title: Negotiating norms, navigating care: findings from a qualitative study to assist in decreasing health inequity in cardiac rehabilitation.
abstract: OBJECTIVE
  People from culturally and linguistically diverse backgrounds (CaLDBs) have lower rates of participation in cardiac rehabilitation (CR). Systematically evaluating barriers and facilitators to service delivery may decrease health inequalities. This study investigated approaches for promoting cultural competence in CR.
  
  
  METHODS
  A qualitative study of 25 health practitioners was undertaken across three CR programs using a purposive sampling strategy. Interviews and participant observation were undertaken to identify factors to promote culturally competent care.
  
  
  RESULTS
  Three key foci were identified for implementing cultural competence approaches: (1) point of contact; (2) point of assessment; and (3) point of service. Based upon study findings and existing literature, a conceptual model of cultural competency in CR was developed.
  
  
  CONCLUSIONS
  Culturally competent strategies for identifying and tailoring activities in the CR setting may be a useful approach to minimise health inequities. The findings from this study identified that, in parallel with mainstream health services, CR service delivery in Australia faces challenges related to cultural and ethnic diversity. Encouragingly, study findings revealed implementation and integration of culturally competent practices in rehabilitation settings, in spite of significant odds.
authors: Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. a.haghshenas@curtin.edu.au
authors: Abbas
authors: A
authors: Haghshenas
authors: Patricia M
authors: PM
authors: Davidson
authors: Arie
authors: A
authors: Rotem