In the UK, there are thousands of cardiac events every year, which include Myocardial Infarctions (MIs), heart surgery, device insertions and heart failure. The journey of each cardiac patient is likely to be influenced by many factors and follows three main temporal stages: symptom recognition and treatment, the offer of Cardiac Rehabilitation, and recovery. Symptoms may develop rapidly or more gradually. How one approaches these symptoms and the decisions made about health care can be highly personal and contingent on socio-cultural influences. Cardiac Rehabilitation will typically be offered as part of the journey. Levels of patient participation in Cardiac Rehabilitation in the UK, which is exercise-based, have been sub-optimal for many years. This relates not only to overall participation, but also specifically to numbers of women attending, and to those from deprived areas. Research examines inputs into, outputs and outcomes from Cardiac Rehabilitation, but to date, scant sociological attention has been given to the lived experience of the cardiac patient journey. Given that targets and initiatives have failed to instigate significant change in attendance rates at Cardiac Rehabilitation programmes, it is important to investigate in-depth some of the socio-cultural factors shaping and influencing (non)participation. Further, through the exploration of how individuals navigate the recovery stage following a cardiac event, insight can be gained into the complexities of ‘getting on with life’ following serious ill-health.
The theoretical framework offered by Pierre Bourdieu provides a powerful way of illuminating several key aspects in understanding socio-cultural influences on exercise and health, and healthcare decision making throughout the cardiac patient journey. This includes recognition of both structure and agency, and how the two may interact in the social world, guiding an individual’s chances and choices along the cardiac patient journey.
Ethnographically inspired fieldwork was conducted over a six-month period in the UK, during which, participant observations, repeat semi-structured interviews, and reflexive journaling were utilised. Reflexive thematic analysis subsequently enabled six key themes to be identified. These themes are discussed in three sections. The first explores the approach to symptoms, examining the influence of the habitus’ work, and how capital has been accumulated and deployed within the field of health care. The second examines Cardiac Rehabilitation (non)participation, noting how dispositional inclinations help shape the formation of practice, and thus how one may approach the offer of rehabilitation, and whether accessing this field is commensurate with the habitus. The third appraises the recovery stage and considers the corporeal and psychological impact of the cardiac event and how social actors might utilise their capital resources to renegotiate embodiment.
The study adds to the existing literature by illuminating some of the socio-cultural complexities associated with: health care decision making when experiencing cardiac symptoms, exercise experience in uptake of and adherence to Cardiac Rehabilitation, and the process of recovery. Most notably, participants’ material conditions and personal biography, and the influence of other people, were found to serve to constrain or enable the navigation of fields, such as health care and Cardiac Rehabilitation.