Gippsland's Healthy CHAT project
Australian Institute of Health and Welfare (AIHW) statistics show that 50% of Australians have a common chronic health condition, such as diabetes, heart disease, a mental illness or cancer, and almost 25% have two or more of these conditions. Most of these chronic health conditions share preventable risk factors, such as smoking, excessive alcohol consumption, poor nutrition and being physically unfit (AIHW, 2018).
Statistics for Gippsland, in Victoria's south east, indicate that residents have chronic disease risk factors well above the state averages (PHN, 2018). This is perhaps because the Aboriginal and Torres Strait Islander population in Gippsland is considerably higher than the rest of the state, with approximately 10% of Victoria's Indigenous population living in this area (PHN, Gippsland, 2018). The Heart Research Institute (2018) states that Indigenous Australians are still around twice as likely to be affected by heart disease, twice as likely to have a heart attack, 10.5 times more likely to die from coronary heart disease and 1.2 times more likely to have high blood pressure than other Australians.
These prevalence rates prompted local health agencies to come together to identify new ways of getting key messages about health to those most at risk. The project was led by Latrobe Community Health Service (LCHS), a primary and community health service focused on providing patient-centred primary health care, especially for those with multiple health conditions and high support needs.
Other organisations involved include Gippsland Lake Health Service, Monash University Department of Rural Health and Ramahyuck Aboriginal District Corporation. Together, they have developed a face to face and online training package for nursing, allied health and Aboriginal health workers, in the effective and frequent delivery of health advice using the Very Brief Advice (VBA) format.
A VBA is a short and opportunistic health promotion message, delivered during routine clinical appointments and focused on encouraging patients to change habits. It involves pro-actively raising awareness of, and assessing a person's willingness to engage in further discussion (advice) about unhealthy lifestyle issues. The Gippsland program is known as Health CHAT (Check, Hear, Advise, Talk). Key topics include smoking, nutrition, alcohol and physical activity.
A grant of $125,200 from FRRR's Enhancing Country Health Outcomes (ECHO) program, funded by Beyond Medical Education, enabled LCHS to engage a part-time Project Manager to lead the project. The grant also covered costs of filming and development of the online training education modules.
A steering committee was formed to oversee the development of the training content. An Aboriginal liaison support worker from LCHS provided feedback on the training modules to ensure the materials are culturally appropriate and relevant to the local Aboriginal community members.
Four instructional videos were developed, which included interviews with healthcare workers as well as people who use or volunteer at each of the services. A training package accompanies the instructional videos to ensure allied health and nursing staff have the knowledge, confidence and skills to deliver the Healthy CHAT program in their everyday practice.
The online modules were piloted with multiple stakeholders and key staff, before being rolled out to around 50 health care workers at two LCHS community health services and one LCHS Aboriginal health service in the Gippsland area. The online learning modules and other useful resources are now available on the Healthy CHAT website.
The grant also provided funding for formal evaluation and a structured approach to assessing the changes in knowledge, confidence and attitudes about delivering Healthy CHAT, which was completed in December 2019. It is hoped that this pilot project will provide a proven way forward for other rural, regional and remote clinical settings, especially in reaching groups with lower health literacy and/or who are socially and economically disadvantaged.