Strong Hearts, Strong Community – delivering accessible heart health education to First Nations communities

Imagine needing an injection of penicillin every 21 to 28 days for the rest of your life. The large needle used makes it notoriously painful, and some people have a reaction to the injection. It is probably not your idea of fun, but for people living with rheumatic heart disease (RHD), that is the reality.

RHD is a devastating, yet preventable, condition that causes valves in the heart to become permanently damaged meaning they cannot open or close normally. This leads to interruptions to blood flow around the body, causing significant ill-health and ultimately premature death. There is no cure for RHD, and the injections of penicillin merely protect people from future infections that could make their condition worse.

In the 1940s and 50s in Australia, RHD was the most common reason a bed was occupied in a children’s hospital. But since the discovery of penicillin, as well as improvements in healthcare and socioeconomic conditions, RHD rates in Australia declined dramatically.

But this drop in RHD rates hasn’t reached everybody – with First Nations communities still disproportionately experiencing the disease. Of the reported RHD cases in Australia in 2022, 79% were in First Nations peoples.

RHD is caused by a Group A Streptococcus (Strep A) bacterial infection of the throat and skin. Although Strep A infections are very easily treated, First Nations communities often lack equal access to basic amenities, culturally safe healthcare options, and healthcare awareness and education.

“It sounds simple, but for people living in remote communities there are more complex issues at play. Staffing clinics can be difficult, meaning healthcare staff can be transient and may not have had exposure to Strep A and RHD, and sometimes a mistrust in the healthcare system, lack of culturally safe care and community awareness are barriers to early diagnosis and treatment,” says Heart Foundation First Nations Heart Health team lead, Jacinta Hegarty.

This means that Strep A infections in these communities are often left untreated and can progress to acute rheumatic fever (ARF) and then RHD.

“In our conversations with people in remote communities there is an awareness of the seriousness of RHD, but next to no knowledge of Strep A being the key, treatable stage in the causal pathway,” Jacinta explains.

The key to eliminating RHD is breaking this cycle of infection in First Nations communities.

In 2024, the Heart Foundation launched the Strong Hearts, Strong Community project. The project was a collaborative partnership with Remote Laundries project run by the Aboriginal Investment Group. Using the laundries as a way to engage with people, the project delivered heart health literacy sessions to remote communities.

Delivered by the Heart Foundation’s First Nations team, the Strong Hearts, Strong Community project delivered culturally tailored heart and skin health education sessions to three remote Northern Territory communities (Gunbalanya, Angurugu and Umbakumba). The sessions were attended by 86 First Nations people including 39 school students, 23 women and 24 men. These sessions focused on the way the heart functions, healthy skin and how it is linked to healthy hearts, and RHD prevention – whilst also promoting use of the laundries to reduce Strep A and skin infections.

In addition to culturally and contextually relevant print educational materials, the sessions used videos in local languages, and interactive activities including drawing and painting to explain complex health information.

The sessions had a strong focus on cultural relevance, with the Heart Foundation’s First Nations team working with members of the local communities to translate health messages into local language and audience-friendly analogies such as ‘cheeky germs’. As indicated by one participant, “having [the sessions delivered] in local language was a bonus.”

The sessions gave participants a better understanding of how their heart works and ways they can protect themselves, their families and communities from RHD. Participants also reported that following the sessions they had spoken to other people in their communities about their heart and skin health and encouraged people to use the laundries and visit clinics. One participant stating that after the sessions, some mums in their community, “went to visit the child nurse because they were concerned about their child's skin.”

In 2025, the Heart Foundation First Nations team will build on the project's success and insights, expanding it to additional interested First Nations communities. The initiative will maintain a partnership-driven approach, prioritising First Nations-led programs and organisations while exploring ways to better reach women and young people, who face a higher risk of RHD.

Expressions of interest are now open to contribute to the development of the 2025 Australian Guideline for the diagnosis and management of hypertension, a key initiative led by the Heart Foundation in collaboration with Stroke Foundation.

The Heart Foundation and Stroke Foundation are seeking experts in hypertension management who have an understanding of regional, rural, and remote health, as well as experience with special populations. If you're interested in being considered to participate in the pool of experts, consultants and consumers on whom the project will rely please express your interest here.