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Blackwell J, Allen-Collinson J, Evans A, Henderson H. How Person-Centred Is Cardiac Rehabilitation in England? Using Bourdieu to Explore Socio-Cultural Influences and Personalisation. QUALITATIVE HEALTH RESEARCH 2024; 34:239-251. [PMID: 37933668 PMCID: PMC10768332 DOI: 10.1177/10497323231210260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support.
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Affiliation(s)
- Joanna Blackwell
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | | | - Adam Evans
- Department of Nutrition, Exercise, and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Hannah Henderson
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
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Dong K, Gagliardi AR. Person-centered care for diverse women: Narrative review of foundational research. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231192317. [PMID: 37596928 PMCID: PMC10440084 DOI: 10.1177/17455057231192317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Despite advocacy and recommendations to improve health care and health for persons who identify as women, women continue to face inequities in access to and quality of care. Person-centered care for women is one approach that could reduce gendered inequities. We conducted a series of studies to understand what constitutes person-centered care for women and how to achieve it. The overall aim of this article is to highlight the key findings of those studies that can inform policy, practice, and ongoing research. We conducted a narrative review of all studies related to person-centered care for women conducted in our group starting in 2018 over a 5-year period, which was general at the outset, and increasingly focused on racialized immigrant women who constitute a large proportion of the Canadian population. We organized study summaries by research phase: synthesis of person-centered care for women research, exploration of existing person-centered care for women guidance, consultation with key informants, consensus survey of key informants to prioritize strategies to achieve person-centered care for women, and consensus meeting with key informants to prioritize future research. We conducted the reported research in collaboration with an advisory group of diverse women and managers of community agencies. Our research revealed that little prior research had fully established what constitutes person-centered care for women, and in particular, how to achieve it. We also found little acknowledgment of person-centered care for women or strategies to support it in medical curriculum, clinical guidelines, or healthcare policies. We subsequently consulted women who differed by age, ethno-cultural group, health issue, education and geography, and clinicians of different specialties, who offered considerable insight on strategies to support person-centered care for women. Other diverse women, clinicians, healthcare managers, and researchers prioritized issues that warrant future research. We hope that by compiling a summary of our completed research, we draw attention to the need for person-centered care for women and motivate others to pursue it through policy, practice, and research.
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Affiliation(s)
- Kelly Dong
- Division of General Surgery and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Parry M, Visintini S, Johnston A, Colella TJ, Kapur D, Liblik K, Gomes Z, Dancey S, Liu S, Goodenough C, Hay JL, Noble M, Adreak N, Robert H, Tang N, O'Hara A, Wong A, Mullen KA. Peer-support interventions for women with cardiovascular disease: protocol for synthesising the literature using an evidence map. BMJ Open 2022; 12:e067812. [PMID: 36198466 PMCID: PMC9535150 DOI: 10.1136/bmjopen-2022-067812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The leading cause of death for women is cardiovascular disease (CVD), including ischaemic heart disease, stroke and heart failure. Previous literature suggests peer support interventions improve self-reported recovery, hope and empowerment in other patient populations, but the evidence for peer support interventions in women with CVD is unknown. The aim of this study is to describe peer support interventions for women with CVD using an evidence map. Specific objectives are to: (1) provide an overview of peer support interventions used in women with ischaemic heart disease, stroke and heart failure, (2) identify gaps in primary studies where new or better studies are needed and (3) describe knowledge gaps where complete systematic reviews are required. METHODS AND ANALYSIS We are building on previous experience and expertise in knowledge synthesis using methods described by the Evidence for Policy and Practice Information (EPPI) and the Coordinating Centre at the Institute of Education. Seven databases will be searched from inception: CINAHL, Embase, MEDLINE, APA PsycINFO, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, and Scopus. We will also conduct grey literature searches for registered clinical trials, dissertations and theses, and conference abstracts. Inclusion and exclusion criteria will be kept broad, and studies will be included if they discuss a peer support intervention and include women, independent of the research design. No date or language limits will be applied to the searches. Qualitative findings will be summarised narratively, and quantitative analyses will be performed using R. ETHICS AND DISSEMINATION The University of Toronto's Research Ethics Board granted approval on 28 April 2022 (Protocol #42608). Bubble plots (ie, weighted scatter plots), geographical heat/choropleth maps and infographics will be used to illustrate peer support intervention elements by category of CVD. Knowledge dissemination will include publication, presentation/public forums and social media.
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Affiliation(s)
- Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy Johnston
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Tracey Jf Colella
- Toronto Rehabilitation Cardiovascular Prevention & Rehabilitation Program, KITE - University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Deeksha Kapur
- Lawrence S. Bloomberg Faculty of Nursing (Research Assistant), University of Toronto, Toronto, Ontario, Canada
| | - Kiera Liblik
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Zoya Gomes
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sonia Dancey
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shuangbo Liu
- Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Goodenough
- Canadian Women's Heart Health Alliance, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jacqueline L Hay
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Meagan Noble
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Indigenous Services Canada, Toronto, Ontario, Canada
| | - Najah Adreak
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Robert
- Canadian Women's Heart Health Alliance, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Natasha Tang
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Arland O'Hara
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Anice Wong
- Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Intersectionality and heart failure: what clinicians and researchers should know and do. Curr Opin Support Palliat Care 2021; 15:141-146. [PMID: 33905386 DOI: 10.1097/spc.0000000000000547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW To review the application of intersectionality to heart failure. Intersectionality refers to the complex ways in which disenfranchisement and privilege intersect to reproduce and influence health and social outcomes. RECENT FINDINGS Intersectionality challenges approaches that focus on a single or small number of socio-demographic characteristics, such as sex or age. Instead, approaches should take account of the nature and effects of a full range of socio-demographic factors linked to privilege, including: race and ethnicity, social class, income, age, gender identity, disability, geography, and immigration status. Although credible and well established across many fields - there is limited recognition of the effects of intersectionality in research into heart disease, including heart failure. This deficiency is important because heart failure remains a common and burdensome syndrome that requires complex pharmacological and nonpharmacological care and collaboration between health professionals, patients and caregivers during and at the end-of-life. SUMMARY Approaches to heart failure clinical care should recognize more fully the nature and impact of patients' intersectionality- and how multiple factors interact and compound to influence patients and their caregivers' behaviours and health outcomes. Future research should explicate the ways in which multiple factors interact to influence health outcomes.
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Colella TJ, Hardy M, Hart D, Price JA, Sarfi H, Mullen KA, Mulvagh S, Norris CM. The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 3: Patient Perspectives. CJC Open 2021; 3:229-235. [PMID: 33778439 PMCID: PMC7985007 DOI: 10.1016/j.cjco.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022] Open
Abstract
In recent years, public awareness campaigns have targeted knowledge gaps and inequities in care while focusing on the unique female experience and heightened cardiovascular disease (CVD) risk profile. Recognizing and understanding the sex and gender constructs, barriers, facilitators, and factors that affect access, treatment, and recovery after an acute cardiac event from the unique patient perspective is a key step in transforming clinical practice and care patterns. The aim of this atlas chapter is to provide a knowledge review and to identify gaps regarding the experience of living with CVD from the perspective of the female survivor. The sections are as follows: (1) experiencing and living with CVD as a woman; (2) "stopped at the gate": barriers to accessing acute cardiovascular care; and (3) action items to "open the gate" to women: what our patients want and need. The final section culminates with targeted recommendations stemming from recent literature and most importantly, from women with the lived experience of CVD.
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Affiliation(s)
- Tracey J.F. Colella
- Toronto Rehab Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada
| | - Marsha Hardy
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Jennifer A.D. Price
- Women’s College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
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Jbilou J, Grenier J, Chomienne MH, Talbot F, Tulloch H, D'Antono B, Greenman P. Understanding men's psychological reactions and experience following a cardiac event: a qualitative study from the MindTheHeart project. BMJ Open 2019; 9:e029560. [PMID: 31562150 PMCID: PMC6773299 DOI: 10.1136/bmjopen-2019-029560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Emotional issues such as depression, anxiety and post-traumatic stress disorder are common following a cardiac event. Despite their high prevalence, they often go undiagnosed and research suggests that men in particular are at higher risk. Therefore, a better understanding of men's experiences with a cardiac event and ensuing health services is key for adapting approaches that meet their needs. The aim of this study was to describe the self-reported emotional challenges that men face following a cardiac event and to understand their patterns of psychosocial adjustment. DESIGN Qualitative study (focus groups and one-on-one interviews) using an interpretive phenomenal analysis. SETTING Clinical settings (cardiac departments in hospitals, cardiac rehabilitation programme and family medicine clinics) and in the community in three Canadian provinces. PARTICIPANTS A total of 93 men participated in the study through 22 focus groups and 5 semi-structured interviews, none has been excluded based on comorbidities. RESULTS Four major themes emerged: (1) managing uncertainty and adversity; (2) distancing, normalising and accepting; (3) conformity to traditional masculine norms and (4) social, literacy and communication challenges. CONCLUSIONS Healthcare professionals caring for men following a cardiac event must be aware of the psychological and social adjustments that accompany the physical challenges. However, there is a lack of explicit guidelines, tools and clinical training in men-sensitive approaches. Further research is required to better inform clinical practices and healthcare services.
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Affiliation(s)
- Jalila Jbilou
- Psychology, Universite de Moncton, Moncton, New Brunswick, Canada
- Centre de formation médicale du Nouveau Brunswick, Universite de Moncton, Moncton, New Brunswick, Canada
| | - Jean Grenier
- Institut du Savoir Montfort, Hopital Montfort, Ottawa, Ontario, Canada
| | - Marie-Helene Chomienne
- Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - France Talbot
- Psychology, Universite de Moncton, Moncton, New Brunswick, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Cardiac Prevention and Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Bianca D'Antono
- Psychology Department and Research Centre at the Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
| | - Paul Greenman
- Institut du Savoir Montfort, Hopital Montfort, Ottawa, Ontario, Canada
- Département de Psychoéducation et de Psychologie, Universite du Quebec en Outaouais, Gatineau, Quebec, Canada
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TSAI CC, LI AH, TU CM, HWANG KL, JENG C. Effectiveness of a Tailored Lifestyle Management Program for Middle-Aged Women With Coronary Artery Disease: A Preliminary Study. J Nurs Res 2019; 27:1-10. [PMID: 29985820 PMCID: PMC6369882 DOI: 10.1097/jnr.0000000000000271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of death in women. Many of the risk factors for CAD relate to lifestyle and thus may be influenced by lifestyle modification. However, middle-aged women often find it difficult to adjust their lifestyle behaviors. Thus, providing individualized treatment is crucial to reducing the risk and incidence of CAD in this population. PURPOSE The aim of this study was to explore the effectiveness of a tailored lifestyle management program (TLMP) for middle-aged women with CAD. METHODS An experimental design was employed. Thirty-five middle-aged women with CAD (with stenosis [> 50%] of at least one main artery as determined by cardiac catheterization examination results) were recruited. The 35 women were randomlyassigned to the experimental group (n = 17) or the control group (n = 18). Both groups received regular health education during their hospitalization. After discharge, the experimental group received the 12-week, home-based TLMP. A generalized estimating equation was used to examine the effects of the TLMP on metabolic and biomarker indicators for CAD. RESULTS The average age of participants was 56.1 ± 5.6 years. No significant demographic differences were identified between the two groups. Compared with the control group, the experimental group had a significantly higher high-density lipoprotein level (B = 7.83, p < .001), a lower level of total cholesterol (B = -49.21, p = .04), and a lower waist circumference (B = -6.42, p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE This study suggests that using tailored interventions is an effective approach to improving high-density lipoprotein, total cholesterol, and waist circumference in middle-aged women with CAD. This result is expected to have important implications for women's healthcare, particularly in terms of preventing the incidence of CAD.
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Affiliation(s)
- Ching-Ching TSAI
- PhD, RN, Assistant Professor, Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, and Assistant Researcher, Department of Cardiology, Chang Gung Memorial Hospital
| | - Ai-Hsien LI
- PhD, MD, Attending Physician, Division of Cardiology, Cardiovascular Center, Far-Eastern Memorial Hospital, and Adjunct Assistant Professor, College ofMedicine, National Taiwan University Hospital
| | - Chung-Ming TU
- MD, Attending Physician, Division of Cardiology, Cardiovascular Center, Far-Eastern Memorial Hospital, and Adjunct Instructor, Center for General Education, Chihlee University of Technology
| | - Kai-Lin HWANG
- MS, Adjunct Assistant Professor, Department of Public Health, Chung Shan Medical University
| | - Chii JENG
- PhD, RN, Professor, School of Nursing, College of Nursing, Taipei Medical University
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Gabet A, De Peretti C, Iliou MC, Nicolau J, Olié V. National trends in admission for cardiac rehabilitation after a myocardial infarction in France from 2010 to 2014. Arch Cardiovasc Dis 2018; 111:625-633. [DOI: 10.1016/j.acvd.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/16/2017] [Accepted: 07/29/2017] [Indexed: 10/18/2022]
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Qualizza M, Bressan V, Rizzuto A, Stevanin S, Bulfone G, Cadorin L, Ghirotto L. Listening to the voice of patients with head and neck cancer: A systematic review and meta‐synthesis. Eur J Cancer Care (Engl) 2018; 28:e12939. [DOI: 10.1111/ecc.12939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Valentina Bressan
- Department of Otolaryngology/Head and Neck Surgery University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata di Udine Via Pozzuolo Udine Italy
| | - Antonio Rizzuto
- Department of Otolaryngology/Head and Neck Surgery University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata di Udine Via Pozzuolo Udine Italy
| | | | | | - Lucia Cadorin
- Continuing Education Centre CRO Aviano National Cancer Institute Aviano, Pordenone Italy
| | - Luca Ghirotto
- Arcispedale Santa Maria Nuova—IRCCS Reggio Emilia Italy
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Optimal Gender-Specific Strategies for the Secondary Prevention of Heart Disease in Women: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2018; 38:279-285. [PMID: 30074521 DOI: 10.1097/hcr.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of evidence on gender-specific, individually tailored secondary prevention (cardiac rehabilitation [CR]) services for women with heart disease. Women participate less in CR programs, thus increasing their risk of further cardiac events. This review aims to (1) determine the effectiveness of gender-specific interventions specifically designed for women with heart disease, delivered in outpatient CR settings; and (2) classify key elements of effective CR strategies/models for women with heart disease. METHODS Using the PRISMA guidelines, this is a systematic review of CR models tailored to women to improve cardiovascular risk. Four databases were searched for randomized controlled trials (RCTs) between January 1974 and July 2017 published in peer-reviewed English language journals. RESULTS Three RCTs comprising 725 women of gender-specific CR strategies were identified. Significant improvements were found in one-third (1 study) of the included multicomponent CR strategies for outcomes including general health, social functioning, vitality, mental health, depression, and quality of life. CONCLUSION Further large-scale RCTs are required to replicate positive findings and accurately assess the capacity for gender-specific multicomponent CR programs that incorporate participant-driven collaborative models to moderate psychological risk and improve functional capacity and quality of life for women with heart disease.
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Galdas PM, Harrison AS, Doherty P. Gender differences in the factors predicting initial engagement at cardiac rehabilitation. Open Heart 2018; 5:e000764. [PMID: 29632680 PMCID: PMC5888444 DOI: 10.1136/openhrt-2017-000764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/11/2018] [Accepted: 03/06/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To determine whether there are gender differences in the factors that predict attendance at the initial cardiac rehabilitation baseline assessment (CR engagement) after referral. Methods Using data from the National Audit of Cardiac Rehabilitation, we analysed data on 95 638 patients referred to CR following a cardiovascular diagnosis/treatment between 2013 and 2016. Eighteen factors that have been shown in previous research to be important predictors of CR participation were investigated and grouped into four categories: sociodemographic factors, cardiac risk factors, patient medical status and service-level factors. Logistic binary regression models were built for male patients and female patients, assessing the likelihood for CR engagement. Each included predictors such as age, number of comorbidities and social deprivation score. Results There were no important differences in the factors that predict the likelihood of CR engagement in men and women. Seven factors associated with a reduced probability of CR engagement, and eight factors associated with increased probability, were identified. Fourteen of the 15 factors identified as predicting the likelihood for engagement/non-engagement were the same for both men and women. Increasing age, being South Asian or non-white ethnicity (other than Black) and being single were all associated with a reduced likelihood of attending an initial CR baseline assessment in both men and women. Male patients with diabetes were 11% less likely to engage with CR; however, there was no significant association in women. Results showed that the overwhelmingly important determinant of CR engagement observed in both men and women was receiving an invitation to attend an assessment session (OR 4.223 men/4.033women; p<0.05). Conclusions Consideration of gender differences in predictors of CR uptake should probably be more nuanced and informed by the stage of the patient care pathway.
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Affiliation(s)
- Paul Michael Galdas
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | | | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, York, UK
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Angus JE, Dale CM, Nielsen LS, Kramer-Kile M, Lapum J, Pritlove C, Abramson B, Price JA, Marzolini S, Oh P, Clark A. Gender matters in cardiac rehabilitation and diabetes: Using Bourdieu's concepts. Soc Sci Med 2018; 200:44-51. [PMID: 29421471 DOI: 10.1016/j.socscimed.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/30/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Habitual practices are challenged by chronic illness. Cardiac rehabilitation (CR) involves changes to habits of diet, activity and tobacco use, and although it is effective for people with diabetes and cardiovascular disease (CVD), some participants are reportedly less likely to complete programs and adopt new health related practices. Within the first three months of enrolling in CR, attrition rates are highest for women and for people with diabetes. Previous studies and reviews indicate that altering habits is very difficult, and the social significance of such change requires further study. PURPOSE The purpose of the study was to use Bourdieu's concepts of habitus, capital and field to analyse the complexities of adopting new health practices within the first three months after enrolling in a CR program. We were particularly interested in gender issues. METHODS Thirty-two men and women with diabetes and CVD were each interviewed twice within the first three months of their enrolment in one of three CR programs in Toronto, Canada. RESULTS Attention to CR goals was not always the primary consideration for study participants. Instead, a central concern was to restore social dignity within other fields of activity, including family, friendships, and employment. Thus, study participants evolved improvised tactical approaches that combined both physical and social rehabilitation. These improvised tactics were socially embedded and blended new cultural capital with existing (often gendered) cultural capital and included: concealment, mobilizing cooperation, re-positioning, and push-back. CONCLUSIONS Our findings suggest that success in CR requires certain baseline levels of capital - including embodied, often gendered, cultural capital - and that efforts to follow CR recommendations may alter social positioning.
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Affiliation(s)
- Jan E Angus
- University of Toronto, Toronto, Ontario, Canada.
| | - Craig M Dale
- University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | - Paul Oh
- University Health Network, Toronto, Canada.
| | - Alex Clark
- University of Alberta, Edmonton, Alberta, Canada.
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Kim B, White K, Patterson P. Understanding the experiences of adolescents and young adults with cancer: A meta-synthesis. Eur J Oncol Nurs 2016; 24:39-53. [PMID: 27697276 DOI: 10.1016/j.ejon.2016.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE To conduct a meta-synthesis of qualitative studies exploring experiences of young cancer patients to identify the overarching concepts that inform future service and research directions. METHOD A systematic literature search was conducted, and 51 articles published between January 2004 and March 2014 were collected via CINAHL, Medline and PsycINFO databases. Deductive thematic analysis was conducted to identify major themes, guided by Hermeneutic notions on interpretation. RESULTS Cancer impacted a wide range of life domains. These impacts were interconnected and bi-directional. The meanings of these impacts were closely related to their unique developmental needs and a social position as youth. Emotional struggles during these radical changes were evident, but efforts to make sense of their experiences and find meaning pervaded. CONCLUSIONS Given the interrelated nature of the cancer challenges young cancer patients experience, there needs to be an emphasis on conducting studies which further refine our understanding of these relationships. This can help to structure effective youth cancer services. Generic informational resources and support services should be tailored so that they have relevance to the young person's life context. The treating team has an important role in fostering young patients' ability to make sense of their experiences by providing developmentally-relevant psychosocial support.
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Affiliation(s)
- Bora Kim
- School of Nursing, The University of Wollongong, Building 41, 215 Northfields Ave, Keiraville, NSW, Australia; Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown NSW, Australia.
| | - Kate White
- Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown NSW, Australia; Cancer Nursing Research Unit, Level 6 North, The Chris O'Brien Life house, 119-143 Missenden Road, Camperdown NSW, Australia
| | - Pandora Patterson
- Cancer Nursing Research Unit, Level 6 North, The Chris O'Brien Life house, 119-143 Missenden Road, Camperdown NSW, Australia; Research & Youth Cancer Services, CanTeen Australia, 75 King Street, Newtown, NSW, Australia
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Hardcastle SJ, McNamara K, Tritton L. Using Visual Methods to Understand Physical Activity Maintenance following Cardiac Rehabilitation. PLoS One 2015; 10:e0138218. [PMID: 26381147 PMCID: PMC4575075 DOI: 10.1371/journal.pone.0138218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/27/2015] [Indexed: 11/26/2022] Open
Abstract
Few studies have explored the factors associated with long-term maintenance of exercise following cardiac rehabilitation. The present study used auto-photography and interviews to explore the factors that influence motivation and continued participation in physical activity among post cardiac rehabilitation patients. Twenty-three semi-structured interviews were conducted alongside participant-selected photographs or drawings with participants that had continued participation in physical activity for at least two years following the cardiac rehabilitation programme. Participants were recruited from circuit training classes in East Sussex in the UK. Thematic content analysis revealed seven main themes: fear of death and ill health avoidance, critical incidents, overcoming aging, social influences, being able to enjoy life, provision of routine and structure, enjoyment and psychological well-being. Fear of death, illness avoidance, overcoming aging, and being able to enjoy life were powerful motives for continued participation in exercise. The social nature of the exercise class was also identified as a key facilitator of continued participation. Group-based exercise suited those that continued exercise participation post cardiac rehabilitation and fostered adherence.
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Affiliation(s)
- Sarah J. Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
- * E-mail:
| | - Keira McNamara
- Department of Clinical Sciences, Brunel University, London, United Kingdom
| | - Larette Tritton
- School of Sport and Service Management, University of Brighton, Brighton, United Kingdom
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