Incentives for lifestyle changes in patients with coronary heart disease


  • Anita Kärner RN PhD,

  • Pia Tingström RN PhD,

  • Madeleine Abrandt-Dahlgren RPT PhD,

  • Björn Bergdahl MD PhD

Anita Kärner,
Department of Medicine and Care,
Division of Cardiology,
Faculty of Health Sciences,
Linköping University,


Aim.  This paper reports a study exploring how patients in the rehabilitation phase of coronary heart disease experience facilitating and constraining factors related to lifestyle changes of importance for wellbeing and prognosis.

Background.  Lifestyle change is important but complex during rehabilitation after a myocardial infarction or angina pectoris. The intentions to perform behaviours and to experience control over facilitators and constraints are important determinants of behaviour.

Methods.  A total of 113 consecutive patients below 70 years of age (84 men and 29 women) were interviewed within 6 weeks of a cardiac event and again after 1 year. Interview transcriptions and notes taken by hand were qualitatively analysed using the phenomenographic framework. The distribution of statements among the categories identified was quantitatively analysed. The data were collected in 1998–2000.

Findings.  Four main categories portrayed patients’ experiences of facilitating or constraining incentives for lifestyle changes. ‘Somatic incentives’ featured bodily signals indicating improvements/illness. ‘Social/practical incentives’ involved shared concerns, changed conditions including support/demand from social network, and work/social security issues. Practical incentives concerned external environmental factors in the patients’ concrete context. ‘Cognitive incentives’ were characterized by active decisions and appropriated knowledge, passive compliance with limited insights, and routines/habits. ‘Affective incentives’ comprised fear of and reluctance in the face of lifestyle changes/disease, lessened self-esteem, and inability to resist temptations. Cognitive incentives mostly facilitated physical exercise and drug treatment. Social/practical incentives facilitated physical exercise and diet change. Physical exercise and diet changes were mainly constrained by somatic, social, and affective incentives.

Conclusion.  The results illustrate important incentives that should be considered in contacts with patients and their families to improve the prospects of positively affecting co-operation with suggested treatment and lifestyle changes.