Table 6 Joint display of changes in physical activity, dietary quality, quality of life, anxiety, depression, and self-efficacy

Physical activity > 30 min

17

0–1 times per week

5 (29)

2( 12)

2 (12)

No overall changes in physical activity. However, totally sedentary behavior (physical active 0–1 times per week) is reduced at follow-up

Most mentees work out in various workout settings in their communities

I have been offered and accepted a 3-month rehabilitation course at the gym where I go twice a week. (Owen, 78 years)

All the mentees recognize themselves as active in their daily lives compensating or supplementing the offered physical training sessions at CR. Some of the participants follow exercise instructions at home

I have been given a schedule of what exercises I should do from the hospital, so I have been working out at home with myself. (Allan, 78 years)

Expansion. No overall increase in physical exercise could be detected.

However qualitative data expands knowledge of mentee physical activities. As mentees practice a variety of psychical activities at the cardiac rehabilitation program or at home

2–4 times per week

4 (24)

7 (41)

4 (24)

5–6 times per week

1 (6)

2 (12)

3 (17)

7–7+ times per week

7 (41)

6( 35)

8 (47)

Dietary score

13

Fat score (0–100)

60 (47, 25–77, 25)

63 (50–77, 50)

70 (54,50–79, 59)

0% mentees practice a heart-healthy diet. And no overall improvement in heart healthy diet was observed. However, there was a 10-point increase in fat score

None of the mentees have changed their diet post MI. Some because they do not feel like going through the trouble of trying to eat differently

My daily life is the same. I eat the same as before. I haven’t changed anything... well, I do go for more walks now and exercise at a gym (Allan, 78 years)

Others believe they practice a healthy diet already eating vegetables, fish, and whole-grain and see no reason to optimize their diet accordingly

I haven’t changed anything in relation to diet or workouts. I have always eaten healthy and lived an active life (Annie, 69 years)

Discordance

Qualitative and quantitative findings are discordant. Qualitative data suggest that mentees regard themselves as practicing a healthy diet; however, quantitative data suggest that none of the mentees practice a heart-healthy

diet

15

Fish/fruit/vegetables score (0–100)

52 (45–61)

53 (42–59)

49.0 (45–58)

Heart healthy diet

15

Yes

0 (0)

0 (0)

0 (0)

No

15 (100)

15 (100)

15 (100)

Quality of life

15

HQol emotional (0–3)

2.25 (1.50–3.00)

2.75 (2.00–3.00)

3.00 (2.75–3.00)

Overall improvement in quality of life

Mentees live their life frontstage and view the heart disease as backstage. Living with a heart disease and the risk of potentially new cardiac events does not occupy the daily lives of mentees. Constrains, due to MI, would negatively impact the quality of life of the mentees and is therefore avoided

If we constrained ourselves all the time our quality of life would be very negatively impacted…we don’t want to go there. Maybe it would get you to be 95 but 90 is fine too (Annie, 69 years)

The mentees have their focus on living their lives without worrying about the future

My heart disease is backstage in my life…I don’t think about it that often (Todd, 77 years)

Expansion. Quantitative findings indicate an improvement in quality of life. Qualitative findings expand this, by showing how mentees view the heart disease as backstage and life as frontstage, thus prioritizing their quality in life post MI, avoiding constraints that could limit quality of life

15

HQol physical (0–3)

1.80 (0.90–2.29)

2.30 (1.70–2.90)

2.50 (1.80–3.00)

15

HQol global (0–3)

1.86 (0.93-2.36–

2.25 (1.79–2.86)

2.50 (2.07–3.00)

Anxiety score

16

0–7, no anxiety

11 (69

14 (88)

13 (81)

31% of the mentees experience symptoms of anxiety and 6% symptoms of depression at baseline. All patients were free of depression symptoms at 24-week follow-up

Most mentees did not feel frightened or were anxious in the disease trajectory. They had a strong belief that everything was under control, and they were well-taking care of

I did not feel any fear… …I knew from the very beginning it was an MI because the paramedics told me, but it didn’t occur to me, that it could be dead serious before they attached the pads on my chest in the ambulance. (Annie, 69 years)

However, some did get worried at first, but these worries did not stay with them

I got a little scared at first because I have not tried anything like this before, but hey it’s probably just age telling you that you are an old bastard (Todd, 77 years)

Expansion

Interviews indicate that mentees are not that affected by their MI; however, quantitative findings indicate that some mentees do show signs of anxiety or depressive symptoms post MI; these symptoms are however diminished over time

8–10, possible anxiety

2 (12)

1 (6)

2 (12)

11–21, proably anxiety

3 (19)

1 (6)

1 (6)

16

Anxiety median (Q1–Q3)

5.63 (2.00–8.75)

3.81 (1.00–6.50)

4.19 (1.25–6.00)

Depression score

16

0–7 no depression

15 (94)

14 (88)

16 (100)

8–0, possible depression

1 (6)

2 (12)

0 (0)

11–21, probably depression

0 (0)

0 (0)

0 (0)

16

Depression median (Q1–Q3)

4.25 (2.25–7.00)

3.44 (1.00–4.75)

3.25 (1.25–5.75)

Self-efficacy score

15

Self-efficacy median (Q1–Q3)

35 (30–38)

32 (30–38)

33 (30–39)

High levels of self-efficacy at baseline and follow-up

Overall, the mentees felt on top of the situation. They had different experiences to tap into, strengthening their coping abilities, e.g., previous serious illness or handling stressful events privately or at work

My husband also has a heart disease and has had several small strokes prior to my MI. So..we are familiar with severe diseases and know we are vulnerable in some way. We have had a lot of serious talks and experiences that we tap into in this new situation. (Annie, 69 years)

I have a Master’s degree of Science (MSc) in Economics and Business administration, have received management training, done a myriad of courses, conferences, and seminars, and have had a lot of management jobs. I'm used to getting started on my own (Sue, 80 years)

Confirmation

Both qualitative and quantitative findings indicate that mentees possess high self-efficacy levels as mentees are used to having to deal with difficult situations in life and thus use life experience to strengthen self-efficacy