Background: A comprehensive understanding of the various aspects of patients' myocardial infarction (MI) experiences may help to guide these patients and their relatives through the many ...uncertainties they face and help them to stabilize their lives after the disruption they experienced.
Objectives: To explore MI patients' experiences of life with MI, the challenges they face during the process of accepting their condition, and the setting and resetting of their personal goals.
Methods: Thirty semi-structured, individual interviews were conducted. The grounded theory method was used, and Atlas.ti qualitative data analysis software was used to facilitate the analysis.
Results: Three main themes and explanatory models emerged from the data analysis: a good adaptation - the 'new normality;' maladjustment - a continuous search for a 'new normality;' and perceived needs in the search for a new normality. Patients perceived several areas of need that they felt must be met before they could reach the state of a new normality. These needs included overcoming the anxiety of a possible MI recurrence; acquiring knowledge about MI in general and about 'my MI' in particular; the need for a timeline; for patience and steadiness; for both objective and subjective health status improvement; for taking control over the disease; and living within a supportive context.
Conclusion: When faced with a dramatic life event, most patients succeed in achieving a new normality in which they live changed but still satisfying lives. The needs experienced by patients when searching for a new normality may guide practitioners in leading patient-centred consultations.
KEY MESSAGES
Most MI patients achieve a new normality.
My physical identity is new: my body is different but still functional.
My personal identity is new: I am not the same as before, the disease is part of me, but I retain parts of my previous self.
AIM. To investigate illness perception in patients with type 2 diabetes mellitus and its association with the degree of control over relevant cardiovascular risk factors. METHODS. A cross-sectional ...questionnaire-based study was performed from June 2007 to March 2008. A stratified random sample of 46 Croatian general practitioners was asked to select, using systematic sampling, the first 6 patients with type 2 diabetes mellitus aged > or =18 years who visited them for consultation during the study period. Data on 250 patients included patient illness perception assessment (Brief Illness Perception Questionnaire, IPQ), cardiovascular risk factors, and socio-demographic data. RESULTS. The patients' mean age was 63.0+/-10.9 years and mean duration of diabetes was 9.3+/-7.8 years. The patients' illness perception assessment on an 11-point (0 to 10) scale showed the highest median scores (interquartile range): 10 (8 to 10) for "timeline" and 8 (7 to 9) for "treatment control," followed by 7 (5 to 8) for "personal control," 7 (5 to 9) for "understanding," 5 (3 to 7) for "consequences," 6 (4 to 7) for "concern," and 5 (2 to 7) for "emotional response." The lowest score was 3 (1 to 5) for "identity." Multivariate logistic regression showed that the Brief IPQ item "concern" (P<0.001) was a significant predictor of body mass index; "personal control" (P<0.001) and "concern" (P=0.048) were significant predictors of fasting blood glucose; "treatment control" (P=0.009) was a significant predictor of total cholesterol; and "understanding" (P=0.010) was a significant predictor of blood pressure. CONCLUSION. As patients' beliefs seem to be associated with the degree of control over cardiovascular risk factors, they should be included in routine clinical assessments.
Abstract
Background: Patient experience is increasingly recognized as one of the three pillars of quality in health care, alongside clinical effectiveness and patient safety. However, little ...attention has been paid to the patients' experience from the point of view of health care delivery.
Objective: To explore the initial experience of patients facing a new diagnosis of myocardial infarction (MI).
Methods: Thirty semi-structured, individual interviews were performed. The Grounded Theory method was used. Atlas.ti qualitative data analysis software facilitated the analysis.
Results: Three patterns of MI diagnosis experience were found: a close encounter with death, severe pain, and 'silent' MI. Newly-diagnosed MI patients who experienced a close encounter with death expected that, after necessary life-saving measures, their physician would not force immediate conversation, but leave them alone, simply to take pleasure in being alive. Newly-diagnosed MI patients who did not experience a close encounter with death expected that their physician would provide not only medical care but also immediate emotional support and opportunities to discuss in their own words their ideas, thoughts, concerns and fears. Six factors facilitated patients coping with a new diagnosis of MI: stay in hospital, completion of diagnostic tests, trust in physicians, the patient's previous expectation that he/she could have a heart attack, the patient's personality, and the need for solitude.
Conclusion: Physicians should be aware that different patterns of patient experience when facing MI could indicate patients' differing needs for immediate emotional support and communication.
To explore type 2 diabetic patients' attitudes, thoughts, and fears connected with their illness; their expectations of the health care system; and the problems they encountered while adhering to the ...therapeutic regimen.
Explanatory descriptive focus groups were held with 49 type 2 diabetic patients. Patients were recruited by their general/family practitioners and divided into seven focus groups. The group discussions were audio taped and transcribed, then analyzed to find emerging themes and sub-themes. Textual data were explored inductively using content analysis to generate categories and explanations. Hypotheses were derived from the qualitative content analysis.
Eight major themes and explanatory models of patient's perspective emerged out of the data: confronting the diagnosis, illness-related changes, treatment of illness, social context, relation to the health professionals, self-control, knowledge about the illness, and expectations from health professionals. Health beliefs, quality of the doctor-patient relationship, social environment of the family, workplace, health care system, and quality of the information they receive from health professionals and media were all important factors in patient adherence.
There were many obstacles for bettering patients adhering to the therapeutic regimen, as from the patients' socio-economical aspect, and in the existing health system of Croatia as well. Providing of updated information about the disease, empathy and support of physicians can improve adherence to treatment.
Abstract
Background: Expression of strong emotions by patients is not a rare event in medical practice, however, there are few studies describing general practitioner (GP) communication with a crying ...patient. Objective: The aim of this study was to describe GP behaviour with a patient who cries in a family practice setting. Methods: A semi-qualitative study was conducted on 127 Croatian GP trainees, 83.5% female, and 16.5% male. The study method used was the 'critical incident technique.' GP trainees described their recent experience with patients who cried in front of them. Textual data were explored inductively using content analysis to generate categories and explanations. Results: All 127 (100.0%) GP trainees initially let patients cry, giving them verbal (81.9%) and/or nonverbal support (25.9%). GP trainees (69.3%) encouraged their patients to verbalize and to describe the problem. Most GP trainees (87.4%) tried to establish mutual problem understanding. Approximately half of the GP trainees (55.1%) made a joint management plan. A minor group (14.2%) tried to maintain contact with the patient by arranging follow-up appointments. The vast majority of GP trainees shared their patient's emotion of sadness (92.9%). Some GP trainees were caught unaware or unprepared for patient's crying and reacted awkwardly (4.7%), some were indifferent (3.9%) or even felt guilty (3.1%).
Conclusion: GP trainees' patterns of communication with crying patients can be described in five steps: (a) let the patient cry; (b) verbalization of emotions and facilitation to express the problem; (c) mutual understanding and solution finding; (d) evaluation-maintaining contact; and (e) personal experience of great emotional effort.
There is little research on laypersons' perceptions regarding common cold and influenza, their symptomatic distinction and considerations of risk. This study investigates understanding of ...pathogenesis across three European countries and provides a knowledge base from which adequate prevention recommendations and treatment advice can be derived.
This is a qualitative research study. Semi-structured face-to-face interviews were conducted with 85 participants from three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24) about their experiences, perceptions and risk considerations regarding the common cold and influenza. We performed a qualitative thematic content analysis.
Three main themes were identified: common cold as harmless with individualistic symptoms; influenza as mainly distinguishable by fever, confinement to bed and severity of symptoms, but description about onset and duration are diverse; and views on pathogenesis contain references to disease causing agents and circumstances. Overall we found that risk perception is based largely on personal experience and risk is assumed moderate for both diseases.
Study participants possessed a fairly good understanding of symptoms, differences and pathogenesis of common cold and influenza; but explanations integrated misconceptions, such as misinterpretation of fever, disease continuums, diverse onset ideas etc. Perceptions were largely based on lived experiences and interventions for prevention and treatment should be led by health care workers and focus on these issues. Basic consultations, awareness raising activities and other knowledge disseminations strategies should include aspects of communicableness and the self-limiting nature of both diseases. An informed understanding of both infectious diseases is crucial and may also increase influenza vaccination coverage in the three respective countries effectively.
Background: Common cold and influenza result in an increased number of primary care consultations, significant work/school absences and cause a socio-economic burden. Laypeople's perceptions and ...knowledge regarding common cold and influenza prevention is poorly understood and under-researched.
Objectives: Our study explores laypeople's knowledge of prevention of common cold and influenza across three European countries. Furthermore, it investigates if there is any distinction between prevention activities focussing on reasons impacting the attitude towards influenza vaccination as well as investigating cross-country variation.
Methods: In total, 85 semi-structured individual interviews were performed across three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24). Qualitative thematic content analysis was performed.
Results: Most participants across all three countries made no distinction between the prevention of the common cold and influenza and referenced the same preventative measures for both conditions. They mainly expressed negative attitudes towards influenza vaccination possibly effective but only intended for high-risk groups (bedridden/older people, chronic patients or health workers). There were very few cross-country differences in results.
Conclusion: The perception of health risk of contracting influenza and a primary healthcare physicians' recommendation played an important role in shaping participants' decisions towards vaccination. Primary healthcare physicians are invited to assess and if necessary adjust inappropriate prevention behaviour through their everyday patient consultations as well as add to the knowledge about influenza severity and influenza vaccination benefits to their patients.
The paper explores lay persons' perception of common cold and influenza as well as their experience in treatment and prevention of those conditions, with emphasis on the reasons impacting their ...decision towards influenza vaccination. 24 semi-structured, individual interviews were conducted, then transcribed and analysed to find emerging themes and subthemes. Textual data were explored inductively using content analysis to generate categories and explanations. Five major themes and explanatory models of lay persons' perspective emerged from the data. The participants expressed satisfying knowledge regarding influenza and common cold symptoms, length, transfer and treatment options describing a clear distinction between the two diseases. On the other hand, they mentioned the same general preventive measures for both common cold and influenza, considering influenza vaccination primarily an option for chronic, old or bedridden patients and health workers. Factors facilitating the vaccination decision making process included the recommendation by health professionals (mostly general practitioners), anxiety about influenza and possible complications, existence of chronic diseases and a positive vaccination experience. The main reasons against vaccination stated by participants were the perception of being at low risk for influenza, opinion that vaccination is necessary only for bedridden and old people, chronic patients or health workers, and questionable effectiveness of the vaccine. Participants' influenza vaccination knowledge was insufficient, which should inform further interventions, especially having in mind low vaccination rates. Since participants perceived a general practitioner's recommendation as a crucial factor in forming their positive attitude towards vaccination, practitioners are invited to assess and, when needed, modify inappropriate perception towards influenza prevention during person centred consultations.
The implementation of information systems into primary health care opened the possibilities of providing integrated and co-ordinated health care, improved in quality and focused on the healthcare ...user. The healthcare system, researchers, physicians, and patients have recognised the benefits offered by informatics, but also raised questions that have yet to be answered.
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