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Cultural Diversity in Heart Failure Management: Findings from the DISCOVER Study (Part 2)
Patricia M Davidson
Professor of Cardiovascular and Chronic Care, School of Nursing and Midwifery, Curtin University of Technology, Sydney Campus, NSW
Peter Macdonald
Associate Professor, St Vincents Hospital and University of New South Wales, Sydney NSW
Debra K Moser
Professor and Gill Chair of Nursing, University of Kentucky, Lexington; St George Hospital Cardiology Department, Sydney NSW
Esther Ang
Diversity Health, South East Health, Sydney NSW
Glenn Paull
Diversity Health, South East Health, Sydney NSW
Sam Choucair
Diversity Health, South East Health, Sydney NSW
John Daly
Dean, Faculty of Nursing Midwifery and Health, University of Technology Sydney, Sydney NSW
Leila Gholizadeh
Doctoral Candidate, University of Western Sydney, Australia and Sydney West Area Health Service, Sydney NSW
Kathleen Dracup
Dean and Professor, University of California, San Francisco CA, United States of America (on behalf of the DISCOVER Investigators)
Abstract
Self-management is a critical dimension in managing chronic conditions, particularly in heart failure (HF). Knowledge, attitudes and beliefs, relating to both illness and wellness, are strongly influenced by culture and ethnicity, impacting upon an individual's capacity to engage in self-care behaviours. Effective management of HF is largely dependent on facilitation of culturally informed, self-care behaviours to increase adherence to both pharmacological and non-pharmacological strategies.
The Understanding the cultural experiences of individuals with chronic heart failure (CHF) in South East Health (DISCOVER) study is an exploratory, observational study investigating health patterns, information needs and the adjustment process for overseas-born people with HF living in Australia. An integrative literature review was augmented by qualitative data derived from key informant interviews, focus groups and individual interviews. A key finding of this study is that culture provides an important context to aid interpretations of attitudes, values, beliefs and behaviours, not only in illness but in health. While individual differences in attitudes and beliefs were observed among participants, common themes and issues were identified across cultural groups.
Data from the DISCOVER study revealed the primacy of family and kinship ties. These relationships were important in making decisions about treatment choices and care plans. Participants also revealed the critical role of the 'family doctor' in assisting people and their families in brokering the health care system. In this study, heart disease was considered to be a significant condition but cancer was the condition that people both feared and dreaded the most, despite the high mortality rates of HF. This sample reported that religious and traditional beliefs became more important as people aged and considered their mortality. As HF is predominately a condition of ageing, the information derived from this study will assist clinicians to tailor health care service delivery for older people with HF, across multiple ethnic backgrounds.
Keywords
heart failure, DISCOVER study, health seeking behaviours, cultural diversity, cultural competence
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