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Patients' perceptions of risk factor modification following an acute myocardial infarction Stewart, Sheila Margaret


This qualitative study was designed to explore the experience of risk factor modification from the perspective of patients who had sustained an acute myocardial infarction. Research has shown that modification of coronary risk factors including stopping smoking, reducing hypercholesterolemia and obesity, reducing hypertension, developing a habit of regular exercise, and developing methods to modify the coronary-prone behavior pattern reduces morbidity and mortality due to coronary heart disease. The literature reviewed indicated that cardiac rehabilitation programs are generally structured to provide the patient with information on coronary artery disease. However, it has been shown that information alone may not be enough to ensure that changes in behavior occur. Since there was a scarcity of information on measures to assist patients to modify their coronary risk factors, and as the literature indicated that the experience of risk factor modification had not been explored from patients' perspectives, a phenomenological design was therefore selected as the methodology for this study. Data were collected through twelve in-depth interviews with six participants. A guide of semi-structured questions was used for the initial interview and additional questions were generated from the data themselves. The constant comparative method of data analysis enabled the researcher to construct an analytic framework which represented patients' perceptions of their experiences in risk factor modification. In this framework, the central theme of patients' experiences was gaining mastery over their risk behavior(s). Gaining mastery occurred in three phases: searching for attribution, acknowledging risk, and attaining control. In attaining control, various cognitive and behavioral strategies were identified which led to a delineation of measures that could be provided to assist other patients in modifying their coronary risk factors. The findings demonstrated that a unique perspective of risk factor modification has been provided by patients based on their own experiences. It was also shown that intervention, consisting of teaching, counseling, and support, is essential to each phase of this process. The implications of this study focus on the importance of intervention in both in-hospital and out-patient cardiac rehabilitation programs. Intervention to assist patients to develop and use those skills that will enable them to gain a sense of mastery over their risk behaviors is essential if an initial or recurrent myocardial infarction is to be prevented. Implications for nursing practice, education, and research are outlined in light of the research findings.

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