Faculty Bibliography

Coronary heart disease (CHD) requires a significant amount of self-care conceptualized as a process of treatment adherence (self-care maintenance) and symptom response (self-care management).Yet, there are no instruments that measure self-care in this population. Purpose: To test the psychometric properties of the Self-Care of Chronic Angina Index (SCCAI). Methods: A sample of 392 adults with CHD (e.g., history of MI, angina) completed the SCCAI and the General Adherence Scale (GAS). Multidimensional factor analysis was used to identify item structure. Factor determinacy scores (FDS) were computed for multidimensional scales. Cronbach's alpha and FDS were computed for unidimensional scales. Validity was tested using correlations to test associations between observed domains of self-care and adherence (GAS). Results: 62% of the sample was male; mean age 61.4+/-9.6 years; mean duration of CHD 7+/-10 years. A multidimensional self-care maintenance factor entailed "consultative behaviors" (keep appointments, take aspirin and medicines as prescribed, check blood pressure, use medication reminder system, and avoid smoking/smokers) and "autonomous behaviors" (exercise, ask for low sodium foods, eat fruits/vegetables, and try to lose weight) (FDS = 0.83). A multidimensional self-care management factor entailed "immediate recognition and response" (recognize symptoms, reduce activity and take nitroglycerine) and "delayed response" (call doctor, take aspirin and evaluate treatment effectiveness) (FDS = 0.74). A unidimensional confidence factor captured patients' self-efficacy in following treatment advice, and recognizing, evaluating and treating symptoms (alpha=0.84, FDS = 0.91). Consultative (r=0.89) and autonomous (r=0.82) behaviors, immediate recognition and response (r=0.86), delayed response behaviors (0.79) and confidence (r=0.27) were associated with adherence (all p<0.001). Conclusion: The findings support the conceptual basis of self-care in patients with CHD as a process of maintenance, i.e. consultative and autonomous behaviors, and management, with symptom awareness and response. The SCCAI confidence scale as a measure of self-efficacy can be used to identify behaviors to target in future interventions

Cardiovascular disease is the leading cause of death globally. Despite a greater burden of disease, ethnocultural minorities in both the United States and Canada are significantly less likely to access cardiac rehabilitation (CR). Without equitable access to CR, these patients may be more likely to experience recurrent cardiac events and unnecessarily premature death. In this article, the current state of ethnocultural diversity in CR patients and unique barriers that ethnocultural minority patients face are reviewed. Strategies for CR program delivery and diversity of CR program staff are considered. Guidance on ethnocultural considerations in American and Canadian associations of CR is also reviewed. Lower rates of access to CR are seen among ethnocultural minorities in both American and Canadian CR programs. Only 2 studies evaluating ethnoculturally tailored CR could be identified in the literature. American CR staff are predominantly white ( approximately 96%), whereas ethnocultural data are not collected from Canadian CR professionals. American guidelines emphasize the importance of ethnocultural competency. Meanwhile, Canadian guidelines underscore the low use of CR services among ethnocultural minorities, and support ethnoculturally informed CR delivery. The American and Canadian populations are rapidly diversifying, yet the CR workforce is not, and ethnocultural minorities continue to be underrepresented in our programs. Although recent CR guidelines have made some preliminary recommendations to overcome these discrepancies, more focused efforts are needed. Thirteen points of action are proposed for the CR community with the goal of promoting the development and delivery of more ethnoculturally sensitive CR services.