Commentary on Kristofferzon M-L, Löfmark R & Carlsson M (2007) Striving for balance in daily life: experiences of Swedish women and men shortly after a myocardial infarction. Journal of Clinical Nursing 16, 391–401


  • Doris SF Yu PhD, RN,

  • David R Thompson PhD, RN, FRCN, FESC

David R Thompson, Professor, Department of Health Sciences, University of Leicester, Leicester, UK. E-mail:

Myocardial infarction (MI) poses a serious threat to individuals and often disrupts the normal functioning of almost every aspect of their daily lives. Information about the experiences of men and women after MI is important to inform the development of needs-led, individualized cardiac care and rehabilitation, yet there is a paucity of qualitative studies investigating this issue.

Kristofferzon et al. (2007) attempted to address this deficiency with a phenomenological study of the daily life experiences of Swedish men and women during the time from the onset of the MI to the interview, conducted four to six months later. The analysis generated three themes –‘threatening ordinary life’, ‘struggling for control’ and ‘the ambiguous network’– and a general pattern ‘striving for balance’. It is, however, not clear whether any analysis was undertaken to examine the process of adjustment of the patients after MI. The information presented in the different themes was discrete and even contradictory. For example, in the theme ‘threatening ordinary life’, the hindering factors for lifestyle change for women and men were respectively described as the ingrained habits of family members and low motivation of patients. However, the information in the theme ‘struggling for control’ indicated that women identified family as an important support for lifestyle changes and men tried to take their own initiative to change unhealthy habits. Also, in the theme ‘the ambiguous network’, the authors stated that women had problems in knowing what to ask the formal caregiver, but in another paragraph, women were found to appreciate the dialogues with the cardiac nurse while they were seeking health advice. Such inconsistencies might be because of the fact that the patients were describing their situations at different times during the four to six months after the MI. Perhaps what is needed now is research that explores the way patients’ situations change over the recovery period. Such information would be valuable in offering nurses and other health care professionals insights into the factors that are likely to facilitate or hinder successful adjustment to MI. As previous studies have only examined the adjustment process in female patients (Kerr & Fothergill-Bourbonnais 2002, Sutherland & Jensen 2000, Tobin 2000), information about gender differences in this regard is needed.

Kristofferzon et al. (2006) focused on problems, managing problems and social support. Although the study identified gender differences in these areas, most of the findings do not appear unique or particularly different from previous studies of men and women with MI (Tobin 2000, Kristofferzon et al. 2003). However, there were some exceptions. For example, the finding about men's positive illness behaviour in response to chest pain was very different from that of the study by White and Johnson (2000), in which men reacted with denial to maintain their self-concept as ‘healthy’. The high social support of women also contrasted with an earlier review paper by the same authors (Kristofferzon et al. 2003). Comparing and contrasting the different aspects of these studies, in fact, might provide important cues to explain the differences in internal and external coping resources of patients after MI, and it is, perhaps, surprising that the authors did not allude to this in their paper.

The process of adjustment to MI is complex and, although previous studies consistently report that patients initially attempt to make sense of a very disruptive situation and try strategies to return to a state of equilibrium, success is likely to be affected by a variety of factors, including gender and social network. Research should start to focus on issues such as: how does this process operate, what are the other possible influencing/mediating factors, how is a patient's coping resources affected, and to what extent should an MI be regarded as an issue in the patient's family and social contexts. The provision of such information would help shape the organization and delivery of cardiac care and rehabilitation services that play such an important role in assisting individuals to return to a normal life (Thompson 2002).