Understanding dietary decision-making in patients attending secondary prevention clinics.

Purpose: Secondary prevention clinics are becoming
common, yet many individuals are not implementing nor
maintaining the necessary lifestyle changes (EUROSPIRE
I and II Group 2001). Research has focused on
compliance in general, and only a small number of
quantitative studies address the issues specific to dietary
modification. This study aimed to explore the decisions
patients attending a secondary prevention clinic make
regarding their diet after a heart attack. The objectives
were to discuss individual experiences of following dietary
recommendations, and to explore the appropriateness of
advice received.

Method: Interpretive Phenomenology was felt to be the
most appropriate approach for this qualitative study
enabling patients' lived experiences to be explored. A
purposeful sample of nine post-myocardial infarction (MI)
participants were selected from a cardiac secondary
prevention clinic. Semi-structured interviews were taped,
transcribed and analysed using a method described by
Colaizzi (1978).

Results: Interpretation of the results revealed six themes
influencing patients' decisions related to dietary modification
after an MI. There were three enabling factors: fear,
determination and self control. Conversely three disabling
factors were identified: poor recall of information, a need for
additional support and a lack of will power. Patients'
motivation and ability to continue healthy eating can decline
as disabling factors depress their determination and self
control, and initial fear subsides.

Conclusion: This study highlights the precarious balance
patients endeavour to achieve in order to make advised
dietary changes. Fear of disease progression is a powerful
incentive initially, and when coupled with determination and
self control positive dietary changes are made. However,
patients find it difficult to recall initial advice and without the
necessary support or will power poor dietary habits can
return.

The study has produced a valuable insight into the issues
influencing patients' compliance with dietary recommendations
following a heart attack, revealing that health care
professionals need to be proactive in maintaining motivation
and re-iterating advice in order to help patients overcome
disabling factors. This knowledge may be useful in
developing the dietary advice strategies nurses provide to
patients who have had a heart attack in order to facilitate long
term dietary improvement.