'Watchful insecurity' : a grounded theory to explain the meaning of recovery after a heart attack
A heart attack can be devastating. If recovery is not well managed, such an event can seriously impair quality of life. However, recovery is a relatively unexplored concept in research. This study aimed to generate a theory to explain the meaning of heart attack recovery from the perspective of those who have encountered a heart attack. The theory of 'Watchful Insecurity" was developed. The study used a modified constructivist grounded theory methodology, incorporating qualitative methods and grounded theory analysis techniques. The sample included i) twenty four cardiac support group members who attended one of four group interviews ii) 10 patients six to eight months following their heart attack who participated in individual interviews iii) 10 informal interviews with people with "expert" conceptual knowledge. The theory of Watchful Insecurity emerged from the participants' stories and their perception that they were a different person after their heart attack. Watchful Insecurity is identified as an enduring state that dominates the process of recovery. Recovery is understood as a social process through which people come to live with and manage Watchful Insecurity. Thetriggers of Watchful Insecurity after a heart attack are identified. Different types and levels of "watchful insecurity" become apparent. The theory of Watchful Insecurity challenges the assumption that recovery follows a linear trajectory. Instead, recovery is experienced as a series of "peaks and troughs". Watchful Insecurity is a core category that applies to all, but the overall trajectory of recovery is unique for each individual. Tools that participants used in order to learn to deal with Watchful Insecurity are discussed. This study illuminates heart attack recovery by exploring it as a concept and a process. This understanding can be used in developing acceptable and accessible services to support recovery.