Family processes and individual health-related decisions in response to heart-health initiatives

Cardiovascular disease, the major cause of death, disease, and illness in Canada, is costly in terms of health, quality of life, and dollars spent on health care. Three decades of trend analysis and evaluation of community-based heart-health interventions indicate that these interventions have been moderately successful most notably with more affluent segments of Western societies. Future success depends on creating supportive environments and policies that make healthful choices easier for all Canadians. Family is one environment not well understood for its influence on individual health-related decisions in response to heart-health initiatives. The objective of this study was to explore social processes in families that influence individual health-related decisions in response to heart-health initiatives. Grounded theory, informed by critical and feminist perspectives, is the methodology of this study. Twenty-eight families participated, representing considerable diversity with regards to family type, socioeconomic status, age, and geographic location. Participants' accounts are rich and, when analyzed, generate a theory of family influence on individual health-related decisions. Participants were consistent in their view that health decisions made in response to heart-health initiatives are conceived within a broad definition of health of which heart health is a part. Family climate was developed in the analysis as important for health decisions — a climate of comfort enhances self-worth and strengthens the will to be healthy, while a family climate of stress consumes this will. Family climate of stress or comfort is not a binary opposite but rather like the weather, ever-present and changing. Further, family climate may not be perceived similarly by family members. A family climate of comfort and stress has both relational and contextual dimensions. Family stress has an additional dimension — perpetrated stress, occurring when actions taken by one family member are unwholesome thereby affecting the perceived stress and health of others. Two family processes, talking (either productive, unproductive, or dismissive), and modelling are family action strategies that interact with relational and contextual factors and family climate to determine the ultimate family influence on individual health-related decisions. Productive talking and modelling provide inspiration and rationale for individual health-related decisions. On the other hand, the lack of co-operation characteristic of unproductive and dismissive talking may lead to inaction. Family exerts its influence on individual health-related decisions in response to a heart-health initiative by shaping self-worth and agency with regard to heart health-related responses. In light of the scholarly literature on families and health, participants' accounts suggest that theory development in health promotion should attend to the family as a unit of concern. Moreover, health promotion practice and research concerned with heart health that considers the everyday lived reality of family life has potential to be effective in working with clients toward healthful change.Applied Science, Faculty ofNursing, School ofGraduat