General self-efficacy and health-related quality of life after myocardial infarction

Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.

The influence of personality traits and beliefs about medicines on adherence to asthma treatment

AIM

To explore the influence of personality traits and beliefs about medicines on adherence to treatment with asthma medication.

METHODS

Respondents were 35 asthmatic adults prescribed controller medication. They answered questionnaires about medication adherence, personality traits, and beliefs about medicines.

RESULTS

In gender comparisons, the personality traits "Neuroticism" in men and "adherence to medication" were associated with lower adherent behaviour. Associations between personality traits and beliefs in the necessity of medication for controlling the illness were identified. Beliefs about the necessity of medication were positively associated with adherent behaviour in women. In the total sample, a positive "necessity-concern" differential predicted adherent behaviour.

CONCLUSION

The results imply that personality and beliefs about medicines may influence how well adults with asthma adhere to treatment with asthma medication.

Motivational foci and asthma medication tactics directed towards a functional day

BACKGROUND

There appears to be an obvious gap between a medical and patient adherence perspective. Deviating from a medication prescription could be regarded as fairly irrational, but with respect to patients' goals and/or concerns it could be seen as understandable. Thus, the aim was to elucidate adherence reasoning in relation to asthma medication.

METHODS

This was a qualitative study; data collection and analysis procedures were conducted according to Grounded Theory methodology. Eighteen persons, aged 22 with asthma and regular asthma medication treatment, were interviewed.

RESULTS

The emerged theoretical model illustrated that adherence to asthma medication was motivated by three foci, all directed towards a desired outcome in terms of a functional day as desired by the patient. A promotive focus was associated with the ambition to achieve a positive asthma outcome by being adherent either to the received prescription or to a self-adjusted dosage. A preventive focus was intended to ensure avoidance of a negative asthma outcome either by sticking to the prescription or by preventively overusing the medication. A permissive focus was associated with unstructured adherence behaviour in which medication intake was primarily triggered by asthma symptoms.

CONCLUSIONS

As all participants had consciously adopted functioning medication tactics that directed them towards the desired goal of a functional day. In an effort to bridge the gap between a patient- and a medical adherence perspective, patients need support in defining their desired functionality and guidance in developing a person-based medication tactic.

Person-centered care--ready for prime time

Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

The influence of personality traits on reported adherence to medication in individuals with chronic disease: an epidemiological study in West Sweden

BACKGROUND

Limited research exists exploring the influence of personality on adherence behaviour. Since non-adherence is a major obstacle in treating prevalent chronic diseases the aim was to determine whether personality traits are related to reported adherence to medication in individuals with chronic disease.

METHODOLOGY/PRINCIPAL FINDINGS

Individuals with chronic disease (n = 749) were identified in a random population sample of 5000 inhabitants aged 30-70 in two municipalities in West Sweden. Data on five personality traits, Neuroticism, Extraversion, Openness to experiences, Agreeableness, and Conscientiousness, and medication adherence behaviour was collected by questionnaires. Statistical analyses resulted in a negative relationship between Neuroticism and medication adherence (P < 0.001), while both Agreeableness (P < 0.001) and Conscientiousness (P < 0.001) were positively related to adherence. At high levels of Conscientiousness, low adherence was related to higher scores in Neuroticism. At high levels of Agreeableness, low adherence was related to low scores in Conscientiousness and high scores in Openness to experiences.

CONCLUSIONS

This study demonstrated that multiple personality traits are of significant importance for adherence behaviour in individuals with chronic disease. The findings suggest that several personality traits may interact in influencing adherence behaviour. Personality traits could putatively be used to focus efforts to educate and support patients with high risk of low medical adherence.

Physical activity six months after a myocardial infarction

In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged <or= 65 years. The self-report question showed that < 40% of the patients were engaged in at least 30 min of physical activity every day. The pedometric physical activity data showed a daily mean number of steps of 6719. The self-report question was correlated with the pedometric registration data. Among myocardial infarction patients, physical activity 6 months after the acute heart attack was insufficient in the majority of patients, both when evaluated with a self-report question and when evaluated with a pedometer. Efforts to increase physical activity after myocardial infarction are warranted.

Illness perception of nursing students regarding myocardial infarction

Health interventions aimed at secondary prevention of myocardial infarction (MI) are important. Patients' illness perceptions influence adherence behaviors and actions. Providing adequate infomation about the disease and lifestyle interventions is an important task for health care professionals. Therefore, a question of interest is how health care professionals perceive myocardial infarction themselves. The aim with the present study was to investigate how nursing students at a Swedish university perceived MI and to determine whether their illness perceptions changed during their six-term program of education. Illness perception was measured using the Revised Illness Perception Questionnaire (IPQ-R) in a sample of 196 students enrolled in terms 2, 4, and 6 of the nursing program. A quasi-experimental design was used. Illness perceptions among nursing students were also compared to illness perceptions in a group of patients with coronary heart disease. The belief that it is possible to control MI through medical treatment became stronger during the course of nursing education. Nursing students were found to view the consequences of MI as serious, but also as medically treatable and responsive to lifestyle changes.

Illness consequences after myocardial infarction: problems with physical functioning and return to work

AIM

This paper is a report of a study to explore health problems, physical and mental functioning, and physical activity in working-age patients after myocardial infarction, in order to assess the possible effects of these factors on return to work.

BACKGROUND

A diagnosis of myocardial infarction may discourage patients from continuing an active working life. Enabling myocardial infarction patients to return to work has benefits for both individuals and society.

METHODS

A convenience sample was recruited of 88 patients, <or=65 years of age, who had suffered a myocardial infarction. Assessments of employment, health-related quality of life and physical activity (footsteps per day) were conducted in 2005-2006, 4-6 months after myocardial infarction. To explore data and compare groups, t-tests were applied. Logistic regression analyses were performed to identify variables that best predicted return to work.

RESULTS

Differences were identified between individuals who were employed after myocardial infarction and those who were not. Those not in work scored lower on variables related to the physical dimension of health-related quality of life and on physical activity. Logistic regression revealed that a multivariate model including age, physical dimension of health-related quality of life and footsteps per day predicted return to work in 68% of all cases (R2=0.344).

CONCLUSION

Low physical health and low physical activity after myocardial infarction negatively affect returning to work. These findings stress the importance of clinical assessment of myocardial infarction patients' daily physical activity and physical functioning.

Adaptation Positions and Behavior Among Post—Myocardial Infarction Patients

This study explores myocardial infarction patients' experiences of adaptation to illness consequences after one year, focusing on experiences of “the self.” The study sample consisted of 19 respondents (10 women, 9 men) who have suffered a first-time myocardial infarction. They were interviewed 1 year after the acute heart attack. A constant comparative method for grounded theory provided the strategies used for data collection and analysis. Codes emerged and memos clarified theoretical reflections. The resulting model was able to illustrate possible mechanisms underlying two different behaviors: self-modifying and self-protecting behavior. Four different adaptation positions were identified: put up with current health, struggle for health, ignore illness , and struggle against illness. These categories were related to two core categories: self-agency and coping with illness consequences . This model may clarify the different adaptive behavior observed among post—myocardial infarction patients.

Personality, adherence, asthma control and health-related quality of life in young adult asthmatics

BACKGROUND

Striving for improved adherence and asthma control is of vital concern in today's asthma management. Several influential factors have been identified, but the importance of personality traits has been insufficiently explored. The aim was first to determine whether personality traits in young adult asthmatics are related to asthma control and health-related quality of life (HRQL), and second to examine the influences of personality traits on adherence to regular asthma medication treatment.

METHODS

Young adult asthmatics, 22 years of age (n=268) completed questionnaires. Statistical analyses were performed.

RESULTS

The personality traits Negative Affectivity and Impulsivity correlated negatively with asthma control, whereas in women Hedonic Capacity correlated positively with asthma control. Negative Affectivity, Impulsivity, Hedonic Capacity, Alexithymia and asthma control predicted the mental dimension of HRQL. Asthma control and physical activity predicted the physical dimension of HRQL. Among respondents with regular asthma medication (n=109), Impulsivity correlated negatively with adherence. In men, Antagonism and Alexithymia were associated with low adherence. Additionally, Alexithymia, Hedonic Capacity and Negative Affectivity showed non-linear relationships with adherence, meaning that initially increased scores on these personality traits scales were associated with increased adherence but higher scores did not increase adherence. Respondents who were prescribed a single inhaler combining ICS and LABA reported higher adherence than those with monotherapies.

CONCLUSION

These data suggest that personality can influence how asthma patients adhere to asthma medication treatment, and report their control and HRQL. Tools determining personality traits may be useful in the future in individualizing management of asthma patients.

Readjustment 5 months after a first-time myocardial infarction: reorienting the active self

AIM

This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction.

BACKGROUND

Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood.

METHOD

Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis.

FINDINGS

Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping.

CONCLUSION

Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.

Associations Between Depression, Fatigue, and Life Orientation in Myocardial Infarction Patients

BACKGROUND

The possible preventive and treatment measures for post-myocardial infarction fatigue may rely on gaining insight into the psychosocial factors associated with fatigue. One such factor may be life orientation, that is, having an optimistic versus pessimistic view of life. Optimists expect things to turn out for the good, whereas pessimists generally expect that bad things will happen to them.

OBJECTIVE

The aim of this study was to explore the relations among life orientation (optimism-pessimism), depression, and fatigue after a first-time myocardial infarction.

METHODS

The sample included 98 patients in total, 33 women and 65 men, who had suffered a first-time myocardial infarction 1 year before the testing. Linear and curvilinear regression analysis models were used to describe and explore the associations between the variables.

RESULTS

A nonlinear relationship between postmyocardial fatigue and life orientation was found. The interpretation was that a pessimistic view of life could have more negative consequences for postmyocardial fatigue than an optimistic view of life could have positive consequences. The association between depression and fatigue was weak, supporting the notion that fatigue may be experienced by myocardial infarction patients without coexisting depression.

CONCLUSION

Post-myocardial infarction fatigue must be investigated further and explicitly focused upon. One way to decrease postmyocardial fatigue could be to focus on steps that cause the most pessimistic individuals to feel less pessimistic.

Health-related quality of life in women and men one year after acute myocardial infarction

The purpose of the present study was, first, to detect possible changes in health-related quality of life (HRQL) over time and, second, to predict HRQL at 1 year based on measures made 1 week and 5 months after a first-time acute myocardial infarction. There was an improvement in HRQL at 1 year, as measured by the questionnaire 36-item Medical Outcomes Study Short-Form (SF-36), for both men and women as compared with the assessment 5 months after the acute myocardial infarction. However, the pattern was somewhat different for women and men. Women mainly reported increased scores on scales reflecting better mental health, whereas men, on the whole, demonstrated higher scores in the physical health domain. Depression (HAD) and fatigue were identified as early predictors of lower HRQL at the 1-year follow-up. Our conclusion is that early assessment of fatigue and depression is worthwhile, as they may indicate decreased HRQL in men and women 1 year after first-time myocardial infarction.

Absence of response: a study of nurses' experience of stress in the workplace

It has become clear that nursing is a high-risk occupation with regards to stress-related diseases. In this study, we were interested in nurses' experiences of stress and the emotions arising from stress at work. Results showed that nurses experienced negative stress which was apparently related to the social environment in which they worked. Four nurses were interviewed. The method used was grounded theory. Analysis of the interviews singled out absence of response as the core category. Recurring stressful situations obviously caused problems for the nurses in their daily work. Not only did they lack responses from their supervisors, they also experienced emotions of frustration, powerlessness, hopelessness and inadequacy, which increased the general stress experienced at work. Our conclusion is that the experience of absence of response leads to negative stress in nurses.