Ruth L. Kirschstein NRSA Doctoral Fellow, Research on Vulnerable Women, Children and Families (T32NR007100), School of Nursing, University of Pennsylvania, Philadelphia, PA, United States.
Professor and Edith Clemmer Steinbright Chair of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States.
Int J Nurs Stud. 2021 Apr;116:103383. doi: 10.1016/j.ijnurstu.2019.06.014. Epub 2019 Jul 9.
Self-care is critical for maintaining health, minimizing disease complications, and improving quality of life. Understanding valid, culturally-specific practices and their influence on self-care behaviors can inform development of interventions to improve outcomes for individuals living with cardiovascular disease (CVD). To date, the influence of culture on self-care behaviors has not been adequately examined in different CVD populations.
The aim of this review was to synthesize past empirical literature examining cultural factors influencing self-care in patients with CVD.
An integrative review method was used. A literature search was conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus, and the International Bibliography of the Social Sciences (IBBS) computerized databases. No limit was placed on publication date. Articles were included if they were: (1) peer-reviewed original primary research studies, (2) published in English with full-text availability, (3) conducted in adults (≥19 years), (4) addressed culture related to health and health behaviors, (5) related to self-care or elements of self-care, and (6) related to CVD. Fourteen articles met the inclusion criteria and were included in this review.
Culture influences self-care in general, but predominantly self-care maintenance behaviors. In African American and South Asian populations, cultural beliefs such as fatalism, collectivism and traditional gender roles clashed with dietary adherence. Traditional beliefs and ideas, collectivism, family and kinship ties, fatalism, cultural norms and normative thinking played critical roles in medication adherence and use of complementary/alternative medicine. Similarly, cultural beliefs and social norms influenced how individuals interpreted and responded to their symptoms.
The findings shed light on the importance of understanding cultural factors that help or hinder self-care behaviors among individuals with CVD. Understanding such influences is anticipated to facilitate the design of effective, tailored interventions.
自我护理对于维持健康、最大限度地减少疾病并发症和提高生活质量至关重要。了解有效且具有文化特异性的实践及其对自我护理行为的影响，可以为改善心血管疾病（CVD）患者的治疗效果提供干预措施。迄今为止，文化对自我护理行为的影响尚未在不同 CVD 人群中得到充分研究。
本综述的目的是综合过去有关影响 CVD 患者自我护理行为的文化因素的实证文献。
采用综合综述方法。使用 PubMed、Cumulative Index to Nursing and Allied Health Literature（CINAHL）、Anthropology Plus 和 International Bibliography of the Social Sciences（IBSS）计算机数据库进行文献检索。没有对发表日期进行限制。如果文章符合以下标准，则被纳入本综述：（1）同行评议的原始研究论文；（2）以英文发表且全文可获取；（3）研究对象为成年人（≥19 岁）；（4）涉及与健康和健康行为相关的文化因素；（5）与自我护理或自我护理的组成部分相关；（6）与 CVD 相关。符合纳入标准的文章共有 14 篇，被纳入本综述。
文化普遍影响自我护理，但主要影响自我护理维持行为。在非裔美国人和南亚人群中，宿命论、集体主义和传统性别角色等文化信仰与饮食依从性相冲突。传统信仰和观念、集体主义、家庭和亲属关系、宿命论、文化规范和规范性思维在药物依从性和使用补充/替代医学方面发挥了关键作用。同样，文化信仰和社会规范也影响了个体对自身症状的理解和反应。
这些发现强调了理解有助于或阻碍 CVD 患者自我护理行为的文化因素的重要性。预计了解这些影响因素将有助于设计有效的、量身定制的干预措施。
