Socio-Cultural Influences of Self-Care among African Americans with Heart Failure

Abstract

Heart failure (HF) places a disproportionate burden on African Americans including poorer outcomes than other populations. Self-care, which encompasses adherence to diet, medication and symptom management behaviors, is the cornerstone of HF management and linked to improved health. However, self-care is significantly poorer among African Americans, who report low adherence rates to medication, diet and symptom monitoring even after interventions to improve self-care. Purpose: Since culture is central to the development of self-care (e.g., food preferences, medication adherence, symptom meaning), we sought to explore the socio-cultural influences of self-care among African Americans with HF. Methods: In this mixed methods study, 20 African Americans (mean age 66.71 ± 15 years; 57% male, 77% NYHA III) participated in in-depth interviews about HF self-care, culture (values and beliefs about HF and self-care) and social norms; and completed standardized instruments measuring self-care (Self-Care of Heart Failure Index) and illness-related factors in order to describe the sample.Thematic content analysis was used to elicit themes about the influences of socio-cultural factors on self-care in this population. Results: Overall, self-care was poor in this sample (mean SC maintenance 67.67 ± 12.03; SC management 62.55 ± 15.97). Narrative accounts of self-care revealed strong personal beliefs about adherence to low-salt diet and exercise. Cultural food preferences (“Island food…I will not give that up…”) and social factors including limited access to exercise programs due to financial or safety concerns served as potent barriers to daily self-care activities. A theme that emerged from the qualitative data was spirituality as an influence on individuals' beliefs about self-care (“my heart is in God's care”). One women described her delay in initiating a newly prescribed medication, “the doctor may order it, but I will pray on it…” Although support from church-based friends and family members was integral to daily activities for many (“they bring me what I need”…), many reported selectivity in whom they confided their health issues (“I don't tell them <children/friends> everything”) that led to delay in symptom management or confounded self-care practices. Conclusions: Research to develop and test culturally sensitive interventions is critically needed. Community-based interventions (e.g., faith-based) that may promote inclusion of trusted family and friends who can provide ongoing self-care support to individuals with HF should be explored. Heart failure (HF) places a disproportionate burden on African Americans including poorer outcomes than other populations. Self-care, which encompasses adherence to diet, medication and symptom management behaviors, is the cornerstone of HF management and linked to improved health. However, self-care is significantly poorer among African Americans, who report low adherence rates to medication, diet and symptom monitoring even after interventions to improve self-care. Purpose: Since culture is central to the development of self-care (e.g., food preferences, medication adherence, symptom meaning), we sought to explore the socio-cultural influences of self-care among African Americans with HF. Methods: In this mixed methods study, 20 African Americans (mean age 66.71 ± 15 years; 57% male, 77% NYHA III) participated in in-depth interviews about HF self-care, culture (values and beliefs about HF and self-care) and social norms; and completed standardized instruments measuring self-care (Self-Care of Heart Failure Index) and illness-related factors in order to describe the sample.Thematic content analysis was used to elicit themes about the influences of socio-cultural factors on self-care in this population. Results: Overall, self-care was poor in this sample (mean SC maintenance 67.67 ± 12.03; SC management 62.55 ± 15.97). Narrative accounts of self-care revealed strong personal beliefs about adherence to low-salt diet and exercise. Cultural food preferences (“Island food…I will not give that up…”) and social factors including limited access to exercise programs due to financial or safety concerns served as potent barriers to daily self-care activities. A theme that emerged from the qualitative data was spirituality as an influence on individuals' beliefs about self-care (“my heart is in God's care”). One women described her delay in initiating a newly prescribed medication, “the doctor may order it, but I will pray on it…” Although support from church-based friends and family members was integral to daily activities for many (“they bring me what I need”…), many reported selectivity in whom they confided their health issues (“I don't tell them <children/friends> everything”) that led to delay in symptom management or confounded self-care practices. Conclusions: Research to develop and test culturally sensitive interventions is critically needed. Community-based interventions (e.g., faith-based) that may promote inclusion of trusted family and friends who can provide ongoing self-care support to individuals with HF should be explored.