Study aims to find better ways to promote cardiac rehabilitation
South Asian men—those who originate from India, Pakistan, Bangladesh, Nepal or Sri Lanka—are amongst the largest groups of immigrants in B.C. However, little is known about their health behaviours, experiences of illness, or how they relate to and engage with Canadian health care services.
Seeking to change that is School of Nursing Assoc. Prof. John Oliffe, whose work looks at the complex links between masculinity, culture and health, with previous studies on prostate cancer, smoking, depression and immigrant men’s health.
Oliffe recently led a research team to develop more effective ways to promote healthy heart and cardiac rehabilitation (CR) programs among South Asian Canadian men.
“There is a high rate of heart disease among South Asians that is seen worldwide,” explains Oliffe. “South Asian men tend to experience cardiac disease much earlier in life and in greater numbers than those of European, British or Chinese ancestry—even if risk factors such as hypertension or smoking are the same.”
Researchers have not yet been able to discover the causes, he says. “However, health professionals are emphasizing secondary prevention programs such as CR, which can reduce the risk of early death by about 25 per cent.”
CR measures include changes to diet and exercise and sessions with health specialists, among them nurses, occupational therapists and physiotherapists. Across all Canadian communities, the sign up rate for CR programs is low, about 20 to 30 per cent. However, the participation rate among South Asian Canadians falls even below that, says Oliffe.
To find out why, the research team worked with a cohort of 30 Canadian men of Indian ancestry, all Punjabi-speaking, who had experienced a recent heart attack. Over a 12-month period, the researchers conducted interviews with the study participants, both those who had attended CR and those who hadn’t.
“Knowing what facilitated or prevented their CR participation can help us recommend more effective healthcare strategies,” says Oliffe.
For some of the men, factors such as language or lack of transportation presented barriers to CR. Others described strong beliefs and practices that influenced their health decisions. The Sikh spiritual tenet dharam dee kirat karnee, for example, stresses self-reliance and care for oneself.
These and other spiritual beliefs could feature in culturally specific health outreach programs, says Oliffe. “The tenet dharam dee kirat karnee can also support seeking out medical care and participating in CR.”
The men also discussed seva, which in Punjabi means selfless service. An example of seva would be the free communal meals or langar, prepared by members of Sikh gurudwaras, which are Sikh places of worship.
“While the local practice is for women to do most of the cooking,” explains Oliffe, “the men take part in serving as a way to practice their faith.”
Similarly, the men could provide community service by encouraging one another to do or learn more about heart health, he says.
Oliffe says that the strong collectivist foundations of South Asian culture—especially evident at Sikh gurudwaras and seniors’ groups—“would provide time- and cost-efficient opportunities to reach many men at a place where they routinely congregate.”
The study received support from the Institute of Gender and Health, Canadian Institutes of Health Research.
The study co-authors are: Paul Galdas, a lecturer at Sheffield University; Langara College School of Nursing educator Suki Grewal; Claire Prentice, nurse coordinator at Surrey Memorial Hospital’s cardiac outpatient program; Prof. Joy Johnson; Prof. Pam Ratner; Assoc. Prof. Sabrina Wong and PhD candidate Bindy Kang, all at UBC School of Nursing.