Negotiating norms, navigating care: findings from a qualitative study to assist in decreasing health inequity in cardiac rehabilitation

Abstract

Purpose. People from culturally and linguistically diverse backgrounds (CaLDBs) have lower rates of participation in cardiac rehabilitation (CR). Systematically evaluating barriers and facilitators to service delivery may decrease health inequalities. This study investigated approaches for promoting cultural competence in CR. Methods. A qualitative study of 25 health practitioners was undertaken across three CR programs using a purposive sampling strategy. Interviews and participant observation were undertaken to identify factors to promote culturally competent care. Results. Three key foci were identified for implementing cultural competence approaches: (1) point of contact; (2) point of assessment; and (3) point of service. Based upon study findings and existing literature, a conceptual model of cultural competency in CR was developed. Conclusion. Culturally competent strategies for identifying and tailoring activities in the CR setting may be a useful approach to minimise health inequities. The findings from this study identified that, in parallel with mainstream health services, CR service delivery in Australia faces challenges related to cultural and ethnic diversity. Encouragingly, study findings revealed implementation and integration of culturally competent practices in rehabilitation settings, in spite of significant odds. What is known about the topic? Cultural competence can improve the ability of health systems and health providers to deliver appropriate services to diverse populations in order to reduce disparities and improve health outcomes. What does this paper add? Description of cardiac rehabilitation practitioners’ interaction and views on interacting with patients from culturally and linguistically diverse backgrounds. An empirically derived model of cultural competence identifying key points of intervention. What are the implications for practitioners? This model improves practitioner’s ability to address diverse needs of individuals from culturally and linguistically diverse backgrounds and improve equity in health care delivery in Australia.