Rojas Z/ Enfermería Investiga, Research, Linkage, Teaching and Management Vol. 9 No. 1 2024 (January - March)

PERSONAL VALUES IN THE CONSTRUCTION OF HEALTHY LIFESTYLES IN THE POST-INFARTTED PATIENT

Zuneida Rojas1 https: //orcid.org/0009-0001-3893-7259, Vicenta Fernández2 https://orcid.org/0009-0000-5487-9119

1Associate Professor assigned to the basic department of the Dr. “Gladys Román de Cisneros” School of Nursing. Faculty of Health

Sciences. University of Carabobo. Valencia / Venezuela.

2Professor assigned to the integrated adult health department of the Dr. “Gladys Román de Cisneros” School of Nursing. Faculty of

Health Sciences. University of Carabobo. Valencia / Venezuela.

Received: October 10, 2023

Accepted: December 10, 2023

ABSTRACT

Introduction: Myocardial infarction is one of the main

causes of death and disability in the world. It is important

to discover the meaning of personal values in the

construction of lifestyles for people who have suffered a

myocardial infarction in order to delve into facets of daily

life and the feelings generated by the disease, from their

own perspective. Objective: Generate a theoretical

approach based on the meaning that personal values

have for people who have suffered a myocardial infarction

in the construction of healthy lifestyles. Methods:

Qualitative study, under the hermeneutic

phenomenological approach, using the Spiegelberg

method. The key informants were five people who have

suffered a myocardial infarction who are in phase III of

cardiac rehabilitation and who are at home. The in-depth

interview was the data collection technique. Results:

Personal values were developed such as camaraderie,

humility, solidarity, family love, value for life and faith. This

was possible through understanding healthy lifestyles

before and after having suffered a myocardial infarction,

with priority to modify unhealthy lifestyles to healthy ones

based on adequate nutrition, physical activity and

reduction of stress for which the person requires making

decisions, based on in autonomy and self-responsibility.

Conclusions: People highlight the meaning of lifestyles,

in their lived experience, where they recognize the

importance of their existence and adopt healthy self-care

behaviors such as good nutrition, rest, exercising and not

consuming tobacco or alcohol.

Keywords: healthy lifestyle, myocardial infarction,

cardiac rehabilitation, hermeneutics

Corresponding Author: Mg. Zuneida Rojas de Tovar. Email:zuneida.rojas@hotmail.com

INTRODUCTION

Lifestyles have been studied by several disciplines such as

sociology, anthropology and epidemiology. The origin of the term

and the major conceptual developments have been formulated

in the field of sociocultural sciences, where they are defined as

patterns of group behavior on which the social structure exerts a

considerable influence. The WHO defines health as “a state of

complete physical, mental and social well-being”, which means

that more than a healthy life we should talk about a healthy

lifestyle that includes diet, physical exercise, work, and the

relationship with the environment and social activity (1)

People's lifestyles can lead to behaviors considered unhealthy

and, therefore, they become risk factors for chronic non-

communicable diseases. According to the World Health

Organization (WHO), 36 million deaths in the world are due to

coronary events, only due to cardiovascular diseases. It is

estimated that by 2030 the figure will be around 25 million deaths

(2).

In Latin America, according to the Pan American Health

Organization (PAHO), these diseases are the most frequent

cause of death and disability, both in men and women. Indeed,

in the Venezuelan population, heart and blood vessel conditions

are the main cause of death and represent a growing health,

social and economic burden. Thus, in Venezuela, it is estimated

that conditions of the heart and blood vessels caused 52,706

deaths in 2015, this number of deaths represented 31% of all

mortality and 43% of mortality due to non-communicable disease

(3).

The fact that the main causes of death range from infectious

processes to environmental factors makes the debate on healthy

lifestyles and their impact on health more important. The

problems around the world are globalized due to the various

social, cultural, political, economic and ideological dynamics that

denote the multiplicity of factors to which people are exposed.

This fact concatenates the views and actions of both health

promotion, as well as disease prevention, since these contribute

to the health-disease-care process and demand changes from

the health sector, the State, educational institutions, workplace,

family and, above all, the participation of people as a community

(4).

In this sense, the contribution that science and medicine have

made is considerable when seeking to clarify the concept of

lifestyles and their applications in various fields such as health,

specifically in the field of health policies, epidemiology,

preventive medicine and health education among others. It is

worth noting the contribution that the German sociologist Max

Weber made in this field from his theory of formal rationality and

ideas about lifestyle, since this has been a starting point for other

authors to apply the ideas proposed by him in the development

of the concept of health lifestyle (5).

The first discussions that arose around the analysis of lifestyles

date back to the 19th century with the writings prepared by Karl

Marx around the year 1850 (Coreil, Levin, Jaco in 1985;

Cokerham, Abel, Luschen in 1993 and Backett, Davison in 1995).

Marx considered that people's lifestyles were economically

determined, because in a production system, both the income

and employment position of an individual were part of the lifestyle

experienced by social groups (6).

The WHO Health Promotion Glossary defines a person's lifestyle

as one "made up of their habitual reactions and the behavioral

patterns that they have developed during their socialization

processes. These patterns are learned in the relationship with

parents, classmates, friends and siblings, or by the influence of

the school, the media, among others. These behavioral patterns

are continually interpreted and tested in various social situations

and, therefore, are not fixed, but are constantly being tested. are

subject to modification" (7)

Among the theories that underpin this study, it is important to

consider Nola Pender's nursing theory (8) and Jerome Bruner's

theory of meaning (9). In the health promotion model proposed

by Nola Pender, the determinants of health promotion and

lifestyles are divided into cognitive-perceptual factors,

understood as those conceptions, beliefs, ideas that people have

about health that they carry it or induce certain conducts or

behaviors, which in the case at hand, are related to decision-

making or behaviors that promote health (8).

In this way, the promotion of healthy lifestyles and actions must

be aimed at facilitating a wide range of options that allow people

to make the best decisions about their lives, which constitutes a

fundamental difference with the medical model, in which health

actions are imposed on subjects without taking into account the

environment. This is why there is a growing morbidity and

mortality of people with cardiovascular conditions. This scenario

motivates us to look for tools to reflect and explore the meaning

of personal values in the construction of healthy lifestyles in

people who have suffered a myocardial infarction, to finally

interpret and understand them.

The objective of this research was to generate a theoretical

approach based on the meaning that personal values have for

people who have suffered a myocardial infarction in the

construction of healthy lifestyles. Likewise, it is assigned to the

research line of the Doctorate in Nursing, promotion of human

care in the experience of health and quality of life.

The theoretical contribution of the present study is the expression

of a constructivist approach, under a conception of ontological

and epistemological nature, whose axiological contribution is to

reinforce the value of health, responsibility and self-

determination for decision making in favor of a change in the

healthy lifestyle. From the point of view of the results, it will help

to promote the practice of healthy lifestyles in post-infarct people.

METHODS

The present study belongs to the qualitative paradigm, with a

phenomenological, hermeneutic approach, since it focuses on

the understanding and interpretation of phenomena as they are

experienced and perceived by human beings. The Spiegelberg

methodology was used, which consists of six phases:

a. Description of the phenomenon: In this phase the

researcher describes the phenomenon in all its richness

without omitting details, their speech is not rigorous, they

can speak in first person (10)

Search for multiple perspectives: Here not only the opinions

of the study subjects are taken into account, but also the

vision of the phenomenon by external agents. Modern

society has advanced in knowledge and technology, it has

not yet stopped to discuss the impact that this has.

b. or people involved, in addition to their own opinion about

the phenomenon, it should be noted that the perspective

presented by the researcher is about the phenomenon

under study and not a criticism of the opinions expressed

by the other participating actors (10).

c. Search for essences and structures: In this process,

information is organized through matrices to be contrasted

so that similarities and differences about the phenomenon

under study emerge (10)

d. Constitution of meanings: The phenomenological

constitution means "the process in which the phenomenon

takes shape in our consciousness until we obtain an image

of its structure" (11)

e. Suspension of judgments: it is about distancing from the

activity to be able to contemplate it freely, without the

theoretical constraints or beliefs that determine one way or

another of perceiving (10)

f. Interpretation of the phenomenon: The objective of this

stage is the discovery of meanings, the product of

instructing, analyzing and describing. Therefore, the

interpreter must go beyond what is apparent (12).

The key informants were five people who have suffered a

myocardial infarction who are in phase III of cardiac rehabilitation

and who are at home in the City of Valencia, Carabobo State,

Venezuela. The data collection technique was the in-depth

interview, which was developed through previously established

meetings with key informants at home or in other places of their

preference. They recordings were transcribed with prior informed

consent.

Key informants are those people who provide the researcher with

all the information necessary to understand the meanings and

actions that take place in a certain context (10). The selection of

the sample was intentional and it was considered to select the

participants according to the convenience of the topic that was

addressed in the research. Therefore, five (5) people who had

suffered a myocardial infarction who were in phase III of cardiac

rehabilitation participated. To have access to these informants,

the following steps were carried out: initial approach by the

researchers to the informants to provide them with detailed

information about the objectives of the study. Clear explanation

to the selected interviewees about their anonymity, as well as the

confidentiality of the information given by them. Request for

authorization from the social actors to visit them at home or in

any other place according to their preference. Access to the field

of study was a continuous process, since there was a need to

resort to key informants on more than one occasion to be able to

validate and specify the relevant and necessary information

regarding the phenomenon of study. In relation to ethical

considerations to protect the rights of the participants,

pseudonyms were assigned to them, with prior authorization to

guarantee their anonymity and respect for their privacy. For

informed consent, an unpublished format was designed, which

contained aspects that were read and accepted by the

informants, such as: the objective of the research, the benefits,

the confidentiality of the information according to their decision,

as well as their freedom. to withdraw from the study if they

considered it pertinent, among other aspects.

The methodological rigor was given by the criteria of credibility,

auditability and transferability(13). Process of categorization,

triangulation and structuring of information: includes narrative

synthesis, and the categorization of the information provided by

key informants during the interviews carried out.

RESULTS AND DISCUSSION

Binding questions with the phenomenon of study:

1. What values prevail in you, after having suffered a myocardial

infarction?

2. What does a healthy lifestyle mean to you before and after having

a heart attack?

CONSTITUTION OF THE MEANINGS OF THE PHENOMENON

OF STUDY

The meaning of values in the construction of healthy lifestyles for

the person who has suffered a myocardial infarction was

considered from the conception of each of the key informants

participating in this study. This meaning was inferred from the set

of responses given by them, in the different interviews carried

out, which made it possible to develop a series of categories and

subcategories that make up the responses given as a whole. The

process of coincidences or intersections allowed us to identify

the meanings immersed in the consciousness of the people

interviewed, which were argued with the support of the relevant

approaches of some authors.

The first category that emerged in the responses given by the

key informants was the interpretation of the values in the post-

infarction patient: companionship, humility, solidarity,

responsibility, love of life, love for family, love of God.

Ideal values are present in any human society and in every

individual, guiding their behavior in certain directions. According

to Bermejo: ¨value is a quality of being or acting, or that which

our behavior aspires to (14). Values are taught, acquired and

assumed within a concrete reality and not as absolute entities,

representing, therefore, an option with cultural, ideological, social

and religious bases.

Within the social context, values constitute the reference points

for the establishment of norms and institutions. This is how

Gallegos expresses: "Values do not appear only as requirements

of the educational process, but educational processes

incorporate the axiological because the internal structure of the

human personality demands and requires it" (15). Seen from this

point of view, it consists of educating in the social sphere to lead

it towards the assimilation of the value system (16).

Courage has an intellectual and an emotional component.

Knowledge precedes and is necessary, but it is not sufficient.

That is why the values are shown, not demonstrated. They are

modeled, but they are not imposed (17). According to this

approach, values are characterized by being a series of beliefs,

predisposing the individual to act or respond to a situation in a

predictable manner. Which coincides with the current research

In this sense, an education in values must promote significant

changes that lead to the formation of a human being capable of

functioning in a society in which they can critically practice life,

freedom, health, among others.

The second category that emerged in the responses given by the

key informants was: understanding healthy lifestyles before and

after having suffered a myocardial infarction. Before: foods rich

in fat, stress, sedentary lifestyle, insomnia, tobacco, and alcohol.

After: healthy eating, not consumption of tobacco or alcohol, daily

walks, sleep the necessary hours, avoidance of stress,

compliance with medical treatment.

Currently, cardiovascular diseases are considered a public

health problem worldwide. The number of deaths due to heart

disease has increased by more than 2 million people since 2000,

reaching almost 9 million people in 2019. Heart disease currently

represents 16% of total deaths, due to all the causes (18)

These figures require the modification of behaviors that are

harmful to health, such as cigarette smoking, inadequate eating

habits, alcohol consumption, and the absence of a regular

exercise pattern.

Risk factors exist as individual conditions that can increase the

risk of developing atherosclerotic cardiovascular disease. Among

them we have the non-modifiable ones that are constitutive of the

person, who will always have that risk factor and it is not possible

to reverse or eliminate it. For example, we can mention sex, age,

inheritance, and personal history. And the modifiable ones are

those that can be corrected or eliminated through changes in

lifestyle such as high blood pressure, obesity, smoking,

sedentary lifestyle, diabetes, hypercholesterolemia, alcohol and

stress (19)

These factors trigger harmful processes, present in a society, at

a given time. According to Nettina: “Lifestyles play a fundamental

role in most of the morbid processes that produce mortality” (20).

These results reflect the priority of modifying unhealthy lifestyles,

which requires making decisions based on the autonomy and

self-responsibility of the person interested in protecting their

health. There are three conditions in the decision-making

process: 1. The freedom with which the person makes the

decision without pressure from others. 2. The rationality with

which the best decision is consistent with the values and

preferences of the person who decides and 3. Willfulness (21).

In relation to the people interviewed, who verbalized the

modification of their unhealthy lifestyle, it is important to note that:

“these people, feeling vulnerable to the disease and believing

that it is really serious, adhere early and more easily to the

therapeutic regimen” (22). Within this order of ideas, it can be

seen that more and more people are adopting an active and

responsible attitude towards health and illness, which is reflected

in the practice of healthy lifestyles and which translates into a

reduction in mortality, an increase in life expectancy and an

adequate quality of life. This can be seen in the current research.

Consequently, health professionals must be interested in

facilitating behavioral change in their patients without forgetting

the beliefs, values and attitudes that are the result of learning

acquired during life and that must be the axis of promotion and

prevention of health behaviors. Therefore, intervening in

lifestyles becomes one of the most effective actions for disease

prevention and health promotion.

It is common to talk about promotion and prevention to refer to

healthy lifestyles, some authors have expressed promotion as a

more ambitious dynamic than prevention. Promotion points

towards life, development and fulfillment of the human being.

Hence the Model of promotion of Leavell and Clark expresses:

"Preventive medicine aims to do what has been called predictive

medicine by identifying people or groups who, for genetic or other

reasons, are more susceptible to certain risks in order to avoid

them with more emphasis than the rest of the individuals." (2. 3).

Lifestyle constitutes a learning effect that is produced by

assimilation or imitation of family pattern models or formal or

informal groups. In fact, Ramos states that normally human

beings have a tendency to imitate actions, attitudes, values, anti-

values or emotional responses of different real or symbolic

models that they observe and reproduce by imitation (24).

Nowadays, behavioral therapy is being taken into account from

a psychological point of view since it focuses on the identification

and modification of the person's thoughts, processes and

cognitive structures. Likewise, Fernández is based on the

assumption of highlighting the nuclear role of personality as the

articulating axis of personal and social experience, taking into

account the different levels of processing that are present in

human life. Leyton establishes that the satisfaction of basic

psychological needs predicts intrinsic motivation, and this in turn

predicts the variables related to lifestyles that enhance health,

both predictions in a positive and significant way. The relevance

of developing motivation more self-determined through the

satisfaction of basic psychological needs is highlighted (26).

Bandura's social learning is another model that is being used to

achieve stable and lasting behavior change (27). It is applied to

the field of health and maintains that healthy behaviors are

learned habits and therefore their acquisition, maintenance and

modification are subject to the principles of learning. In this order

of ideas, cognitive dissonance is a concept used in conjunction

with theories of meaning, because it allows us to address healthy

lifestyles in people, in areas such as motivation, decision making,

changing attitudes and group dynamics (28). Cognitive

dissonance refers to the tension, discomfort or discomfort that is

perceived when two contradictory or incompatible ideas are held,

or when beliefs are not in harmony with behavior, with what we

do (29). Cognitive dissonance is currently used in therapy

successfully to help people change their unhealthy attitudes and

behaviors.

Another important aspect for the construction of values and

beliefs is the health belief model, which is a theory built on the

subjective assessment of a certain expectation. In terms of

health, the value will be the desire to avoid the disease or illness,

and the expectation will be the belief that an action possible to

perform will prevent or improve the process (30).

Theoretical approach to personal values in the construction

of healthy lifestyles in post-infarction patients. The lived

experience expressed by the study participants as a threat to

their health helped them to recognize and value their health more

and the importance of taking care of themselves through caring

actions, different from the usual ones, to improve their quality of

life. This requires an education in values that promote significant

changes that lead to the formation of a human being capable of

functioning in a society in which they can critically practice

freedom as a standard, health, responsibility and value of life.

Education towards a healthy lifestyle must necessarily include a

joint and articulated effort of the family, school, community and a

multidisciplinary health team.

CONCLUSIONS

Some elements related to the perception and meaning of healthy

lifestyles and personal values can be pointed out, which indicate

the epistemic bases consistent with the aforementioned

theorists. This will allow, at this point in the research, to construct

meanings about healthy lifestyles for people who have suffered

a myocardial infarction. Lifestyles constitute a learning process

that occurs through imitation of family patterns or formal or

informal groups. Therefore, intervening in lifestyles becomes one

of the most effective actions for the prevention of illness and

health promotion.

Through values, the events that happen during life are

interpreted and given meaning, that is, education in values must

promote changes that enable human beings to develop in a

society in which they can practice life as a norm, freedom, health,

love, among others. Finally, the most important thing about

values such as the meaning of life and/or existence is to think

about them in a sociocultural context. In this way, it is possible to

understand the meaning and significance in the lives of people

who have suffered a myocardial infarction.

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