Table 1

Representative quotes of themes

Theme
Subtheme	Representative quote (Q)
1. Health behaviour change/modifiable risk reduction
Guidance	Q1 ‘What to do to tackle being overweight’.
	Q2 ‘The risk factors and how to beat it’.
	Q3 ‘Ways to include regular exercise in my day’.
	Q4 ‘Exercise description and reason given for the exercise gave me incentive to continue in the early days’.
	Q5 ‘What to eat’.
Engaging	Q6 ‘More exercise and healthier eating habits’.
	Q7 ‘Regular daily exercise and routine has certainly increased my fitness and recovery levels’.
	Q8 ‘Stopping smoking’.
	Q9 ‘I’ve stopped smoking, I’m eating better and I’m doing more exercise especially walking’.
	Q10 ‘I’ve lost some weight but not a lot else. I was already very active with a vegan diet. Non smoker/drinker etc’.
Awareness	Q11 ‘More aware of the importance of lifestyle consideration’.
	Q12 ‘A much livelier awareness of the importance of a healthier diet’.
	Q13 ‘Awareness of food labelling. Awareness of the need to practise relaxation’.
	Q14 ‘The awareness of need to maintain regular exercise. Also to pay more attention to diet’.
	Q15 ‘Consciously thinking about reducing risk factors’.
	Q16 ‘More aware of things to do on a daily basis for example, walking and exercising especially and to pace myself’.
Consequences	Q17 ‘I am more energetic and far more active’.
	Q18 ‘I am more relaxed and have lost weight’.
	Q19 ‘General health has improved. Walking more’.
	Q20 ‘Restored my love for exercise. Closer to wife with walks taken together and chance to talk openly. Careful with food. Positive lost over 1.5 stone so far!’.
	Q21 ‘Restricted my hobbies’.
	Q22 “As a racing cyclist I will miss the racing and training, just going out for fun won’t be the same. I will still go out to keep fit’.
Attitude	Q23 ‘Change of attitude to exercise, diet and lifestyle’.
	Q24 ‘My whole outlook on my lifestyle - that is, how to exercise properly, how and what to eat, that will help me to recover’.
	Q25 ‘I now have a determination to put general health issues before anything else, when you feel well everything in life is more enjoyable’.
	Q26 ‘Contentment - how to care for your body. How to enjoy life, and to understand life in general’.
	Q27 ‘Appreciate life more’.
No change	Q28 ‘Nothing much - I am still a carer for my husband who is permanently in a wheelchair and has cancer. I feel much better walking everywhere without pain in stomach and chest’.
	Q29 ‘No great change - always had healthy lifestyle’.
Motivation For change	Q30 ‘More committed to healthier lifestyle’.
	Q31 ‘The incentive to get walking and exercising’.
2. Psychosocial support
Stress management	Q32 ‘Learning about controlling stress was very very good. I do not worry about things any more, and this makes my life a lot happier’.
	Q33 ‘More assertive about prioritising my needs. Accepting help from others/realising I cannot (will not) do as I did’.
	Q34 ‘I don’t smoke or drink. I have had a lot of stress at work and family history with heart disease so the reduction of stress/relaxation has been very helpful’.
	Q35 ‘Sections on stress and anxiety’.
Pacing	Q36 ‘I was very active for a 76 year old. Now I take life a little slower. I do just as much but over a longer period’.
	Q37 ‘Considering some activities prior to acting as to their benefits etc.’.
	Q38 ‘I think I have learnt to listen to my body and not rush things!’
	Q39 ‘To try pace myself and to admit when in trouble’.
Relaxation	Q40 ‘Relaxation… I have devised my own breathing and visualisation which I try to do daily’.
	Q41 ‘Listen to relaxation CD every day. Sleeping better at nights’.
	Q42 ‘More relaxed, eating a better diet, a new lease of life to look forward to’.
	Q43 ‘I have slowed down the mad pace in which I used to do everything and am more laid back and relaxed’.
Increased self-efficacy	Q44 ‘I do short walks alone: I used to wait to arrange with friends. I now do some exercises at home’.
	Q45 ‘Explanation about the condition and the psychological approaches to the problem and the reassurances’.
	Q46 ‘Less likely to worry about my condition’.
	Q47 ‘I am more prepared to push myself without expecting angina pain’.
	Q48 ‘My confidence has improved and I am getting stronger each day’.
Validation	Q49 ‘Completing the programme has re-affirmed the things I already did as being correct’.
Mental health	Q50 ‘Turning negative thoughts to positive ones!’
	Q51 ‘Low spirits after a heart procedure (depression)’.
	Q52 ‘Mostly about operation and recovery and help for couples to cope with mood swings’.
	Q53 ‘Angina, stress and anxiety’.
Self-perception	Q54 ‘I have become more tolerant of myself’.
	Q55 ‘I feel more hopeful than I did prior to completing the programme. Each day I feel I am making progress with small tasks around the house, and this gives me a feeling of worth once again’.
	Q56 ‘I found it hard to accept I had a heart attack. Previous to it I had been feeling good. The programme has helped me to realise I had a heart problem’.
	Q57 ‘I now accept that I have to change my lifestyle to my condition’.
3. Education
Understanding	Q58 ‘Learning to understand my health issues and dealing with them’.
	Q59 ‘What the risk factors are and how to reduce them to prevent other heart attacks’.
	Q60 ‘Knowing the truth. So simple but so useful’.
	Q61 ‘Understanding the process of recovery’.
	Q62 ‘Explaining what uses tablets are for and explaining about stents’.
	Q63 ‘Recovery section, exercises section and different ways to deal with emotions after bypass’.
Awareness	Q64 ‘Made me fully aware of the seriousness of my heart attack’.
	Q65 ‘I am more aware of the workings of the heart, what food is good for me, what is bad’.
	Q66 ‘More aware of condition and the treatment’.
4. Support
	Q67 ‘Back to normal. Reassured about recovery process’.
	Q68 ‘If I forget I can look it up in your Heart Manual. Plus other advice’.
	Q69 ‘Reading the manual knowing it is there to check any time I feel insecure’.
	Q70 ‘The stories about how other people feel because one gets the same feelings and I find that the stories have helped me to cope better’.
5. Medical risk management
	Q71 ‘Hospital tests and treatments.’
	Q72 ‘At 82 it is difficult to change lifestyle - but the stent has improved me 100%. Still have some aches and pains - a result of old age?!’
	Q73 ‘I had never taken a pill. I have now’.
	Q74 ‘Awareness and control of behaviour. Difficulty in managing medicine regime’.
6. Vocational support
	Q75 ‘Take breaks when go back to work’.
	Q76 ‘Reduced time at work’.
	Q77 ‘It is just over a year since my heart attack. I am back to normal doing a full time job’.
	Q78 ‘I have handed in my notice at work’.
7. Long-term maintenance
Normality	Q79 ‘Early days but trying to get back normal as what I used to do but it is taking time’.
	Q80 ‘Not a lot other than getting back to life as it was up to a few weeks before the heart attack but some changes in diet’.
Halted or interrupted progress	Q81 ‘Contracting severe sciatica approx 6 weeks after heart attack has really been debilitating regarding loss of mobility & pain’.
	Q82 ‘The programme brought me along very nicely but unfortunately introducing me to Beta-Blockers stopped me in my tracks’.
No change	Q83 ‘Nothing doing what I did before’.
	Q84 ‘My life is much the same as before - I am 91 so do what I can when I can. I have no home help. As I am 92 this year I think I must have been doing something right! I have enjoyed good health until this happened. I don’t think a lot of the manual applied to me!’
8. Access to a comprehensive home-based cardiac rehabilitation programme
	Q85 ‘Difficult to specify as book is useful in every section’.
	Q86 ‘The whole manual has been most helpful to me’.
	Q87 ‘I found all information helpful and informative. It’s really interesting and helped me understand what has happened and what was to come over the weeks’.
	Q88 ‘All the sections were useful as one built up another as you progressed through’.
	Q89 ‘It was all interesting and informative and good to be able to keep referring as I have a bad memory!’
	Q90 ‘All the sections have added to achieving a steady, effective and sustained recovery’.
9. The Heart Manual programme
	Q91 ‘The weekly programme (week by week)’.
	Q92 ‘Having a daily record to reflect back on in particular when I had the odd set back, it made a positive impact’.
	Q93 ‘The emphasis on daily action/attention helped me focus on my situation and concentrate on what I needed to do’.
	Q94 ‘Routine’.
	Q95 ‘The daily exercise records. I have found that using them pushes one into making more effort’.