Sociocultural Influences on Heart Failure Self-care Among an Ethnic Minority Black Population

Background: Heart failure (HF) places a disproportionate burden on ethnic minority populations, including blacks, who have the highest risk of developing HF and experience poorer outcomes. Self-care, which encompasses adherence to diet, medication, and symptom management, can significantly improve outcomes. However, HF self-care is notoriously poor in ethnic minority black populations. Objectives: Because culture is central to the development of self-care, we sought to describe the self-care practices and sociocultural influences of self-care in an ethnic minority black population with HF. Methods: In this mixed-methods study, 30 black patients with HF (mean [SD] age, 59.63 [15] years; 67% New York Heart Association class III) participated in interviews about self-care, cultural beliefs, and social support and completed standardized instruments measuring self-care and social support. Thematic content analysis revealed themes about sociocultural influences of self-care. Qualitative and quantitative data were integrated in the final analytic phase. Results: Self-care was very poor (standardized mean [SD] Self-care of Heart Failure Index [SCHFI] maintenance, 60.05 [18.12]; SCHFI management, 51.19 [18.98]; SCHFI confidence, 62.64 [8.16]). The overarching qualitative theme was that self-care is influenced by cultural beliefs, including the meaning ascribed to HF, and by social norms. The common belief that HF was inevitable ("all my people have bad hearts'') or attributed to "stress'' influenced daily self-care. Spirituality was also linked to self-care ("the doctor may order it but I pray on it''). Cultural beliefs supported some self-care behaviors like medication adherence. Difficulty reconciling cultural preferences (favorite foods) with the salt-restricted diet was evident. The significant relationship of social support and self-care (r = 0.451, P = .01) was explicated by the qualitative data. Social norms interfered with willingness to access social support, and "selectivity'' in whom individuals confided led to social isolation and confounded self-care practices. Conclusions: Research to develop and test culturally sensitive interventions is needed. Community-based interventions that provide culturally acceptable resources to facilitate self-care should be explored.