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Patients' conceptions of coronary heart disease – a phenomenographic analysis
Linköping University, Department of Medicine and Care.
Linköping University, Department of Medicine and Health Sciences.
Linköping University, Department of Medicine and Health Sciences.
2003 (English)In: Scandinavian Journal of Caring Sciences, ISSN 02839318 (print) 14716712 (online), Vol. 17, no 1, 43-50 p.Article in journal (Refereed) Published
Abstract [en]

Readjustment after an event of coronary heart disease (CHD) is defined to comprise cognitive, instrumental and affective components. The cognitive dimension refers to understanding of the disease. Twenty-three patients (<60 years) with CHD were interviewed about the nature of their disease and encouraged to use their own words. The study was conducted 1 year after the event of myocardial infarction (MI) and some patients had also been revascularized. The interviews were transcribed in extenso and analysed according to the phenomenographic approach. The main finding was the great variation of conceptions revealed. Six different conceptions were found concerning CHD. Some patients comprehended MI by involving (A) blood and vessels, (B) either blood or vessel or referred to (C) risk factors/symptoms. Angina pectoris was expressed as (A) insufficient heart capacity, (B) atherosclerosis/contracted vessel or as (C) symptoms. Several patients found it difficult to expand their answers and some expressed misconceptions about the course of events. Patients' pre-existing knowledge and their way of reasoning about central phenomena related to their disease should be taken into consideration in patient education and is also applicable in individual encounters with patients.

Place, publisher, year, edition, pages
2003. Vol. 17, no 1, 43-50 p.
Keyword [en]
coronary disease, patient education, patient knowledge, qualitative analysis
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13740DOI: 10.1046/j.1471-6712.2003.00113.xOAI: diva2:21240
Available from: 2008-11-13 Created: 2008-11-13 Last updated: 2009-02-19
In thesis
1. Patients’ and Spouses’ Perspectives on Coronary Heart Disease and its Treatment
Open this publication in new window or tab >>Patients’ and Spouses’ Perspectives on Coronary Heart Disease and its Treatment
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment.

Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework.

Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent.

Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes.

Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes.

Place, publisher, year, edition, pages
Institutionen för medicin och vård, 2005
Linköping University Medical Dissertations, ISSN 0345-0082 ; 849
Causal attributions, coronary disease, drug treatment, lifestyle changes, phenomenography, patient adherence, spouses
National Category
Cardiac and Cardiovascular Systems
urn:nbn:se:liu:diva-5264 (URN)91-7373-824-7 (ISBN)
Public defence
2004-05-19, Täppan 1, Täppan, Campus Norrköping, Linköpings universitet, Norrköping, 09:00 (English)
On the day of the public defence of the doctoral thesis the status of article V was Submitted.Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2013-09-03

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Kärner, AnitaGöransson, AnneBergdahl, Björn
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