A collaborative approach to developing culturally appropriate heart failure self-care tools for Indigenous Australians using multi-media technology

Background/Aim: Indigenous Australians have a 70% higher incidence of heart failure (HF), and twice as many deaths as non-Indigenous people. Patient education that is consistent with the values of Indigenous communities is needed to improve self-care. In collaboration with the local Indigenous community we have developed culturally appropriate tools for teaching self-care.

Methods: A mixed methods study was conducted in two phases. Phase 1 used action research to engage a HF expert panel to adapt the existing resource to be evidence-based, reflect Indigenous Australian culture and be suitable to delivery on a tablet-computer. The resource was then reviewed by a stakeholder group (Indigenous staff and HF patients, researchers and clinicians). Phase 2, the resource was tested on a sample of Indigenous HF patients to assess feasibility and acceptability. Knowledge, satisfaction and self-care behaviours were measured with validated questionnaires.

Results: Results of the stakeholder consultation indicated that the resource needed to accurately reflect the local Indigenous community, with the appropriate clothing, skin tone and voice. This included voiceovers from members of the local community, images and converting text to the first person and using plain language. This was a small pilot test statistical comparisons were not appropriate. Five Indigenous Australians (aged 61.6±10.0 years) with HF participated in feasibility testing. Participants reported a high level of satisfaction with the resource (83.0%) and expressed their intentions to weigh themselves daily following education. HF knowledge score increased by 20.8% (9.6±1.3 to 11.6±2.0), and the self-care index indicated a 95% increase in confidence score (46.7±16.0 to 91.1±11.5).

Conclusion: By working collaboratively, engaging Indigenous researchers and patients, capacity-building, and being responsive to local systems a culturally appropriate HF resource has been developed for Indigenous Australian patients. Positive participant feedback shows that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.