Emotional, psychological, spiritual, and historic factors influence heart health among Indigenous Canadians, according to a recent qualitative study. Previous experiences affect how Indigenous patients access and evaluate care, the researchers said. 

Indigenous people in Canada are about 2.5 times more likely to develop cardiovascular diseases (CVD) than non-Indigenous people. The factors that contribute to this discrepancy include a cultural divide in discussions about care, distrust of the medical system, and poor access to consistent care in remote regions, senior author Sahr Wali, PhD, a scientific associate at the Ted Rogers Centre for Heart Research at Toronto General Hospital, told Medscape News Canada. "We as a society have failed to meet them where they're at and [discover] what they define as wellness and what they need."

The research was published June 10 in CJC Open. 

Data Emerge From 'Sharing Circles'

To investigate more effective strategies for care, the researchers worked in partnership with a convenience sample of members from the Indigenous community to explore perspectives through storytelling. Their goal was to learn what heart health means to the community and what is needed to improve it.

The team used unconventional data gathering methods, the primary source being "sharing circles" conducted in Moosonee, Ontario, and developed an arts-based graphic report. Illustrating the novel approach, the cover page of the report has a heart at its center, framed by a boat, truck, and helicopter to reflect the travel barriers that community members experience in getting care on the island of Moose Factory.

Sharing circles are similar to focus groups, Wali said, but one difference is that a community elder opens the sharing circle "to reclaim the space as a safe space for all stories, all voices. It allows that sense of equity." The following four themes emerged from the circles: that heart health is more than metrics, trauma must be honored, care can be destigmatized through relationship building, and innovative solutions start with community.

Wali describes a tendency in Western medicine to attribute higher CVD risk in the Indigenous community to lifestyle factors. "But what we found was that heart health is way more than metrics. A lot of Indigenous practices are rooted in these years of wellness traditions, and we fail to recognize the value of where they come from. We have this idea that Western medicine is the end all, be all." Directives for improving health may feel like "forced assimilation" and may imply that community members don't want to improve their health, when that is not the case, she said.

Wali described how Western medicine may not honor the trauma of the Indigenous community and therefore impede care strategies. For example, when physicians talk to Indigenous patients about controlling their diet or controlling fluids or salt, Wali said, it may trigger thoughts of the colonization First Nation people have survived.

"I see the physician, and they ask me about my blood pressure, they ask me about my symptoms, but they don't ask me about how it feels to be taking care of my grandchildren, that my son is in a detox center, or that my wife has just gone through surgery," said one the authors, an elder in the Indigenous community, according to Wali. That's where heart health beyond metrics comes in, she said.

She also noted that every region in Canada has specific areas with different Indigenous communities, and each community has different needs regarding healthcare strategies. In this study, the researchers partnered with the Weeneebayko Area Health Authority, a regional community-focused organization providing healthcare services across six predominantly Cree communities: Moose Factory, Moosonee, Attawapiskat, Fort Albany, Peawanuck, and Kashechewan.

Communicating With Visual Aids

Thao Huynh, MD, PhD, a cardiologist and associate professor of cardiology at McGill University Health Center in Montreal, called the paper "innovative." 

"It is not a traditional quantitative research paper, but more a qualitative research method," said Huynh, who did not participate in the study. Whether it can lead to improved CVD outcomes "will need to be proven in another more traditional paper," she told Medscape News Canada.

"Nevertheless, I applaud the authors in their work of reaching out to the Indigenous, where there may be more barriers of communication and distrust of the medical profession. I find the approach original and something I may try to apply in my clinical practice. Visual aids are a good way to communicate."

After reading this paper, Wali said, "I would hope people ask themselves, 'Is the way I'm currently practicing medicine, practicing research, really benefiting people in a way that is meaningful?' If we're not personalizing our approach to each individual, is it really benefiting people from different walks of life?"

The study was funded by the Ted Rogers Centre for Heart Research, TRANSFORM HF, and a Canadian Institutes of Health Research Health System Impact Embedded Early Career Researcher Award. Wali and Huynh reported no relevant financial relationships. 

Marcia Frellick is an independent healthcare journalist and a regular contributor to Medscape.