Sociocultural Considerations in Heart Failure Self-Care Readiness: A Thematic Analysis.

Introduction: Heart failure (HF) is a significant health problem affecting approximately 6.7 million people in the United States and 64 million people globally. It contributes to over one-third of all cardiovascular deaths and remains the number one cause of Medicare hospitalizations resulting in substantial burden on healthcare systems. Managing HF and its symptoms is essential, requiring individuals to engage in HF self-care (HFSC) behaviors to improve outcomes. However, readiness to engage in HFSC has not been extensively studied. Organizational culture is a significant factor determining an individual's readiness for change. While sociocultural factors are related to HFSC, cultural considerations in HFSC readiness are also largely unexplored. Objective: The purpose was to explore cultural influences on HFSC readiness. Methods: An inductive qualitative approach and applied thematic analysis were employed. After IRB approval, using purposive sampling, 11 participants from an outpatient HF clinic and 10 from the hospital during a HF readmission were interviewed. Ongoing, concurrent, and comparative data analysis was used. Results: Participants were 71% male, 52% White, aged 47-92 years (M = 64.76), and from seven counties in Southeastern NC. Three themes emerged: cultural dietary practices, sociocultural roles and expectations, and cultural beliefs. Conclusion: Culture is an important factor in HFSC readiness. Cultural dietary practices, in some cases, contradicted current HF dietary recommendations. Sociocultural gender roles, responsibilities, and societal expectations of men contributed to feelings of grief and loss over their inability to work and fulfill their roles as financial providers and heads of household. Spiritual and religious beliefs affected one's readiness to understand, accept, and commit to performing HFSC behaviors. Culture influences commitment and capacity and must be assessed in people with HF to address their readiness to engage in HFSC.