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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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2
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van den Houdt SCM, Mommersteeg PMC, Widdershoven J, Kupper N. Sex and Gender Differences in Psychosocial Risk Profiles Among Patients with Coronary Heart Disease - the THORESCI-Gender Study. Int J Behav Med 2024; 31:130-144. [PMID: 37170007 PMCID: PMC10803502 DOI: 10.1007/s12529-023-10170-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Psychosocial factors tend to cluster and exhibit differences associated with sex assigned at birth. Gender disparities, though, remain uncharted so far. The current study aimed to first explore the clustering of eight established psychosocial risk factors among patients with coronary heart disease (CHD), followed by examining how sex and gender differences characterize these psychosocial risk profiles, while adjusting for the effect of age. METHOD In total, 532 patients with CHD (Mage = 68.2 ± 8.9; 84% male) completed the comprehensive psychosocial screener and questionnaires to gauge gender identity, traits, and sociocultural norm scores. A three-step latent profile analysis (LPA) was performed to identify latent profiles and their correlates. RESULTS LPA revealed six psychosocial risk profiles: (1) somewhat distressed overall (32%); (2) low distress (27%); (3) anger, hostility, and Type D (15%); (4) emotional distress and trauma (11%); (5) anxiety (9%); and (6) high overall distress (7%). Masculine traits and older age increased the odds to belong to the low distress profile (#2), while feminine traits and a feminine gender norm score increased the chance to belong to profiles with moderate to high distress. The effects of gender identity and feminine traits were sex dependent. CONCLUSION The current study's findings explain heterogeneity among patients with CHD by considering the joint occurrence of psychosocial risk factors, and the role of sex, age, and gender within those profiles. Being more sensitive to the roles that sex, gender, and an integrated set of risk factors play may ultimately improve treatment and adherence.
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Affiliation(s)
- Sophie C M van den Houdt
- Center of Research On Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Paula M C Mommersteeg
- Center of Research On Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Jos Widdershoven
- Center of Research On Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Doctor Deelenlaan 5, 5042 AD, Tilburg, the Netherlands
| | - Nina Kupper
- Center of Research On Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
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Cooper-Stanton GR, Gale N, Sidhu M, Allen K. A qualitative systematic review and meta-aggregation of the experiences of men diagnosed with chronic lymphoedema. J Res Nurs 2022; 27:704-732. [DOI: 10.1177/17449871221088791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Lymphoedema is a chronic condition that is estimated to affect up to four people per 1000 of the UK population with this increasing with age. Men account for up to 20% of lymphoedema service caseloads with research focussing upon women affected. Aims To retrieve primary qualitative research on the experiences of men with chronic lymphoedema. Methods A qualitative review was undertaken using the Joanna Briggs Institute (JBI) meta-aggregation method. A search strategy was applied to 12 databases, from inception to February 2021, with 22 studies identified and appraised. The findings were extracted and synthesised via the JBI approach. Results Four synthesised findings were identified: (1) The ‘New Norm’, how diagnosis led to men being faced with a ‘new version’ of themselves; (2) ‘Journey into the Unknown’ relates to the unforeseen diagnosis of the condition; (3) ‘Access’ – challenge in receiving a diagnosis, and support; and (4) ‘Personhood’ – the impact of the condition upon external constructs and relationships. Conclusions Men are faced with similar challenges as women coupled with societal expectations with respect to gender identity and expression. This leads to those wishing to engage with men to adopt ‘gender-based tailoring’ within healthcare services, information and support.
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Affiliation(s)
- Garry R Cooper-Stanton
- Doctoral Researcher/Lecturer, Health Services Management, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Professor, Health Services Management, University of Birmingham, Birmingham, UK
| | - Manbinder Sidhu
- Research Fellow, Health Services Management, University of Birmingham, Birmingham, UK
| | - Kerry Allen
- Senior Lecturer, Health Services Management, University of Birmingham, Birmingham, UK
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Lara-Morales A, Gandarillas-Grande A, Díaz-Holgado A, Serrano-Gallardo P. Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65. Aten Primaria 2022; 54:102302. [PMID: 35430460 PMCID: PMC9036116 DOI: 10.1016/j.aprim.2022.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/26/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022] Open
Abstract
Aim Design Setting and participants Main measurements Results Conclusions
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Rasmussen AN, Petersen KS, Overgaard C. An Overwhelming Burden of Psychosocial Stress: Life With Ischemic Heart Disease for Midlife Patients With Low Socioeconomic Status and Lack of Flexible Resources. QUALITATIVE HEALTH RESEARCH 2021; 31:2666-2677. [PMID: 34605705 DOI: 10.1177/10497323211043493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The largest social inequalities in ischemic heart disease are found in the midlife population. These inequalities are often explained by lifestyle factors, while the role of structural factors and psychosocial stress are generally less acknowledged. In this study, we explore the influence of psychosocial stress on life with ischemic heart disease for midlife patients with low socioeconomic status and lack of flexible resources. In-depth interviews were conducted with 18 participants, and a critical hermeneutic approach was used to analyze and interpret data. We found that the participants were exposed to several external psychosocial stressors related to their family relationships, employment conditions, and experiences of stigmatization. These stressors reinforced each other and created an overwhelming burden of psychosocial stress. Our findings call for supportive interventions that target external psychosocial stressors and stressful feelings among this vulnerable group of patients.
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Gibson K, Pollard TM, Moffatt S. Social prescribing and classed inequality: A journey of upward health mobility? Soc Sci Med 2021; 280:114037. [PMID: 34033978 DOI: 10.1016/j.socscimed.2021.114037] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
Social prescribing, characterised by a link worker connecting patients with local groups and services, is currently being widely implemented in the UK. Taking clients' experiences of a social prescribing intervention in the North of England between November 2019 and July 2020 as its focus, this paper employs ethnographic methods to explore the complex social contexts in which social prescribing is delivered. Building on Bourdieusian approaches to class, we concentrate on four case studies to offer a theoretically-grounded analysis which attends to the relationship between everyday contexts and the classed processes by which health capital may be accrued. By following clients' experiences and trajectories through shifting positions across time - often entailing moments of tension and disjuncture - we explore how processes of classed inequality relate to engagement in the social prescribing intervention. Our results show how structural contexts, and relatedly the possession of capital, shape clients' priorities to invest in the cultural health capital offered by the intervention. Importantly, while inequalities shaped participants' capacity to engage with the intervention, all participants recognised the value of the health capital on offer. We conclude by arguing that inequalities cannot be tackled through focusing on the individual in the delivery of personalised care and therefore offer a counter narrative to socio-political assumptions that social prescribing reduces health inequalities. Crucially, we argue that such assumptions wrongly presuppose that people are homogenously disposed to engaging in their future health.
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Affiliation(s)
- Kate Gibson
- Population Health Sciences Institute, Faculty of Medical Sciences, Ridley 1, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK.
| | - Tessa M Pollard
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK
| | - Suzanne Moffatt
- Population Health Sciences Institute, Faculty of Medical Sciences, Ridley 1, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
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D’Souza A, Fabricius A, Amodio V, Colquhoun H, Lewko J, Haag H(L, Quilico E, Archambault P, Colantonio A, Mollayeva T. Men’s gendered experiences of rehabilitation and recovery following traumatic brain injury: A reflexive thematic analysis. Neuropsychol Rehabil 2020; 32:337-358. [DOI: 10.1080/09602011.2020.1822882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Andrea D’Souza
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Acquired Brain Injury and Society Laboratory, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Acquired Brain Injury Research Laboratory, University of Toronto, Toronto
| | - Alexis Fabricius
- Acquired Brain Injury and Society Laboratory, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Acquired Brain Injury Research Laboratory, University of Toronto, Toronto
| | - Vanessa Amodio
- Acquired Brain Injury and Society Laboratory, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Acquired Brain Injury Research Laboratory, University of Toronto, Toronto
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - John Lewko
- School of Rural and Northern Health, Laurentian University, Sudbury, Canada
| | - Halina (Lin) Haag
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
| | - Enrico Quilico
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Acquired Brain Injury Research Laboratory, University of Toronto, Toronto
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Acquired Brain Injury and Society Laboratory, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Acquired Brain Injury Research Laboratory, University of Toronto, Toronto
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Tatyana Mollayeva
- Acquired Brain Injury and Society Laboratory, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Acquired Brain Injury Research Laboratory, University of Toronto, Toronto
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Participants' Perspectives of a Primary Exercise-Based Prevention Program for Cardiac Patients: A Prepost Intervention Qualitative Case Study. Rehabil Res Pract 2020; 2020:6215428. [PMID: 32351738 PMCID: PMC7180414 DOI: 10.1155/2020/6215428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/06/2020] [Indexed: 11/26/2022] Open
Abstract
Perseverance in exercise-based, cardiovascular disease prevention programs is generally very low. The purpose of this case study is to understand the experience of participants enrolled in a 6-month primary and secondary exercise-focused, cardiovascular disease prevention out of hospital program. Ten participants were interviewed about their experiences at entry and after it ended 6 months later to understand the facilitators and difficulties encountered by participants in such exercise programs. Four out of ten participants completed the 6-month program. The six participants who left the program accepted to contribute to the postprogram interview. The results showed that the four participants who persevered in the program became aware of cardiac risk factors and their conditions were willing to make changes in their lifestyles to reach their objectives, felt a strong perception of self-efficacy, and felt like they belonged in the program. Both persevering and nonpersevering participants experienced many episodes of discouragement during the program and faced many barriers that interfered with their progress. Suggestions to help coping with these barriers while reinforcing self-efficacy and the sentiment of belonging are discussed.
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Pedersen A, Haslund-Thomsen H, Curtis T, Grønkjær M. Talk to Me, Not at Me: An Ethnographic Study on Health-Related Help-Seeking Behavior Among Socially Marginalized Danish Men. QUALITATIVE HEALTH RESEARCH 2020; 30:598-609. [PMID: 31431140 DOI: 10.1177/1049732319868966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research shows that men tend to have delayed health-related help-seeking behavior. In this ethnographic study, we explored influential factors related to health-related help-seeking behavior among socially marginalized men who seem not to benefit from existing municipal health care services in a large Danish municipality. The study included 200 hours of participant observations and 25 ethnographic interviews with men between 45 and 65 years of age in their own homes and in public parks among their peers. In this study, we found that the men had several complex and interacting social- and health-related conditions, which seemed to affect their health-related help-seeking behavior. We conclude that collaborative initiatives between the outreach team who occasionally visits bench sites in the public parks and the municipal health care services in the local areas could lay the groundwork for encouraging men's health-related help-seeking behavior and aid men in supporting each other.
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Affiliation(s)
- Annette Pedersen
- Aalborg University, Aalborg, Denmark
- University College of Northern Denmark, Aalborg, Denmark
| | | | - Tine Curtis
- Aalborg University, Aalborg, Denmark
- Centre for Applied Health Research, Aalborg Municipality, Denmark
| | - Mette Grønkjær
- Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Aalborg, Denmark
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McHale S, Astin F, Neubeck L, Dawkes S, Hanson CL. A systematic review and thematic synthesis exploring how a previous experience of physical activity influences engagement with cardiac rehabilitation. Eur J Cardiovasc Nurs 2019; 19:31-43. [PMID: 31612725 DOI: 10.1177/1474515119882549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation is recognised internationally as an effective therapy to improve quality of life and reduce the risk of hospital readmission for individuals diagnosed with acute coronary syndrome. Despite this, half of eligible individuals choose not to engage and the main reason is lack of interest. Furthermore, prior to attending, 40% of eligible individuals report meeting physical activity guidelines. It is unclear whether this influences decisions about engagement. AIMS The aim of this review is to examine systematically qualitative evidence describing patients' perceptions and experiences, and synthesise what is known about how a previous experience of physical activity in adults diagnosed with acute coronary syndrome influences engagement with physical activity during cardiac rehabilitation. METHODS A systematic review and thematic synthesis was conducted of primary qualitative studies to examine peer-reviewed literature published between1990 and 2017, accessed from database searches of MEDLINE, CINHAL, PsycINFO and Embase. RESULTS The initial search produced 486 studies, and of these 12 relevant studies were included in this review. Studies included 388 participants from six countries. For previously active individuals, communication factors, self-perceptions of an exercise identity and experience of cardiac rehabilitation influence engagement in physical activity during cardiac rehabilitation. CONCLUSION In adults diagnosed with acute coronary syndrome, communication post event and during cardiac rehabilitation is a source of self-appraisal and creates expectations of cardiac rehabilitation. In addition, perceptions of an exercise identity and experience of exercise-based cardiac rehabilitation influence decisions about engagement. To improve uptake and adherence, health professionals should consider previous physical activity levels and tailor information to optimise physical activity post event.
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Affiliation(s)
- Sheona McHale
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield, UK
| | - Lis Neubeck
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK.,Sydney Nursing School, University of Sydney, Australia
| | - Susan Dawkes
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK
| | - Coral L Hanson
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK
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Pritlove C, Safai P, Angus JE, Armstrong P, Jones JM, Parsons J. "It's Hard Work": A Feminist Political Economy Approach to Reconceptualizing "Work" in the Cancer Context. QUALITATIVE HEALTH RESEARCH 2019; 29:758-773. [PMID: 30296921 DOI: 10.1177/1049732318803885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Within mainstream cancer literature, policy documents, and clinical practice, "work" is typically characterized as being synonymous with paid employment, and the problem of work is situated within the "return to work" discourse. The work that patients perform in managing their health, care, and everyday life at times of illness, however, is largely overlooked and unsupported. Drawing on feminist political economy theory, we report on a qualitative study of 12 women living with cancer. Major findings show that the work of patienthood cut across multiple fields of practice and included both paid and unpaid labor. The most prevalent types of work included illness work, body work, identity work, everyday work, paid employment and/or the work of maintaining income, and coordination work. The findings of this study disrupt popular conceptualizations of work and illuminate the nuanced and often invisible work that cancer patients may encounter, and the health consequences and inequities therein.
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Affiliation(s)
| | | | - Jan E Angus
- 3 University of Toronto, Toronto, Ontario, Canada
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12
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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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