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Table 2 Quotes from participants unless otherwise indicated

From: Risk of cardiovascular disease? A qualitative study of risk interpretation among patients with high cholesterol

A Judith: We are at risk here in our part of the world, in our culture…. In other places, the risk is different – environmental pollution in India or Japan… that’s the way it is. It’s different. (…) Maybe it has something to do with our way of life in Denmark, you know, generally speaking. Many Danes have it [high cholesterol], don’t they. (…) We live in abundance here in Denmark, you know….anyway, I really watch what I eat, I mean I don’t eat that much sugar and fat.
A Ursula: We just eat everytime we meet. Pizzas, shawarmas…when you meet in the city on a café, or you go out at night… and we always end up in a pizza bar somewhere at 3 a.m. Sure, it’s not that healthy for your body, but… I probably wouldn’t miss it.
A Ulla: You meet for a cosy chat, have something to eat… We hold on to the South Jutish cakes [det sønderjyske kaffebord], seven soft cakes, seven hard cakes…. Sometimes up to 30 cakes…! […] Good, old-fashioned food for us.
A Christina: My diabetes, I have to be careful […] Gravy and pork cracklings… It’s extra important to enjoy every bite, when you think about it. In the family…I mean, carrots and mineral water! [..?..] they would be very disappointed indeed.
B Judith: no, I’m not really afraid of it [high cholesterol]. But I find it annoying […]. Then I think to myself “OK you’re not as young as you were”. You can’t… That’s how I think about it. Something will turn up as you get older. Something will turn up.
B Karen: well, you don’t get younger as years go by, that’s it, really. [..] You go into ’repair mode’, something happens in your body and you won’t really feel it.
B Beth: [about husband Kent] he plays in the Old Boys League, and that’s one way to do it, so you don’t get a heart attack sitting in front of the TV…. you’ll die on the football field (both laugh).
C Ivan: I trust the experts. If they tell me, that it is the right thing to do [take medication] – then it is the right thing to do. And as he said to me, we cannot prolong your life. But you can still do something – maybe you can avoid a blood clot or something else. And then perhaps you could have a better quality of life. But of course, you can’t take pills for everything and then live 15 years longer. He said, that’s not the point. He said that the point is to reduce the numbers [cholesterol level]. That’s what it’s all about. Reducing the number.
C Kurt: he said it was OK, no danger ahead, and the medication keeps it low. […] He keeps an eye on me, my blood pressure, the fat in the blood, all my numbers, so it won’t go too high. I can’t feel it, but they see it…the good and the bad fat in you. Not his fault I enjoyed my youth.
C Laura: you live your own life, it’s no one’s responsibility in the end, you know. He just keeps an eye on you, the nurse keeps an eye… […] it was 6.2 [turns over pages of a printout from the lab] and now its below 3, see, all is in place. You still have to eat… properly, or the medication won’t work, for sure, I’m sure it won’t.
D [Fieldnotes] Mary, Frank, married, retired early after a life of hard physical work. Mary, tiny woman, swears that she never eats sweet things, Frank, a sturdy man with a self-reported ‘sweet tooth’. Mary says her father died because his main coronary artery clotted, and her GP worried that Mary might die from the same thing, if she doesn’t take her cholesterol-reducing medication. In both Mary’s and Frank’s families, many members have died from blood clots, but Mary thinks she has ‘a certain kind of cholesterol’, different from that of Frank’s. [Quote] Mary: slim people get it too. One of our friends… he is quite slim. And his cholesterol is very high indeed. It has nothing to do with obesity.
D Tom: No surprise, really, if your dad had a stroke at 40…. or if you were extremely overweight….then you can have someone stitch your lips together [laugh] but in those cases, medication is probably not even enough…. In the end, it’s different, really, when it’s not running in the family, and you live a healthy life and feel OK and fit. It’s not that complicated. […] You do what you can do, move your body, take the stairs […] I don’t think that good cholesterol is dangerous, only to some people.
E [Fieldnotes] Kent, Beth, 65 years old, retired, unskilled labour. Beth’s cholesterol level is too high, takes medication. Kent had a health check 14 days ago.
[Interview dialogue]
Kent: Then, mine was really a bit too high, too.
Interviewer: what did she [the GP] say to you?
Kent: she said ‘it’s a bit too high.’ Then she said ‘what should we do about that?’ Then I said ‘we don’t do any damn thing about it’.
Interviewer: what did she say then?
Kent: you know, I eat a herring every day!
Beth (interrupting) [she said] we should try to lose some weight at Christmas time.
Kent: we’ll have to give it another go.
Interviewer: so you’ll just try again?
Kent: Yes! I won’t take medication to prevent disease.
Interviewer: no..?
Kent: I only want medication if something is wrong with me.
Interviewer: what did she say, then? Why…?
Kent: I don’t want a load of trash in me. I’m a natural kind of guy!
[…]
Interviewer: what if it turns out that you really need cholesterol-reducing medication?
Kent: well, it has to be absolutely necessary. Because, as I said before, I won’t take medication to prevent disease. I’d rather have another herring.
Beth: [laughing] well, another herring won’t necessarily lower it.
Interviewer: but what do you think it [herring] will prevent?
Kent: well, I don’t know.. what is it supposed to prevent?
Beth: well, cardiovascular disease and… that’s it.
Kent: yes, but..there’s nothing wrong with me. My blood pressure is fine. I have no diabetes even though it runs in the family. My mother’s brother whom I never knew, died of diabetes in the 30’ies or 40’ies or whenever the hell it was. 1940. And my mother died of diabetes. And my sister died of diabetes.
E Christian: I said to him that….. I’m not really… fond of taking pills. I thought that we should wait and see.
Interviewer: and this happened 5 or 6 years ago…?
Christian: yes, and then later on the pursuaded me to try it.
Interviewer: OK. What did he say?
Christian: Well… he said that… I might get… blood clots and stuff if I didn’t do something.
Interviewer: OK. Has anyone in your family had a blood clot?
Christian: Yes. I have a brother who is paralysed on one side..
Interviewer: Does it frighten you to think about that?
Christian: oh no. Not the least.
Interviewer: when did your GP tell you to try cholesterol-reducing medication?
Christian: well, he wanted me to start it when I went to see him. Every single time for the last… 2 or 3 years. Until I gave in.
Interviewer: what did he say to make you…[give in]?
Christian: he said…well, actually I don’t remember, apart from him threatening me… saying that I could risk getting a blood clot too.
Interviewer: did he tell you about your cholesterol level, what your numbers were, and stuff?
Christian: well, I think it was about 6 at the time. And he wanted it to be lower than that.
(…)
Christian: It is unhealthy from my point of view. It is not natural. And I can’t see the point in taking it as long as I am not ill.
Interviewer: but you do take it anyway…?
Christian: I do, yes.
Interviewer: Why?
Christian: Well, uhm, I am under pressure.
Ulla: come on, it’s not like that.
F Kurt: In the end, all that fuss about blood sugar and fat on your belly… or bum, what is it… maybe you should start focusing a bit on other things. Appreciate your friends, take some time off, see all the good things you have in your life. Be a bit positive, for God’s sake, it won’t kill you…. Who invented medicine, that’s my point.
F Kent: we are positive people. Positive people live longer. They really do […] Negative things come out of the blue. You shouldn’t pursue them.
F [Field notes] Judith, 60, retired school teacher, adverse bodily sensations, interprets them as side-effects. Sensations connected to awareness about the potential side-effects as described in patient information leaflet.
[Quote] Judith: I admit that it causes a lot of anxiety. It really does. All the different options. They cause a lot of anxiety. And perhaps sometimes it makes you focus a little bit too much on yourself. A bit anxious. You feel fine, right. That’s one aspect to it. It doesn’t make us happier – and perhaps happiness is the best life-prolonging medicine you can get…Don’t you think? [laugh].