title: The influence of ethnicity and gender on navigating an acute coronary syndrome event.
abstract: BACKGROUND
  Ethnicity and gender may influence acute coronary syndrome patients recognizing symptoms and making the decision to seek care.
  
  
  OBJECTIVE
  To examine these potential differences in European (Caucasian), Chinese and South Asian acute coronary syndrome patients.
  
  
  METHODS
  In-depth interviews were conducted with 20 European (Caucasian: 10 men/10 women), 18 Chinese (10 men/eight women) and 19 South Asian (10 men/nine women) participants who were purposively sampled from those participating in a large cohort study focused on acute coronary syndrome. Analysis of transcribed interviews was undertaken using constant comparative methods.
  
  
  RESULTS
  Participants followed the process of: having symptoms; waiting/denying; justifying; disclosing/ discovering; acquiescing; taking action. The core category was 'navigating the experience'. Certain elements of this process were in the forefront, depending on participants' ethnicity and/or gender. For example, concerns regarding language barriers and being a burden to others varied by ethnicity. Women's tendency to feel responsibility to their home and family negatively impacted the timeliness in their decisions to seek care. Men tended to disclose their symptoms to receive help, whereas women often waited for their symptoms to be discovered by others. Finally, the thinking that symptoms were 'not-urgent' or something over which they had no control and concern regarding potential costs to others were more prominent for Chinese and South Asian participants.
  
  
  CONCLUSIONS
  Ethnic- and gender-based differences suggest that education and support, regarding navigation of acute coronary syndrome and access to care, be specifically targeted to ethnic communities.
authors.affiliation: University of Calgary, Canada kingk@ucalgary.ca.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: King-Shier
authors.affiliation: University of Calgary, Canada.
authors.forename: Shaminder
authors.initials: S
authors.lastname: Singh
authors.affiliation: University of Calgary, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: LeBlanc
authors.affiliation: University of Calgary, Canada.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Mather
authors.affiliation: University of Calgary, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Humphrey
authors.affiliation: University of Calgary, Canada.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.affiliation: St. Paul's Hospital, University of British Columbia, Canada.
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Khan
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000208:ethnology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data*; D001955:British Columbia; D002170:Canada; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D044465:White People / Q000706:statistics & numerical data*
keywords: Ethnicity; acute coronary syndrome; care-seeking; gender; symptom recognition