title: The role of the family in physical activity post-myocardial infarction
Creators: name: Birtwistle, S
Publisher: name: Liverpool John Moores University
Year: 2021

description: Engagement in physical activity (PA) post-myocardial infarction (MI) can reduce the risk of reoccurrence and mortality, whilst promoting improved health and wellbeing. However, uptake to PA through cardiac rehabilitation (CR) is poor. Family support has been suggested as a mechanism through which PA can be both promoted and sustained. However, little is known about how the family support patients’ PA post-MI. Therefore, the aim of this PhD was to explore the role of the family in post-MI patients’ PA experiences to make recommendations for how they can support positive PA engagement post-MI. Study 1 drew on interpretative phenomenology to understand how MI patients and family members experienced, and made sense of PA post- MI. Six families (1 post-MI patient, 1 family member) engaged in longitudinal semi-structured interviews approximately 1, 4-and 9-months post MI. Post-MI, patients appeared to go on a journey of learning to re-engage with PA leaving “normality”, (characterised as patients being able to do what they wanted and when) and transitioned to a “new normality”, (being active but within parameters of their experiences of the MI. The family appeared to go on and influence how patients experienced this journey also. The journey comprised three superordinate themes, ‘I can’t do what I was doing before’, ‘finding my way’ and ‘accepting this way’. The family appeared to influence post-MI patients’ PA, however because this was not always positive, it is worthwhile exploring how to support families support patients’ PA. Study 2 used semi-structured interviews with 14 cardiac rehabilitation practitioners (CRPs) to understand their views of family involvement in CR through the roles they can adopt in post-MI patients PA experiences. CRPs appeared positive about familial involvement in CR and identified three themes as roles family might adopt to influence post-MI patients PA engagement: ‘being a second pair of ears’, ‘’pulling back, pushing forward’ - keeping the patient within PA boundaries’ and ‘providing social support’. A fourth theme ‘factors that influence family support’ was found that influenced the level and type of social support provided by families. Family involvement post-MI appeared to be supported and welcomed by CRPs, particularly in the early stages of recovery, thus integrating them into the CR pathway appeared favourable. However, given the influence families have can be negative, looking at ways to support families through building positive health beliefs is worthwhile. Study 3 drew on the findings from studies 1 and 2 and adopted a co-production approach to develop a PA support resource for family members of MI patients and involved a series of development and acceptability meetings with post-MI patients, family members and CRPs. Findings led to the development of an information booklet and support pathway and were informed by qualitative data collected during the development and acceptability meeting/s. The information booklet included 4 key topics (‘your CR service’, ‘PA after a heart attack’, ‘what to expect this next year’ and ‘providing social support’). The support pathway offered a route to which the information could be delivered in practice. Co-production appeared an acceptable approach to resource development within cardiac care. However, given the early stage of the co-production, further work needs to be done to pilot and evaluate the resource in practice. This thesis highlighted the importance of family in helping promote post-MI patients’ PA engagement. However, family support may not always be positive, and appeared influenced by families own health beliefs. Integrating the family into the CR pathway appeared favourable to help ensure the support family provide patients’ is optimal. The development of an evidence-based PA support information booklet for families of post-MI patients and support pathway appeared a feasible route for how this may be achieved in practice. To see whether integrating family into the CR pathway and offering support positively impacts on post-MI patients’ PA engagement, further work could pilot and evaluate the information booklet and support pathway in practice.