Elsevier

Heart & Lung

Volume 39, Issue 6, November–December 2010, Pages 494-503
Heart & Lung

Issues in Cardiovascular Nursing
Cultural factors facilitating cardiac rehabilitation participation among Canadian South Asians: A qualitative study

https://doi.org/10.1016/j.hrtlng.2009.10.021Get rights and content

Purpose

South Asians experience high rates of cardiovascular disease, yet participate in cardiac rehabilitation (CR) at low rates. Drawing on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, this qualitative descriptive study sought to identify cultural factors facilitating South Asians' participation in CR programs.

Methods

Two semistructured interviews were conducted with each of 16 Canadian South Asian participants enrolled in a 12-month CR program. Transcribed data were analyzed for common themes, and categorized in terms of predisposing, enabling, and reinforcing factors.

Results

Primary cultural facilitators included descriptions of CR as a “medically supervised” program, family and physician support, and previous knowledge of CR via members of the South Asian community.

Conclusion

Previous research identified barriers to CR participation in the South Asian community, and this study is the first to identify facilitators. Results suggest that families should be included in patient-education sessions, CR should be reinforced by healthcare providers, and the provider team should recognize cultural preferences.

Section snippets

Setting

South Asian patients were recruited from the Cardiac Rehabilitation and Secondary Prevention Program offered through the Toronto Rehabilitation Institute (TRI). This is the largest CR outpatient program of its kind in North America. Each year, it treats close to 1600 people who are recovering from various forms of heart disease and surgery. This 10-month program is based on a scientifically proven and medically supervised course of exercise, education, and lifestyle modification aimed at

Results

Demographic and clinical details of participants are listed in Table I. Primary interviews were completed at saturation with 18 South Asians of Indian, Sri Lankan, Bangladesh, Pakistani, and African origin currently attending the CR program at TRI over a 6-week period. Two male patients were excluded from the analysis: 1 had a noncardiac clinical diagnosis, and 1 had mental health-related issues and was removed at the request of TRI. Therefore, the total sample in this study consisted of 16

Discussion

Studies report that South Asian individuals are less likely to attend CR.21, 22, 23, 24, 25 In contrast, our sample of participants clearly demonstrated that South Asians can successfully engage with, and adhere to, a CR program. To increase participation rates in this population, we suggest that future interventions consider the facilitating factors reported here. Although the factors influencing CR attendance among participants in this study are in line with the results of studies in the

Conclusions

Many obstacles to participation cannot be changed (e.g., age, initial disease severity, diagnosis, sex, and educational attainment), which makes it crucial that factors open to modification are aggressively pursued, beginning with efforts to maximize referral rates. Based on our findings, South Asians diagnosed with CVD do have the capacity to utilize the services of CR. Facilitators influencing CR participation among South Asians exist at the universal and cultural levels. Across all levels,

Acknowledgments

The authors are indebted to the South Asian patients, staff, research coordinator (Susan Marzolini), and medical director (Dr. Paul Oh) at the Toronto Rehabilitation Institute for their significant contributions to this study, and to Dr. Janarthan Nikhil (cardiologist) for reviewing an earlier draft of this manuscript.

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