South Asians, specifically Pakistanis living in socio-economically deprived areas of the UK have an elevated risk of cardiovascular disease (CVD), diabetes and obesity(1). CVD is a multifaceted illness and influenced by factors such as age, gender, ethnicity, environment, and individual lifestyle choices(2). Cultural understanding can enable primary care practitioners to advocate appropriate health practices for CVD prevention.
The three integral components of the theory of Social Capital were used to inform data collection (social networks, trust and cultural norms)(3). The aim of the research was to explore how social networks function as a resource for support and information (Social Capital) when developing behaviours associated with CVD prevention in a high-risk, migrant, minority-ethnic group.
A community based interpretative qualitative approach using semi-structured interviews was carried out to 1. collect lay accounts of lifestyle practices, 2. use talk-based methods (community languages of English and Urdu), and 3. apply the Convoy model diagram(4) to elicit responses on social networks and community interactions. A purposive sampling method was applied alongside the snowballing technique to recruit participants(5). Culturally informed lay-led advertising, social media and volunteering services facilitated the recruitment of Pakistani community members from diverse educational and occupational backgrounds.
Interviews lasted up to 120 minutes and were transcribed verbatim (translated where necessary) and analysed using Framework Analysis based on participant typology (age, gender and generation)(6). Participants were tri-generational male and female British Pakistanis (n=42) aged 18 and above with varying educational and occupational backgrounds (e.g. student, housewife, consultant surgeon).
Coding and organising data resulted in the production of 14 thematic matrices. The matrices were further organised into 5 categories that presented the opportunity to discuss the underlying concepts surrounding development and maintenance of relationships within new or existing social networks for behaviours preventing CVD (diet and exercise). The categories develop from a community perspective towards more personal factors including; competition for resources, economic success, being Pakistani (identity and appearance), seeking help and information, and gender inequalities.
Wider community engagement is recommended for patients to help provide greater sources of support and information for pursuing (at times) non-traditional, healthier lifestyles. Understanding the shifting perceptions of health in relation to culture and ethnic-identity will provide primary care practitioners with an informed idea of how to advise patients from high risk backgrounds.
By Farina Kokab, PhD Student
References:
1. Allender, S., Peto, V., Scarborough, P., Boxer, A., Rayner, M. (2007) Coronary heart disease statistics, 2007 edition, Department of Health, University of Oxford: British Heart Foundation
2. Dahlgren G, Whitehead M. European strategies for tackling social inequalities in health: Levelling up part 2, Denmark, World Health Organisation. 2007.
3. Nahapiet J, Ghoshal, S. Social Capital, Intellectual Capital and the Organisational Advantage. The Academy of Management Review. 1998; 23: 242-266.
4. Antonucci, T.C. and Akiyama, H. (1987) Social Networks in Adult Life and a Preliminary Examination of the Convoy Model. Journal of Gerontology, 42: (5): 519-527.
5. Wanat CL. Getting past the gatekeepers: differences between access and cooperation in public school
6. Gale KN, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC medical research methodology.2013; 47: 1451-1458.
