Alumni Lifelong Learning Series: Dr. Jan Angus & cardiac rehabilitation

25 October 2011

The second instalment of the Alumni Lifelong Learning Series at Bloomberg Nursing was held October 19, 2011 and featured a presentation by associate professor Dr. Jan Angus about “gender and habitus in cardiac rehabilitation.”

To start, Angus explored issues in lifestyle change for cardiac risk reduction, how men and women approach change, and how co-morbidity can complicate the process. There are many benefits of cardiac rehabilitation (CR), but participants do not always consistently adhere to or complete programs.  Women tend to have higher levels of attrition than men. Moreover, type II diabetes is a common, additional health problem seen in attendees of CR programs and is linked with low adherence and non-completion for participants – again more frequently in women.

Habitus, explained Angus, is the set of socially learned dispositions, skills and ways of responding that are acquired through repetition and deeply ingrained within everyday settings. According to Pierre Bourdieu, habitus does not only, or even primarily, function at the explicit level of consciousness, but instead works in a deeper, practical and often pre-reflexive way so social positions are embodied and maintained.

Using a variety of examples and excerpts from interviews, Angus illustrated the findings of a qualitative study that aimed to: a) explore the complexities of CR uptake in people with coronary heart disease and type II diabetes; and b) examine how gender manifests in efforts to incorporate recommended lifestyle changes. Interviewees referred with uneasiness to the social repositioning associated with profound illness. The research team also found that lifestyle change is difficult to achieve without the help and cooperation of others, creating further social discomfort. Angus described five strategies people employed when dealing with change and explained how reliance on these strategies varied depending on available resources:

  1. Passing: concealing gestures of self-care/evidence of vulnerability to minimize loss of position and effects on reinstatement;
  2. Mobilizing social capital: reliance on the work of others to solidify lifestyle changes;
  3. Re-positioning: aligning with or representing the knowledge of health providers to reinforce the value of new practices and improve social position;
  4. Hybridization: blending knowledge to obtain a more complex approach to self-care and/or the inclusion of additional, personally significant goals; and,
  5. Push back: CR goals are deemed ‘unreasonable’ and responsibility is shifted to CR providers to improve conditions so goals can be met.

The clearest gender difference was ease or discomfort with reliance on the work and support of others. Women recognized a transition in their positioning from care providers to recipients, and referred to the reciprocity of this arrangement. Men were comfortably reliant on the support of spouses, but not other men unless they were health providers.

Angus concluded cardiac rehab programs could focus on efforts to “REstore HABitus” by working with participants to achieve a new level of social comfort while incorporating the necessary changes based on their CR program.

Hosted by the Centre for Advanced Studies in Professional Practice, the Alumni Lifelong Learning Series calls on the expertise of our outstanding research team and consists of three professional development/continuing education seminars for the Faculty of Nursing’s alumni, as well as current students. The series began October 6, 2011 with Dr. Amy Bender on the topic of the potential of e-mentoring in Ethiopia, and concludes November 9, 2011 with Dr. Doris Howell’s lecture on chronic disease self-management in cancer.