‘A bridge to normal’: an explorative study of Indonesian women’s experiences of heart disease and attending a phase two cardiac rehabilitation programme
Item statusRestricted Access
Embargo end date29/06/2020
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Introduction: Although traditionally cardiovascular disease (CVD) is most commonly framed as a male disease, CVD has become the leading cause of death for both men and women globally. The data in Indonesia indicates that since the 1990s CVD has occupied the top ranking as the leading cause of mortality and now constitutes 37% of the total deaths in the country. It is well established that one of the most effective treatments for patients recovering from acute cardiac illness or surgery is cardiac rehabilitation (CR). CR is a multidisciplinary intervention, designed to improve the quality of life for people with CVD and reduce their morbidity and mortality. Although CR benefits both male and female patients equally, research shows that CR utilisation by women remains lower than for men. This thesis aims to gain an understanding of women’s experiences of heart disease and their attendance in phase two cardiac rehabilitation programme in Indonesia. In doing so, the feminist theory was used to guide the inquiry and to interpret the findings. Methods: A feminist-informed qualitative research was carried out in an outpatient CR unit in the National Cardiovascular Centre, Jakarta, Indonesia. Twenty-six women aged between 30 and 67 years old were interviewed between June and September 2016. Following transcription, data were analysed using qualitative framework analysis, and the findings were theoretically interrogated using an intersectional approach to gender. Findings: The analysis identified four major themes, including: (1) threat to gender identity, (2) saving face in front of family and others, (3) cardiac rehabilitation as a ‘bridge to normal’, and (4) contextual factors influence women’s attendance in CR. Findings showed that heart disease does not only create functional limitations but more importantly, it had a significant impact on women’s sense of self. The limitations to carry out normal roles as a mother/wife and to fulfil gendered expectations, particularly doing the household chores and caring for the family, caused the women to feel less useful and thus threatened their sense of self. The participants sought to find a way to maintain their previous identity and status in the family and society. For this reason, women in this study implemented a number of strategies to mitigate disruption - as well as to reconcile themselves - to their changed life situation. Attending the CR programmes have helped the women in this study to restore themselves, which incorporated both physical restoration and identity/self-restoration. They felt that the CR programme provided them with the opportunity to address, deal with, and cope with the consequences of having CVD, to gain confidence, ultimately, enabling them to regain their previous position within their family and community. In this light, CR has become a bridge for the women to gain competence and knowledge in order to enable them to re-engage with their former live activities, including family, friendship, and employment. Conclusions: The study highlights the importance of the women’s sociocultural and spiritual backgrounds in shaping the way they perceive their gender roles, in the context of suffering from heart disease. This knowledge can assist healthcare professionals to better understand the needs of women and the fit between women’s needs and existing CR programme, thereby providing direction for more effective approaches to the CR programme. The findings of this study also emphasise the need for the development of a personalised care plan within the area of CR, so that the CR programme would be more suitable to the need of each woman. Future work to increase CR attendance in Indonesia, therefore, should be both gender- and culturally-sensitive to the needs of the female CVD patients.