This study explored the experiences of people hospitalized with heart disease at each of four levels: personal, interpersonal, organizational, and societal. Twenty patients (and 13 family members) who were in the hospital during 1994 with heart problems and who were recruited to a large epidemiologic project were interviewed. The interviews were audiotaped and the transcriptions subjected to qualitative analysis to identify emergent themes at each of the four levels and links between the levels. Results of this study can be used to examine (a) prevention messages, (b) techniques to enhance the therapeutic impact of the doctor-patient relationship in light of patients' etiological beliefs, and (c) patients' evaluation of the medical profession in light of the financial impact of heart disease. This study demonstrates how a multilevel analysis of patients' health and illness experiences can be used to better equip health care providers and educators in their exchanges with future heart disease patients.
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References
1.
Affleck, G. , Tennen, H., Pfeiffer, C., & Fifield, J. (1987). Appraisals of control and predicability in adapting to a chronic disease. Journal of Personality and Social Psychology, 53(2), 273-279.
2.
Bar-On, D. (1986). Professional models vs. patient models in rehabilitation after heart attack. Human Relations, 39, 917-932.
3.
Bernard, H. (1988). Unstructured and semistructured interviewing. In H. R. Bernard (Ed.), Research methods in cultural anthropology (pp. 203-224). Newbury Park, CA: Sage.
4.
Cowie, B. (1976). The cardiac patient's perception of his heart attack. Social Science & Medicine, 10, 87-96.
5.
Dalal, A. , & Singh, A. (1992). Role of causal and recovery beliefs in the psychological adjustment to a chronic disease. Psychology and Health, 6, 192-203.
6.
Davison, C. , Frankel, S., & Smith, G. (1989). Inheriting heart trouble: The relevance of common-sense ideas to preventive measures. Health Education Research, 4, 329-340.
7.
Davison, C. , Frankel, S., & Smith, G. (1992). The limits of lifestyle: Re-assessing "fatalism" in the popular culture of illness prevention. Social Science & Medicine, 34, 675-685.
8.
Davison, C. , Smith, G., & Frankel, S. (1991). Lay epidemiology and the prevention paradox: The implications of coronary candidacy for health education. Sociology of Health and Illness, 13, 1-19.
9.
Frankel, S. , Davison, C., & Smith, G. D. (1991). Lay epidemiology and the rationality of responses to health education. British Journal of General Practice, 41, 428-430.
10.
Freedland, K. , Carney, R., Lustman, P., Rich, M., & Jaffe, A. (1992). Major depression in coronary artery disease patients with vs without a prior history of depression. Psychosomatic Medicine, 54, 416-421.
11.
Freedland, K. , Lustman, P., Camey, R., & Hong, B. (1992). Underdiagnosis of depression in patients with coronary artery disease: The role of nonspecific symptoms. International Journal of Psychiatry in Medicine, 22(3), 221-229.
12.
Gilchrist, V. (1992). Key informant interviews. In B. Crabtree & W. Miller (Eds.), Doing qualitative research (pp. 70-89). Newbury Park, CA: Sage.
13.
Good, B. , & Good, M. (1993). "Leaning medicine": The construction of medical knowledge at Harvard Medical School. In S. Lindenbaum & M. Lock (Eds.), Knowledge, power and practice: The anthropology of medicine and everyday life (pp. 81-107). Berkeley: University of California Press.
14.
Heller, R. , Knapp, J., Valenti, L., & Dobson, A. (1993). Secondary prevention after acute myocardial infarction. American Journal of Cardiology, 72, 759-762.
15.
Heller, R. , Walker, R., & Boyle, C. (1993). Response to a family intervention program among relatives of heart attack victims. Health Promotion Journal of Australia, 3, 37-39.
16.
Hoffman, A. , Pfiffner, D., Hornung, R., & Niederhauser, H. (1995). Psychosocial factors predict medical outcome following a first myocardial infarction. Coronary Artery Disease, 6(2), 147-152.
17.
Johnson, J. (1991). Learning to live again: The process of adjustment following a heart attack. In J. Morse & J. Johnson (Eds.), The illness experiences: Dimensions of suffering (pp. 13-88). Newbury Park, CA: Sage.
18.
Johnson, J. , & Morse, J. (1990). Regaining control: The process of adjustment after myocardial infarction. Heart and Lung, 19(2), 126-135.
19.
Katon, W. , & Kleinman, A. (1981). Doctor-patient negotiation and other social science strategies in patient care. In L. Eisenberg & A. Kleinman (Eds.), The relevance of social science for medicine (pp. 253-279). London: D. Reidel.
20.
Keeling, A. , & Dennison, P. (1995). Nurse-initiated telephone follow-up after acute myocardial infarction: A pilot study. Heart and Lung, 24(1), 45-49.
21.
Levy, M. (1981). The experience of undergoing a heart attack: The construction of a new reality. Journal of Phenomenologic Psychology, 12, 153-172.
22.
Lincoln, Y. S. , & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
23.
Magni, G. , Unger, H., Polesel, E., Cesari, F., Rizzardo, R., Paruzzolo, P., & Gallucci, V. (1987). Psychosocial outcome one year after heart surgery: A prospective study. Archives of Internal Medicine, 147, 473-477.
24.
Miles, M. , & Huberman, A. (1984). Qualitative data analysis: A sourcebook of new methods. London: Sage.
25.
National Heart Foundation of Australia . (1995). Heart and stroke facts report. Canberra, Australia: Author.
26.
Ong, L. , de Haas, J., Hoos, A., & Lammes, F. (1995). Doctor-patient communication: A review of the literature. Social Science & Medicine, 40, 903-918.
27.
Patton, M. Q. (1990). Qualitative evaluation and research methods. Newbury Park, CA: Sage.
28.
Roine, R. , Kajaste, S., & Kaste, M. (1993). Neuropsychological sequelae of cardiac arrest. Journal of the American Medical Association, 269(2), 237-242.
29.
Scherk, K. (1992). Coping with acute myocardial infarction. Heart and Lung, 21, 327-334.
30.
Seidel, J. , Kjolseth, R., & Seymour, E. (1988). The Ethnograph (Version 3) [Computer software]. Amherst, MA: Qualis Research Associates.
31.
Taylor, S. (1983). Adjustment to threatening events. American Psychologist, 38(11), 1161-1173.
32.
Tunstall-Pedoe, H. , Kuulasmaa, K., Amouyel, P., Arveiler, D., Rajakangas, A., & Pajak, A. (1994). Myocardial infarction and coronary deaths in the World Health Organization MONICA project Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation, 90(1), 583-612.
33.
Walker, R. , Heller, R., Redman, S., O'Connell, D., & Boulton, J. (1992). Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients. Preventive Medicine, 21, 616-629.
34.
Winett, R. (1995). A framework for health promotion and disease prevention programs. American Psychologist, 50(5), 341-350.
35.
Winett, T. , King, A., & Altman, D. (1989). Health psychology and public health: An integrative approach. Elmsford, NY: Pergamon.
36.
Young, A. (1982). The anthropologies of illness and sickness. Annual Review of Anthropology, 11, 269-271.
