The participants (n = 4, 2 women, 2 men) discussed medicine taking through four superordinate themes (Table 1); they compared themselves to others, knowledge was important to them, they considered the future in some form, and they discussed ways that they fitted their medicines into their lifestyle. A related theme to lifestyle, all participants discussed how a change to their routine adversely affected their medicine taking. They all described their AMI as a “heart attack”, and so this term is used henceforth. The superordinate themes are presented with interview quotes for Gaye (Table 2), Beki (Table 3), Chris (Table 4) and Colin (Table 5).
Table 1
Summary of Themes as Mentioned by Participant
Superordinate theme | Subtheme | Mentioned by Participant |
| | Gaye | Beki | Chris | Colin |
Comparison to others | Health conscious | • | • | | |
Unusual case | • | • | • | |
Parallel self | | | • | |
Compare to acquaintance | | | • | |
Compare to relatives | | | • | |
Chance affects health | | | | • |
Dislike of being labelled with diagnosis | | • | | |
Knowledge | Medicines information | • | • | • | • |
Question cause | • | • | | |
Question medicines | • | • | | • |
Self- Perception (Medicines) | • | | • | |
Self- Perception (Fitness) | • | | | • |
Self-perception (Medical) | | | • | • |
Cynical of care | | • | | |
Overcome medicine issue | • | | • | |
Seeking information | | • | | • |
Theoretical knowledge | | • | • | |
Practical knowledge | | | • | |
Follows professional advice | | • | | • |
Seeking superior healthcare | | | | • |
Paying for healthcare | | | | • |
Sharing knowledge | • | | | |
Strength in number | • | | | |
Considering the future | Planning ahead | • | • | | |
Indefinite | | • | | |
Continuous future | | | | • |
Unknown future | • | • | | |
Assimilation into lifestyle | Initial overwhelmed | • | | | • |
Concern for timing | | | | • |
Continue as usual | | | • | • |
Adapting to incorporate change | • | | • | |
Taking medicine is unremarkable | • | | • | • |
Unconcerned with adherence | | | • | • |
Child is priority | | • | | |
Concern for partner’s anxiety | | • | | |
Made own system | | | • | |
Concern for efficiency | | | • | |
Constructed relationship with regular medicines | | | • | |
Physical issue | • | | | |
Side effect tolerated | | • | | |
Side effect unacceptable | | • | | |
Location of medicine | | • | • | • |
Disturbance to Routine | Being out of the home | • | • | • | • |
Being on holiday | | | | • |
Distracted by activity | | • | • | • |
Changing of timings | | | | • |
Table 2
Superordinate Themes and Example Interview Quotes from Gaye
Superordinate Theme | Theme | Quote | Transcript Line Reference |
Comparison to others | Health conscious | Lifelong vegetarian Never taken medication ...Because I was living that lifestyle (Re: survival) As fit as a butcher’s dog | 44 65 152 169 |
Unusual case | Didn't fit the bill for anyone having a heart attack Didn’t fit anyone’s profile | 43 48 |
Knowledge | Medicine information | [Medicine names, dosage and times] | 77, 79 |
Question cause | Why had it happened, | 146 |
Question medicines | Are they doing what they’re supposed to? What would happen if I didn’t take them? How does the combination work? | 219 220 234 |
Self- Perception (Medicines) | Am I on the highest? Am I on the lowest? | 224 |
Self- Perception (Fitness) | No idea of what level you’re at | 176 |
Sharing knowledge | I told her what I'd been told | 187 |
Strength in numbers | Collective support (re: rehab group) | 234 |
Considering the Future | Planning into the future | To be seen in a couple of years | 172 |
Indefinite | Continue to have to take these | 241 |
Continuous future | Forever and being compliant | 242 |
Unknown future | Not knowing where I was heading... | 152 |
Assimilation into lifestyle | Overwhelmed initially | Started off with a whole raft of things | 52 |
Physical issue | Could never swallow medicines | 92 |
Overcome issue | Always have to have grapes | 113 |
Taking medicine is unremarkable | It’s just a routine now | 107 |
Disturbance to Routine | Being away from home | Can be a bit difficult when you’re travelling | 113 |
Distracted by activity | Been a particularly busy day, it’s not until the evening when I thought, ‘Crickey!’ | 109 |
Table 3
Summarised Themes and Example Interview Quotes from Beki
Superordinate Theme | Theme | Quote | Transcript Line Reference |
Comparison to others | Health conscious | Training for the marathon Planning on starting a family Never smoked Been this weight since...a teenager | 5 137 259 558 |
Unusual case | I’m not kind of, your normal case The youngest person on the cardiac ward I’m not your fat sixty or seventy year-old man My heart function is normal My heart has no damage to it | 628 607 95 456 458 |
Dislike of labelling | I hate that term (re: saying I have heart disease) | 448 |
Knowledge | Medicines information | [Medicine names, dosages, timings] | 77, 78,79, 159, 190, 192, 222, 246, 248 |
Self-perception (Medical) | Cholesterol...high for me All of the data | 256 116 |
Seeking information | Load of Googling A bit of PubMed searching A UK Facebook group A lot of my friends are Doctors Spoke to a friend... endocrinologist Sister-in-law is a consultant | 422 656 427 696 657 734 |
Cynical of care | They were generally a bit rubbish The ECG technician will answer your question Here's a bag of stuff A whole leaflet of aftercare The woman that hands me... probably has no clue | 99 105 293 296 976,977 |
Considering the Future | Future unknown | Try not to dwell, may happen again | 461,462 |
Continuous future | Every day for the rest of my life (re: taking medicine) | 344 |
Planning ahead | Lipids done every year Making an appointment Four medicines every six weeks | 964 622 648 |
Assimilation into lifestyle | Consistent location | They're all in the kitchen Down in the kitchen | 477 375 |
Reason for location | Out of the way Aspirin has to go in water | 478 374 |
Child is priority | Had stopped taking the (contraceptive) pill Came off statin, clopidogrel Breastfed him A break while I was pregnant | 156 177 186 971 |
Concern for partner’s anxiety | Look like a battered wife (re: bruising as side effect) My poor husband... woke up, thought I was dead (re: coldness as side effect) I think my husband worries about it more than I do | 902 141 142 442 |
Side effect tolerated | For the sake of a year, it’s fine (re: clopidogrel causing bruising) | 921 |
Side effect unacceptable | Felt like wading through treacle | 138 |
Disturbance to Routine | Being away from home | I think probably I was out and thought, ‘oh yeah’. | 492, 494 |
Distracted by activity | Just didn’t ’cause I came home and went straight up to bed | 495 |
Table 4
Summarised Themes and Example Interview Quotes from Chris
Superordinate Theme | Theme | Quote | Transcript Line Reference |
Comparison to others | Parallel self | That was the heart attack that would have been fatal And er, if we hadn’t gone – who knows? Thinking - I've got cancer | 52 85 523 |
Comparison to an acquaintance | You know, just passed away on the spot | 66 |
Comparison to relatives | I have two brothers. Both younger. He had a triple. He needed a bypass, but because of his head (re: other brother has pacemaker) We do compare notes between us | 942 944 949 968 |
Unusual case | My heart was undamaged My heart had found ways of getting supplies from other channels It was a re-plumbing job - it wasn’t a heart repair job, which I think was quite significant | 926 924 936, 937, 938 |
Knowledge | Medicines information | [Names, doses, times and identification of medicines] | 169, 182, 183, 194, 195, 196, 223, 273, 284, 285, 286, 474 |
Theoretical knowledge | And also one used for epileptics Which is again, a drug normally used for Parkinson’s disease | 180 190 |
Practical knowledge | Intelligently, I have, you know (re: self-adjusts dose) Self-diagnosed, self-prescribed Did off my own back | 558 500 563 |
Follows advice of professionals | I’ll stick with that one Wouldn't stop taking that one without taking advice ‘Cause it helps with the heart rate If that’s what they say, I won’t question | 581 582 579 976 979 |
Self-perception (Medicine) | I’m on about as low as you can get | 575 |
Self-perception (Medical) | My readings seem to come out OK | 218 |
Assimilation into lifestyle | Continuing as usual | And I’m taking it when it fits in with my life Just throw in the morning ‘cos it’s more convenient to me Take them when it fits me | 205 217 227 |
Adapting to change in routine | And I get on with it ‘cos it’s only short-term (re: antibiotic course) I’d probably do one of those for the flight time (re: small pill box) It lived in the car all day...Wanted to make sure I had the afternoon ropinirole with me | 340 357 368,370 |
Taking medicines is unremarkable | Sort of, pick them up, chuck them in and swallow them And taken without thinking It’s whatever’s in front of me Like having a cup of coffee or a glass of wine (analogy: routine) Coffee for that, wine for this (analogy: cultural) | 297 113 292 535 1092 |
Location of medicine | This square box with a green lid that’s got everything in Sometimes it's in the kitchen Sometimes the worktop, sometimes the cupboard | 361 364 365 |
Constructed relationship with regular medicines | My normal, you know, cocktail A routine, daily medicines, wall to wall Doesn’t become a part of the family of the rest in my box (re: antibiotics) It's a bit of an intruder | 343 1023 336,337 339 |
Made own system | Works absolutely brilliantly That's my method Sorry, but that’s the way I do it | 361 389 391 |
Concern for efficiency | A tenth of the time it would the other way (re: decanting medicine) It’s very time-saving An absolute disgrace (re: overpackaging) | 433 434 415 |
Unconcern with adhering to doses | Wouldn't have bothered me None are things that are life threatening if I miss a day or take too many Totally relaxed There’s no hassle or stress or anything, on it | 500 464 467 478 |
Disturbance to Routine | Distracted by activity | Something distracted me and I was doing something unusual late last night, I went to bed and forgot that I'd not taken my pills | 483 497 |
Table 5
Summarised Themes and Example Interview Quotes from Colin
Superordinate Theme | Theme | Quote | Line Reference |
Comparison to others | Chance affects health | I was pretty unlucky to have a clot I’m just so lucky really | 469 729 |
Knowledge | Medicine information | [Medicine names, doses, timing] | 26, 28, 29, 30, 31, 32 |
Seeking superior healthcare | That’s when we decided to see the consultant privately For longer than most people would recommend Said ‘stay on the clopidogrel for a further year’ Even though the reports say that its rubbish He reckons that it’s worthwhile This consultant, who I trust, said take them He’s pretty well-regarded in his profession | 181 76, 77 97 218 219 390 653 |
| Seeking information | Read the leaflet about what they do and what the side effects are | 629 |
| Self-Perception (Medical) | Always was fine and always is fine Stable ever since Been settled for quite a long time Not in the last, probably nine years Been taking them for such a long time Drug has built up inside me | 147 161 202 505 338 340 |
| Self-Perception (Fitness) | I managed a good peak time A very good walking time | 64 153 |
| Financial exchange to access healthcare | The National Health wouldn’t provide them BUPA don’t think it’s entirely necessary Certainly our GP, they won’t pay for that. That's up to me. Surgery stopped paying for Omacor, it was do it yourself, if you want it I can afford it, let's put it that way. | 83 137 138 141 452 |
Considering the future | Continuous future | I just have to take these forever | 169 |
Assimilation into lifestyle | Initial difficulty | It was all so new then They just said you’re on these, and go Wasn’t in the best for a couple of days A bit difficult to know what each one was doing Felt disappointed that I was going to take medication | 22 178 136 37 172 |
Taking medicine is unremarkable | Just as routine as having a cup of tea Just take them and get on and do things It takes 30 seconds, what's the problem? | 379 391 404 |
Unconcern with missed doses | I don’t notice that I’ve taken anything I don’t get worried if I don’t take them I don’t notice on a daily basis I miss one then never notice any difference | 209 366 497 501 |
Location of medicines | In a little pouch, there the whole time Leave them out, just to remind me Take upstairs, to be by my case Take out the next morning’s medication The evening medication, and put cling film over that Will always have that in my pocket (re: GTN spray) Whereas I’ll clear everything else out of my pocket | 293, 294 290 607, 608 610 612 973 978 |
Disturbance to Routine | Distracted by activity | When all the family were here The routine is a bit different (re: holiday) | 312 591 |
Change of timings | Timing dosages to that of the place we are going (re: time zone change) Might be wider or less | 327 329 |
Comparison to Others
One of the superordinate themes was the way in which participants focussed on their history and lifestyle leading up to their heart attack in reference to other people, often evidencing that they were in a superior position, and as proof that their body was healthier by managing to survive the heart attack.
They frequently gave examples of how they were health conscious. They considered that vegetarianism, non-smoking, training for a marathon, preparing for pregnancy, and gym attendance to be attributes that made their health superior. Most participants were keen to point out how they are different from ‘normal’ heart attack patients, in terms of healthy living status, gender, age and type of heart attack. They used their own biometric results to compare their health to normal ranges as justification that their health is comparable to ‘normal’. They also described similar diagnoses in acquaintances, friends and relatives to discuss how their case was different, with the implication that their case was less morbid. Colin defined himself in terms of luck.
Knowledge
The superordinate theme of knowledge encompassed a range of themes that included questioning the cause of their heart attack and need of their medicines, seeking information, having a theoretical and practical knowledge of their medicines, sharing information with others and receiving support as part of a group. The category of knowledge also encompassed self-perception, including participants' understanding of their own medical status, fitness, and medication.
All participants were able to describe their medicines and medical treatments. In addition, they showed curiosity to know about their treatment, either finding answers themselves or using the knowledge of others. Gaye articulated her lack of knowledge about her medicines.
All the participants could recall the names, timings and strengths of their medicines, often referring to paper copies of medical notes during their interview, although these were not requested by the researcher. They found information through hospital consultants, GPs, acquaintances, family, support group and rehab group members. They used sources such as medicine information leaflets and academic-level databases. Two participants sought the knowledge of a private consultant, reasoning that the consultants’ professional status conferred a better level of care. One participant linked private healthcare with receiving better care and economic status.
Considering the Future
This superordinate theme was drawn out by all participants as they invoked the idea of the future in all their narratives. Gaye, Beki and Colin all mentioned taking medicines continuously into the future, using an almost identical phraseology of “having to take these forever”, and Beki’s “every day for the rest of my life”.
Gaye mentioned that the future is unknown in terms of heart health, and Beki considered that another heart attack is possible. Colin used the future conditional tense as he talked about having taken his medicine for such a long time “it had built up inside”, and that if he missed a dose, it “shouldn’t be a problem”.
Assimilation into Lifestyle
Another broad superordinate theme was assimilation of medication into the participants’ lives. All participants relayed how they accommodate their medicines into their everyday routine in a unique way. This group included themes of personal relationships, medicine location, systems and adaptations.
Gaye and Colin discussed being overwhelmed initially, but then how taking medication has become part of their everyday life. They both described the routine they had created, now as unremarkable and not noticeable. Both Beki and Chris mentioned a difficulty, Beki because of the side-effect, and Chris because of the extra quantity to remember, but they persisted with their set treatment.
Gaye began with swallowing difficulties but was given a “tip” by a pharmacist, and now takes medications simultaneously with a grape.
The location of medication was discussed as a practical decision or based upon their beliefs. Beki sites her medication in her kitchen, “out of the way” as her son’s safety is a priority. Chris decants all packaging and keeps them mixed in a Tupperware box, as an efficiency measure. Colin keeps his medication in a pouch which remains in one location at home, his GTN spray is the only item that he will carry in his pocket whilst at the gym.
Beki discussed how her pregnancy took priority over her medicine taking, as she stopped taking some of her medicines.
Chris and Colin talked about medicine-taking as an effortless activity, both using the analogy of coffee and tea-drinking to describe the automatic nature of taking medicines. Chris compared cultural drinking to taking different medicines, “coffee for that, wine for this”.
Neither Chris and Colin were concerned about missing doses, Chris reasoning that missing medicines wasn’t life-threatening, and Colin because he doesn’t notice any difference.
Disturbance to Routine
All the participants discussed how a disturbance to their daily routine could result in their missing a dose of medication. Disturbances included being away from home, being on holiday, and distraction by another activity.
Being away from home was discussed as a reason by all participants. Gaye talked about going out and forgetting her evening dose of statin. Beki suggested that she might be out and forget to take a dose. Chris took his medicine box out with him to ensure he didn’t miss doses.
Colin’s wife gave him verbal reminders when away on holiday and he mentioned different time zones causing confusion.
Chris gave the example of being absorbed on the internet and so went to bed without taking the evening dose. Colin discussed missing doses when his family came to stay at his home.