The Heart Health Yarning Tool: Co-Designing a Shared Decision-Making Tool With Aboriginal and Torres Strait Islander People for Cardiovascular Disease Prevention and Risk Management.

introductionDue 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 (SDM) is recognised as an essential component of person-centred care. However, there has been a lack of tools to support clinician communication and SDM to address CVD prevention in this important 'at-risk' population.

methodsWe developed the Heart Health Yarning Tool, an online SDM 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, consisting of a stakeholder consultation and co-design (Phase 1), concept mapping of qualitative data to an existing SDM model (Phase 2), and content development and testing (Phase 3).

resultsPhase 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 SDM model, 'Finding Your Way,' 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 SDM formats such as question prompt lists, action planning tools and decision aids to support communication and understanding of CVD risk. This phase included user testing with consumers and health professionals (n = 10), as well as presentation of the tool to key advisory groups.

conclusionsThe Heart Health Yarning Tool supports health professionals in making 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 the use of the Heart Health Yarning Tool improves health professionals' cultural and SDM competencies as well as cardiovascular outcomes in Aboriginal and Torres Strait Islander people. PATIENT OR PUBLIC CONTRIBUTION: Thiitu Tharrmay Aboriginal and Torres Strait Islander Reference Group is convened by Yardhura Walani at the Australian National University. Thiitu Tharrmay members are Aboriginal and Torres Strait Islander peoples who are consumers or providers of healthcare, with knowledge and/or experience with research and health policy. Thiitu Tharrmay advised on the appropriate conduct of this study, and provided comments on the research methods, including recruitment and data collection methods. Aboriginal and Torres Strait Islander researchers were involved in all stages of the project, including study design, data collection, analysis, interpretation, and writing and revising the manuscript (J.P., D.F. and M.D.). Aboriginal and Torres Strait Islander consumers were involved in the co-design and user testing of the Heart Yarning Tool.