Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 20, 2019
Open Peer Review Period: May 23, 2019 - Jul 16, 2019
Date Accepted: Aug 18, 2019
(closed for review but you can still tweet)
1 Deadly Step – evaluation of a novel, community-based chronic disease prevention and management program for Aboriginal people in New South Wales, Australia
ABSTRACT
Background:
Chronic diseases account for over 70% of health gaps between Aboriginal people and the rest of the Australian population. 1 Deadly Step is a community-based program that uses a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW).
Objective:
To evaluate the feasibility and acceptability of a community based chronic disease screening program for Aboriginal people.
Methods:
In 2015 the program was enhanced to include an iPad application for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in nine NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and web portal usage and key informant interviews was conducted.
Results:
1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 61.2% female, 91.5% Aboriginal or Torres Strait Islander). High chronic disease rates were observed (22.1% participants at high cardiovascular disease (CVD) risk, 16.5% with diabetes, 17.3% with albuminuria). A minority at high risk of CVD (42.9%) and with diabetes (42.2%) were meeting guideline-recommended management goals. 297 participants completed surveys (response rate 37%) with 85% reporting satisfaction with event organisation and information gained, and 6% experiencing problems with certain screening activities. Twenty-one interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties impeded smooth processing of information. Only 51.4% of participants had medical review recorded post-event with wide inter-site variability (10.5% - 85.6%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered resource intensive to implement. Support from a central coordinating body and integration with existing operational processes was essential.
Conclusions:
1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no prior knowledge of these issues. Strategies to improve linkage to primary care could enhance the program’s impact in reducing chronic disease burden. Clinical Trial: N/A
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