Build It and They Will Come: Outcomes from a Successful Cardiac Rehabilitation Program at an Aboriginal Medical Service
Dimer, Lyn, Dowling, Ted, Jones, Jane, Cheetham, Craig, Thomas, Tyra, Smith, Julie, McManus, Alexandra, Maiorana, Andrew J., Australian Health Review
Objective. Cardiovascular disease (CVD) is the leading disease burden in Aboriginal Australians, but culturally appropriate cardiac rehabilitation programs are lacking. We evaluated the uptake and effects on lifestyle, and cardiovascular risk factors, of cardiac rehabilitation at an Aboriginal Medical Service (AMS).
Methods. The program involved weekly exercise and education sessions (through 'yarning') for Aboriginal people with or at risk of CVD. Participants' perceptions of the program and the impact on risk factors were evaluated following 8 weeks of attendance.
Results. In twenty-eight participants (20 females) who completed 8 weeks of sessions, body mass index (34.0±5.1 v. 33.3±5.2 kgm-2;P < 0.05), waist girth (113±14 v. 109±13 cm; P < 0.01) and blood pressure (135/78±20/12 v. 120/72± 16/5 mmHg; P < 0.05) decreased and 6- min walk distance increased (296±115 v. 345±135 m; P < 0.01). 'Yarning' helped identify and address a range of chronic health issues including medication compliance, risk factor review and chest pain management.
Conclusions. AMS-based cardiac rehabilitation was well attended, and improved cardiovascular risk factors and health management. An AMS is an ideal location for managing cardiovascular health and provides a setting conducive to addressing a broad range of chronic conditions.
What is known about the topic? Cardiovascular disease is the leading cause of morbidity and mortality in Aboriginal Australians, but less than 5% of eligible Aboriginal people attend hospital-based cardiac rehabilitation.
What does this paper add? This is the first study to describe a culturally appropriate cardiac rehabilitation program conducted in a metropolitan Aboriginal Medical Service. It provides a detailed account of the program's components and its effects on physical and psychosocial determinants of cardiovascular health in participants.
What are the implications for practitioners? Health management programs similar to the one evaluated in this study could be developed to suit the specific needs of other Indigenous communities around Australia to address a range of chronic conditions.
Received 5 December 2011, accepted 28 May 2012, published online 21 December 2012
Cardiovascular disease (CVD) continues to be the leading cause of death among Aboriginal Australians, with deaths occurring at a younger age than in other Australians.1 While a multitude of factors underlie this disparity, the well-documented health service gap for Indigenous compared with non-Indigenous Australians is a significant contributing factor.2 Cardiac rehabilitation is a clear example. Although a variety of models exist,3 Aboriginal people are underrepresented in cardiac rehabilitation programs4 and therefore forego the well-documented benefits, including reduced all-cause mortality,5,6 reduced recurrent cardiac events7 and improved quality of life.8
To help address this service gap, a cardiac rehabilitation program was established in a metropolitan Aboriginal Medical Service (AMS) and its uptake, impact on health management behaviour and cardiovascular risk factors were documented.
Focus groups were held with Aboriginal health professionals and community members to ensure the program met their needs and expectations. The latter group were specifically questioned about their preferred setting for cardiac rehabilitation.
A cardiac rehabilitation program was established under the auspices of Derbarl Yerrigan Health Service (DYHS) (a community controlled AMS) and conducted onsite to provide a culturally secure environment for the provision of exercise and education to address cardiovascular health. The name of the program, 'Heart Health - for our people, by our people' (Heart Health) reflected ownership byDYHSand the broader Aboriginal community.
Participants enrolling in Heart Health were invited to take part in a formal research project to evaluate the program and these participants provided written informed consent. …