How plans change: Anticipation, interferences and unpredictabilities

Making sense of a myocardial infarction in relation to changing lifestyle in the five months following the event: An interpretative phenomenological analysis

OBJECTIVE

Previous research has shown that experiencing an acute cardiac event, such as a myocardial infarction (MI), can lead to lifestyle changes. This study aimed to explore the potential of a MI as a 'teachable moment' (TM) for positive lifestyle changes and to identify psychosocial sensemaking processes that facilitate or hinder the presence of a TM.

METHOD

We conducted semi-structured interviews with 14 patients who suffered their first MI and were hospitalized in a larger Dutch city. Participants were interviewed twice, respectively one and five months after their hospitalization. They were encouraged to explain how they experienced their MI and how this had affected their lifestyle. We used an Interpretative Phenomenological Analysis approach to the data collection and analysis.

FINDINGS

The participants varied in their willingness to adopt a healthy lifestyle due to their MI. Most participants experienced their event as a TM for changing specific health behaviors, for example facilitated by reflecting on self-concept or social roles and by constructing and comprehending a personal narrative of their MI. Some participants struggled to follow through on their intentions to change their behavior, for example because of a negative attitude towards a healthy behavior or because they perceived it as incongruent to their identity. Only three participants maintained most former health behaviors, for example because they failed to acknowledge their MI as severe or because of earlier life events that elicited more blunted cognitive responses.

CONCLUSION

Cardiac patients may experience a TM, which is the consequence of interrelated processes of psychosocial sensemaking. As this does not occur at a singular time point, we suggest using the term 'teachable window' rather than 'moment'. Given these findings, there is a window of opportunity to provide continuous psychosocial and lifestyle support during and after hospitalization for acute cardiac events.

Crisis, recession and social resilience: A biographical life course analysis

This article examines social resilience to the economic crisis and recession across three 'generational cohorts' of Irish people, using a mixed biographical life course approach. Drawing on narrative interviews and individual lifelines conducted as part of a cross-national European study, we describe and explain how age-differentiated lives and times intersected with ill-timed transitions and patterns of inter-generational relations, leading to variations in resilient future orientations. Our analysis yields three key findings. First, failed expectations for intra-generational social mobility, combined with inter-generational obligations, gave rise to negative future orientations amongst those in mid-life. Second, the crisis created multiple negative life changes that compounded the accumulated costs of poorly timed transitions and adverse experiences within biographies. The effect of this varied by generational cohort, life course stage (with its implications for inter-generational obligations), gender and social class. Third, both life course stage and biographical experience affected peoples' orientations towards the future, with implications for their resilience.