Principles and strategies for improving the prevention of cardio-metabolic diseases in indigenous populations: An international Delphi study

Abstract

The disparity in life expectancy between Indigenous and non-Indigenous populations is being driven by a heightened incidence of cardio-metabolic diseases, and is at least partly underpinned by educational, economic and historical determinants. However, there is a lack of consensus with regards to priorities for tackling these determinants. Therefore, the current study recruited experts in Indigenous cardio-metabolic health from Australia, New Zealand and the United States, in order to establish local consensus opinion and initiate dialogue. A three-round Delphi process was used to consolidate and compare the opinions of 60 experts, 20 from each country. Round one, the experts were asked three open-ended questions: (i) historical, (ii) economic and (iii) socio-cultural factors contributors to cardio-metabolic disease risk. Round two, the experts completed a structured questionnaire based on results from the first round, in which they ranked items according to their importance. Final round, the experts were asked to re-rank the same items after receiving summary feedback about the rank ordering from the previous round. Several key findings were identified: (i) an important historical factor is marginalization and disempowerment; (ii) in terms of economic and sociocultural factors, the panellists came to the consensus that socio-economic status and educational inequalities are important; (iii) while consensus was not reached, economic and educational factors also perceived to be historically influential. These findings support the need for multi-level health promotion policy. For example, tackling financial barriers that limit access to health-promoting resources, and improving literacy skills to permit understanding of health education.

Sleep quantity and quality and cardiometabolic risk factors in Indigenous Australians

“…In this study, we identified both behavioural (e.g., smoking) and biological (e.g., diabetes and sleep‐disordered breathing) determinants of poor sleep, potentially indicating that simple sleep health education, particularly surrounding sleep habits and consequences of sleep problems, may be beneficial for improvement of sleep. However, when considering such programmes, the complex combination and the ongoing impact of historical, institutional, sociocultural, economic, environmental and lifestyle‐related factors, as well as access to healthcare, must be remembered in Indigenous people (Stoner et al., 2017). Of utmost importance, if any sleep health education programme is to be developed and implemented in Indigenous populations, it is imperative that these programmes are developed in consultation with, informed and identified by, the Indigenous community.…”

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“…In this case, most commonly injured are articular ligaments, intramuscular tendons, tendon attachments. When applying loads only to the force direction, the process of adaptation by the cardiovascular and respiratory systems (Stoner, Matheson, Perry, Williams, McManus, Holdaway, ... Maiorana, 2017;van der Ster, Bennis, Delhaas, Westerhof, Stok, & van Lieshout, 2018). But these are the main systems for ensuring the normal level of human life.…”

Developing a Support Program for Adult Children of Parents with Mental Illness: A Delphi Study

“…An option that received a rank of ‘1’ was most important. To derive aggregated scores across each expert group, each rank was awarded a score: rank 1 = 3 points, rank 2 = 2 points and rank 3 = 1 point (Stoner et al, 2017 ). This method of calculation awarded highest points to the option ranked first and the lowest point to the option ranked third by each panel member.…”