Cardiovascular disease medication health literacy among Indigenous peoples: design and protocol of an intervention trial in Indigenous primary care services

BMC Public Health

Matire Harwood¹  Jennie Harré Hindmarsh⁷  Ian Anderson⁴  Joanne Luke²  Susan Reid⁵  Michelle Lambert⁶  Margaret Kelaher³  Janet Smylie⁸  Sue Crengle⁶ 

[1] Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;The Victorian Aboriginal Health Service, Fitzroy, Australia;Centre for Health Policy, Programs & Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia;Murrup Barak, Melbourne Institute for Indigenous Development, University of Melbourne, Melbourne, Australia;Workbase Education Trust, Ponsonby, Auckland, New Zealand;National Institute of Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand;Ngati Porou Hauora Charitable Trust, Gisborne, New Zealand;Centre For Research on Inner City Health, Li Ka Shing Ka Shing Knowledge Institute, Saint Michael’s Hospital, Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

关键词: Clinical trial;    Non-randomized study design;    Medication knowledge;    Cardiovascular diseases;    Health literacy;    Indigenous health;   

Others  :  866274
DOI  :  10.1186/1471-2458-14-714

 received in 2014-06-10, accepted in 2014-06-30,  发布年份 2014

【 摘 要 】

Background

Cardiovascular diseases (CVD) are leading causes of mortality and morbidity among Indigenous people in New Zealand, Australia and Canada and are a major driver of the inequities in life expectancy between Indigenous and non-Indigenous people in these countries. Evidence-based pharmaceutical management of CVD can significantly reduce mortality and morbidity for persons diagnosed with CVD or for those at intermediate or high risk of CVD. Health literacy has been identified as a major barrier in the communication and implementation of appropriate pharmaceutical management plans for CVD. Addressing health literacy is particularly relevant in Indigenous populations where there are unique health and adult literacy challenges.

Methods/design

This study will examine the effect of a customized, structured CVD medication programme, delivered by health professionals, on the health literacy of Indigenous people with, or at risk, of CVD. Primary outcomes are patient’s knowledge about CVD medications; secondary outcomes examine changes in health literacy skills and practices. The study will employ a multi-site pre-post design with multiple measurement points to assess intervention efficacy. Participants will be recruited from four Indigenous primary care services in Australia, Canada and New Zealand. Three educational sessions will be delivered over four weeks. A tablet application will support the education sessions and produce a customized pill card for each participant. Participants will be provided with written information about CVD medications. Medication knowledge scores, and specific health literacy skills and practices will be assessed before and after the three sessions. Statistical analyses will identify significant changes in outcomes over each session, and from the pre-session one to post-session three time points.

Discussion

This study will make an important contribution to understanding the effect of a structured primary care-based intervention on CVD health literacy in Indigenous populations. The study also illustrates the incorporation of Indigenous health research principles and processes in clinical trials and provides insights that may be useful in other contexts.

Trial registration

Australian and New Zealand Clinical Trials Register (ACTRN12612001309875; date of registration 18/12/2012).

【 授权许可】

   
2014 Crengle et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Australian Institute of Health and Welfare: Aboriginal and Torres Strait Islander Health Performance Framework 2012: detailed analyses, Volume IHW 94. Canberra: AIHW; 2013.
• [2]Anand SS, Yusuf S, Jacobs R, Davis AD, Yi Q, Gerstein H, Montague PA, Lonn E: Risk factors, atherosclerosis, and cardiovascular disease among Aboriginal people in Canada: the Study of Health Assessment and Risk Evaluation in Aboriginal Peoples (SHARE-AP). Lancet 2001, 358(9288):1147-1153.
• [3]Curtis E, Harwood M, Riddell T: Cardiovascular disease, in Hauora: Màori Standards of Health IV. A study of the years 2000–2005. Edited by Robson B, Harris R. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare; 2007.
• [4]Tobias M, Blakely T, Matheson D, Rasanathan K, Atkinson J: Changing trends in indigenous inequalities in mortality: lessons from New Zealand. Int J Epidemiol 2009, 38(6):1711-1722.
• [5]New Zealand Guidelines Group, ed: New Zealand Cardiovascular Guidelines Handbook: A summary resource for primary care practitioners. 2nd edition. Wellington: New Zealand Guidelines Group; 2009.
• [6]Abbott P, Davison J, Moore L: Too many of us have gone early - priorities in heart health education for Aboriginal people. Aust Fam Physician 2008, 37(4):266-268.
• [7]Riddell T, Lindsay G, Kenealy T, Jackson R, Crengle S, Bramley D, Wells S, Marshall R: The accuracy of ethnicity data in primary care and its impact on cardiovascular risk assessment and management--PREDICT CVD-8. N Z Med J 2008, 121(1281):40-48.
• [8]Wells S, Furness S, Rafter N, Horn E, Whittaker R, Stewart A, Moodabe K, Roseman P, Selak V, Bramley D, Jackson R: Integrated electronic decision support increases cardiovascular disease risk assessment four fold in routine primary care practice. Eur J Cardiovasc Prev Rehabil 2008, 15(2):173-178.
• [9]Wells S, Kerr A, Broad J, Riddell T, Kenealy T, Jackson R: The impact of New Zealand CVD risk chart adjustments for family history and ethnicity on eligibility for treatment (PREDICT CVD-5). N Z Med J 2007, 120(1261):U2712.
• [10]Riddell T, Jackson RT, Wells S, Broad J, Bannink L: Assessing Maori/non-Maori differences in cardiovascular disease risk and risk management in routine primary care practice using web-based clinical decision support: (PREDICT CVD-2). N Z Med J 2007, 120(1250):U2445.
• [11]Bannink L, Wells S, Broad J, Riddell T, Jackson R: Web-based assessment of cardiovascular disease risk in routine primary care practice in New Zealand: the first 18,000 patients (PREDICT CVD-1). New Zeal Med J 2006, 119(1245):U2313.
• [12]Si D, Bailie R, Cunningham J, Robinson G, Dowden M, Stewart A, Connors C, Weeramanthri T: Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia’s Northern Territory - use of the Chronic Care Model. BMC Health Serv Res 2008, 8:112.
• [13]Wu JR, Moser DK, Lennie TA, Burkhart PV: Medication adherence in patients who have heart failure: a review of the literature. Nurs Clin 2008, 43(1):33-53. vii-viii
• [14]Choiniere R, Lafontaine P, Edwards A: Distribution of cardiovascular risk by socioeconomic status among Canadian adults. CMAJ 2000, 162(9 Suppl):S13-S24.
• [15]Frijling BD, Lobo CM, Keus IM, Jenks KM, Akkermans RP, Hulscher ME, Prins A, van der Wouden JC, Grol RP: Perceptions of cardiovascular risk among patients with hypertension or diabetes. Patient Educ Counsel 2004, 52(1):47-53.
• [16]Wagner J, Lacey K, Abbott G, de Groot M, Chyun D: Knowledge of heart disease risk in a multicultural community sample. Ann Behav Med 2006, 31(3):224-230.
• [17]Homko CJ, Santamore WP, Zamora L, Shirk G, Gaughan J, Cross R, Kashem A, Petersen S, Bove AA: Cardiovascular disease knowledge and risk perception among underserved individuals at increased risk of cardiovascular disease. J Cardiovasc Nurs 2008, 23(4):332-337.
• [18]Mooney LA, Franks AM: Evaluation of community health screening participants’ knowledge of cardiovascular risk factors. J Am Pharmacists Assoc: JAPhA 2009, 49(4):529-537.
• [19]Ho PM, Bryson CL, Rumsfeld JS: Medication Adherence: Its Importance in Cardiovascular Outcomes. Circulation 2009, 119(23):3028-3035.
• [20]Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, Krumholz HM, Rumsfeld JS: Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med 2006, 166(17):1842-1847.
• [21]Hope CJ, Wu J, Tu W, Young J, Murray MD: Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. Am J Health Syst Pharm 2004, 61(19):2043-2049.
• [22]Wu JR, Moser DK, Chung ML, Lennie TA: Predictors of medication adherence using a multidimensional adherence model in patients with heart failure. J Card Fail 2008, 14(7):603-614.
• [23]Canadian Public Health Association. http://www.cpha.ca/en/pls.aspx webcite Accessed May 23, 2014
• [24]Berkman ND, DeWalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ: Literacy and Health Outcomes. Evidence Report/Technology Assessment No. 87. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
• [25]Rootman I, Gordon-El-Bihbety D: A Vision for a Health Literate Canada: Report on the Expert Panel on Health Literacy. Ottawa: Canadian Public Health Association; 2008.
• [26]Gazmararian JA, Williams MV, Peel J, Baker DW: Health literacy and knowledge of chronic disease. Patient Educ Counsel 2003, 51(3):267-275.
• [27]Williams MV, Baker DW, Parker RM, Nurss JR: Relationship of functional health literacy to patients’ knowledge of their chronic disease. Arch Intern Med 1998, 158(2):166-172.
• [28]Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A: Inadequate literacy is a barrier to asthma knowledge and self- care. Chest 1998, 114(4):1008-1015.
• [29]Baker DW, Parker RM, Williams MV, Clark WS: Health literacy and the risk of hospital admission. J Gen Intern Med 1998, 13(12):791-798.
• [30]Nutbeam D: The evolving concept of health literacy. Soc Sci Med 2008, 67:2072-2078.
• [31]Safeer RS, Cooke CE, Keenan J: The impact of health literacy on cardiovascular disease. Vasc Health Risk Manag 2006, 2(4):457-464.
• [32]Chao S, Anderson K, Hernandez L: Toward health equity and patient- centeredness: Integrating health literacy, disparities reduction, and quality improvement. Washington, D.C: Institute of Medicine; 2009.
• [33]Ministry of Health: Kōrero Mārama: Health Literacy and Māori Results from the 2006 Adult Literacy and Life Skills Survey. Wellington: Ministry of Health; 2010.
• [34]Satherley P, Lawes E: The Adult Literacy and Life Skills (ALL) Survey: age and literacy. Ministry of Education.: Wellington; 2008.
• [35]Gracey M, King M: Indigenous health part 1: determinants and disease patterns. Lancet 2009, 374(9683):65-75.
• [36]NHMRC: The NHMRC Road Map II: A strategic framework for improving the health of Aboriginal and Torres Strait Islander people through research. Canberra: National Health and Medical Research Council; 2010.
• [37]The Pūtaiora Writing Group: Te Ara Tika Guidelines for Māori research ethics: A framework for researchers and ethics committee members. Auckland: Health Research Council; 2010.
• [38]Canadian Institutes of Health Research: Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada, Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. 2010. http://www.pre.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf webcite. Accessed 3rd July, 2014
• [39]Canadian Institutes of Health Research: CIHR Guidelines for Health Research Involving Aboriginal People. 2007. http://www.cihr-irsc.gc.ca/e/29134.html webcite. Accessed May 23, 2014
• [40]Ngati Porou Hauora Board: Research and Evaluation Policy. 2012.
• [41]Smylie J, Firestone M, Cochran L, Prince C, Maracle S, Morley M, Mayo S, Spiller T, McPherson B: Our Health Counts Urban Aboriginal Health Database Research Project: Community Report. 2011. http://www.stmichaelshospital.com/crich/wp-content/uploads/our-health-counts-report.pdf webcite Accessed May 23, 2014
• [42]National Vascular Disease Prevention Alliance: Guidelines for the management of absolute cardiovascular disease risk. Melbourne: National Stroke Foundation; 2012. http://strokefoundation.com.au/site/media/AbsoluteCVD_GL_webready.pdf webcite. Accessed 11 July 2014
• [43]D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB: General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008, 117(6):743-753.
• [44]Hill-Briggs F, Renosky R, Lazo M, Bone L, Hill M, Levine D, Brancati FL, Peyrot M: Development and pilot evaluation of literacy-adapted diabetes and CVD education in urban, diabetic African Americans. J Gen Intern Med 2008, 23(9):1491-1494.
• [45]Selak V, Crengle S, Elley CR, Wadham A, Harwood M, Rafter N, Bullen C, Pillai A, Arroll B, Rodgers A: Recruiting equal numbers of indigenous and non-indigenous participants to a ‘polypill’ randomized trial. Int J Equity Health 2013, 12:44.
• [46]Smith LT: Decolonising Methodologies: Research and Indigenous Peoples. 2nd edition. London: Zed Books; 2012.
• [47]Smylie J, Kaplan-Myrth N, McShane KE: Métis Nation of Ontario, Pikwakanagan First Nation, Tungasuvvingat Inuit Family Resource Centre. Indigenous Knowledge Translation: Baseline Findings in a Qualitative Study of the Pathways of Health Knowledge in Three Indigenous Communities in Canada. Health Promot Pract 2009, 10(3):436-446.