Issues in cardiovascular nursingCausal attributions, lifestyle change, and coronary heart disease: Illness beliefs of patients of South Asian and European origin living in the United Kingdom
Section snippets
Causal attribution
One facet of illness representation is belief about cause (causal attribution): the factors that individuals typically attribute to the development of their illness. The majority of studies on patients with CHD have focused almost exclusively on men recovering from acute myocardial infarction (AMI) in Western countries. Findings indicate that patients most commonly believed that stress, worry, tension, and overwork caused their CHD. A systematic review identified that 41% of studies found
Methods
We defined “South Asian” people as those individuals originating from the Indian subcontinent and “European” people as all those of white European descent. This definition is consistent with other studies.20 A qualitative methodology was chosen because this research topic has been largely unexplored. Such a method is especially useful in understanding how people make sense of what is happening to them, within a social context.21
Results
This section presents data across ethnic groupings to illustrate participants’ beliefs about causal attributions and their experiences of lifestyle change. Excerpts are labeled and coded according to the ethnicity, gender, hospital site, and heart condition of the patient. In this way, WMDC08 relates to an interview conducted with a European man who was admitted to a hospital to undergo a coronary artery bypass surgery and was the eighth member of this particular subsample.
Generally there was
Discussion
There was considerable variation in patients’ understanding about CHD, both within and across ethnic groups. Knowing what caused their CHD influenced the way in which participants managed their condition and helped them to make decisions about lifestyle modification. Although some patients were equipped with relevant information and advice to make such changes, others lacked motivation and the appropriate support to improve their lifestyle.
South Asian patients, particularly Pakistani-Muslim
Limitations
This study has a number of limitations, including its retrospective design and lack of information about participants’ coronary risk factor profiles. The latter would have been valuable in enhancing the interpretation of participants’ health beliefs and behaviors. The small sample size of each individual group also represented a limitation. The findings, although not generalizable, offer important insights that have implications for both the in-hospital care and the cardiac rehabilitation of
Conclusions
The findings from this comparative study suggest that South Asian and European patients with CHD articulate many similar concerns, worries, and needs. The challenge for those involved in providing cardiac rehabilitation services to these patients is to offer information and advice that is tailored to their particular circumstances and to bear in mind that not every problem or difficulty a person encounters can be attributed to his or her ethnic background. The key to progression in this arena
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The study was funded by The Community Fund and the British Heart Foundation (Grant Number RB217616).