The Heart Health Yarning Tool: co-designing a shared decision-making tool for cardiovascular disease prevention and risk management

ABSTRACT

Due to the ongoing impact of colonisation, Aboriginal and Torres Strait Islander people live with a greater burden of cardiovascular disease (CVD) than non-Indigenous Australians. Shared decision-making is recognised as an essential component of person-centred care. However, the previous guidelines for CVD risk assessment and prevention did not engage Aboriginal and Torres Strait Islander people. Additionally, there has been a lack of tools to support clinician communication and shared decision-making to address CVD prevention in this important “at-risk” population. We developed the Heart Health Yarning Tool, an online shared decision-making resource co-designed with Aboriginal and Torres Strait Islander people, to be implemented alongside the new Australian guidelines for primary CVD risk assessment and management. This was a three phase project: Phase 1 consisted of a stakeholder consultation and co-design process, including consumer yarning workshops (n=21), individual yarning sessions with Aboriginal and Torres Strait Islander Health Workers/Practitioners (n=8), consumers (n=17), and interviews with general practitioners (n=5). Phase 2 involved a mapping process, where qualitative interview data was integrated into the conceptual framework of an existing culturally adapted shared decision-making model, ‘Finding Your Way,’ in order to tailor the model to the CVD context. Phase 3 involved developing and testing content for the new tool, based on findings from Phases 1 and 2, using evidence-based shared decision-making formats. The resulting tool supports health professionals to make shared decisions about heart health with Aboriginal and Torres Strait Islander people. It can be used as a conversation guide in primary care consultations or as a training tool for health professionals. Future research will assess whether use of the Heart Health Yarning Tool improves health professionals’ cultural and shared decision-making competencies as well as cardiovascular outcomes in Aboriginal and Torres Strait Islander people.

What is already known on this topic

• Despite the fact that shared decision-making is recognised as an essential component of person-centred care, there are few culturally adapted shared decision-making resources

• Culturally specific resources are needed to support shared decision-making around heart health with Aboriginal and Torres Strait Islander people, a priority group for cardiovascular disease prevention

What this study adds

• We developed an online shared decision-making tool to be used by primary care providers with the new Australian guidelines for primary cardiovascular disease prevention

• The Heart Health Yarning Tool was co-designed with Aboriginal and Torres Strait Islander people, incorporating culturally relevant content with evidence-based shared-decision making formats.

How this study might affect research, practice or policy

• The Heart Health Yarning Tool can be used as a conversation guide, health consumer

• education resource, and as a training tool for health professionals.

• The Heart Health Yarning Tool may support health professionals to offer culturally responsive health care to Aboriginal and Torres Strait Islander people