Culture and the understanding of advanced heart failure: A mixed-methods systematic review

Background Cultural values and beliefs influence understanding of health and illness, but we do not know their impact on patients’ understanding of advanced heart failure. Aims We explore how culture influences the understanding of advanced heart failure for patients and their family members, and how culture influences the adoption of healthy behaviours. Method/Data Sources In this mixed-methods systematic review, we systematically searched MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO, and Cochrane CENTRAL with no time limits using relevant MESH terms and keywords. Papers were themed, synthesised, and grouped into domains. The theoretical framewok PEN-3 was used to underpin the findings. Findings We screened the full-text of 194 studies and found 13 articles eligible; of which six were qualitative studies, five quantitative and two were mixed-method studies. In these studies, patients’ understanding of, and response to, symptoms were strongly linked to cultural beliefs. Patients from Eastern and Middle Eastern countries somatised symptoms more than those from Western cultures. Patients from Western cultures reported higher symptom distress scores. Peoples’ cultural beliefs about health and disease inform lay knowledge of heart failure diagnosis, causes, treatment and self-management and influence their healthcare decisions and behaviours. Conclusion We found that health care practice and research in heart failure has not previously been influenced by culture. People with heart failure and their family members could be helped better by health care practitioners if their cultural values and beliefs were integrated into health care practice and policy. We argue that this is essential for the successful development of culturally competent care interventions for all people with advanced heart failure.