Impact of targeted health promotion on cardiovascular knowledge among American Indians and Alaska Natives

Brega, Angela G.; Pratte, Katherine; Jiang, Luohua; Mitchell, Christina M.; Stotz, Sarah; Loudhawk-Hedgepeth, Crystal; Morse, Brad; Noe, Tim D.; Moore, Kelly; Beals, Janette

doi:10.1093/her/cyt054

Cited by 16 publications

(15 citation statements)

References 45 publications

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“…Culturally appropriate interventions have previously demonstrated an association with improved health knowledge about diabetes and CVD. 45 46 Counselling that incorporates successful adult education techniques such as reinforcement and feedback, teachback, assessing and confirming patients’ understandings, and patient-tailored information all build health literacy. 44 47 Research involving pill cards for health literacy has tended to focus on pill cards as a management tool for low health literate populations as opposed to assessing how they build health literacy skills and capabilities.…”

Section: Discussionmentioning

confidence: 99%

“…Intervention trials located within Indigenous communities are rare. Brega et al 45 found that the ‘Honouring the Gift of Heart Health’ intervention increased knowledge about CVD, symptoms associated with MI and stroke, and CVD risk factor control, in both high and low health literacy groups of American Indian and Alaska Native peoples. 45 The current study and that of Brega et al demonstrate that appropriately designed interventions can be successfully implemented in Indigenous communities.…”

Section: Discussionmentioning

confidence: 99%

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Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand

et al. 2018

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ObjectivesTo assess the effect of a customised, structured cardiovascular disease (CVD) medication health literacy programme on medication knowledge among Indigenous people with, or at high risk of, CVD.DesignIntervention trial with premeasures and postmeasures at multiple time points.SettingIndigenous primary care services in Australia, Canada and New Zealand.Participants171 Indigenous people aged ≥20 years of age who had at least one clinical diagnosis of a CVD event, or in Canada and Australia had a 5-year CVD risk ≥15%, and were prescribed at least two of the following CVD medication classes: statin, aspirin, ACE inhibitors and beta blockers.InterventionAn education session delivered on three occasions over 1 month by registered nurses or health educators who had received training in health literacy and principles of adult education. An interactive tablet application was used during each session and an information booklet and pill card provided to participants.Primary outcome measuresKnowledge about the CVD medications assessed before and after each session.ResultsKnowledge at baseline (presession 1) was low, with the mean per cent correct answers highest for statins (34.0% correct answers), 29.4% for aspirin, 26.0% for beta blockers and 22.7% for ACE inhibitors. Adjusted analyses showed highly significant (P<0.001) increases in knowledge scores between preassessments and postassessments at all three time points for all medication classes. For the four medications, the absolute increases in adjusted per cent correct items from presession 1 to postsession 3 assessments were 60.1% for statins, 76.8% for aspirin, 71.4% for ACE inhibitor and 69.5% for beta blocker.ConclusionsThe intervention was highly effective in contextually diverse Indigenous primary healthcare services in Australia, Canada and New Zealand. The findings from this study have important implications for health services working with populations with low health literacy more generally.Trial registration numberACTRN12612001309875.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand

et al. 2018

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“…For instance, AI/AN knowledge of heart attack and stroke symptoms was more limited than that of the general population [ 91 ]. Although they understand the risk of obesity and importance of physical inactivity in CVD development, they are unable to tell what blood pressure values would be considered high [ 91 , 92 ]. The National Heart, Lung, and Blood Institute (NHLBI) developed the Honoring the Gift of Heart Health (HGHH) curriculum to focus on improving the HL level of AI/AN communities.…”

Section: Prevention Of Dm and Cvd In The Ai/an Populationmentioning

confidence: 99%

“…The National Heart, Lung, and Blood Institute (NHLBI) developed the Honoring the Gift of Heart Health (HGHH) curriculum to focus on improving the HL level of AI/AN communities. Improvements in HL levels, including heart attack knowledge, stroke, and general CVD knowledge, have been observed in HGHH curriculum participants [ 92 ].…”

Section: Prevention Of Dm and Cvd In The Ai/an Populationmentioning

confidence: 99%

Diabetes and Associated Cardiovascular Complications in American Indians/Alaskan Natives: A Review of Risks and Prevention Strategies

Poudel

Zhou

Story

et al. 2018

Journal of Diabetes Research

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Diabetes mellitus (DM) is the seventh leading cause of death in the United States and the leading cause of death in the U.S. American Indian/Alaskan Natives (AI/ANs), who comprise only 2% of the total population. The AI/AN population has a high prevalence of DM in adults aged 20 years or older and is developing DM at a younger age than the general U.S. population. DM is a major risk factor for cardiovascular disease (CVD), and mortality from CVD is higher in AI/ANs than the general population, as is the prevalence of stroke and 1-year poststroke mortality for both genders when compared to non-Hispanic whites. A genome-wide scan found a number of chromosome linkages in the AI/AN population that suggest that genetic factors may contribute to their high risk of DM and CVD. Importantly, studies also suggest that in addition to race/ethnicity, cultural norms and historic conditions play important roles in the prevalence of DM and CVD in this population. Therefore, multiple factors should be taken into consideration when establishing prevention programs to decrease the prevalence of obesity, diabetes, and CVD incidence among adults and children in the AI/AN population. Prevention programs should focus on behavioral risk factors and lifestyle changes like encouraging smoking cessation, healthy diet, and increased physical activity while taking into consideration cultural, economic, and geographic factors.

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“…Evidence from the United States (2) and Canada (3) confirms that indigenous people have up to twice the risk of stroke, compared with nonindigenous people; because of a higher prevalence of diabetes, they also have a higher risk of experiencing stroke at younger ages (4,5). Although culturally tailored cardiovascular disease prevention programs have been developed for indigenous communities, such as the Honoring the Gift of Heart Health Curriculum (6), Montana Cardiovascular Health Program (7), or In Our Voice Curriculum for American Indian Students (8), evaluations indicate that such programs often do not produce expected improvements in stroke awareness, unless culturally specific and community-relevant content is offered.…”

Section: Introductionmentioning

confidence: 99%

Teach Our Children: Stroke Education for Indigenous Children, First Nations, Ontario, Canada, 2009–2012

Hill

Bodnar

Fenton³

et al. 2017

Prev. Chronic Dis.

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BackgroundBecause of the heightened risk for stroke among indigenous people, we conducted this multiyear community case study from 2009 through 2012 to address stroke education needs among children aged 11 to 13 years residing in northern urban, rural, and remote First Nations in Ontario, Canada. The goal was to determine what young people understand about stroke and to develop an age-appropriate and culturally appropriate educational product.Community ContextThis project responded to First Nations requests that we educate their young people about the signs and symptoms of stroke and the need for early response. Ten First Nations and 4 indigenous health organizations took part; 7 contributed to the educational product.MethodsThis study was developed under the guidance of the Northwestern Ontario Regional Stroke Network Aboriginal Advisory Committee. It employed indigenous researchers and facilitators to ensure that methods used (questions assessing children’s knowledge of stroke and their ideas on how best to deliver messages) reflected the cultural values of participating study sites.OutcomeIndigenous children had limited knowledge about stroke and its signs, symptoms, and consequences; children in remote communities were better informed than those in other locations. Educators agreed that a DVD was the most effective way to deliver stroke information to children in this age group. The principal outcome from this 3-year community engagement was an 11.5-minute DVD titled Act F-A-S-T 1-2-3!. Follow-up indicated that the educational tool continued to be used to educate indigenous children and adults about stroke signs and symptoms, the need for early response, and risk reduction.InterpretationAlthough indigenous communities are each unique in their culture and traditions, all have a strong commitment to improving health and are generous in their support for research that addresses their needs. Our study provides examples of the engagement and participatory research strategies that were effective, the practical supports required, limitations to the study, and how barriers to stroke education can be overcome.

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Impact of targeted health promotion on cardiovascular knowledge among American Indians and Alaska Natives

Cited by 16 publications

References 45 publications

Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand

Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand

Diabetes and Associated Cardiovascular Complications in American Indians/Alaskan Natives: A Review of Risks and Prevention Strategies

Teach Our Children: Stroke Education for Indigenous Children, First Nations, Ontario, Canada, 2009–2012

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