Primary care intervention to address cardiovascular disease medication health literacy among Indigenous peoples: Canadian results of a pre-post-design study

Janet Smylie, Kristen O’Brien, Chloé G. Xavier, Marcia Anderson, Constance McKnight, Bernice Downey, Margaret Kelaher, De dwa da dehs nye>s Aboriginal Health Centre

Cardiovascular diseases (CVD) are a leading cause of illness and death for Indigenous people in Canada and globally. Appropriate medication can significantly improve health outcomes for persons diagnosed with CVD or for those at high risk of CVD. Poor health literacy has been identified as a major barrier that interferes with client understanding and taking of CVD medication. Strengthening health literacy within health services is particularly relevant in Indigenous contexts, where there are systemic barriers to accessing literacy skills. The aim of this study is to test the effect of a customized, structured health literacy educational program addressing CVD medications. Pre-post-design involves health providers and Indigenous clients at the De dwa da dehs nye>s Aboriginal Health Centre (DAHC) in Ontario, Canada. Forty-seven Indigenous clients with or at high risk of CVD received three educational sessions delivered by a trained Indigenous nurse over a 4- to 7-week period. A tablet application, pill card and booklet supported the sessions. Primary outcomes were knowledge of CVD medications and health literacy practices, which were assessed before and after the programe. Following the program compared to before, mean medication knowledge scores were 3.3 to 6.1 times higher for the four included CVD medications. Participants were also more likely to refer to the customized pill card and booklet for information and answer questions from others regarding CVD. This customized education program was highly effective in increasing medication knowledge and health literacy practice among Indigenous people with CVD or at risk of CVD attending the program at an urban Indigenous health centre.