‘I don’t do it for myself, I do it for them’. A grounded theory study of South Asians’ experiences of making lifestyle change after myocardial infarction.

Aims and objectives: To explore South Asians’ experience of choosing and prioritising lifestyle changes during their recovery from first myocardial infarction. Background Coronary heart disease continues to be a leading cause of premature death globally. South Asians suffer increased risk of CHD and have poorer outcomes post myocardial infarction compared to other ethnic groups. Lifestyle modification alters the course of heart disease and models of behaviour change to facilitate such changes have been proposed. However, little is known about the experiences of those from the South Asian community who attempt to make these changes. Design A constructivist grounded theory design, using longitudinal, face-to-face, semi-structured in-depth interviews. Method Audio recorded interviews were conducted with a purposive sample of South Asian patients, recruited from three hospitals in the North West of England, who had suffered their first myocardial infarction at two time points (3 weeks and 16 weeks following discharge from hospital). Data collection and analysis occurred simultaneously. Transcripts were analysed line by line with focused and theoretical coding using the constant comparative method and memo writing. Settings Participants were recruited from three hospitals in the North West of England. Participants Purposive sampling was used to select South Asian patients who had recently suffered their first myocardial infarction. Results Making lifestyle changes was characterised by an inherent conflict of priorities and the need for harmony was identified as the substantive theory. The following three categories were conceptualised: patronage of the family, affinity towards one’s group and conforming to the religious and health beliefs. Patronage of the family refers to the role that family played in supporting recovery but where conflict existed between the needs of the family and the individual, family needs took priority. “Conforming to the beliefs” captures the influences of the participants’ religious and health beliefs regarding their diagnosis of heart attack and the lifestyle changes they have to make. Affinity towards one’s group referred to the conflictual nature afforded by social and religious norms. Lifestyle modifications were not given priority when conflicting with valued societal roles. To avoid conflict, decisions were based on what helped them to maintain harmony rather than individual need. Conclusion: The findings of this study show how the wider social network influences the way South Asian people choose and prioritise lifestyle changes after first myocardial infarction. South Asian patients make lifestyle changes against a backdrop of competing religious, cultural and family beliefs and need the necessary skills to resolve conflicts that emerge when attempting to make lifestyle changes. Keywords: Myocardial infarction, Cardiac rehabilitation, South Asians, Grounded theory, Shared efficac