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Patients’ and Spouses’ Perspectives on Coronary Heart Disease and its Treatment
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-2646-8715
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.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 849
Keyword [en]
Causal attributions, coronary disease, drug treatment, lifestyle changes, phenomenography, patient adherence, spouses
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-5264ISBN: 91-7373-824-7 (print)OAI: oai:DiVA.org:liu-5264DiVA: diva2:21245
Public defence
2004-05-19, Täppan 1, Täppan, Campus Norrköping, Linköpings universitet, Norrköping, 09:00 (English)
Opponent
Supervisors
Note
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
List of papers
1. Patients' conceptions of coronary heart disease – a phenomenographic analysis
Open this publication in new window or tab >>Patients' conceptions of coronary heart disease – a phenomenographic analysis
2003 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, 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.

Keyword
coronary disease, patient education, patient knowledge, qualitative analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13740 (URN)10.1046/j.1471-6712.2003.00113.x (DOI)
Available from: 2008-11-13 Created: 2008-11-13 Last updated: 2017-12-13Bibliographically approved
2. Conceptions on treatment and lifestyle in patients with coronary heart disease: a phenomenographic analysis
Open this publication in new window or tab >>Conceptions on treatment and lifestyle in patients with coronary heart disease: a phenomenographic analysis
2002 (English)In: Patient Education and Counseling, ISSN 0738-3991, Vol. 47, no 2, 137-143 p.Article in journal (Refereed) Published
Abstract [en]

Twenty-three patients with an acute event of coronary heart disease (CHD) received routine care including information about medication and lifestyle changes. They were interviewed after 1 year about their conceptions concerning drug treatment and lifestyle changes. The interviews were taped, transcribed and analysed using the phenomenographic approach. Conceptions were hierarchically categorised with regard to level of understanding. The results showed that the patients’ understanding of the effects and health benefits of their treatment was superficial as judged on an informed layman level. The knowledge was fragmentary and mechanistic. Several misconceptions were revealed. Few answers related to prognostic benefits. However, a conception about effects of stopping drug intake was risk of relapse. Some patients considered fate and heredity as the main causes of CHD. Thus, our patients had not achieved an adequate understanding of CHD treatment. The level of knowledge was lower than anticipated.

Keyword
Coronary disease, Drug therapy, Lifestyle, Patient education, Patients and knowledge
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13741 (URN)10.1016/S0738-3991(01)00185-9 (DOI)
Available from: 2008-11-13 Created: 2008-11-13 Last updated: 2016-08-31
3. Coronary heart disease: causes and drug treatment - spouses’ conceptions
Open this publication in new window or tab >>Coronary heart disease: causes and drug treatment - spouses’ conceptions
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 13, no 2, 167-176 p.Article in journal (Refereed) Published
Abstract [en]

Background. Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event.

Aims and objectives. To explore spouses' conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event.

Design. Qualitative with an empirical and inductive approach.

Methods. Semi-structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework.

Results. Spouses' conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease.

Conclusion. A variation of spouses' conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co-operative behaviour.

Relevance to clinical practice. Spouses' pre-existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.

Keyword
cardiovascular disease, causal attributions, drug treatment, phenomenography, risk factors, spouses
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13742 (URN)10.1046/j.1365-2702.2003.00871.x (DOI)
Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2016-08-31
4. Rehabilitation after coronary heart disease: spouses’ views of support
Open this publication in new window or tab >>Rehabilitation after coronary heart disease: spouses’ views of support
2004 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 46, no 2, 204-211 p.Article in journal (Refereed) Published
Abstract [en]

Background. Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles.

Aim. The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes.

Method. Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework.

Findings. The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation.

Conclusion. Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

Keyword
spouses, cardiac rehabilitation, support, communication, contextual analysis, phenomenography, nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13743 (URN)10.1111/j.1365-2648.2003.02980.x (DOI)
Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2016-08-31
5. Incentives for lifestyle changes in patients with coronary heart disease
Open this publication in new window or tab >>Incentives for lifestyle changes in patients with coronary heart disease
2005 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, 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.

Keyword
adherence, cardiac rehabilitation, drug treatment, lifestyle changes, nursing, qualitative analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13744 (URN)10.1111/j.1365-2648.2005.03467.x (DOI)
Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2017-12-13

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