Rehabilitation after myocardial infarction: experiences and perspectives of people who do not use cardiac rehabilitation and / or CHD 'self-help' groups and their ‘significant others’

Abstract

Background and goals: This thesis explores the experience of rehabilitaion following myocardial infarction (MI) from the perspective of people who did not attend either a cardiac rehabilitation programme (CR) or a CHD 'self-help' group and their ‘significant others’. These resources are intended to support post-MI rehabilitation and readjustment and research identifies various benefits, yet many people do not use them. Given the scale of the population affected by CHD, the issues of why people do not use the resources, their experience and that of their family members, and the kinds of support people need and want, are of public health importance. These issues formed my investigative goals. Methods: The study used a qualitative methodology, informed by ‘grounded theory’. A screening questionnaire identified non-participants from the post-MI population in Lothian, from which a sample of ‘maximum diversity’ was selected. In-depth interviews were conducted with twenty-seven post-MI people and seventeen ‘significant others’. The analysis combined identifying emergent themes and searching the data for key issues relating to study objectives. Findings: Additional to the barrier of non-invitation, a spectrum of factors relating to people’s ‘lifeworld’ circumstances, beliefs, and identity could either encourage or discourage participation. Factors were highly similar for both resources. Reasons for, and the process of non-participation could be grouped into three categories: “No need / no point”, “Not worth it”, or “Not possible”. These were based on the way the factors that influenced individuals related to three key issues. Shifts between categories were also possible. A link between non-participation and a range of rehabilitation difficulties among post-MI people and family members is also demonstrated. Conclusions and implications: The study addresses a gap in understanding post-MI non-participation and its significance, providing insight into the process by which CR and CHD Group nonuse occurs and the impacts for people who have had MI and family members. Recommendations are made, identifying realistic ways rehabilitation support might be improved, barriers and opportunities, and areas for further investigation.