Exploring the health care experiences of rural Thai people living with acquired valvular heart disease : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
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Date
2010
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Massey University
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Abstract
Valvular heart disease (VHD) is a preventable disease but it is one of the major causes
of chronic illness in developing countries. As this disease is curable by surgery, access
to appropriate and effective health care is necessary to prevent people from developing
this disease and to treat people with VHD. The voices of people living with this
condition will provide direction for health professionals in the development of better
health care services for those living with VHD. This qualitative narrative study aimed to
explore the experiences of individuals living with VHD.
Thirty individuals diagnosed with VHD participated in this study drawn from a
population of individuals attending a Thailand provincial hospital. They participated in
(open and honest conversation) which was supported by a Thai cultural
stance to build the trust necessary for the conversations. Conversations aimed at
eliciting information about personal health care experiences were undertaken and lasted
from 30 to 90 minutes, all were audio-taped and transcribed verbatim. Multistage
narrative analysis methodology was used to identify emerging themes and three major
themes emerged: autonomy and life with VHD, the effort of learning for life with VHD,
and the maximisation of resources for the management of life with VHD. All of these
themes indicated difficulty of access of acceptable and affordable care and difficulty in
involvement in health care and illness management. These findings suggest that health
care structures, resource distribution and the way professionals interact and
communicate are important factors in the health care experiences of individuals living
with VHD.
Health care services that are based on the principles of equity and balance of power
between institutions and clients may support the development of appropriate health care
services for all individuals. Culturally-based narrative research is recommended to
increase the possibility of expanding ways of knowing with the inclusion of a range of
points of views for understanding health care provision. This knowledge is necessary
for the development of client-centred and community-based health care services to
improve health care outcomes for the rural population in Thailand.
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Keywords
Valvular heart disease, Heart diseases, Health care, Thailand