The open coding phase
Identified categories and their antagonistic relations
To be at high risk of cardiovascular disease, having cardiovascular disease, to be healthy, to be unhealthy, to know about illness, to know enough, to change life style, to live unchanged, to take medicine, to live without medicine, to add risk, not to add risk, preventive demands from the health care system, the GP or the family, preventive demands from the risk patient themselves, to contain risk, to act preventively, to know about risk, a lifestyle with stress and many demands, a lifestyle without stress and fewer demands, priority of free time and/or health and/or physical activity and/or family and/or resources
The axial coding phase
The common dimension of the categories and their characteristics
Conflicting feelings and reflections regarding:
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1. To have cardiovascular disease versus to be at high risk of cardiovascular disease.
2. To be healthy versus to be unhealthy.
3. To know about risk/disease versus not to know.
4. To know about risk/disease versus to know enough.
5. To change lifestyle versus to live on without changes.
6. To take medicine versus to live without medicine.
7. To change lifestyle versus to take medicine.
8. To add risk to life versus to stay status quo.
9. Preventive demands from the health care system versus preventive demands from the risk patient.
10. Preventive demands from the general practitioner versus the demands from the risk patient.
11. Preventive demands from the network such as family versus the risk patient's own demands.
12. To know about risk versus to contain risk.
13. To contain risk versus to decide to do something about risk.
14. To know about risk versus to act preventively.
15. Priority of spare time or family or work or physical activity versus priority of the risk patients' own resources and health in every day life.
16. To live a stressed life with many demands versus to live an unstressed life with fewer demands
The selective coding phase
The antagonistic categories with their two dimensions were collected into main categories and named on behalf of their empirical characteristics leading to the main concept of ambivalence, its different sub-types and the concurrent reflective process
Main category 1: Perception ambivalence (sub-categories 1+2)
Main category 2: Demand ambivalence (sub-categories 9–11 and 16).
Main category 3: Information ambivalence (sub-categories 3+4, 12+14)
Main category 4: Priority ambivalence (sub-category 15).
Main category 5: Treatment ambivalence (sub-categories 5–8, 13)
The theory or concept generating phase
Definition and types of ambivalence
Ambivalence was defined by conflicting feelings that were found to interact with patients' reflections on lifestyle changing in an iterative and concurrent process. Our analysis brought forward five different ambivalence sub-types: perception, demand, information, priority and treatment ambivalence.