Causal models of heart disease among South Asian immigrants

Context: Asian Indians and Pakistanis (South Asians) are among the most rapidly growing immigrant groups in the US. Cardiovascular disease (CVD) is the leading cause of death in South Asians, and South Asians may be at greater risk for CVD than many other US racial/ethnic groups.

Objectives: To compare South Asians' causal models of CVD to the biomedical model and to determine perceptions of CVD risk in order to develop culturally-targeted heart disease prevention messages.

Design, Setting, Participants: We conducted qualitative, semi-structured interviews in English, Hindi and Urdu with 75 respondents from a federally qualified health center and at a community center for South Asian immigrants in Chicago, Illinois. Age ranged from 20-70; 60% were women; 60% held advanced degrees; 70% were recent immigrants (i.e. came to the US in the last 10 years) and 60% of the interviews were in Hindi or Urdu.

Results: The interviews revealed that South Asians' causal models of heart disease, encompassed not just conventional biomedical risk factors, but also spiritual, emotional, and psychological risk factors. Several respondents also suggested that heart disease was sudden or inexplicable. Women more frequently cited a relationship between stress and CVD than men. Perceived risk of having a heart attack was low, especially among women and Urdu-speakers.

Conclusion: CVD prevention messages must take into account South Asian immigrants' causal models of CVD, as well as the low perceptions of CVD risk among South Asian women and non-English speaking South Asians.