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Table 1 Characteristics of included studies

From: Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples’ experiences

Author and country of origin Aim of study, design, method Cohort – detail if stated Main findings
1. Boutin-Foster (2005) USA [31] To evaluate the types of instrumental social support that people with CAD find helpful to health behaviour modification. 63 participants (Mean age 69 years. 60% male. The types of instrumental support perceived as most helpful were those that made it easier to engage in healthy behaviours alleviated stressful situations and facilitated the process of receiving medical care.
Phenomenological interview study using semi-structured questionnaires. Diagnosed with coronary artery disease and recruited from a coronary care unit in a single centre.
2. Condon & McCarthy (2006) Ireland [32] To explore patients’ perspectives of making lifestyle changes post MI. 10 participants (38–75 years of age) 90% male. Four main themes: lifestyle warning signs, taking responsibility for lifestyle changes, professional support and looking forward to the future.
Qualitative descriptive interview study. All post AMI. Community setting. Interviewed 6 weeks post discharge. All had completed Phase 1 cardiac rehabilitation.
Findings highlight the difficulty of making too many lifestyle changes at once as well as a lack of professional support.
Overprotection from family members creates frustration and aggravation for participants.
3. Coyle (2009) USA [33] To determine what patients thought was important after experiencing an acute MI and performing self-care. 62 participants (Mean age 63 years, range 37–86 years), 63% male (25% African American). Seven main themes: The story surrounding the MI, symptom explanations, stresses and loss surfaced during the reflections, fearing death, changing self-care behaviours, reflections on death and gratefulness.
Part of larger quantitative study – one question asked by telephone. All post AMI and recruited from a single centre with follow-up at 2 weeks and 30 days post hospital discharge.
Colaizzi method of phenomenological analysis.
4. Doiron-Maillet & Meagher-Stewart (2003) Canada [34] To explore younger women’s perceptions of their process of recovery following an MI. 8 participants (33–61 years of age), 100% female. The main themes were: Living with uncertainty, truths learned from others, rude awakening, disconnected knowing and reconnecting self. Women with heart disease were living with an overwhelming sense of uncertainty.
Interview study using interpretive enquiry with feminist perspective. Interviewed within 2 weeks of discharge, post AMI and 6–8 weeks later.
5. Eastwood (2001) Australia [35] To provide information on change of risk factor behaviour after a PTCA/stent. 4 participants. (100% male), no age specified. The major influences on whether or not to adopt behaviour change are a new positive health perspective, family considerations, return to work issues and a reluctance to participate in cardiac rehabilitation issues.
Interview study using a descriptive naturalistic approach. All were 3 months post PTCA/stent.
6. Gambling (2003) UK [36] To investigate understanding of the factors perceived as important in reducing CHD risk factors. 30 to 40 participants. 32–85 years of age. Main themes were: coping with the diagnosis, participants’ perception of the aetiology of CHD, information seeking behaviour, lifestyle changes, and participants’ appraisal of risk factors relating to CHD.
Focus group study. All were post AMI or diagnosed with angina. Recruited from a self-help group, 6 months - 2 years since diagnosis
Patients have difficulty processing health information and needed individualised information to help them understand their own risk factors and the necessary action to take.
7. Gregory et al. (2005) Working Paper Scotland [37] To identify patients’ views and experiences of recovery and rehabilitation from CHD. 53 participants (Aged <65 years), 66% male. Main themes were: advice and help making sense of the experience and relevance of lifestyle changes, putting advice into practice, barriers to leading a normal life and how things could be improved.
Focus groups and interviews and interviews analysed using principles drawn from grounded theory. All were post AMI in a community setting. 2-3 yrs post discharge
8. Gregory et al. (2005) Scotland [29] To identify barriers to and facilitators of following advice about lifestyle change and maintenance after an MI. 53 participants (Aged <65 years) 66% male. A major finding was participants’ desires for long-term monitoring and support which would include regular contact with health professionals, help in following lifestyle advice, reassurance and shared experiences with other MI survivors.
Focus groups and interviews analysed using principles drawn from grounded theory. All were post AMI in a community setting. 2-3 yrs post discharge
9. Gulanick et al. (1998) USA [38] To examine patients’ responses to suggested lifestyle changes after their PTCA procedure, to identify barriers and facilitators to risk factor reduction, to identify sources of health information, and to elicit suggestions for nursing interventions to aid in long-term recovery. 55 participants, post PTCA*, (Mean age 61 years, range 34–74 years), 47% male. The main facilitators to lifestyle change were: Permission to cheat, wanting to stay alive, belief that had some control by reducing risk factors, peer support found in cardiac rehabilitation, stress reduction through relaxation or yoga.
Community setting with some having attended cardiac rehabilitation, 3-18 months post PTCA.
A focus group study informed by Cox’s interaction model of client health behaviour framework. Analysis conducted using principles of grounded theory. The barriers to lifestyle change were: Lack of spousal or family support, powerless to alter disease progression, lack of willpower, fear of overexertion, difficulty coping with stress.
10. Jensen & Petersson (2003) Denmark [39] To investigate patients’ experiences of illness after a first MI, focusing on life situation and the recovery process over time. 30 participants (40–89 years of age) 73% male. A core finding was the uncertainty of the life situation with four categories: treatment seeking behaviour, existential threat, preventing another coronary and a need for knowledge and support.
Semi-structured interviews based on Lunde’s perception model. Post AMI and interviewed twice: 2nd/3rd day on ward and 17wks post-admission.
11. Johansson et al. (2003) Sweden [40] To explore women’s’ experiences after an MI. 8 participants (No ages provided), 100% female. Women’s’ experience is characterised by uncertainty and a loss of context. Their relationship with their body and the lived world is interrupted and well-being is regained through reconciliation with their body and illness.
Interviews using a phenomenological approach. Contacted through patient association. Interviewed 2–25 years post AMI.
12. Johnson & Morse (1990) Canada [41] To examine the process of adjustment that individuals experience after an MI. 14 participants (43–72 years of age), 50% male. Four stages of adjustment are identified: defending oneself, coming to terms, learning to live and living again. A core theme to all stages is the importance of control; the perceived loss of control and the struggle to regain control.
Unstructured interviews using a grounded theory approach. Selected from cardiac rehabilitation and cardiac self-help group. All 1–45 months post AMI.
13. Kerr & Fothergill-Bourbonnais (2002) Canada [42] To examine the experience of recovery in women aged 65+ during initial recovery from an MI. 7 participants (Mean age 74 years, range 67–86 years of age), 100% female. Four main themes were: life is scattered, trying to make sense of it, learning to live with it and getting settled.
Unstructured interactive interviews using a Heideggerian phenomenological approach. All post AMI and interviewed within 5 weeks of discharge. Recovery was likened to a “mosaic” where women had to create a new picture for themselves.
14. MacInnes (2005) England [43] To explore relationships between illness perceptions and adoption of health-promoting behaviours and attendance at cardiac rehabilitation for women after an acute MI. 10 participants (Mean age 72 years), 100% female. Main themes were: stress as a cause of illness, loss of confidence and inability to complete household chores, the episodic nature of the illness and a perceived lack of control.
All referred to cardiac rehabilitation and interviewed 3 months post MI.
Interview study using Leventhal and Nerenz’s self-regulatory model of illness behaviour as a theoretical framework
15. McGillion (2007) Canada [44] To examine potential shifts in the meaning of cardiac pain after a 6 week angina psychoeducational programme. Interview study with descriptive analysis. Subsample of 66 participants drawn from a larger sample (130) recruited for an RCT. Angina pain changes from being a burdensome life change to a pain problem requiring self-management in order to preserve life goals and functioning.
(Mean age 67 years), 80% male, 73% Caucasian).
All had chronic stable angina and ischaemic heart disease and an average of 6 years living with angina. Attending a psychoeducational programme for chronic angina self-management.
16. Mohan, Wilkes & Jackson (2008) Australia [45] To report lifestyle factors of Asian Indians in Australia in relation to coronary heart disease. 8 participants (Aged 31–80 years, 63% male. Asian Indians). The main themes were: diet, social and religious customs, exercise, stress, help-seeking behaviour, impact of migration.
Semi-structured in-depth interviews using a naturalistic approach. All post AMI in a community setting and interviewed at least 6 months since AMI. Knowledge of risk factors did not help participants to follow a healthy lifestyle. Any changes made lacked consistency and continuity.
17. Ononeze (2009) Ireland [46] To explore the individual experience of heart disease and the implication in heart disease prevention and management in the West of Ireland. 26 participants (Mean age 68 years, 62% male). The main themes were: making sense and coming to terms with illness, increased understanding and learning to live with illness, and managing everyday life with illness.
In-depth interviews study using a grounded theory approach. Post AMI or angina from community setting with mixture of paid for and free healthcare. 1.5 - 21 years living with heart disease.
18. Paquet et al. (2005) Canada [47] To describe how cardiac patients experience the first 3 months following a cardiac event requiring hospitalization. 20 participants (Mean age 69.6 years, range 50–91 years), 80% male. The main themes were categorised into: elements at the personal level, elements at the environmental level and elements in interaction at the personal and the environmental level.
Post AMI, angina or PCA requiring hospitalization, community setting and interviewed 3 months after hospitalization.
Focus group study
Participants focused on stress management rather than on modifying health habits.
19. Roebuck et al. (2001) England [48] To explore and gain insights into the effects of myocardial infarction on health-related quality of life. 31 participants (28–74 years of age), 66% male. The main themes were: physical activity/symptoms, insecurity, emotional reactions, dependency, lifestyle modification, concerns over medication.
Semi-structured interviews Interviewed post AMI, in community setting 6 weeks after discharge but prior to cardiac rehabilitation.
Breathlessness, insecurity and feelings of overprotection were major problems and participants were dissatisfied with the provision of information and support.
20. Sjostrom-Strand (2006) Sweden [49] To describe and explore how women cope with stress at the time of and after an MI. 20 participants (30–80 years of age), 100% female. Cogitative actions, social belonging and emotional diversion were identified as ways of managing stress at the time of and after the MI.
A descriptive interview study using a phenomenographic approach. Interviewed in hospital setting (Day 2–3 post AMI) and then between 4–10 months later in community setting.
21. Sutherland & Jensen (2000) Canada [50] To explore and describe elderly (70+ years) women’s perceptions of having an MI. 11 participants (70–85 years of age), 100% female. The main themes were: searching for a diagnosis, being hit with the reality, moving with the change, discovering the nature of the change, adjusting to the change.
Interview study Interviewed in a community setting 8 weeks post AMI.
Women are met with the constant challenge of being in control, managing uncertainty, making sense, being independent and sheltering others.
22. Warren-Findlow & Prohaska (2008) USA [51] To examine how family members support or inhibit African American women’s efforts to manage their health conditions. 12 participants (50–73 years of age), 100% female. African - American women only, from a low income minority population. Most women lived in multi-generational households. Instrumental support was given by family members. Informational support was based on family history of heart disease and behavioural support either reinforced or discouraged lifestyle behaviour changes.
27 in-depth interviews over a 2 year period. Data analysed using grounded theory. All had stable CAD.
23. Warren-Findlow & Issel (2010) USA [52] To examine stress and coping in older African-American women with CHD. 12 participants. Mean age 62 years (50–73 years of age). 100% female. African - American women only. Stress was perceived as a cause of CHD. Women used their own family history of heart disease as a reference by which to evaluate their own health. Emotional coping, such as “not worrying” and cognitive coping in the form of spiritual beliefs were used by women.
Multiple in-depth interviews over a 2 year period. All had CAD.
24. White et al. (2010) UK [53] To explore medicine taking and lifestyle changes in patients after a cardiac rehabilitation programme. 15 participants (42–72 years of age), 73% male. Participants had unmet informational needs about lifestyle change. They wanted more individualised information and advice. Participants tended to only maintain lifestyle changes that they perceived as causes of their heart attack, but perceived causes could change over time.
In-depth interviews. All post AMI and cardiac rehabilitation. Interviewed 3 and 12 months post cardiac rehabilitation.
25. White et al. (201 1) UK [54] To explore cardiac rehabilitation patients perspectives on making and maintaining dietary change. 15 participants (42–72 years of age), 73% male. Participants only made and maintained dietary changes if they perceived their diet to be a cause of their CHD. Dietary changes involved “cutting things out” and no changes were made if they felt that they didn’t need to cut things out.
In depth interviews. All post AMI and cardiac rehabilitation. Interviewed 3 and 12 months post cardiac rehabilitation.
26. Wiles (1998) England [55] To examine the understandings and beliefs about heart attack and recovery and how lifestyle change fits into these understandings. 25 participants (34–80 years of age), 52% male. As people recover from the shock of heart attack they begin to lose trust in health professionals accounts of cause and recovery and perceive lifestyle change as an action that cannot guarantee protection from a further heart attack.
In-depth interview study. Recruited from a larger RCT study sample. All post AMI and interviewed at 2 weeks and 5 months after hospital discharge.
27. Wiles & Kinmonth (2001) England [56] To explore patients’ understandings of heart attack in order to contribute to the design of effective secondary prevention services. 25 participants (34–80 years of age), 52% male. Three important issues: whether MI is understood as an acute or chronic condition, whether the event is seen as mild or severe and the effect of advice that is at odds with patients’ experiences.
  Interview study with grounded theory approach. Recruited from a larger RCT study sample. All post AMI and interviewed at 2 weeks and 5 months after hospital discharge. These provide a rationale for the apparent low motivation for long-term lifestyle changes. However there are changes over time.