Using co-design to improve accessibility and acceptability of cardiac services for vulnerable populations: The Equal Hearts Study

Coronary heart disease (CHD) remains a leading cause of death in Australia, and lower socioeconomic groups carry the greatest burden of disease. Healthcare services have an important role to play in addressing this social gradient, by ensuring the care they provide is accessible for all, including people with lower health literacy. Health literacy is a proxy measure of equity and a significant predictor of health care access. Accessibility can be conceptualised as the availability of services, their acceptability and appropriateness, and their affordability. We propose a mixed-methods research study that uses a health literacy-based, co-design approach to identify how hospital cardiac services can improve and measure accessibility for under-served population groups with CHD. The study will: 1) use mixed-methods approaches to describe and understand health literacy-related factors that influence accessibility and acceptability of cardiac services for under-served populations with CHD; 2) use a modified intervention-mapping approach to co-design and evaluate an intervention that targets these factors in a pilot randomised controlled trial; 3) develop a series of ‘equity indicators’ for hospital-based cardiac services to measure access for vulnerable populations with CHD.