Policy makers’ perceptions of the high burden of heart disease in rural Australia: Implications for the implementation of evidence-based rural health policy

Abstract

Background Rural Australian populations experience an increased burden of ischaemic heart disease (IHD) compared to their metropolitan counterparts, similar to other developed countries, globally. Policy and other efforts need to address and acknowledge these differences in order to reduce inequalities in health burden. This paper examines rural health policy makers’ perceptions and use of evidence in efforts to reduce the burden of IHD in rural areas. Methods Policy makers and government advisors (n = 21) who worked with, or advised on, rural health policy at local, state and federal government levels, with specific focus on the state of Victoria (n = 9) were identified from publicly available documents and subsequent snowball sample. Semi-structured qualitative interviews were conducted in regards to the use of evidence in policy to prevent IHD and thematic analysis undertaken applying two theoretical perspectives: context-based evidence-based policy making and the conceptual framework for understanding rural and remote health. Results The rural context, particularly low resourcing, was seen as limiting potential for evidence based policy at local government (LG) level. Lower levels of political pressure and education were seen as constraints to evidence-based policy in rural communities. Participants described the potential for policy to have a greater impact on reducing heart disease in rural areas though they felt under-resourced and out of touch with the scientific evidence. Scientific studies were less valued than local anecdote to prioritise specific policy. At all levels (local, state and federal) low self-efficacy in interpreting evidence and perceived lack of relevance inhibited development of evidence informed policy. Conclusion The rural context constrains the use of scientific evidence in policy making for the prevention of heart disease in rural areas in Australia with multiple factors influencing the capacity for evidenced based health policy. This is similar to findings at the international scale and is for consideration across other developed countries that experience inequalities in IHD disease burden between rural and urban populations.

Limited dietary interventions in rural Australian communities: A systematic review

“…Moreover, of the studies included, the majority of studies were rated neutral indicating several methodological concerns with the study designs. This review also provides evidence that there is a lack of evidence on rural‐applicable interventions to drive rural health policy and drive the prevention of NCDs like cardiovascular disease 8 . A lack of high‐quality evidence has previously been highlighted by policymakers in rural Australia and has been noted as a barrier to action to improve the health of rural Australian communities 8 …”

“…Rural policy makers feel there is not enough rural applicable evidence on addressing preventable health issues like cardiovascular diseases in rural Australia 8 and rural health and communities continue to remain under‐researched 9 . More evidence is needed to understand how diet‐related disease risk can be reduced in future generations for rural communities.…”

World Heart Federation Roadmap for Heart Failure

“…European Heart Failure Awareness Week, Heart Failure Awareness Week-"Do Your Part, Know Your Heart" Campaign (Heart Failure Society of America) and "Keep it Pumping" Campaign (Cardiology Society of India) are examples of programs designed to create awareness among patients and caregivers and gather the support of national societies. Whereas evidence is lacking in the effectiveness of awareness campaigns in heart failure specifically, research in other disease areas indicates that increased awareness directly correlates with earlier detection and diagnosis [52,53] For an integrated approach to improving awareness of heart failure, see Table 3 [54,57,58].…”

“…Evidence in Practice PAHO Rallies New Partners for Chronic Disease Prevention: the Pan American Health Organisation (PAHO) brought together health advocates across the continent to become partners in a public-private effort to fight NCD focusing on key actions areas including changing policy, reducing risk factors, and improving treatment. "Policy makers' perceptions of the high burden of heart disease in rural Australia" [57]: a paper highlighting inequality in resourcing, and political pressure and education as key constraints to evidence-based policy in rural communities. Pan African Ministries of health meeting on hypertension: an example of a regional meeting involving ministries of health, education, agriculture, transport and finance, among other stakeholders, to support a move from science into policy and to leverage support for key recommendations in addressing hypertension in Africa [58].…”

Characterizing the Health of Older Rural Australians Attending Rural Events: Implications for Future Health Promotion Opportunities

“…The reasons for this are complex and multifactorial [ 13 , 14 , 15 , 16 ]; however, the health inequities have been widely acknowledged to be unjust and preventable [ 10 , 17 ]. Issues such as geographical isolation, limited access to health services, lower education and health literacy levels, differences in modifiable risk factors, lower socioeconomic status, and a lack of evidence to inform health policy, compared to metropolitan communities, contribute to these health outcomes for older people in these areas [ 9 , 10 , 13 , 14 , 15 , 16 , 18 ]. Rurality has been shown to be a risk factor for chronic diseases, over and beyond the influence of factors such as socio-economic status [ 19 ].…”