Perspectives and Experience of Patients From Minority Ethic Communities on Advice Provided About Diet and Lifestyle Advice in Management of Their Cardiovascular Disease

Background The experience of patients from ethnic and differing cultural backgrounds may range from unempathetic to discriminatory. Treatment and management pathways may be contrary to patients' cultural beliefs and values. Lack of awareness of cultural differences among individual clinicians and healthcare organisations contributes to racial disparities in health. The risk of cardiovascular disease is higher in ethnic minorities in developed countries than for white populations. This is reflected in patients of South Asian and African Caribbean heritage living in the UK. Lifestyle factors including diet and physical activity contribute to the social determinants of health which place some communities at a disadvantage relative to others.

Support with self-managing chronic disease can be individual, from family and friends, the wider community as well as from local primary and secondary care services. Social stigma and dietary challenges are significant barriers to effective diabetes management in South Asian patients. The role of family members and religious observance can be important in optimising diabetes management. Adherence to recommended diet is the most significant challenge for diabetes management. While media from healthcare professionals, leaflets and magazines can be valuable, it needs to be culturally attuned. This includes the preferred language of communication for patients. The role of family members in supporting dietary adaptation and adherence is significant.

Cardiovascular risk factors apply across all populations in all regions and include lifestyle factors. Management of lifestyle factors is important in both primary and secondary prevention of cardiovascular disease and requires patient adherence to recommendations. Lifestyle modification programmes can improve patient knowledge, self-care behaviours and glycaemic control when tailored to patient experience, psychosocial characteristics, culture, and worldview. Guidelines should account for patient's daily routines, with cultural and familial expectations of different ages and genders as well as facilitators and barriers for each group. Patients are aware of the facilitators and barriers to behavioural change affecting them though this may not apply to their clinicians and healthcare providers.

Clinicians and organisations providing care to minority ethnic patients with chronic cardiovascular disease need to be aware of the facilitators and barriers to self-management of cardiovascular disease. This includes engendering a sense of personal vulnerability and empowering self-efficacy among individuals to achieve optimal self-care.

Whilst there is existing research on this topic, it is often focussed on self-management of diabetes. Diabetes is itself a risk factor for cardiovascular disease. This study will consider patients' experience of dietary advice and facilitators and barriers to adherence in the context of a diagnosis of cardiovascular disease. Cardiovascular disease is defined as any condition relating to the heart, blood vessels and blood supply to the brain in which the management of risk factors including lifestyle is relevant to preventing the progression of the disease. Studies of risk factors in diverse populations highlight the impact of cross-cultural differences in diet or lifestyle resulting in variation in disease patterns. Diet is very influential on primary prevention of cardiovascular disease. Dietary interventions require tailoring to specific ethnic minority communities. The determinants of food choice include the nutritional environment, economic, cultural and individual factors. As well as the lack of time and motivation affecting white populations, ethnic communities may have issues around cultural commitments including extended family and faith events. Lack of access to culturally relevant information may prevent dietary change. Adjustment of cultural traditions in adaptation to the host country (acculturation) may affect health and dietary habits. In particular for dietary advice, a lack of support post intervention may lead to return to prior habits.