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Incentives for lifestyle changes in patients with coronary heart disease
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-2646-8715
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.ORCID iD: 0000-0001-5066-8728
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
2005 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 51, no 3, 261-275 p.Article in journal (Refereed) Published
Abstract [en]

Aim. This paper reports a study exploring how patients in the rehabilitation phase of coronary heart disease experience facilitating and constraining factors related to lifestyle changes of importance for wellbeing and prognosis.

Background. Lifestyle change is important but complex during rehabilitation after a myocardial infarction or angina pectoris. The intentions to perform behaviours and to experience control over facilitators and constraints are important determinants of behaviour.

Methods. A total of 113 consecutive patients below 70 years of age (84 men and 29 women) were interviewed within 6 weeks of a cardiac event and again after 1 year. Interview transcriptions and notes taken by hand were qualitatively analysed using the phenomenographic framework. The distribution of statements among the categories identified was quantitatively analysed. The data were collected in 1998–2000.

Findings. Four main categories portrayed patients' experiences of facilitating or constraining incentives for lifestyle changes. 'Somatic incentives' featured bodily signals indicating improvements/illness. 'Social/practical incentives' involved shared concerns, changed conditions including support/demand from social network, and work/social security issues. Practical incentives concerned external environmental factors in the patients' concrete context. 'Cognitive incentives' were characterized by active decisions and appropriated knowledge, passive compliance with limited insights, and routines/habits. 'Affective incentives' comprised fear of and reluctance in the face of lifestyle changes/disease, lessened self-esteem, and inability to resist temptations. Cognitive incentives mostly facilitated physical exercise and drug treatment. Social/practical incentives facilitated physical exercise and diet change. Physical exercise and diet changes were mainly constrained by somatic, social, and affective incentives.

Conclusion. The results illustrate important incentives that should be considered in contacts with patients and their families to improve the prospects of positively affecting co-operation with suggested treatment and lifestyle changes.

Place, publisher, year, edition, pages
2005. Vol. 51, no 3, 261-275 p.
Keyword [en]
adherence, cardiac rehabilitation, drug treatment, lifestyle changes, nursing, qualitative analysis
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13744DOI: 10.1111/j.1365-2648.2005.03467.xOAI: diva2:21244
Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2016-08-31
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: 2016-08-31

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