Equal Hearts Study

Using co-design to improve accessibility and acceptability of cardiac services

Coronary heart disease (CHD) is a leading cause of death in Australia and is more common among people living with socioeconomic disadvantage, including people from culturally diverse backgrounds and those who live in rural areas. Healthcare services have an important role to play in addressing these inequalities, by ensuring the care they provide is accessible for all. Accessibility means more than just the availability of services; it also means how acceptable and appropriate they are for patients. Health services that are seen as more ‘accessible’ by patients can lead to stronger relationships with providers and greater usage of the service; in turn leading to better overall health. However, not all Australians have equitable access to cardiac services, meaning that not everyone benefits in the same way to achieve their health potential.

One factor that is strongly associated with health care access is health literacy – itself a proxy measure of equity. This research will use a health literacy-based, co-design approach to identify how hospital cardiac services can improve and measure accessibility for disadvantaged population groups with CHD.

This is a multi-centre, mixed-methods study that uses a co-design approach. The study is based in Victoria in two metropolitan health services (Monash Health and Northern Health) and two rural/regional health services (Colac Area Health and Grampians Health Services).

This research will be undertaken in four stages:

• In stage one, both quantitative and qualitative data will be used to identify predictors of access to care and to explore perspectives of consumers about accessibility of cardiac services. Quantitative data will be obtained from an existing cohort study called the ENHEARTEN study. Qualitative data will be collected via focus groups/interviews with patients, consumers and clinicians.
• In stage two, we will co-design a health literacy intervention to improve accessibility of cardiac services. This will be undertaken in a series of workshops/meetings with patients, consumers and clinicians.
• In stage three, this health literacy intervention will be evaluated in a pilot randomised controlled trial (RCT).
• In stage four, this study will develop a set of ‘equity indicators’, i.e. measures that could be used to determine if hospital cardiac services are equitable and accessible. Development of these indicators will use a Concept Mapping approach in collaboration with patients, clinicians and health service managers

The Equal Hearts study is funded by the Medical Research Future Fund (MRFF).

Findings

We conducted 13 focus groups and 14 interviews with cardiac patients and clinicians and three cultural community groups (African, Sikh, Arabic-speaking) between June 2023 and January 2024.

General themes identified from cardiac patients and clinicians included:

• Information given to patients is not personalised to each patient; often patients feel overloaded with information
• Clinicians use jargon and communication is often brief and rushed
• Patients not feeling ready for discharge; unsure about symptoms, physical activity and diet
• People ‘lost’ in the system after discharge e.g., who will contact me, who do I call if I don’t hear anything about follow-up
• Follow-up appointments and cardiac rehabilitation referrals often not made
• Long wait times to start cardiac rehabilitation
• Difficulty seeing a GP early, especially for rural patients

Themes heard from cultural communities included:

• Language and communication barriers between patients and health professionals
• Cultural barriers such as lack of understanding of their different cultures and religious customs
• Perceptions of discrimination in hospital settings and the need for more culturally diverse health professionals

News: Equal Hearts Study

Research team

Partners

Contact

A/Prof Alison Beauchamp
ENHEARTEN Primary Investigator
Phone: +61 414 411 296
Email: alison.beauchamp@monash.edu

Dr Denise Azar
Equal Hearts Project Manager
Phone: +61 403 026 241
Email: denise.azar@monash.edu