February 1, 2008

Pacific Islanders’ Perspectives on Heart Failure Management

Joseph Keawe‘aimoku Kaholokula, Erin Saito, Marjorie K. Mau, Renee Latimer, and Todd B. Seto

Patient Education and Counseling

Objective—To identify the health beliefs, attitudes, practices and social and family relations important in heart failure treatment among Pacific Islanders.

Methods—Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care.

Results—Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physicians’ care, poor physician-patient relations, finances, dietary changes, and competing demands on time.

Conclusion—The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions are affected by an array of psychosocial and socio-cultural factors.

Practice Implications—Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system.

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