PATIENTS PERCEPTIONS OF THEIR HEART-ATTACK AND RECOVERY - THE INFLUENCE OF EPIDEMIOLOGIC EVIDENCE AND PERSONAL-EXPERIENCE

Secondary prevention of heart disease is widely viewed as likely to be more successful and cost effective than primary prevention. However, people's willingness to adopt lifestyle change is a complex issue in w hich people's perceptions of disease causation and risk as well as a r ange of socio-economic factors are important. This paper reports on a qualitative study of people following heart attack which examines thei r understandings of heart attack and the salience that lifestyle advic e has in the light of these understandings. In-depth, qualitative inte rviews were conducted with 25 people recovering from heart attack. Eac h person was interviewed twice. at around two weeks and five months fo llowing their heart attack. The study found that information about rec overy provided by health professionals was based on a simplified versi on of epidemiological evidence. This information played a central role in people's understandings about the nature of heart attack and their future risk in the early weeks following heart attack. However, as in terviewees came to terms with the shock of the event, they tended to l ose their trust in ''official'' accounts of cause and recovery and evi dence from lay epidemiology that contradicted official accounts tended to emerge. This evidence encouraged interviewees to question the expl anatory power of official accounts and to view the adoption of long-te rm lifestyle change as an action that would not guarantee protection f rom a further heart attack. This was true whether or not people's expe riences of recovery reflected those ''predicted'' by health profession als although those awaiting further surgery or tests tended to maintai n trust in official accounts over a longer period. It is concluded tha t the failure of official accounts to acknowledge the random nature of the occurrence of heart attack, the severity of heart attack and the level of recovery from heart attack is a central feature in people's r eluctance to view lifestyle change as a rational action to take to pre vent a further cardiac event. (C) 1998 Elsevier Science Ltd. All right s reserved.