Paper
Thursday, July 12, 2007
Cognitive Maps of Women with Coronary Heart Disease
Joy A. Pollard, Nursing, University of Michigan, Ann Arbor, MI, USA
| Learning Objective #1: understand that both representations of cognition and emotion impact women's individual Illness Representation structures and responses to coronary heart disease. |
| Learning Objective #2: recognize the impact of healthcare systems and gender roles on women with CHD in the United States. |
By 2010 an estimated 40 million persons aged 65 and older in the United States will have CHD. This will have a profound impact on women, as CHD is more prevalent over age 65, prognosis is worse for women than men and women often report being disabled by their symptoms. Lack of understanding about stimuli integration, impact of CHD care systems, and expectations for health decision making on the lives of women with CHD generated the impetus for this research.
Philosophical and theoretical structures of phenomenology, cognitive maps, and Leventhal’s Illness Representation Model grounded the research. Design was qualitative with a mixed method analyses. The sample consisted of 41 women with documented CHD. The conceptual content cognitive map (3CM) method with affective coding and Likert scale rank of importance was employed. Data analyses were sequential thematic and pattern analysis employing the QSR NVivo software program, SPSS analyses of frequency, and correlation analyses.
Themes included physical symptoms, healthcare system interactions, emotional responses, medications, co-morbid conditions, comparison of self to others, effects on family and independence, risk factors, and health responsibility attributions. Negative emotional responses were correlated with physical symptoms, a focus on risk factors, and limits to independence. Ambiguity of symptoms led women to report “surprise” at their diagnosis and inability to define an Illness Representation symptom label. Symptom duration was the least articulated illness representation structure. Cause, focused on exercise, diet, and family history. Representations of medications and treatments indicated a strong belief that the scientific perspective could cure/control CHD. Consequences were linked to gender roles and social obligations.
Representations confirmed CHD complexity. Over 95% of women identified emotional representations, consistent with a dual processing of cognition and emotion that impacted stimuli integration. The women described a culture of medical authoritarianism where health professionals frequently acted as surrogate social support.