Author Identifier

Kunwar Kaur: https://orcid.org/0000-0002-7017-7245

Date of Award

2026

Keywords

Ethnic groups, health promotion, myocardial ischemia, perception, primary health care, knowledge, myocardial ischemia, risk factors, migrants, mixed methods, qualitative content analysis, hybrid coding

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy (Integrated)

School

School of Nursing and Midwifery

First Supervisor

Rosemary Saunders

Second Supervisor

Nilufeur McKay

Third Supervisor

Ma'en Abu-Qamar

Fourth Supervisor

Amineh Rashidi

Abstract

Ischaemic heart disease (IHD) is a global health concern, and prior research underscores a significant association between ethnicity and IHD that must be considered when evaluating individual risk. Indian people, regardless of their country of residence, demonstrate a notably high prevalence and early onset of IHD. Research is required to fill the existing gaps in the literature concerning IHD and ethnicity, particularly for high-risk migrant populations. This study assesses Indian migrants’ knowledge of IHD risk factors and explores their perceptions of personal risk and also identifies the factors influencing both their knowledge and risk perceptions.

Utilising convergent parallel mixed-method with an equal-status concurrent design, the quantitative strand employed a cross-sectional survey with the qualitative strand using a qualitative descriptive approach. Participants for both strands were recruited through convenience sampling. Quantitative data was gathered through an online survey using a modified Heart Disease Facts Questionnaire while the qualitative data was gathered through face-to-face and online semi-structured interviews. Descriptive statistics and multivariable logistic regression analysed knowledge levels and influencing factors. Qualitative content analysis (QCA) was employed to examine the data using a hybrid coding technique that combined both inductive and deductive approaches.

Over 75 % of respondents (n= 400) had a good knowledge of IHD risk factors. From interviews with 20 participants, four main themes emerged: 1) Awareness of IHD and associated risk factors; 2) Perceptions of own risk of IHD; 3) Perceived barriers to IHD prevention; and 4) perceived motivators to modify ischaemic heart disease risks. Those who perceived themselves at risk of IHD did not believe their risk was higher than their peers. Perception of risk is shaped by life experiences, while lifestyle choices are influenced by migration, the role of healthcare professionals, family commitments, and cultural factors. The quantitative and qualitative findings are consistent across common domains The study findings are discussed in the context of Capability, Opportunity, and Motivation (COM-B) model of behaviour change. This study provides valuable insights into the IHD risk perceptions among Indian migrants. These findings are instrumental in advancing primary and secondary prevention strategies and enhancing support for high-risk and hard-to-reach migrant populations within clinical settings. These findings are of significance to nurses and other healthcare professionals working in primary healthcare settings. Furthermore, the implications of this study extend to shaping health policies and guiding future research endeavours. Although the study primarily examines the experiences of Indian migrants, its findings offer valuable insights applicable to other racial and ethnic minority populations due to most migrants facing similar challenges during and after the migration process.

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Link to publisher version (DOI)

10.25958/qyw6-a149