The purpose of attributing cause: beliefs about the causes of myocardial infarction

Patients’ beliefs concerning the causes of their illnesses are core to a number of theoretical models of illness behaviour. The current study explored the themes that emerged from patients’ accounts of the causes of their first myocardial infarctions (MIs). Semi-structured interviews were conducted with 12 patients within a week of their MI, at a UK district hospital. Transcripts were analysed using interpretative phenomenological analysis. Three researchers noted themes that emerged from each interview, then common themes were selected and refined on the basis of an aggregation of interviews. Three dominant themes emerged: (1) single versus multiple causation, (2) causes as triggers versus underlying dispositions, and (3) the potentially conflicting motives of avoiding blame whilst at the same time, seeking control. Whilst many participants had complex ideas concerning what caused their MI, and could often name several causes, they tended to emphasise the importance of a single cause, which often related to their symptoms. Further, several participants interpreted “cause” in terms of an acute trigger of MI, rather than as a chronic causal factor. Participants were apparently attempting to answer the question about why they had an MI now, leading to talk about single causes that trigger MI. By contrast, much previous research has been concerned with patients’ knowledge of “risk factors”, considering the production of only a few causes to reflect ignorance. A key process in participants attributing cause appeared to be attempting to avoid blaming themselves or others for their MI, whilst simultaneously seeking to assert control over future recurrence. Analysis of the functions and purposes of causal attribution suggests that patients’ focus on blame and control may be both emotionally and behaviourally adaptive, if not necessarily epidemiologically precise. These findings suggest that interventions to change causal attributions may be misguided, and may even be harmful.