Discussion
cognitive and emotional reactions
CVD, SECONDARY
The results showed that cognitive and emotional reactions were highly interlinked in the orchestration of health behaviour, from the initial reactions to the risk communication, across the decision-making process, to maintenance of health behaviour. The main theme, The two subthemes, The encouragement-driven process is, to the best of our knowledge, to a less extent described in the literature. A plausible explanation for a positive health message leading to improved health is that it leads to positive affect, which, in turn, influences cognition and behaviour. The informants’ optimistic beliefs regarding possibilities to influence their health show how hope and being future-oriented are highly important, which also alludes to the concept of We acknowledge the importance of medication for decreasing CVD risk, and also the importance of adherence to medication, and therefore explored questions also on medication intake and attitudes to medications. However, not much data was generated regarding this, and only a couple of individuals started to taking medication as a result of their baseline visit in VIP or after inclusion in VIPVIZA (one individual also decreased use of medication due to lifestyle modification).As outlined above, there were several factors of relevance for implementation of health behaviour, including cognitive (e.g. increased awareness of health behaviour) and emotional reactions (e.g. enjoyment of healthy habits) as well as contextual factors (e.g. retirement and social support). This corresponds well to the complex framework proposed by Kiviniemi et al. [Whereas the informants’ emotional reactions varied whether they had a problem-focused or encouragement-driven process, expressions of self-efficacy and response efficacy were very important in both processes. An intuitive interpretation of this is that as long as an emotional reaction was present, the valence of emotion was secondary.The high extent of efficacy beliefs expressed by the informants independently of perceived severity of the risk message, challenges the assumptions of the Interestingly, the informants’ descriptions of reactions to the ultrasound result letter seem to be very similar to those of the From the interviews it became clear that the importance and meaning of the two parts of the intervention differed among informants. For some, the ultrasound result letter was enough, for others the follow-up call was crucial, and yet for others the combination was important. The fact that the emergent design allowed the inclusion criteria to be adapted (to include any or a combination of ultrasound result letter and follow-up call) deepened the analysis of the informants’ understanding of the risk message. Even though the informants’ reactions to the risk message were linked in different ways to the two parts of the intervention, they shared perceptions of the quality and meaning of the message. The message was described as clear, accurate, reliable, engaging and supportive, and the definite nature of the message laid the ground for emotional and cognitive reactions and decision making. In the informants’ descriptions of reactions to the intervention, it was obvious that the potential of the picture is greater than just ‘evoking emotions’, and that the follow-up call can do more than ‘provide support’.