Lived experience of cardiovascular disease: A dialogical narrative analysis

BackgroundCardiovascular disease (CVD) contributes to a third of all deaths from Myocardial Infarction (MI) and is one of the leading causes of morbidity and mortality, resulting in significant human and economic cost globally. Prevention and management strategies for CVD concentrate on modifying risk-factors and promoting personal responsibility for healthy lifestyle choices (World Heart Federation, 2023). Globally and nationally, rates of CVD remain high despite decades of behaviour modification policy and practice initiatives. This study seeks to understand the impact of responsibilisation discourses by investigating how people make sense of their illness to inform decision-making about health practices following Myocardial Infarction.MethodFollowing a critical discourse analysis of CVD policy, an interpretive narrative methodology was employed to collect and analyse illness stories. Ethical approval was granted to conduct interviews, and collect photographs and diaries from 16 participants, using purposive sampling methods. Using Dialogical Narrative Analysis (DNA), plots and subplots were identified, and themes and narratives were constructed through a dialogue with the data to explore stories ‘told’ and what these stories ‘do’. Typologies were then constructed from the spaciotemporal structures in story.ResultsFour narrative typologies: Enduring, transformative, waiting, and overtaken were identified. Findings demonstrated the changing relationship between the body, space and time in chronic illness. Spaciotemporal structures in the narratives show how clinicians’ practices were structured by thinking about illness as acute, linear and curative, compared to patients, who gave non-linear stories about managing long-term illness. Experiences of marginalisation are revealed through story.ConclusionPrioritising voice, findings from this study have implications for how narratives function to inform and sustain health practices, with consequences for the strategies and interventions used by clinicians to support individuals following MI. Results also reveal limits to ongoing debates about personal responsibility for modifying behaviour that influence CVD health policy strategy. Findings expose experiences of testimonial injustice that are suppressed by alternative narrative frameworks.