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Gender matters in cardiac rehabilitation and diabetes: Using Bourdieu's concepts
Jan E Angus1, Craig M Dale1, Lisa Seto Nielsen2
1University of Toronto, Toronto, Ontario, Canada.
Insights
Cardiac rehabilitation (CR) participants prioritize social dignity over program goals, using tactics to blend new health practices with existing social roles. Success in CR depends on social capital and may impact one's social standing.
Area of Science:
- Sociology of Health and Illness
- Health Behavior Change
- Chronic Disease Management
Background:
- Chronic illnesses challenge habitual practices, necessitating lifestyle changes in cardiac rehabilitation (CR).
- High attrition rates in CR are observed within the first three months, particularly among women and individuals with diabetes.
- The difficulty of habit alteration and its social implications require further investigation.
Purpose of the Study:
- To analyze the complexities of adopting new health practices during the initial three months of CR using Bourdieu's concepts of habitus, capital, and field.
- To specifically investigate gender-related issues in health behavior change within CR programs.
Main Methods:
- Qualitative study involving in-depth interviews with 32 men and women diagnosed with diabetes and cardiovascular disease (CVD).
- Participants were interviewed twice within the first three months of enrollment in one of three CR programs in Toronto, Canada.
Main Results:
- Participants prioritized restoring social dignity in various life domains (family, work) over strict adherence to CR goals.
- Improvised tactics, blending physical and social rehabilitation, were developed, including concealment, cooperation, repositioning, and push-back.
- These tactics involved integrating new cultural capital with existing, often gendered, cultural capital.
Conclusions:
- Successful CR engagement necessitates baseline levels of social and cultural capital, including embodied, gendered capital.
- Adherence to CR recommendations can potentially alter participants' social positioning.
- Health behavior change in CR is a socially embedded process influenced by existing social structures and individual strategies.
Background:
Habitual practices are challenged by chronic illness. Cardiac rehabilitation (CR) involves changes to habits of diet, activity and tobacco use, and although it is effective for people with diabetes and cardiovascular disease (CVD), some participants are reportedly less likely to complete programs and adopt new health related practices. Within the first three months of enrolling in CR, attrition rates are highest for women and for people with diabetes. Previous studies and reviews indicate that altering habits is very difficult, and the social significance of such change requires further study.
Purpose:
The purpose of the study was to use Bourdieu's concepts of habitus, capital and field to analyse the complexities of adopting new health practices within the first three months after enrolling in a CR program. We were particularly interested in gender issues.
Methods:
Thirty-two men and women with diabetes and CVD were each interviewed twice within the first three months of their enrolment in one of three CR programs in Toronto, Canada.
Results:
Attention to CR goals was not always the primary consideration for study participants. Instead, a central concern was to restore social dignity within other fields of activity, including family, friendships, and employment. Thus, study participants evolved improvised tactical approaches that combined both physical and social rehabilitation. These improvised tactics were socially embedded and blended new cultural capital with existing (often gendered) cultural capital and included: concealment, mobilizing cooperation, re-positioning, and push-back.
Conclusions:
Our findings suggest that success in CR requires certain baseline levels of capital - including embodied, often gendered, cultural capital - and that efforts to follow CR recommendations may alter social positioning.