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Shahsavari H, Shahriari M, Alimohammadi N. Motivational factors of adherence to cardiac rehabilitation. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2012; 17:318-24. [PMID: 23833634 PMCID: PMC3702154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Main suggested theories about patients' adherence to treatment regimens recognize the importance of motivation in positive changes in behaviors. Since cardiac diseases are chronic and common, cardiac rehabilitation as an effective prevention program is crucial in management of these diseases. There is always concern about the patients' adherence to cardiac rehabilitation. The aim of this study was to describe the motivational factors affecting the patients' participation and compliance to cardiac rehabilitation by recognizing and understanding the nature of patients' experiences. MATERIALS AND METHODS The participants were selected among the patients with cardiac diseases who were referred to cardiac rehabilitation in Isfahan Cardiovascular Research Center, Iran. The purposive sampling method was used and data saturation achieved after 8 semi-structured interviews. FINDINGS The three main concepts obtained from this study are "beliefs", "supporters" and "group cohesion". CONCLUSIONS In cardiac rehabilitation programs, emphasis on motivational factors affects the patient's adherence. It is suggested that in cardiac rehabilitation programs more attention should be paid to patients' beliefs, the role of patients' supporters and the role of group-based rehabilitation.
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Affiliation(s)
- Hooman Shahsavari
- PhD Candidate, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahriari
- Assistant Professor, Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Mohsen Shahriari, Assistant Professor, Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Nasrollah Alimohammadi
- PhD Candidate, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
PURPOSE : While cardiac rehabilitation has been established as an essential part of comprehensive cardiac care, participation rates for female patients are substantially lower than for male patients. Lower referral rates and higher ages of female patients partly explain this underutilization. Gender differences in recovery goals of cardiac patients have not been examined. METHODS : Five hundred ninety patients (22.2% women) admitted to the hospital because of an acute myocardial infarction answered a questionnaire regarding 24 goals in 5 domains of recovery (physical functioning, risk-factor modification, psychological well-being, independence in daily life, and return to work). In addition, psychological symptoms and medical data were assessed. Gender differences were tested by using χ and Student t tests, as well as multivariate logistic and linear regression models. RESULTS : Gender differences were found in 7 of the 24 recovery goals. After adjustment for psychosocial and clinical characteristics, women still reported a higher importance of "performance of household duties" (odds ratio [OR] = 8.62; 95% confidence interval [CI], 5.43-13.66), "independence in activities of daily living" (OR = 2.38; CI, 1.58-3.59), and "emotional equilibrium" (OR = 1.58, CI, 1.01-2.46). Men rated "physical endurance" and "reducing strain at workplace" as more important goals (OR = 0.64; CI, 0.42-0.97 and OR = 0.39; CI, 0.17-0.93). Except for psychological distress, gender differences in health status were not related to differences in goals. CONCLUSIONS : Gender roles and differences in social-life conditions may have an important influence on the recovery goals of patients after an acute myocardial infarction. Recovery goals should be explored when planning intervention programs for individual patients.
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Yan J, You LM, He JG, Wang JF, Chen L, Liu BL, Zhou JJ, Chen JH, Jin SY. Illness perception among Chinese patients with acute myocardial infarction. PATIENT EDUCATION AND COUNSELING 2011; 85:398-405. [PMID: 21159480 DOI: 10.1016/j.pec.2010.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 11/05/2010] [Accepted: 11/21/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore illness perception (IP) and its predictors among Chinese patients with myocardial infarction (MI). METHODS The revised Illness Perception Questionnaire (IPQ-R) was used in the present study. A cross-sectional, descriptive design was employed. The study was conducted in four major hospitals in Guangzhou (China) with a sample of 193 MI patients. Pearson's and Spearman's correlation, t test, one-way ANOVA, factor analysis and multiple linear regression were used. RESULTS Among the 12 common symptoms of MI, on average only 3.37 were recognized by the subjects. Among the six factors of the cause dimension, "immune factors" received the highest score, followed by "gene and chance", "behavioral factors", "psychological factors", "environmental factors", and "physical factors". Subjects perceived MI as a chronic, cyclic illness with serious consequences that could be controlled through treatment, and believed that they had a negative affective response to MI. Furthermore, the dimensions of patients' IP were correlated, and illness-related factors and socio-demographic factors acted as predictors of IP. CONCLUSION The IP of Chinese patients with MI needs to be improved. PRACTICE IMPLICATIONS Based on our findings, effective interventions can be designed to promote MI patients' IP to facilitate their coping strategies after an episode of MI.
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Affiliation(s)
- Jun Yan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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54
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Waiver of informed consent in prehospital emergency health research in Australia. Monash Bioeth Rev 2011; 29:07.1-16. [PMID: 22031986 DOI: 10.1007/bf03351323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Informed consent is a vital part of ethical research. In emergency health care research environments such as ambulance services and emergency departments, it is sometimes necessary to conduct trial interventions or observations without patient consent. At times where treatment is time critical, it may be impossible or inappropriate to seek consent from next of kin. Emergency medicine is one of the few areas where the process of informed consent can be waived to allow research to proceed without patient consent. This article will explore the ethics of informed consent in the prehospital emergency research context. This will include an overview of current Australian guidelines for ethical research, and recent changes in law internationally which have affected the conduct of international emergency health research. An overview of the ethical reasoning behind the waiver of informed consent in emergency research is presented, also addressing issues relating to emergency health research such as proxy consent, unconscious patients, and patient decision making capacity. The unusual circumstances encountered in the prehospital ambulance environment will also be discussed, including the dependent and coercive relationship between patients and ambulance professionals, and a lack of alternatives for care and transport for patients who refuse consent. The conflict arising from differences in medical culture and values between patients and health care professionals will also briefly be discussed. It will be argued that, while emergency care research should not require informed consent due to the restrictions of time and dependent nature of the relationship between patient and health professional, emergency health researchers still have a responsibility to consider the patients' perspective when considering the ethical issues of an emergency research project, particularly in the prehospital environment.
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Reges O, Vilchinsky N, Leibowitz M, Manor D, Mosseri M, Kark JD. Perceptions of cause of illness in acute myocardial infarction patients: a longitudinal study. PATIENT EDUCATION AND COUNSELING 2011; 85:e155-e161. [PMID: 21310582 DOI: 10.1016/j.pec.2010.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 10/31/2010] [Accepted: 12/31/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess change in patient's attributions of illness over the long term in patients with acute myocardial infarction (AMI). METHODS 178 patients were asked during the index hospitalization and 2-2.5 years after discharge whether they thought each of 13 possible factors may have contributed to their illness. Two dichotomous variables, conventional attribution (attribution to traditional risk factors, CA) and psychosocial attribution (PA), were defined and assessed for each patient. RESULTS General stress, cigarette smoking, and heredity were the most commonly mentioned attribution for the AMI. The proportion of individuals with positive CA increased at follow up. There was little congruence between patients' attributions and actual self-reported risk factors, either at baseline or at follow up. Age, education, country of birth, and anxiety were found as independent predictors of illness attribution. The participation in a cardiac prevention and rehabilitation program (CPRP) did not contribute to a significant change in CA attributions. CONCLUSION Substantial proportions of patients have a poor understanding of the causes of their AMI both at onset of the illness and 2-2.5 years later, notwithstanding CPRP. PRACTICE IMPLICATIONS The health care system can ill afford complacency with regards patient education and understanding.
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Affiliation(s)
- Orna Reges
- Meir Medical Center, Department of Cardiology, Kfar Saba, Israel.
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DeJong H, Hillcoat J, Perkins S, Grover M, Schmidt U. Illness perception in bulimia nervosa. J Health Psychol 2011; 17:399-408. [DOI: 10.1177/1359105311416874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The study was designed to extend our understanding of illness perceptions in patients with bulimia nervosa (BN). Seventy-eight participants with BN or BN-type Eating Disorder Not Otherwise Specified (EDNOS-BN) completed the Revised Illness Perception Questionnaire (IPQ-R) ( Moss-Morris et al., 2002 ). Clinical variables were also assessed. Participants experienced their ED as chronic, with serious consequences and high associated levels of anxiety and depression. The disorder was attributed primarily to psychological causes. The results indicate the perceived severity of BN, and high level of associated distress. These findings highlight the potential for targeting illness perceptions in treatment.
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Medical, Psychological, and Sociodemographic Factors Associated With Adherence to Cardiac Rehabilitation Programs. J Cardiovasc Nurs 2011; 26:202-9. [DOI: 10.1097/jcn.0b013e3181ef6b04] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sherwood SA, Povey RC. Influences on women's completion of a cardiac rehabilitation programme. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.5.266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Rachel C Povey
- Health Psychology, Centre for Health Psychology, Staffordshire University, College Road, Stoke-On-Trent, UK
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Sherwood SA, Povey RC. Influences on women's completion of a cardiac rehabilitation programme. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.4.266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Rachel C Povey
- in Health Psychology, Centre for Health Psychology, Staffordshire University, College Road, Stoke-On-Trent, UK
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Williams L, O'Connor RC, Grubb NR, O'Carroll RE. Type D personality and illness perceptions in myocardial infarction patients. J Psychosom Res 2011; 70:141-4. [PMID: 21262416 DOI: 10.1016/j.jpsychores.2010.07.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/29/2010] [Accepted: 07/29/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the relationship between Type D personality (the tendency to experience negative emotions and to be socially inhibited) and illness beliefs in postmyocardial infarction (MI) patients. METHODS One hundred and ninety-two MI patients participated. Patients were assessed on demographic variables and completed the Type D Scale (DS14) and Brief Illness Perceptions Questionnaire one week post-MI. RESULTS Multivariate analysis of variance revealed that Type D patients were significantly different from non-Type D patients on every illness perception dimension. Type D patients believe that their illness has significantly more serious consequences (P<.001), will last significantly longer (P<.001), will be significantly less controllable by them (P<.05) or through treatment (P<.001) compared to non-Type D patients, and experience significantly more symptoms that they attribute to their illness (P<.001). In addition, they are significantly more concerned about their illness (P<.05), experience significantly more emotions as a result (P<.001), and find their illness to be significantly less comprehensible compared to non-Type D individuals (P<.001). CONCLUSION Type D individuals possess a distinct profile of illness beliefs, which may help explain the adverse effect of Type D on health outcomes following MI. Future research should evaluate intervention strategies to tackle illness perceptions in these high-risk patients.
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Affiliation(s)
- Lynn Williams
- School of Social Sciences, University of the West of Scotland, UK.
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French DP, James D, Horne R, Weinman J. Causal beliefs and behaviour change post-myocardial infarction: How are they related? Br J Health Psychol 2010; 10:167-82. [PMID: 15969848 DOI: 10.1348/135910705x26722] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Weinman, Petrie, Sharpe, and Walker (2000) showed that the causal attributions of a sample of first-time myocardial infarction (MI) patients and their spouses from Auckland, New Zealand, were associated with changes in health-related behaviour over the first 6 months post-MI. However, their analyses did not control for pre-MI health-related behaviour. METHOD This paper reports a re-analyses of the Auckland data, and a replication study conducted with 155 first-time MI patients in Brighton, United Kingdom (UK), to investigate whether baseline attributions for MI were related to health-related behaviour change at 6 months (N=132). Spouses (N=85) also completed the attribution questionnaire at baseline. RESULTS There was no consistent relationship between the causal attributions of patients and subsequent behaviour change in Auckland and Brighton. For both samples, causal attributions were associated with pre-MI behaviour. CONCLUSIONS The data from both samples suggest that the causal attributions of MI patients and their spouses may be realistic, but not predictive of subsequent changes in behaviour.
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Affiliation(s)
- David P French
- School of Sport and Exercise Sciences, University of Birmingham, UK.
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Murphy BM, Elliott PC, Worcester MUC, Higgins RO, Le Grande MR, Roberts SB, Goble AJ. Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event. Br J Health Psychol 2010; 13:135-53. [PMID: 17535492 DOI: 10.1348/135910707x173312] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. METHOD A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. RESULTS Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. CONCLUSION Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event.
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Hirani SP, Pugsley WB, Newman SP. Illness representations of coronary artery disease: An empirical examination of the Illness Perceptions Questionnaire (IPQ) in patients undergoing surgery, angioplasty and medication. Br J Health Psychol 2010; 11:199-220. [PMID: 16643694 DOI: 10.1348/135910705x53443] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study sought to validate empirically, through factor analysis, the theoretically developed Illness Perceptions Questionnaire (IPQ) measure of illness representations, and investigated how illness representations varied within an illness condition between different treatments. METHODS Two hundred and fourteen coronary artery disease (CAD) patients, 70 of whom were undergoing medication, 71 to undergo angioplasty and 73 to undergo coronary artery bypass surgery (CABG), completed the New Zealand Heart Attack Recovery Project version of the IPQ. The core cognitive illness representation statement responses were subject to principal components analyses (PCA), with oblique rotation. Identity data were examined regarding symptom frequency. Subscales based on factor structures and frequency scores were utilized to investigate treatment group differences in illness beliefs through analysis of covariance (ANCOVA). FINDINGS PCA of the core components indicated four factors labelled: 'illness impact', 'duration', 'control', and 'self-image', accounting for 46.5% of the variance. The most frequently experienced symptoms were fatigue, breathlessness and chest-pain (angina). ANCOVAs showed significant treatment group differences in frequency of chest-pain experienced (medication<CABG, p<.01) and differences on illness 'duration' beliefs (medication>revascularization groups, p<.001). DISCUSSION The results produced a modified structure for the IPQ, which appeared to reflect the nature of the illness under study and the possible fractionation of the core illness representation components. Responses on the subscales created were also related to the position within the 'subjective experience with the illness' that a patient had reached and the treatment being undertaken.
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Affiliation(s)
- Shashivadan P Hirani
- Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London, and Department of Cardiothoracic Surgery, Brighton and Sussex University Hospitals NHS Trust, UK
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Lau-Walker M. A conceptual care model for individualized care approach in cardiac rehabilitation - combining both illness representation and self-efficacy. Br J Health Psychol 2010; 11:103-17. [PMID: 16480558 DOI: 10.1348/135910705x41914] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE This paper analyses the two prominent psychological theories of patient response--illness representation and self-efficacy--and explore the possibilities of the development of a conceptual individualized care model that would make use of both theories. METHODS Analysis of the literature established common themes that were used as the basis to form a conceptual framework intended to assist in the joint application of these theories to therapeutic settings. RESULTS Both theories emphasize personal experience, pre-construction of self, individual response to illness and treatment, and that the patients' beliefs are more influential in their recovery than the severity of the illness. Where the theories are most divergent is their application to therapeutic interventions, which reflects the different sources of influence that each theory emphasizes. Based on their similarities and differences it is possible to integrate the two theories into a conceptual care model. CONCLUSION The Interactive Care Model combines both theories of patient response and provides an explicit framework for further research into the design of effective therapeutic interventions in rehabilitation care.
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Affiliation(s)
- Margaret Lau-Walker
- European Institute of Health and Medical Sciences, University of Surrey, Guildford, UK.
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65
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Medley AR, Powell T, Worthington A, Chohan G, Jones C. Brain injury beliefs, self-awareness, and coping: A preliminary cluster analytic study based within the self-regulatory model. Neuropsychol Rehabil 2010; 20:899-921. [DOI: 10.1080/09602011.2010.517688] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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66
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Keib CN, Reynolds NR, Ahijevych KL. Poor use of cardiac rehabilitation among older adults: a self-regulatory model for tailored interventions. Heart Lung 2010; 39:504-11. [PMID: 20561883 PMCID: PMC2972354 DOI: 10.1016/j.hrtlng.2009.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/11/2009] [Accepted: 11/19/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND A greater number of older adults now live with coronary heart disease (CHD). This poses a significant public health problem, because older adults are at high risk for CHD-related mortality and morbidity. Overwhelming data support the benefits of cardiac rehabilitation for secondary prevention, yet only a small portion of eligible older adults receive it. METHODS AND RESULTS Whereas many studies examined factors that affect the use of cardiac rehabilitation among older adults, few interventions aimed to improve their cardiac rehabilitation participation rates. A substantial body of evidence indicates that an individual's illness perceptions play a pivotal role in health behavior, and may be a promising target for intervention. Drawing from the theoretic and empiric findings of others, a self-regulatory model is proposed that explicates how CHD perceptions of older adults may influence participation in cardiac rehabilitation. CONCLUSION The model may provide a useful guide for the development of effective interventions tailored to older adults.
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Affiliation(s)
- Carrie N Keib
- Department of Nursing, Cedarville University, Cedarville, Ohio 45314, USA.
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67
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Grace SL, Racco C, Chessex C, Rivera T, Oh P. A narrative review on women and cardiac rehabilitation: Program adherence and preferences for alternative models of care. Maturitas 2010; 67:203-8. [DOI: 10.1016/j.maturitas.2010.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 07/01/2010] [Accepted: 07/03/2010] [Indexed: 12/18/2022]
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68
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Cultural factors facilitating cardiac rehabilitation participation among Canadian South Asians: A qualitative study. Heart Lung 2010; 39:494-503. [DOI: 10.1016/j.hrtlng.2009.10.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 10/23/2009] [Accepted: 10/30/2009] [Indexed: 11/20/2022]
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69
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Noël LT. An Ethnic/Racial Comparison of Causal Beliefs and Treatment Preferences for the Symptoms of Depression Among Patients with Diabetes. DIABETES EDUCATOR 2010; 36:816-27. [DOI: 10.1177/0145721710380145] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of the study was to explore African American, Latino, and Non-Hispanic White adult patients with type 2 diabetes cultural perceptions of symptoms of depression and factors that predict depression care treatment preferences between these groups. Methods A community sample of African Americans, Latinos, and White diabetic adults receiving services in 1 of 2 central Austin, Texas facilities participated in the study. Each participant was given a survey, which consisted of the following 5 components: (1) illness screener questions, (2) demographic questions, (3) Patient Health Questionnaire, (4) Depression Treatment Questionnaire, and (5) Illness Perception Questionnaire. A binary logistic regression was used to examine the relationship between cultural perceptions of symptoms and the predictor variables. A multinomial logistic regression analyses was used to examine the relationship between treatment and provider preferences for the symptoms of depression and ethnicity. Results The first research question addressed whether there were differences across ethnicity in how symptoms of depression are attributed among patients with diabetes. There were 7 causal beliefs that were associated with differences in cultural endorsements of the causes of depressive symptoms. In addition, culture was associated with treatment preferences but not with provider preferences. Conclusions The utility of assessing a patient’s understanding of symptoms of depression to determine how personal illness models impact treatment preferences and clinical implications of how knowledge of patient’s causal attributions can aid medical and behavioral health providers working in collaborative management of diabetes and depression are discussed.
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Affiliation(s)
- La Tonya Noël
- Florida State University, College of Social Work, Tallahassee,
Florida,
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70
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Juergens MC, Seekatz B, Moosdorf RG, Petrie KJ, Rief W. Illness beliefs before cardiac surgery predict disability, quality of life, and depression 3 months later. J Psychosom Res 2010; 68:553-60. [PMID: 20488272 DOI: 10.1016/j.jpsychores.2009.10.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 08/18/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the influence of patients' presurgery illness beliefs and cardiac risk factors on health-related outcomes 3 months following cardiac surgery. METHODS In a prospective design, 56 patients undergoing elective cardiac surgery (coronary artery bypass grafting (CABG), heart valve surgery, or a combined procedure) were approached on admission to hospital and reassessed 3 months after surgery. Presurgery assessment included cardiac risk factors and measures of illness severity. Illness beliefs were assessed using the Illness Perception Questionnaire-Revised (IPQ-R). Outcome measures included levels of illness-related disability, physical functioning, psychological well-being, and depressive symptoms. RESULTS Physical functioning of patients improved 3 months after surgery, while disability and psychological well-being did not change significantly. Cardiac risk factors prior to surgery were unrelated to the outcomes 3 months later. With the use of hierarchical multiple regression analyses, after controlling for demographic variables and baseline scores of outcome variables, patients' beliefs about their illness predicted disability (adjusted R(2)=.350, P<.01), physical functioning (adjusted R(2)=.283, P<.01), and depressive symptoms (adjusted R(2)=.302, P<.01). Illness severity measures did not mediate the association between illness beliefs and outcomes. CONCLUSION Patients' beliefs about their illness before surgery strongly influence recovery from cardiac surgery. The results suggest that patients could benefit from presurgery cognitive interventions aimed at changing maladaptive illness beliefs to improve physical functioning and disability following cardiac surgery.
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Affiliation(s)
- Meike C Juergens
- Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany.
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71
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Davidson PM, Gholizadeh L, Haghshenas A, Rotem A, DiGiacomo M, Eisenbruch M, Salamonson Y. A review of the cultural competence view of cardiac rehabilitation. J Clin Nurs 2010; 19:1335-42. [DOI: 10.1111/j.1365-2702.2009.03004.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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72
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Chauhan U, Baker D, Lester H, Edwards R. Exploring Uptake of Cardiac Rehabilitation in a Minority Ethnic Population in England: A Qualitative Study. Eur J Cardiovasc Nurs 2010; 9:68-74. [DOI: 10.1016/j.ejcnurse.2009.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 10/10/2009] [Accepted: 10/29/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Umesh Chauhan
- National Primary Care Research and Development Centre, The University of Manchester, UK
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Petricek G, Vrcic-Keglevic M, Vuletic G, Cerovecki V, Ozvacic Z, Murgic L. Illness perception and cardiovascular risk factors in patients with type 2 diabetes: cross-sectional questionnaire study. Croat Med J 2010; 50:583-93. [PMID: 20017227 DOI: 10.3325/cmj.2009.50.583] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM. To investigate illness perception in patients with type 2 diabetes mellitus and its association with the degree of control over relevant cardiovascular risk factors. METHODS. A cross-sectional questionnaire-based study was performed from June 2007 to March 2008. A stratified random sample of 46 Croatian general practitioners was asked to select, using systematic sampling, the first 6 patients with type 2 diabetes mellitus aged > or =18 years who visited them for consultation during the study period. Data on 250 patients included patient illness perception assessment (Brief Illness Perception Questionnaire, IPQ), cardiovascular risk factors, and socio-demographic data. RESULTS. The patients' mean age was 63.0+/-10.9 years and mean duration of diabetes was 9.3+/-7.8 years. The patients' illness perception assessment on an 11-point (0 to 10) scale showed the highest median scores (interquartile range): 10 (8 to 10) for "timeline" and 8 (7 to 9) for "treatment control," followed by 7 (5 to 8) for "personal control," 7 (5 to 9) for "understanding," 5 (3 to 7) for "consequences," 6 (4 to 7) for "concern," and 5 (2 to 7) for "emotional response." The lowest score was 3 (1 to 5) for "identity." Multivariate logistic regression showed that the Brief IPQ item "concern" (P<0.001) was a significant predictor of body mass index; "personal control" (P<0.001) and "concern" (P=0.048) were significant predictors of fasting blood glucose; "treatment control" (P=0.009) was a significant predictor of total cholesterol; and "understanding" (P=0.010) was a significant predictor of blood pressure. CONCLUSION. As patients' beliefs seem to be associated with the degree of control over cardiovascular risk factors, they should be included in routine clinical assessments.
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Affiliation(s)
- Goranka Petricek
- Department of Family Medicine, Andrija Stampar School of Public Health, School of Medicine University of Zagreb, Rockefellerova 4, 10000 Zagreb, Croatia.
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White S, Anderson C. The involvement of pharmacists in cardiac rehabilitation: a review of the literature. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/0022357055984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To identify, review and evaluate the literature regarding the role of the pharmacist in cardiac rehabilitation (CR).
Method
Electronic databases searched up to October 2004 were Medline, Pharmline, Iowa Drug Information service, International Pharmacy Abstracts, Embase, Scanners and Web of Science. Reference lists of identified papers were searched and a Zetoc email alert was created to identify additional papers. Papers were included only if they referred specifically to a CR programme or CR patients, and also referred to the involvement of pharmacists or concerned pharmacy practice research. Reports were not excluded on the basis of quality, however reports that met the criteria for inclusion were allocated an evidence grade to indicate quality.
Key findings
Thirteen reports were identified, of which six reports were purely descriptive accounts of pharmacists' involvement in CR (all were from the US) and seven were evaluative reports (four from the US, two from the UK and one from Canada). Descriptions of the involvement of pharmacists in CR included providing medicines information and education to patients, and optimising drug therapy. The lack of substantial research was notable among the evaluative reports. One study found quality of life and economic benefits as a result of the involvement of a pharmacist in CR, and another found that health professionals provide most of the medicines information and education required by CR patients. However these studies were weakened by a lack of meaningful outcome measures.
Conclusion
There is insufficient evidence on which to base firm conclusions about the effectiveness of the involvement of pharmacists in CR. This has implications for pharmacy practitioners, researchers and policymakers in CR.
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Affiliation(s)
- Simon White
- Centre for Pharmacy, Health and Society, School of Pharmacy, University of Nottingham, UK
- United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston, UK
| | - Claire Anderson
- Centre for Pharmacy, Health and Society, School of Pharmacy, University of Nottingham, UK
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Aspinwall LG, Tedeschi RG. The Value of Positive Psychology for Health Psychology: Progress and Pitfalls in Examining the Relation of Positive Phenomena to Health. Ann Behav Med 2010; 39:4-15. [PMID: 20091429 DOI: 10.1007/s12160-009-9153-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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LaPier TK, Cleary K, Kidd J. Exercise self-efficacy, habitual physical activity, and fear of falling in patients with coronary heart disease. Cardiopulm Phys Ther J 2009; 20:5-11. [PMID: 20467523 PMCID: PMC2845254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The purpose of this study was to determine if a relationship exists between self-efficacy for physical activity and other pertinent factors in patients with coronary heart disease (CHD). A secondary purpose of this study was to determine if self-efficacy and exercise behavior are different in patients who report a fearing of falling (fallers) as compared to patients who do not report a fear of falling (non-fallers). This study included 50 patients who were admitted to the hospital for a CHD related diagnosis. Patients completed assessments of cardiac self-efficacy (Modified Barnason Efficacy Expectation Scale) and exercise behavior self-efficacy (Self Efficacy for Exercise Behavior Scale). In addition, the Physical Function subscale of the RAND 36-Item Health Survey and the Telephone Interview of Cognitive Function were used to characterize physical and cognitive function, respectively. Data analysis consisted of descriptive statistics, correlations, t-tests, and chi-square. Older patients reported higher levels of cardiac self-efficacy. Further, a positive correlation was found between cardiac self-efficacy and pre-hospitalization level of physical function. Patient income level and Self-efficacy for Exercise Behavior Resisting Relapse subscale scores were significantly correlated. A higher percent of fallers failed to meet minimum exercise guidelines as compared to non-fallers. It is important to identify the factors that are associated with exercise self-efficacy to improve health behavior adoption and adherence in patients with CHD.
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Affiliation(s)
- Tanya Kinney LaPier
- Associate Professor, Department of Physical Therapy, Eastern Washington University, Spokane, WA
| | - Kimberly Cleary
- Associate Professor, Department of Physical Therapy, Eastern Washington University, Spokane, WA
| | - Joshua Kidd
- Graduate Research Associate, Department of Physical Therapy, Eastern Washington University, Spokane, WA
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Dunlay SM, Witt BJ, Allison TG, Hayes SN, Weston SA, Koepsell E, Roger VL. Barriers to participation in cardiac rehabilitation. Am Heart J 2009; 158:852-9. [PMID: 19853708 DOI: 10.1016/j.ahj.2009.08.010] [Citation(s) in RCA: 175] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 08/13/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Participation rates in cardiac rehabilitation after myocardial infarction (MI) remain low. Studies investigating the predictive value of psychosocial variables are sparse and often qualitative. We aimed to examine the demographic, clinical, and psychosocial predictors of participation in cardiac rehabilitation after MI in the community. METHODS Olmsted County, Minnesota, residents hospitalized with MI between June 2004 and May 2006 were prospectively recruited, and a 46-item questionnaire was administered before hospital dismissal. Associations between variables and cardiac rehabilitation participation were examined using logistic regression. RESULTS Among 179 survey respondents (mean age 64.8 years, 65.9% male), 115 (64.2%) attended cardiac rehabilitation. The median (25th-75th percentile) number of sessions attended within 90 days of MI was 13 (5-20). Clinical characteristics associated with rehabilitation participation included younger age (odds ratio [OR] 0.95 per 1-year increase), male sex (OR 1.93), lack of diabetes (OR 2.50), ST-elevation MI (OR 2.63), receipt of reperfusion therapy (OR 7.96), in-hospital cardiologist provider (OR 18.82), no prior MI (OR 4.17), no prior cardiac rehabilitation attendance (OR 3.85), and referral to rehabilitation in the hospital (OR 12.16). Psychosocial predictors of participation included placing a high importance on rehabilitation (OR 2.35), feeling that rehabilitation was necessary (OR 10.11), better perceived health before MI (excellent vs poor OR 7.33), the ability to drive (OR 6.25), and post-secondary education (OR 3.32). CONCLUSIONS Several clinical and psychosocial factors are associated with decreased participation in cardiac rehabilitation programs after MI in the community. As many are modifiable, addressing them may improve participation and outcomes.
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78
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Royer HR, Phelan CH, Heidrich SM. Older breast cancer survivors' symptom beliefs. Oncol Nurs Forum 2009; 36:463-70. [PMID: 19581237 DOI: 10.1188/09.onf.463-470] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To use Leventhal's Common Sense Model (CSM) to describe older breast cancer survivors' symptom representations, symptom management strategies, and perceived barriers to symptom management. DESIGN A secondary analysis was conducted using data from three pilot studies that tested a theory-based intervention to improve symptom management in older breast cancer survivors. SETTING Advanced practice nurses conducted open-ended interviews with older breast cancer survivors either in their homes or via telephone. SAMPLE Participants were recruited from the community, an oncology clinic, and a state tumor registry. The women (N = 61, X age = 69.5) were an average of 4.7 years after breast cancer diagnosis and reported an average of 17 symptoms. METHODS Content analysis was conducted with field notes taken during baseline interviews. MAIN RESEARCH VARIABLES Symptom representations, symptom management strategies, and perceived barriers to symptom management. FINDINGS Women described their symptoms as chronic, incurable, and uncontrollable, with multiple causes (usually not aging) and numerous negative consequences. Women described an average of six symptom management strategies, most typically self-care. The most frequent barrier to symptom management was communicating with healthcare providers. CONCLUSIONS The CSM is a useful framework for understanding the symptom beliefs of older breast cancer survivors. IMPLICATIONS FOR NURSING Addressing women's beliefs and barriers may result in better communication with healthcare providers and more effective interventions for symptom management.
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Mccorry NK, Corrigan M, Tully MA, Dempster M, Downey B, Cupples ME. Perceptions of exercise among people who have not attended cardiac rehabilitation following myocardial infarction. J Health Psychol 2009; 14:924-32. [DOI: 10.1177/1359105309341144] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Perceptions of exercise among nonattenders of cardiac rehabilitation (CR) were explored using semi-structured interviews. Analysis indicated that participants did not recognize the cardiovascular benefits of exercise, and perceived keeping active through daily activities as sufficient for health. Health professionals were perceived to downplay the importance of exercise and CR, and medication was viewed as being more important than exercise for promoting health. The content of CR programmes and the benefits of exercise need to be further explained to patients post-MI, and in a manner that communicates to patients that these programmes are valued by significant others, particularly health professionals.
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80
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Lee GA. Commentary on Lau-Walker MO, Cowie MR & Roughton M (2009) Coronary heart disease patients' perception of their symptoms and sense of control are associated with their quality of life three years following hospital discharge. Journal of Clinical Nursing 18, 63-71. J Clin Nurs 2009; 18:2776-8. [PMID: 19744031 DOI: 10.1111/j.1365-2702.2009.02918.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Geraldine A Lee
- Division of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
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81
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Cossette S, D'Aoust LX, Morin M, Heppell S, Frasure-Smith N. The Systematic Development of a Nursing Intervention Aimed at Increasing Enrollment in Cardiac Rehabilitation for Acute Coronary Syndrome Patients. ACTA ACUST UNITED AC 2009; 24:71-9. [DOI: 10.1111/j.1751-7117.2009.00038.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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82
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Philip EJ, Lindner H, Lederman L. Relationship of illness perceptions with depression among individuals diagnosed with lupus. Depress Anxiety 2009; 26:575-82. [PMID: 19242982 DOI: 10.1002/da.20451] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationship of illness perceptions, as outlined in the Self-Regulatory Model of illness, with depression among individuals diagnosed with lupus. METHODS A mail-out questionnaire was completed by 154 members of the Australia Lupus Foundation and Lupus Foundation of New South Wales. Each questionnaire consisted of a Lupus Medical and Symptoms Questionnaire, the Illness Perceptions Questionnaire-Revised and the Cardiac Depression Scale. RESULTS Hierarchical regression analysis revealed that individuals who reported a perception of their illness as having negative life consequences, an unpredictable nature and themselves possessing little understanding of lupus, reported high levels of depression. CONCLUSIONS This study indicated the existence of a high level of depressive symptoms among individuals diagnosed with lupus, and reinforces the need for screening procedures in chronic illness, and treatment interventions that target maladaptive illness perceptions.
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Affiliation(s)
- Errol J Philip
- Department of Psychology, University of Notre Dame, Indiana, USA
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83
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Broadbent E, Ellis CJ, Thomas J, Gamble G, Petrie KJ. Can an illness perception intervention reduce illness anxiety in spouses of myocardial infarction patients? A randomized controlled trial. J Psychosom Res 2009; 67:11-5. [PMID: 19539813 DOI: 10.1016/j.jpsychores.2008.11.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 11/03/2008] [Accepted: 11/13/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether a brief in-hospital illness perception intervention for myocardial infarction (MI) patients and their spouses could change spouses' illness perceptions and reduce spouses' anxiety about the illness. METHODS Fifty-seven spouses participated in a randomized controlled trial of an illness perception intervention for MI patients. Spouses of patients randomized to the intervention attended one half-hour patient-and-spouse session with a psychologist in addition to standard care. Spouses completed measures of illness perceptions, expectations, and illness anxiety at admission and at 1 week following discharge, and spouses' illness worry was rated by the patients at 3 months. The main outcome for spouses was differences in anxiety between intervention and control groups. RESULTS One week following discharge, spouses in the intervention group had higher illness understanding, lower concern, stronger causal attributions to hereditary factors, and fewer questions about their partner's heart condition compared to the control group. Intervention group spouses reported more positive expectations about the ability of the patient's heart to recover, and lower perceived likelihood of another MI. They had lower anxiety about the patient doing physical activity and about the patient's medications, and lower distress about the patient's symptoms. Spouses in the intervention group were rated as less worried about the illness at 3 months. CONCLUSION Spouses of patients represent a new target for illness perception interventions and these results demonstrate that a brief illness perception intervention can change illness perceptions and reduce anxiety about the illness in spouses of MI patients.
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Affiliation(s)
- Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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84
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Broadbent E, Ellis CJ, Thomas J, Gamble G, Petrie KJ. Further development of an illness perception intervention for myocardial infarction patients: a randomized controlled trial. J Psychosom Res 2009; 67:17-23. [PMID: 19539814 DOI: 10.1016/j.jpsychores.2008.12.001] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To further develop and trial a brief in-hospital illness perception intervention for myocardial infarction (MI) patients. METHODS One hundred and three patients admitted with acute MI were randomized to receive either standard care or standard care plus an illness perception intervention, which consisted of three half-hour patient sessions and one half-hour patient-and-spouse session delivered in hospital. Patients were followed up to 6 months. The main outcome was the difference between groups in rate of return to work. RESULTS The intervention group had a faster rate of return to work than the control group, and more patients in the intervention group had returned to full time work by 3 months than in the control group. At discharge, patients in the intervention group demonstrated changes in causal attributions regarding their MI and higher perceived understanding of their condition, which remained at the 6-month follow-up. They also reported a better understanding of the information given in hospital, higher intentions to attend cardiac rehabilitation classes, lower anxiety about returning to work, greater increases in exercise, and made fewer phone calls to their general practitioner about their heart condition at follow-up. CONCLUSION This study replicates the findings of an earlier trial that a brief in-hospital illness perception intervention can change perceptions and improve rates of return to work in MI patients. It increases the generalizability of the intervention to the current broader definition of MI and to patients who have had previous infarcts.
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Affiliation(s)
- Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Shah P, Hull T, Riley GA. Associations between the Illness Perception Questionnaire for Schizophrenia and engagement in treatment in a secure setting. CLIN PSYCHOL-UK 2009. [DOI: 10.1080/13284200902849450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Prveen Shah
- Department of Psychology, University of Birmingham , Birmingham
| | - Tim Hull
- South Staffordshire Healthcare NHS Foundation Trust, Hatherton Centre , Stafford, UK
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Sampson F, O'Cathain A, Goodacre S. Feeling Fixed and its Contribution to Patient Satisfaction with Primary Angioplasty: A Qualitative Study. Eur J Cardiovasc Nurs 2009; 8:85-90. [DOI: 10.1016/j.ejcnurse.2008.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 06/27/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Fiona Sampson
- Health Services Research, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK
| | - Alicia O'Cathain
- Health Services Research, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK
| | - Steve Goodacre
- Health Services Research, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK
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Kayaniyil S, Ardern CI, Winstanley J, Parsons C, Brister S, Oh P, Stewart DE, Grace SL. Degree and correlates of cardiac knowledge and awareness among cardiac inpatients. PATIENT EDUCATION AND COUNSELING 2009; 75:99-107. [PMID: 18952393 PMCID: PMC2935489 DOI: 10.1016/j.pec.2008.09.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 08/20/2008] [Accepted: 09/07/2008] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate the degree of CHD awareness as well as symptom, risk factor, and treatment knowledge in a broad sample of cardiac inpatients, and to examine its sociodemographic, clinical and psychosocial correlates. METHODS 1308 CHD inpatients (351 [27.0%] female), recruited from 11 acute care sites in Ontario, participated in this cross-sectional study. Participants were provided with a survey which included a knowledge questionnaire among other measures, and clinical data were extracted from medical charts. RESULTS 855 (68.8%) respondents cited heart disease as the leading cause of death in men, versus only 458 (37.0%) in women. Participants with less than high school education (p<.001), an annual family income less than $50,000CAD (p=.022), low functional capacity (p=.042), who were currently smoking (p=.022), who had no family history of heart disease (p<.001), and who had a perception of low personal control (p=.033) had significantly lower CHD knowledge. CONCLUSIONS Awareness of CHD is not optimal, especially among women, South Asians, and those of low socioeconomic status. CHD patients have a moderate level of disease knowledge overall, but greater education is needed. PRACTICE IMPLICATIONS Tailored educational approaches may be necessary for those of low socioeconomic status, particularly with regard to the nature of CHD, tests and treatments.
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Pullen SA, Povey RC, Grogan SC. Deciding to attend cardiac rehabilitation: A female perspective. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.4.41194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Are illness perceptions about coronary artery disease predictive of depression and quality of life outcomes? J Psychosom Res 2009; 66:211-20. [PMID: 19232233 DOI: 10.1016/j.jpsychores.2008.09.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 08/13/2008] [Accepted: 09/04/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Depression occurs commonly in coronary artery disease (CAD) and is associated with substantial disability. Modifiable cognitive determinants of depression in this population have not been identified. We investigated the impact of potentially modifiable illness beliefs about CAD on depressive symptomatology. We also examined the association between these beliefs and health-related quality of life (HRQOL) and socio-demographic variations in illness beliefs. METHODS A prospective study of 193 recently hospitalized CAD patients was conducted. Data were collected from medical records and by self-report 3 and 9 months post-discharge. Socio-demographic differences were analysed with independent sample t-tests. Predictive models were tested in a series of hierarchical linear regression equations that controlled for known clinical, psychosocial, and demographic correlates of outcome. RESULTS Negative illness beliefs, particularly those associated with the consequences of CAD, were significantly predictive of higher levels of depressive symptomatology at 3 and 9 months. Positive illness perceptions were significantly associated with better HRQOL outcomes. Older and less socially advantaged patients demonstrated more negative illness beliefs. CONCLUSIONS Illness beliefs are significantly associated with depressive symptomatology and HRQOL in CAD patients. These beliefs can be easily identified and constitute a meaningful and clinically accessible avenue for improving psychological morbidity and HRQOL in CAD patients. Older and more socially vulnerable patients may require heightened monitoring of their illness beliefs. Research needs to translate these and other predictive findings into interventions.
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Bucks RS, Hawkins K, Skinner TC, Horn S, Seddon P, Horne R. Adherence to treatment in adolescents with cystic fibrosis: the role of illness perceptions and treatment beliefs. J Pediatr Psychol 2009; 34:893-902. [PMID: 19196850 DOI: 10.1093/jpepsy/jsn135] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study was conducted to explore the relationships between illness perceptions, emotional representations, treatment beliefs and reported adherence in adolescents with cystic fibrosis (CF). METHODS Thirty-eight adolescents completed questionnaires assessing their perceptions of CF, beliefs about prescribed treatments and reported adherence to chest physiotherapy, enzyme supplements, and antibiotics. RESULTS Reported non-adherence to chest physiotherapy was associated with the way in which patients judged their personal need for treatment relative to their concerns about potential adverse effects. Patients reported strong doubts about the necessity of chest physiotherapy. Reported non-adherence to antibiotics was related to doubts about the necessity of antibiotics, believing that CF is not amenable to treatment control. Despite these beliefs about treatment, participants perceived CF as a chronic condition. CONCLUSIONS The findings provide preliminary support for the self-regulatory model, using the necessity-concerns framework to operationalize treatment beliefs, in explaining adherence to treatment in adolescents with CF.
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Affiliation(s)
- Romola S Bucks
- School of Psychology, University of Western Australia, Crawley, WA, Australia.
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91
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Abstract
BACKGROUND Marital status has been clearly linked to subsequent health outcomes in those with established coronary heart disease (CHD). This robust association may be because of both pathophysiological and behavioural mechanisms. DESIGN We employed meta-regression to examine the association between marital status and attendance at outpatient cardiac rehabilitation (CR) in published studies. METHODS We searched electronic databases, for example, Medline and Science Citation Index, for published studies that reported an association between a measure of marital or partnered status and CR attendance in patients with diagnosed CHD. RESULTS Eleven studies were identified which incorporated 6,984 CHD patients. Being married/partnered was associated with significantly higher odds of attending CR. Using a fixed effects model, the pooled odds ratio of CR attendance was 1.72 [95% confidence interval (CI) 1.50-1.97] for those who were married/partnered. There was no evidence of heterogeneity of effects (P=0.42) or publication bias (P=0.12). CONCLUSION CHD patients who are married or have a partner are between 1.5-2 times more likely to attend CR. Associations between marital status and CR attendance may partly explain CHD outcomes.
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Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study. ACTA ACUST UNITED AC 2009; 15:548-56. [PMID: 18830085 DOI: 10.1097/hjr.0b013e328305df05] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an established means of reducing mortality, yet is grossly underutilized. This is due to both health system and patient-level factors; issues that have yet to be investigated concurrently. This study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment. DESIGN A prospective multisite study, using a multilevel design of 1490 coronary artery disease outpatients nested within 97 Ontario cardiology practices (mean 15 per cardiologist). METHODS Cardiologists completed a survey regarding CR attitudes. Outpatients were surveyed prospectively to assess factors affecting CR enrollment. Patients were mailed a follow-up survey 9 months later to self-report CR enrollment. This was verified with 40 CR sites. RESULTS Five hundred and fifty (43.4%) outpatients were referred, and 469 (37.0%) enrolled in CR. In mixed logistic regression analyses, factors affecting verified CR enrollment were greater strength of physician endorsement (P=0.005), shorter distance to CR (P=0.001), being married (P=0.01), and fewer perceived CR barriers (P=0.03). CONCLUSION Both physician and patient factors play a part in CR enrollment. Patient CR barriers should be addressed during referral discussions, and reasons why physicians fail to uniformly endorse CR exploration. Although distance to CR was related to patient enrollment patterns, greater access to home-based CR services should be provided.
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Lau-Walker MO, Cowie MR, Roughton M. Coronary heart disease patients’ perception of their symptoms and sense of control are associated with their quality of life three years following hospital discharge. J Clin Nurs 2009; 18:63-71. [DOI: 10.1111/j.1365-2702.2008.02386.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Coutu MF, Durand MJ, Baril R, Labrecque ME, Ngomo S, Côté D, Rouleau A. A review of assessment tools of illness representations: are these adapted for a work disability prevention context? JOURNAL OF OCCUPATIONAL REHABILITATION 2008; 18:347-61. [PMID: 18719981 DOI: 10.1007/s10926-008-9148-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 07/30/2008] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Musculoskeletal disorders are among the main causes of short- and long-term disability. AIM Identify the methods for assessing multidimensional components of illness representations. METHODS An electronic literature search (French, English) from 1980 to the present was conducted in medical, paramedical and social science databases using predetermined key words. After screening titles and abstracts based on a specific set of criteria, sixty-four articles were reviewed. RESULTS Qualitative approaches for assessing illness representation were found mainly in the fields of anthropology and sociology and were based on the explanatory models of illness. The interviews reviewed were: the Short Explanatory Model Interview, the Explanatory Model of Illness Catalogue and the McGill Illness Narrative Interview. Quantitative approaches were found in the health psychology field and used the following self-administered questionnaires: the Survey of Pain Attitudes, the Pain Beliefs and Perceptions Inventory, the Pain Beliefs Questionnaire, the Fear-Avoidance Beliefs Questionnaire, the Implicit Model of Illness Questionnaire, the Illness Perception Questionnaire, including its derivatives, and the Illness Cognition Questionnaire. CONCLUSION This review shows the actual use and existence of multiple interviews and questionnaires in assessing multidimensional illness representations. All have been used and/or tested in a medical context but none have been tested in a work disability context. Further research will be needed to determine their suitability for use in a work disability context.
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Affiliation(s)
- Marie-France Coutu
- Rehabilitation Department, Centre for Action in Work Disability Prevention and Rehabilitation, Université de Sherbrooke, Longueuil, QC, Canada.
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Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008; 28:1426-46. [PMID: 18848740 PMCID: PMC2669084 DOI: 10.1016/j.cpr.2008.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/15/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
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96
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Abstract
OBJECTIVE We investigated illness beliefs of recently hospitalized patients with coronary artery disease (CAD) and the prospective association between these beliefs and adherence to secondary prevention behaviors. Causal attributions of CAD and their concordance with actual patient risk profiles were also examined. METHOD A prospective study of 193 patients was conducted. Data were collected by self-report and from medical records at 3, 6, and 9 months after discharge. Baseline depression was assessed by structured clinical interview. The association between illness beliefs and adherence was tested with hierarchical linear regression controlling for clinical and demographic confounders. RESULTS Most participants perceived high personal and treatment control and believed CAD to be chronic in duration with severe consequences. A relatively low number of symptoms were endorsed as being part of CAD. Heredity was considered the single most important and most commonly perceived cause of CAD. Smoking, alcohol, emotional state, and heredity were significantly more likely to be endorsed as causal factors by respondents with these risk profiles. In multivariate analysis, illness beliefs contributed an additional 6% of the total variance explained by the model (p = .02). Perceptions of more serious consequences predicted better adherence (p = .03). Social desirability was the best single predictor of adherence. CONCLUSION Patient perceptions of risk factors were largely consistent with actual risk factors. Despite modest effect sizes, illness beliefs do contribute to our understanding of adherence to secondary prevention behavior. Interventions aimed at modifying these beliefs, particularly those related to the consequences of CAD, may improve patient outcomes.
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97
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Negative illness perceptions are associated with new-onset depression following myocardial infarction. Gen Hosp Psychiatry 2008; 30:414-20. [PMID: 18774424 DOI: 10.1016/j.genhosppsych.2008.04.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 04/10/2008] [Accepted: 04/11/2008] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To test the hypothesis that negative perceptions about heart disease at the time of the myocardial infarction (MI) were associated with the onset of new episodes of depression following MI. METHOD We recruited 269 subjects admitted following first MI and monitored their depression status over the subsequent 12 months. At baseline, we recorded demographic information, family and personal history of cardiac disease and severity of MI; subjective health beliefs were assessed using the Illness Perceptions Questionnaire (IPQ). We assessed depression at baseline, 6 and 12 months following MI using a standardised questionnaire, validated in this population against a semistructured research interview. RESULTS In the days following MI, patients who subsequently developed depression were more likely to anticipate that their heart disease would last a long time (P=.012) and was unlikely to be cured (P=.038). Controlling for potential confounding variables, scores on the IPQ remained associated with subsequent depression (P = .036), with anticipation that heart disease would last a long time [odds ratio (OR)=2.7, P=.013] and that heart disease could be cured (OR=0.45, P=.048) showing strongest association. CONCLUSIONS Negative perceptions about heart disease in the days following admission to hospital with first MI are associated with the development of subsequent new episodes of depression.
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98
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O'Connor SM, Jardine AG, Millar K. The prediction of self-care behaviors in end-stage renal disease patients using Leventhal's Self-Regulatory Model. J Psychosom Res 2008; 65:191-200. [PMID: 18655865 DOI: 10.1016/j.jpsychores.2008.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 01/29/2008] [Accepted: 02/05/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the utility of Leventhal's Self-Regulatory Model (SRM) to predict self-care behavior with regard to dietary, medication, and fluid regimes in end-stage renal disease (ESRD) patients. METHODS In a prospective study, ESRD patients treated via hospital-based haemodialysis (N=73) were screened for cognitive deficits and completed questionnaires that enquired about illness perceptions, coping strategies, knowledge of kidney disease, and psychological distress at Time 1. Physiological proxy measures of self-care behaviors regarding diet (serum potassium levels), fluid intake (mean and standard deviation of interdialytic weight gain), and medication (serum phosphate levels) regimes were collected 3 weeks later at Time 2. RESULTS Illness representations (emotional and timeline perceptions) predicted self-care behaviors with regard to diet and medication. Emotion-focused coping strategies predicted higher levels of variation in adherence to fluid restrictions. Younger males were less likely to adhere to the fluid restrictions. CONCLUSIONS The SRM has predictive utility. Psychological interventions should focus on alleviating disease-specific distress and challenging erroneous timeline perceptions in order to increase adherence to dietary and medication regimes in ESRD patients. A more specific measure of coping for ESRD is required to clarify the role of coping strategies in this population. Younger, male patients should be targeted for extra support with fluid restrictions.
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Affiliation(s)
- Susan M O'Connor
- Section of Psychological Medicine, Medical Faculty, University of Glasgow, Glasgow, Scotland, UK. suzy.o'
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Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans. J Behav Med 2008; 31:391-400. [PMID: 18618236 DOI: 10.1007/s10865-008-9165-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 06/18/2008] [Indexed: 12/27/2022]
Abstract
Hypertension, particularly among African Americans, has been increasing in importance in the past 10 years. One aspect of this problem is poor disease management. This study examined illness beliefs, behaviors, and hypertension control among 102 African American outpatients. Participants were interviewed about their commonsense beliefs concerning hypertension and its management in accordance with Leventhal's commonsense model of self-regulation (CSM). Also assessed were medication adherence, stress-reducing behaviors, and lifestyle behaviors recommended for blood pressure control. Blood pressure was measured at about the time of interviewing. Results indicated that endorsement of a medical belief model of hypertension (i.e., caused and controlled by factors such as diet, age, and weight) was cross-sectionally associated with lower systolic blood pressure, a relationship that was statistically mediated by lifestyle behaviors (e.g., cut down salt, exercise). Endorsement of a stress belief model (i.e., stress is the main factor in hypertension cause and control) was associated with engagement in stress-related behaviors but not with blood pressure. These results further support the utility of the CSM for understanding patients' disease management behaviors.
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Fernandez RS, Salamonson Y, Griffiths R, Juergens C, Davidson P. Sociodemographic predictors and reasons for participation in an outpatient cardiac rehabilitation programme following percutaneous coronary intervention. Int J Nurs Pract 2008; 14:237-42. [DOI: 10.1111/j.1440-172x.2008.00685.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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