Abstract
To explore South Asians' experience of choosing and prioritising lifestyle changes during their recovery from first myocardial infarction. Coronary heart disease continues to be a leading cause of premature death globally. South Asians' suffer increased risk of coronary heart disease and have poorer outcomes following myocardial infarction compared to other ethnic groups. Lifestyle modification slows atherosclerosis, and models of behaviour change have been proposed to support such changes. However, little is known about the experiences of South Asians' when attempting to modify their lifestyle. Constructivist grounded theory design, using longitudinal, face-to-face, semistructured in-depth interviews. The consolidated criteria for reporting qualitative research checklist were used to report the study. A series of in-depth interviews with a purposive sample of South Asian patients were conducted at 3 and 16weeks following hospital discharge. Transcripts were analysed line by line with focused and theoretical coding using the constant comparative method and memo writing. Data collection and analysis occurred simultaneously. Three categories characterised the findings. First, patronage of the family, referring to the role that family played in supporting recovery. Conflict often existed between the needs of the family and the individual with the family needs taking priority resulting in lifestyle modifications being abandoned. Second, conforming to beliefs, which explain how religious and health beliefs influenced decisions. Third, affinity towards one's group which refers to the conflictual nature afforded by social norms. The need for "harmony" was identified as the substantive theory. Decisions about choosing and prioritising lifestyle changes were based on what helped participants to maintain harmony in their life rather than meeting individual health needs. South Asians' choose and prioritise lifestyle changes after first myocardial infarction against a backdrop of competing religious, cultural and family beliefs. This paper illustrates that South Asians attempt to balance their individual needs with their family goals, cultural priorities and their religious beliefs when attempting to adopt a healthy lifestyle post myocardial infarction. We propose a model of shared priority setting as a means of promoting behaviour change with South Asians.
Highlights
Diseases of the heart and circulation lead to 17.7 million deaths each year and account for one third of global mortality (Benjamin et al, 2018)
South Asians’ suffer increased risk of coronary heart disease and have poorer outcomes following myocardial infarction compared to other ethnic groups
Conflict often existed between the needs of the family and Keywords: Myocardial infarction, Cardiac rehabilitation, South Asians, Grounded theory, Sharedpriorities
Summary
Diseases of the heart and circulation lead to 17.7 million deaths each year and account for one third of global mortality (Benjamin et al, 2018). The disease burden shows no egalitarian pattern and standardised comparisons among different ethnicities show that South Asian people have a disproportionately higher CVD prevalence (Scarborough, Bhatnagar, Wickramasinghe, Mitchell & Smolina, 2010), higher risk of atherosclerotic events (Joshi et al, 2007; Yusuf et al, 2004; Zahid et al, 2011; Anand et al, 2000; Gupta & Brister, 2006; Gupta et al, 2002), higher rates of hospital admissions (Ahmed and El-Menyar, 2015) and earlier disease onset (Volgman et al, 2018) Such disparity is not limited to British South Asians but is evident in worldwide migrant South Asians (Fischbacher, Bhopal & Povey, 2007).
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