Academic journal article Australian Health Review

Negotiating Norms, Navigating Care: Findings from a Qualitative Study to Assist in Decreasing Health Inequity in Cardiac Rehabilitation

Academic journal article Australian Health Review

Negotiating Norms, Navigating Care: Findings from a Qualitative Study to Assist in Decreasing Health Inequity in Cardiac Rehabilitation

Article excerpt


Globally, cultural and linguistic diversity challenge health care delivery and culturally competent care. Australia is one of the most culturally diverse countries in the world, endorsing universal health coverage and promoting access and participation in health care programs. Cardiac rehabilitation (CR) programs are generally coordinated, multidisciplinary interventions to improve the physical, psychological, and social functioning of people with, or at high risk of, heart disease.1 Despite the benefits of CR, participation rates remain low, particularly for patients from cultural and ethnic minorities who do not access CR services.2 The manner in which practitioners respond to patient needs and preferences has implications for health service engagement. To date, few studies have described models of engagement for culturally diverse patients.3,4

There is a growing consensus that cultural competence is necessary to improve access to services, eliminate health disparity, promote quality and equitable care, and improve health outcomes for people from culturally and linguistically diverse backgrounds.5,6 Cultural competence has been defined as: 'A set of congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations'.7 To date, models of cultural competence have been derived with minimal empirical data.8-11 Although this theoretical inference is critical and reasonable, models to inform practice should also be empirically derived and validated. Cultural competence is particularly important in the CR setting because of the crucial need for health practitioners to engage with the individual and their family, not only in the physical dimension but also in the psychological and social domains to assist recovery and adjustment.1 Culturally competent practice has been conceptualised from two distinct, yet overlapping, perspectives, goal-oriented and process-oriented approaches. Goal-oriented theorists view cultural competence as an end point, a set of knowledge and skills that can be learned through training.8 In contrast, process-oriented theorists view cultural competence as a process or continuum, requiring continuous commitment, improvement, and transformation through the path of cultural competence.9,12 In order to achieve a greater understanding of the processes of cultural competence in CR, we undertook a study to describe practitioners' experience, perceptions, and activities. Specifically, we sought to identify the ways in which health practitioners in CR adjust their treatment to accommodate the perceived needs of CaLDB clients and to identify factors affecting engaging with CaLDB communities.


Qualitative methods were used to explore and define constructs of cultural competence in the CR setting,13 including in-depth interviews with health practitioners and field observations. The interviews explored the knowledge, attitudes, beliefs and behaviours of health practitioners. This study was undertaken in two health regions in metropolitan Sydney, Australia, to facilitate recruitment, as well as diverse views and perspectives. These two areas were selected because they provideCRservices to a range of people from CaLDB groups.

Study participants were enrolled using a purposive sampling strategy to ensure that individuals and settings with the most relevant and valuable information were identified. Interviews and data collection were continued until no new information occurred and sufficient representation was obtained across study sites and professional groups.14 The principal researcher (AH) transcribed all audiotaped interviews as well as rewriting and reorganising field notes, research journal, and analytical memos.

The method of qualitative content analysis was used for data analysis.15 Content analysis is the process of reviewing textual data and classifying these into categories on the basis of their importance and relevance to the research question. …

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