. Author manuscript; available in PMC: 2009 Feb 1.

Published in final edited form as: Patient Educ Couns. 2008 Feb;70(2):281–291. doi: 10.1016/j.pec.2007.10.015

Table 2.

Themes of heart failure beliefs, attitudes, and practices and their representative quotes extracted from 4 focus groups with Native Hawaiians and Samoans

Domains and Themes	Representative quotes
Heart Failure Beliefs and Attitudes • Avoidance and denial of illness • Hopelessness and despair • Religious/spiritual faith • Trust in physician’s care (high degree of trust among Samoans, low degree of trust among Hawaiians)	Patient: • “I don’t wanna go to the hospital...I don’t want to hear [the diagnosis].” • “[Heart failure] can hit you any time, and lot of us feel good and everything, we’re in denial, like, I don’t have that, I don’t have that [heart failure].” • “I wish there was a way so that you can take that burden cause it’s constant...it’s constant depression about not being whole again.” • “[God’s] love will come through the doctors and the nurses....it’s God’s will, we accept what happens to us.” • “A doctor is usually the one that [Samoans] would all look up to.” • “I no really care for the doctor because...they hiding something from you....They don’t come out with everything.” (Hawaiian participant) Caregiver: • “He was waiting and biding his time...[the illness] pretty much leaves him homebound”.
Heart Failure Practices • Preference for physician’s care (Samoans only) vs. traditional cultural healing practices (Hawaiians only) • Prayers/faith in God • Diet and exercise changes • Stress management • Subsistence lifestyle	Patient: • “Yeah, if it’s something to do with the heart, they don’t fool around [they see the doctor].” (Samoan participant) • “My girlfriend says, don’t take any pills, when the doctor says, oh, this is a new pill, try ‘em...they’re using you as a guinea pig. Whether that’s true or not, I don’t know, but I don’t take any pills that my doctor gives to me. I don’t go to that doctor.” • “I’m learning to eat vegetables. I’m learning to cut all the fat,...” • “...we all know cut down on the salt, you know, exercise...” • “Relieving stress and everything does help by calming down and doing some breathing techniques.” • “[Before] we’d catch the fish, we’d eat it and if there’s too much we give to the neighbors, everything was fresh. But not anymore....take [Samoans] back to what they used to eat before....” Caregiver: • “Lā‘au lapa‘au [Hawaiian medicinal herbs] is awesome...cause there’s no side effects, whatever’s [sic] wrong, it takes care of the body...” • “There are times when you know, the doctors say, there isn’t anything more that the doctors can do and so they pray [sic] and give it up to God’s hands.” • “I think that maybe coming from the homestead side,...put the Hawaiians [sic] back on the land, and to grow their own food, so, subsistence...maybe we can start small by maybe having a class on growing Hawaiian food right in your back yard, and actually using that and putting it into your diet.”

Domains and Themes

Representative quotes

Heart Failure Beliefs and Attitudes
• Avoidance and denial of illness
• Hopelessness and despair
• Religious/spiritual faith
• Trust in physician’s care (high degree of trust among Samoans, low degree of trust among Hawaiians)

Patient:
• “I don’t wanna go to the hospital...I don’t want to hear [the diagnosis].”
• “[Heart failure] can hit you any time, and lot of us feel good and everything, we’re in denial, like, I don’t have that, I don’t have that [heart failure].”
• “I wish there was a way so that you can take that burden cause it’s constant...it’s constant depression about not being whole again.”
• “[God’s] love will come through the doctors and the nurses....it’s God’s will, we accept what happens to us.”
• “A doctor is usually the one that [Samoans] would all look up to.”
• “I no really care for the doctor because...they hiding something from you....They don’t come out with everything.” (Hawaiian participant)
Caregiver:
• “He was waiting and biding his time...[the illness] pretty much leaves him homebound”.

Heart Failure Practices
• Preference for physician’s care (Samoans only) vs. traditional cultural healing practices (Hawaiians only)
• Prayers/faith in God
• Diet and exercise changes
• Stress management
• Subsistence lifestyle

Patient:
• “Yeah, if it’s something to do with the heart, they don’t fool around [they see the doctor].” (Samoan participant)
• “My girlfriend says, don’t take any pills, when the doctor says, oh, this is a new pill, try ‘em...they’re using you as a guinea pig. Whether that’s true or not, I don’t know, but I don’t take any pills that my doctor gives to me. I don’t go to that doctor.”
• “I’m learning to eat vegetables. I’m learning to cut all the fat,...”
• “...we all know cut down on the salt, you know, exercise...”
• “Relieving stress and everything does help by calming down and doing some breathing techniques.”
• “[Before] we’d catch the fish, we’d eat it and if there’s too much we give to the neighbors, everything was fresh. But not anymore....take [Samoans] back to what they used to eat before....”
Caregiver:
• “Lā‘au lapa‘au [Hawaiian medicinal herbs] is awesome...cause there’s no side effects, whatever’s [sic] wrong, it takes care of the body...”
• “There are times when you know, the doctors say, there isn’t anything more that the doctors can do and so they pray [sic] and give it up to God’s hands.”
• “I think that maybe coming from the homestead side,...put the Hawaiians [sic] back on the land, and to grow their own food, so, subsistence...maybe we can start small by maybe having a class on growing Hawaiian food right in your back yard, and actually using that and putting it into your diet.”

Note. The key themes presented here are summarized or aggregated concepts and phrases of participants’ actual responses and the representative quotes are listed by type of participant - heart failure patient and caregiver.