Causal attributions, lifestyle change, and coronary heart disease: illness beliefs of patients of South Asian and European origin living in the United Kingdom

OBJECTIVE: We examined and compared the illness beliefs of South Asian and European patients withcoronary heart disease (CHD) about causal attributions and lifestyle change.METHODS: This was a qualitative study that used framework analysis to examine in-depth interviews.SAMPLE: The study comprised 65 subjects (20 Pakistani-Muslim, 13 Indian-Hindu, 12 Indian-Sikh, and20 Europeans) admitted to one of three UK sites within the previous year with unstable angina ormyocardial infarction, or to undergo coronary artery bypass surgery.RESULTS: Beliefs about CHD cause varied considerably. Pakistani-Muslim participants were the leastlikely to report that they knew what had caused their CHD. Stress and lifestyle factors were the mostfrequently cited causes for CHD irrespective of ethnic grouping, although family history was frequentlycited by older European participants. South Asian patients were more likely to stop smoking than theirEuropean counterparts but less likely to use audiotape stress-relaxation techniques. South Asian patientsfound it particularly difficult to make dietary changes. Some female South Asians developed innovativeindoor exercise regimens to overcome obstacles to regular exercise.CONCLUSION: Misconceptions about the cause of CHD and a lack of understanding about appropriatelifestyle changes were evident across ethnic groups in this study. The provision of information and advicerelating to cardiac rehabilitation must be better tailored to the context of the specific needs, beliefs, andcircumstances of patients with CHD, regardless of their ethnicity.