(P156) DESIGNING FROM THE HEART: IMPROVING EQUITABLE ACCESS TO CARDIAC CARE IN REMOTE INDIGENOUS COMMUNITIES

Background: Indigenous populations across Canada face higher rates of cardiovascular disease (CVD) morbidity and mortality compared to the general population. In the James and Hudson Bay (JHB) region of Northern Ontario, the impact of these health disparities is further exacerbated as Indigenous communities reside in remote areas with limited access to specialized care. Given the historical and on-going impact of colonial structures on Indigenous well-being, enabling equitable care access in the JHB region must be guided by the values of communities and implemented in a strengths-based fashion. To inform this approach, we collaboratively identified the needs and requirements for a community-led cardiac care program grounded in biomedical expertise and Indigenous values.

METHODS AND RESULTS: A community-based explorative study was conducted in partnership with the Weeneebayko Area Health Authority. A sharing circle was held in Moose Factory, Ontario, to identify the opportunities to improve access to culturally-safe cardiac care. Qualitative data was analyzed using inductive thematic analysis and the Indigenous method of two-eyed seeing. Study data was validated by community members.

Four core themes were identified: (1) Proactive care management starts with cultural safety; (2) Digitally enabled care continuity; (3) Heart health starts with nutrition; (4) Community ties foster care empowerment. With the level of stigma regarding clinical care, the importance of presence and partnership was highlighted as the key drivers to empower culturally-safe and patient-centred care. Recognizing geographic and resource constraint challenges in the JHB region, digital modalities were seen as transformative tools to bring quality care services closer to home. Beyond clinical models, systemic factors related to adequate nutrition were felt to significantly impact community health outcomes. Key features for a cardiac care program included: (1) Clinician cultural safety training; (2) Digitally enabled care support; (3) Heart healthy diet guide inclusive of locally available Indigenous and Western foods; and (4) Virtual community hub for peer support.

Conclusion: Indigenous cardiovascular outcomes in the JHB region are reflective of the historical conditions imposed by Western institutions, resulting in systemic challenges to manage health outcomes. To move towards a path of reconciliation that empowers Indigenous heart health, care programs need to be designed beyond the requirements imposed by clinical guidelines, and community must be part of that co-development. By working in partnership with communities, innovative care strategies which intersect the strengths of community, clinic, and digital solutions can improve timely and appropriate access to care.