Weighing Consequences: An Ethnographic Study of Mexican-American Women with Coronary Heart Disease

Weighing Consequences: An Ethnographic Study of Mexican-American Women with Coronary Heart Disease

Publication No._____________

Rosemarie R. Garza, PhD The University of Texas Medical Branch, 2013

Supervisor: Elnora (Nonie) P. Mendias

Coronary Heart Disease (CHD) is a major cause of death in U.S. Hispanics. One third of U.S. Hispanic women have CHD, but research is lacking about the effects of culture on their health outcomes. The purpose of this ethnography was to elicit cultural beliefs, illness interpretations, explanatory models, and self-care practices of Mexican-American women with CHD. Kleinman’s Cultural Healthcare Systems model and the construct of lay EMs served as the sensitizing framework. The sample included 11 English-speaking adult Mexican-American women with self-reported CHD. Using convenience and snowball sampling, participants were recruited from clinics in rural southwestern U.S. Participants were interviewed one to three times using a semi-structured interview guide. Participant observation included home visits and observations at doctors’ appointments and other public settings. The researcher used the constant comparative method to analyze data. Three important criteria (credibility, fittingness, and auditability), developed by Lincoln and Guba (1985) and modified by Beck (1993), ensured scientific rigor. Three themes, each with sub-themes, were identified. The first theme, Knowing about heart disease, describes what women believed caused their CHD. There were three sub-themes: It runs in my family, It was my lifestyle, and It’s my bad heart. The second theme, It changes your whole life, described women’s perceptions about how CHD had affected their lives. There were four sub-themes: Bodily changes, Emotional changes, Financial changes, and Role changes. The third theme, Living with heart disease, described how women had adjusted to life with CHD. The three sub-themes included Listening to my body, Listening to my doctor, and Relying on my faith. Study participants incorporated CHD as an enduring reality with persisting effects. Adjustment to CHD was difficult, and participants felt consoled and supported by their faith and by the love and care received from others. Participants modified their lifestyles but struggled to maintain their identities. Although aware of the benefits of healthier behaviors, participants weighed behavioral consequences and made choices congruent with their values. Findings may improve Mexican-American women’s CHD outcomes by providing information needed to deliver individually tailored and culturally-sensitive health care and interventions.