Ending rheumatic heart disease in Aboriginal and Torres Strait Islander communities: A systematic review of prevention programs in Australia

Abstract

Purpose Australia has one of the highest incidences of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the world, with a disproportionate disease burden on Aboriginal and Torres Strait Islander communities. This systematic review aimed to explore the effectiveness and cultural responsiveness of prevention programs to prevent, reduce and control RHD, to improve quality of life, and prioritise community engagement and empowerment.Methods A systematic review was conducted involving a comprehensive search of three databases (PubMed, Embase and CINAHL) and grey literature from Australian Indigenous websites and Google Scholar. Articles met inclusion criteria if they evaluated prevention programs, targeted ARF/RHD and centred Aboriginal and Torres Strait Islander communities in Australia. Data were extracted by three reviewers, and results were descriptively analysed. Study quality was appraised via the Mixed Methods Appraisal Tool and the Aboriginal and Torres Strait Islander Quality Appraisal Tool.Main findings Eleven peer reviewed articles were included. Prevention programs varied in their effectiveness and cultural responsiveness to reduce ARF and RHD. Overall, the studies scored higher for generalised methodological quality determined by the Mixed Methods Appraisal Tool than the measurement of cultural responsiveness via the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Research engagement with Aboriginal and Torres Strait Islander communities addressed ways to improve screening strategies to identify ARF, awareness of RHD adherence to penicillin prophylaxis, community-led education and training, environmental health and community-centred traditional language to convey culturally responsive health messaging.Principal conclusions Further research is urgently needed in the provision of effective and culturally responsive prevention programs to reduce the incidence of ARF and RHD. Studies that centre Indigenous-led and community-based prevention programs that value self-determination, community agency and autonomy to advance holistic health and wellbeing for Aboriginal and Torres Strait Islander peoples offer promise in the elimination of ARF and RHD.