African Americans carry a heavier burden of cardiovascular risk factors and have higher rates of death from coronary heart disease than any other racial/ethnic group in the United States, yet they are also less likely to be referred to, participate in, or benefit from Cardiac Rehabilitation (CR). In order to investigate the demographic and biopsychosocial-spiritual factors impacting African American patients' referral to and participation in CR, three research articles were completed: (a) a systematic review of the literature regarding this topic; (b) a descriptive phenomenological study designed to explore the lived experience of seven African American patients recovering from cardiac events and/or surgeries; and (c) a policy brief synthesizing the findings from a systematic review of the literature and a mixed methods study to offer policy-, programmatic-, and individual-level recommendations to best support African American patients' recovery from cardiac events and/or experiences. The systematic review demonstrated a paucity of studies on the demographic and biopsychosocial-spiritual factors impacting African American patients' CR referral and attendance. The studies that were identified demonstrated that, among African American patients, there was a lower likelihood for CR referral, a higher likelihood of enrolling in CR with more cardiovascular risk factors, and a lower likelihood of CR participation and completion due to factors related to low socioeconomic status. The phenomenological study resulted in six emergent themes relevant to the lived experience of seven African Americans (4 men and 3 women) who had experienced a cardiac event and/or surgery: (a) Participants valued medical providers' involvement during treatment and recovery; (b) Social support and participants' need for it changed post-event/surgery; (c) Participants' pre- and post-event/surgery experiences affected health outcomes; (d) Participants' sense of agency affected their life perspectives and health behaviors; (e) Participants experienced inconsistent referral to and utilization of CR; and (f) Participants' investment in faith was intensified or maintained. The policy brief emphasized the role of patients' education and income levels in their likelihood to attend CR. Recommendations for improving cardiac outcomes for African American patients in the rural Southeast included systematizing orders for CR on discharge paperwork, assessing and accounting for patients' levels of social support and spiritual resources, and coaching medical providers to reinforce treatment recommendations in a way that is understandable to patients and opens up discussion regarding potential biopsychosocial-spiritual barriers to implementing these recommendations.
|Advisor:||Hodgson, Jennifer L.|
|Commitee:||Dodor, Bernice A., Knight, Sharon M., Rappleyea, Damon L.|
|School:||East Carolina University|
|Department:||Child Development and Family Relations|
|School Location:||United States -- North Carolina|
|Source:||DAI-B 76/10(E), Dissertation Abstracts International|
|Subjects:||Social research, Public health|
|Keywords:||African americans, Cardiac rehabilitation, Health disparaties, Psychosocial, Qualitative research|
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