Table 1 Categories and original data from the theme ‘Tensions between noticing and normalising (before seeking medical help)’

Noticing symptoms before the participant

Carer: Walking on the flat you do get breathless, you can’t walk and talk really.

Participant: I never really realised that until these [carers] made me aware of it because it was obviously coming on and it was you, weren’t it? A couple of times you said…

Carer: Well it just as you’re walking round the shops you tell me that we need to slow down or you’re struggling to speak and to walk at the same time. (Participant (P)14)

Normalising symptoms through comparison with own ageing

Participant: I was walking a long distance and I needed to stop.

Carer: Of course, as we got older, I’m able to walk really, really well, but I get out of breath when I get to the top of the church road. It’s because it’s a very, very slight incline, but it tells on you. As soon as I get to the shop, I get in the shop, it’s gone. It’s just age, I'm sure. (P6)

Breakdown of normalisations – sudden onset of severe symptoms

He wasn’t very well on Sunday morning. He said he couldn’t breathe properly, so I said, “Well, perhaps we’d better get you to the hospital”. I phoned the paramedics. I said he couldn’t breathe, he couldn’t get his breath properly and they said, “We’ll come along”. (Carer of P6)

Breakdown of normalisations – prolonged symptoms

The thing is, this cough had gone on for weeks and weeks. I thought, that’s not normal. You can’t go on like that forever, just constant cough. (Carer of P9)