Abstract
BACKGROUND: Cardiac disease is a leading cause of death in American Indian populations, and echocardiographic screening within 1 tribal nation revealed 6% of tribal members had undiagnosed structural heart disease (SHD). However, improved strategies for scale-up of screening and wrap-around care are needed to improve outcomes. The purpose of this study was to engage tribal members in identifying priorities related to heart health to inform scalable models for improved SHD diagnosis, care, and outcomes. METHODS AND RESULTS: We used group-level assessment, a qualitative and participatory large group method, to collaboratively generate information and interactively evaluate themes with relevant community members. Together with a Community Research Leadership Board established for this project, we held 4 group-level assessment sessions throughout the tribal land. Themes from each session were combined and distilled into priority areas. A total of 163 tribal members participated in the group-level assessment sessions. Five priorities for an SHD program were identified: (1) heart health/SHD education and awareness; (2) cultural considerations; (3) inclusive, multigenerational community engagement; (4) improved resources for general health and wellness; and (5) accessible, patient-centered health care with local cardiac care. CONCLUSIONS: Group level assessment was the first step in our efforts to improve outcomes for American Indian tribal members with SHD. The generated community insights will directly inform the development of a cardiac disease extender program that will be codesigned with members of the Community Research Leadership Board, tribal community health workers, and the larger community.