronary events than other Australians. 1 Cardiac rehabilitation (CR) is a structured approach to secondary prevention and cardiac care involving exercise, behavioural modification and education, and is endorsed by Australian state and federal government policy.2 Following an acute coronary event, CR has proven effective in reducing cardiovascular risk. Although participation rates in CR are less than optimal for all Australians, Aboriginal participation in CR programs is significantly lower.3 The barriers to service access for Aboriginal patients and developing enabling strategies are critical public health issues. In spite of targeted guidelines to promote access, uptake and adherence is limited.4

In 2008, Australian Prime Minister Kevin Rudd offered a historic apology to Aboriginal people and the Stolen Generations, in which he emphasised the importance of improving health services for Aboriginal people and engaging Aboriginal people in health research, services, and education to reduce health inequities, improve access, and achieve equitable policy outcomes. 5 Engaging consumers in the planning, delivery and evaluation of health care arises from the belief that better health outcomes result from collaborative, community-involved decision- making.6 However, ensuring that collaboration with Aboriginal health service consumers genuinely results in service translation can be challenged by a lack of understanding of cultural differences.7 Overcoming these challenges requires appreciating the beliefs and values of an individual's culture and adopting approaches that facilitate appropriate patient-provider interactions. This process, known as cultural competence in health care, appreciates the social and cultural influences on patients' health beliefs and behaviours and adopts steps to incorporate these understandings into patient-provider interactions and, ultimately, service delivery.8

In 2005, the National Health and Medical Research Council (NMHRC) released Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples:AGuide for Health Professionals9 (hereafter the Guide). The Guide provides health professionals with a practical framework for delivering culturally competent and improved CR services to Aboriginal people. These guidelines provide information on cultural competency and approaches to improving Aboriginal participation in CR as well as checklists for health professionals working in primary care, CR, and health management settings. The Guide was distributed to a wide range of interested and relevant individuals and organisations, including Aboriginal Community Controlled Health Services, throughout Australia. Limited implementation strategies have shown inadequate awareness of these guidelines.4

In Western Australia (WA), there is disparity in the health and life expectancy between Aboriginal and non-Aboriginal Australians.10 The remoteness of many areas and unbalanced population distribution combined with cultural differences contribute to complexities in health service planning and effective delivery for Aboriginal communities.6 To better understand CR services available to Aboriginal people in WA, a project was undertaken to assess CR implementation of the Guide state-wide. The Guide included a seven-page toolkit on cultural competency, including avenues to obtain further information and develop cultural expertise, tips on communicating with individuals, communities, and Aboriginal Health Services, using appropriate language, working with cultural mentors, interpreters, and tips for providing organisational support for intercultural service delivery.

As part of the initial evaluation, a striking finding, particularly within non-Aboriginal-specific health facility participants, was their bemusement regarding why Aboriginal people do not attend CR. …

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