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

Heart Lung. Mar-Apr 2008;37(2):91-104. doi: 10.1016/j.hrtlng.2007.03.004.


Objective: We examined and compared the illness beliefs of South Asian and European patients with coronary 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, and 20 Europeans) admitted to one of three UK sites within the previous year with unstable angina or myocardial infarction, or to undergo coronary artery bypass surgery.

Results: Beliefs about CHD cause varied considerably. Pakistani-Muslim participants were the least likely to report that they knew what had caused their CHD. Stress and lifestyle factors were the most frequently cited causes for CHD irrespective of ethnic grouping, although family history was frequently cited by older European participants. South Asian patients were more likely to stop smoking than their European counterparts but less likely to use audiotape stress-relaxation techniques. South Asian patients found it particularly difficult to make dietary changes. Some female South Asians developed innovative indoor exercise regimens to overcome obstacles to regular exercise.

Conclusion: Misconceptions about the cause of CHD and a lack of understanding about appropriate lifestyle changes were evident across ethnic groups in this study. The provision of information and advice relating to cardiac rehabilitation must be better tailored to the context of the specific needs, beliefs, and circumstances of patients with CHD, regardless of their ethnicity.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health*
  • Bangladesh / ethnology
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / etiology*
  • Coronary Artery Disease / psychology
  • Europe / ethnology
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • India / ethnology
  • Life Style*
  • Male
  • Middle Aged
  • Pakistan / ethnology
  • Qualitative Research
  • Retrospective Studies
  • Surveys and Questionnaires
  • United Kingdom / epidemiology