Jill Murie
Aim To explore post-myocardial infarction (MI) patients’ perceptions of a patient-mediated intervention (PMI) for secondary prevention of coronary heart disease (Scottish Intercollegiate Guidelines Network (SIGN) Guideline 41), the extent to which their expectations are currently being met and a collective proposal for a newmodel. Method Qualitative study involving six post-MI patients who, in a workshop and focus group discussion:individually assessed 46 existing materials,collectively selected the most appropriate and relevant material, described the characteristics of an ‘ideal’ intervention and designed a newPMI for the implementation of SIGN Guideline 41.Results Of the 46 materials examined no intervention was considered ‘really good’. While none was ‘wholly irrelevant or bad’, patients identified a lack of information on targets and facts about cardiac surgery. While patients generally accepted cardiologists’ recommendations, there was uncertainty about ‘risk’ and a preference for material thathelped them make informed choices about treatment options. Patients reported that existing materials are introduced too early when they feel unable to assimilate information. They expressed a need for greater carer involvement early post-MI. Patients demonstrated the capacity to work within a framework defined by SIGN Guideline 41. A model for a graded, interactive intervention to provide and assess knowledge and support empowerment wasproposed. Rehabilitated patients demonstrated a willingness to adopt befriending roles. Conclusion This study suggests that existing interventions are not meeting the needs of post-MI patients. Efforts to develop, pilot and implement patient-mediated interventions to assist selfmanagement should continue.
