Cardiovascular system, coronary disease, drug treatment, spouses 

Background: Lifestyle changes and drug treatment can improve the prognosis and quality of
life for patients with coronary heart disease (CHD), but their co-operation with suggested
treatment is often limited. The aim of this thesis was to study how patients and their spouses
conceive CHD and its treatment.
Material and Methods: The research design used was inductive and descriptive. The studies
were based on three complementary sets of data. Patients with CHD (n=23) and spouses
(n=25) were interviewed one year after an episode of the disease. Consecutive patients with
CHD derived from another investigation were interviewed within six weeks or one year after
the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken
by hand, were subjected to analysis within the phenomenographic framework.
Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay
level. They were associated with symptoms rather than with the disease. Co-operation with
drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits
from lifestyle changes and treatment did not give the impression of being based on a solid
understanding of the importance of such changes. Incentives for lifestyle changes were
classified into four categories, all of which contained both facilitating and constraining
incentives. Somatic incentives featured direct and indirect physical signals. Social/practical
incentives involved shared concerns, changed conditions, and factors connected with external
environment. Cognitive incentives were characterised by active decisions and appropriated
knowledge, but also by passive compliance with limited insights, and by the creating of
routines. Affective incentives comprised fear and reluctance related to lifestyle changes and
disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The
cognitive and the social/practical incentives were the most prevalent.
Spouses’ understanding about the causes of CHD involved both appropriate conceptions and
misconceptions. Drug treatment was considered necessary for the heart, but harmful to other
organs. Spouses’ support to partners was categorised, and found to be contextually bound.
The participative role was co-operative and empathetic. The regulative role controlled and
demanded certain behaviours. The observational role was passive, compliant, and empathetic.
The incapacitated role was empathetic, unable to support, and positive to changes. The
dissociative role was negative to changes and reluctant to be involved in lifestyle changes.
Conclusions: These results could be useful in the planning of care and education for CHD
patients. The findings also emphasise the importance of adopting a family perspective to meet
the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle
changes.