``It's up to me with a little support'' - Adherence after myocardial infarction: A qualitative study

Background: Ischemic heart disease and stroke remain the leading causes of death globally. Poor adherence to treatment amongst patients with chronic health conditions is a global unresolved problem of enormous magnitude. Despite extensive research in the field of adherence behaviors, few studies have focused on motivational aspects that can enhance adherence from the patients' points of view post myocardial infarction.

Aim: To gain insights into the perceptions that underline health-related adherence behaviors, from the perspective of patients who experienced a heart attack.

Design: A phenomenological approach.

Methods: The study used a content analysis method, with qualitative criteria to establish trustworthiness. Interviews were conducted with a purposive sample of 22 participants post myocardial infarction, recruited from a hospital cardiac rehabilitation program and communities in Northern Israel.

Results: The abstraction process generated two main categories and six sub-categories imbedded in the Self Determination Theory framework. While inner self determination or willpower, as expressed by the participants, was perceived as the most crucial motivator, it was insufficient. A sense of self competency and the ability to tailor life changes, according to personal preferences, is needed to turn willpower into practice. Extrinsic motivators such as family members, especially spouses and health professionals, are important to strengthen intrinsic motivation. Attitudes of caring, respect for values, and autonomy as opposed to patronization were perceived as helpful. The benefits of a cardiac rehabilitation program were articulated by attendees of the program in contrast to excuses by non-attendees CONCLUSION: Understanding adherence as a complex holistic phenomenon could advance theoretical insights and enhance adherence to therapies and healthy lifestyle among people post myocardial infarction.

Impact: Study findings may advance the self-care of people with long-term health conditions, and assist professionals to conduct interventions that strengthen adherence. Increased adherence can impact life expectancy, quality of life, and reduce the economic burden on health care systems and societies.