Seeking Self-Worth: Physical Activity Behavior Engagement in Rural Nova Scotia Women Post Myocardial Infarction: A Constructivist Grounded Theory Study

Abstract

Evidence indicates that regular physical activity (e.g., aerobic physical activity for 30 minutes most days of the week) reduces recurrent cardiac events and death rates in women with coronary heart disease (CHD). However, study findings consistently report higher rates of physical inactivity among rural versus urban women. In addition, rural women experience significant geographic disparities, health inequities, and limited access to health care services and providers, creating further self-care challenges such as engaging in recommended physical activity behaviors post-MI. To understand how rural Nova Scotia (NS) women engage in physical activity behaviors post MI, and factors that affect their physical activity in the post-MI period, constructivist grounded theory (CGT) and photovoice methodologies and methods were used in this research. Eighteen NS women from rural settings participated in two interviews and in the taking of personal photographs using provided disposable cameras. Findings from the narrative and visual data culminated in a substantive theory, “Seeking-Self Worth: A Theory of How Rural Women Engage in Physical Activity Behavior Post-MI.” What was most problematic for study participants was questioning self-worth as a rural woman post-MI. To manage this problem, study participants engaged in the process of seeking self-worth as a rural woman post-MI. The theory of seeking self-worth also involved the processes of assessing MI damage and physical activity, testing physical activity limits, and choosing physical activity priorities. All of these processes played out within a rural context where gender and contextual factors encouraged or hindered study participants’ seeking of self-worth post-MI and, subsequently, their engagement in physical activity behavior post-MI. This substantive theory has implications for nursing, particularly rural public health nurses and nurse practitioners, in the areas of practice, education, research, and policy development.