title: 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, including within high-income countries, is driven by a heightened risk of cardio-metabolic diseases. The current study recruited independent panels of experts in Indigenous cardio-metabolic health from Australia, New Zealand and the United States, in order to establish local consensus opinion and initiate dialogue on appropriate prevention strategies. Therefore, 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 twelve open-ended questions across six domains: (i) prevention; (ii) consultation; (iii) educational resources; (iv) societal issues; (v) workforce issues; (vi) culture and family. 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 themes emerged common to all three countries: (i) socio-economic and education inequalities should be addressed; (ii) educational, behaviour change and prevention strategies should address physical environmental determinants and be responsive to the local context, including being culturally appropriate; and (iii) cultural appropriateness can be achieved through consultation with Indigenous communities, cultural competency training, use of Indigenous health workers, and use of appropriate role models. These findings highlight several key priorities that can be used to initiate dialogue on appropriate prevention strategies. Such strategies should be contextualized to the local Indigenous populations.
authors.affiliation: School of Public Health, Massey University, Wellington 6140, New Zealand; School of Sport and Exercise, Massey University, Wellington 6140, New Zealand; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. Electronic address: dr.l.stoner@gmail.com.
authors.forename: Lee
authors.initials: L
authors.lastname: Stoner
authors.affiliation: School of Public Health, Massey University, Wellington 6140, New Zealand.
authors.forename: Anna G
authors.initials: AG
authors.lastname: Matheson
authors.affiliation: Center for Service Learning & Department of Human Services, Western Carolina University, Cullowhee 28723, USA.
authors.forename: Lane G
authors.initials: LG
authors.lastname: Perry
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
authors.affiliation: Faculty of Health Sciences, Curtin University, Bentley 6102, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: McManus
authors.affiliation: Research Centre for Maori Health and Development, Massey University, Palmerston North 442, New Zealand.
authors.forename: Maureen
authors.initials: M
authors.lastname: Holdaway
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Bentley 6102, Australia.
authors.forename: Lyn
authors.initials: L
authors.lastname: Dimer
authors.affiliation: Department of Family and Community Medicine, University of Arizona, Tuscon, AZ 85719, USA.
authors.forename: Jennie R
authors.initials: JR
authors.lastname: Joe
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Bentley 6102, Australia; Department of Allied Health, Fiona Stanley Hospital, Murdoch 6150, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Maiorana
mesh_terms: D001315:Australia / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D054521:Cultural Competency / Q000523:psychology; D003697:Delphi Technique; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008659:Metabolic Diseases / Q000517:prevention & control*; D009520:New Zealand / Q000208:ethnology; D044382:Population Groups; D011322:Primary Prevention / Q000379:methods*; D012307:Risk Factors; D064890:Social Determinants of Health; D011795:Surveys and Questionnaires; D014481:United States / Q000208:ethnology
keywords: Aboriginal; Australia; Cardiovascular; Determinants of health; Health policy; Metabolic; New Zealand; United States