The structure of beliefs about the causes of heart attacks: A network analysis

OBJECTIVES: To explore the structure of causal beliefs about heart attack, using network analysis, in particular to determine whether there is a consensual representation and, if so, which putative causes of heart attacks were perceived as being proximal or distal causes and which were perceived to mediate the effects of other causes. METHODS: A total of 107 adult respondents completed questionnaires, indicating the extent to which they perceived each of eight agents as causes of a heart attack, as well as whether they perceived that each of these eight causal agents, in turn, causally affects each of the other seven causal agents. RESULTS: A consensual representation was produced, indicating how these eight agents were perceived as causally relating to each other, and to heart attack. Three key features were evident. First, the type of work a person does was perceived to be a distal cause of heart attack, operating mainly through stress and high blood pressure. Second, the causal impact of stress on heart attack was not seen as mediated by behaviour, but mediated via blood pressure. Third, the causal impact of genes on heart attack was perceived as unmediated by behaviour or physiological processes. CONCLUSIONS: The general public appears to share a reasonably complex view of how different agents lead to heart attack. This complexity would not be elicited by standard methods, suggesting that the network analysis method may be usefully employed as either a process or an outcome measure in health-promotion research.