title: Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples' experiences.
abstract: BACKGROUND
  Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples' experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience.
  
  
  METHODS
  A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings.
  
  
  RESULTS
  The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was 'familiar' to 'unfamiliar'. The transition process involved 'finding new limits and a life worth living' , 'finding support for self' and 'finding a new normal'. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of 'reassessing past, present and future lives' as participants considered their changed identity. Participants experienced a strong urge to get back to 'normal'. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider 'life' change that occurred.
  
  
  CONCLUSIONS
  The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within 'wider' life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity shifted and emotions that reflected the various stages of the grief process were evident in participants' accounts. The process of self-managing lifestyle took place through experiential learning; the level of engagement with lifestyle change reflected an individual's unique view of the balance needed to manage 'realistic change' whilst leading to a life that was perceived as 'worth living'. Findings highlight the importance of providing person centred care that aligns with both psychological and physical dimensions of recovery which are inextricably linked.
authors.affiliation: School of Nursing, Midwifery and Social Work, Mary Seacole Building, Salford, UK. F.Astin@Salford.ac.uk.
authors.forename: Felicity
authors.initials: F
authors.lastname: Astin
authors.forename: Judith
authors.initials: J
authors.lastname: Horrocks
authors.forename: S Jose
authors.initials: SJ
authors.lastname: Closs
mesh_terms: D000223:Adaptation, Psychological; D003327:Coronary Disease / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D004644:Emotions; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology*; D011314:Preventive Health Services / Q000379:methods*; D036301:Qualitative Research; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012649:Self Concept
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