A comparison of the social determinants and self-care behaviours of women at risk and with heart failure between 4 socio-economic groups in Ireland: An interim report from the her-heartbeat project

Background

The incident and burden of heart failure is increasing, particularly among women over the age of 65. There are known causes for this such as the hormonal effects of menopause and co-morbidities, but there are also non-medical causes such as social determinants of health (SDH) factors identified as contributors. Recent research suggests that SDH factors have a negative effect on self-seeking behaviours and reduced compliance leading to increased adverse outcomes, implying there is a relationship between self-care and SDH. The evidence also indicates that women are more negatively impacted by SDH.

Purpose

To explore the lived experience of the self-care and SFH factors among four socio-economic groups of Irish women who are at risk of or diagnosed with heart failure.

Methods

The national deprivation index was used to identify different areas of rural deprivation, urban deprivation and affluent areas. Four peer-based focus groups were arranged in collaboration with six primary care physician practices. Each practice referred 10 patients to consider participation in the respective focus group. One minority group was specifically contacted to consider participation.

The focus groups were recorded and transcribed verbatim. Transcripts were analysed using Braun and Clarke reflexive thematic analysis framework. Themes were compared across the social groups for comparison.

Results

Twenty-eight women participated in four peer-based social groups. Women’s approach to self-care and the impact of SDH across the groups. The four key themes developed included life perspective, describing approaches to well-being from self-sacrifice to resilience; the disadvantage of being a woman, related to gender discrimination in roles at work and home; loneliness, expressed as an emotion related to social isolation and community supports; and stress, experienced by women related to the caring burden and health management. Variances in the approach to self-care across the groups was noted and all themes were impacted by social demographics.

Conclusion

Across all four groups, self-care was fundamentally understood as the ability to maintain one's health. However, the practical application of this concept was heavily influenced by a range of social determinants, leading to distinct differences in behaviours and priorities.WISE-HF ThemesFor image description, please refer to the figure legend and surrounding text.