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Table 1 Themes and key issues identified by participants as having a major impact on design and delivery of CR to Indigenous people

From: Are the processes recommended by the NHMRC for improving Cardiac Rehabilitation (CR) for Aboriginal and Torres Strait Islander people being implemented?: an assessment of CR Services across Western Australia

Theme Key issues
Workforce • AHWs were described as being pivotal in engaging and maintaining relationships with Indigenous patients and their families.
  • AHWs are important in mentoring other health professionals by providing cultural insights into care of Indigenous people:
     "One of the most important things in providing health services to Aboriginal people is to actually work with the people who have the cultural awareness, and that is the health workers, of course, Aboriginal people themselves...The people want services to be provided by their own people."
  • Only 54% of respondents reported having access to Aboriginal and Torres Strait Islander staff which was a major impediment to engaging Indigenous people within mainstream services.
  • Existing AHWs faced limited infrastructure and support:
     "They can't represent their community in that sort of environment, so they leave"
  • High turnover of non-Indigenous staff impacted on initiative sustainability:
     "I'm just relieving for J...". "...been here for three months" "...leaving in two weeks"
Cultural competence • Failure to appreciate reasons for poor participation:
     "I don't know why they don't come. "
  • Features of programs and services are not congruent with Indigenous clients' lifestyles, culture, commitments, and preferences:
     "Maybe we could run an ATSI-specific class, because they have this huge shame factor when they are with other people and stuff that they don't like doing"
Linkages • Few systematic processes for identifying Indigenous people Inadequate communication and referral upon discharge:
     "We don't know exactly what day they (Aboriginal patients discharged from hospital) are getting back. There are issues around the continuity of care even though we should get a discharge summary".
  • Disparate health information management systems between organizations
  • Lack of awareness of available services in different areas:
     "It's probably our fault as there is not a good relationship between us and the cardiologists in Perth or the surrounding areas, because people might not think the service is available"
  • Operating in isolation rather than with existing services