Satici, Sakine (2023) Management of heart disease among Turkish immigrants: A qualitative exploration of facilitators and barriers to secondary prevention measures. Research Master thesis, Victoria University.

Abstract

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality, impacting individual’s quality of life and imposing a significant economic burden on the Australian healthcare system. The benefits of secondary prevention strategies on cardiovascular health outcomes are well recognised. However, they are underutilised, particularly by ethnic minorities. Australia is a multicultural society; one in four Australians was born overseas. While previous studies have explored health outcomes in various immigrant communities in Australia, there is a lack of research specifically focusing on Australian Turkish immigrants’ disparities in heart disease in an Australian context. This thesis aims to understand this significant gap by exploring the barriers and facilitator factors that impact cardiovascular secondary prevention interventions among Australian Turkish communities living in Victoria with existing heart disease. Understanding self-care behaviours is critical in tailoring health interventions to meet patient needs. This explorative qualitative study recruited and conducted semi-structured interviews with fifteen Australian Turkish immigrants with CVD. All participants were born in Turkey and had resided in Australia for a Median of 39 years. Thematic analysis was guided by the socio-ecological model, a multilevel approach including five levels: ‘intrapersonal’, ‘interpersonal’, ‘institutional’, ‘community’ and ‘policy levels.’ Most participants experienced healthcare access issues across all these levels. Factors that put patients at risk for non-compliance with secondary prevention strategies for heart disease or prevent patients from experiencing further cardiac events were identified. The study was undertaken during the COVID-19 pandemic, and a theme specific to patients’ experiences with healthcare during this time is presented. At the intrapersonal level, four themes emerged as barriers: ‘health knowledge deficit,’ ‘limited English proficiency (LEP),’ ‘implication of personal factors’ and ‘financial strains.’ Participants consistently identified knowledge deficits about illness and available services as critical barriers. Language barriers to communication with providers negatively influenced patient access to available health information, understanding of the information received and involvement in the shared decision-making process to accept and adhere to secondary prevention and self-care. Inadequate knowledge and lack of understanding of the consequences of acute cardiac symptoms resulted in a delay in seeking urgent medical attention. LEP, limited health literacy and a lack of comprehensive communication with providers led to difficulties navigating the healthcare system to access necessary healthcare services. At the interpersonal level, two themes emerged. The first theme focuses on the positive influence of family and friends on health-seeking behaviours, compliance with secondary preventative measures, and medication adherence. The second theme highlights how family and friends can also be a source of stress. Participants raised concerns about communication gaps with providers, which is crucial in gaining necessary information regarding heart disease. Poor communication with providers negatively impacted patient education regarding secondary prevention strategies. Language concordance between patients and providers improved health literacy and engendered trust. Barriers within the policy level were ‘long waiting times to access healthcare services’ and ‘limited coverage of Medicare.’ Tailored community-centred public health education conducted in collaboration with Turkish community centres may be a potential solution to optimising health literacy regarding secondary prevention of CVD.

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