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Saffari M, Sanaeinasab H, Rashidi-Jahan H, Aghazadeh F, Raei M, Rahmati F, Al Zaben F, Koenig HG. An Intervention Program Using the Health Belief Model to Modify Lifestyle in Coronary Heart Disease: Randomized Controlled Trial. Int J Behav Med 2024; 31:631-641. [PMID: 37477851 DOI: 10.1007/s12529-023-10201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Most effective interventions to control coronary heart disease (CHD) and prevent negative outcomes involve behavioral modification. This study examined how such modification based on the Health Belief Model (HBM) might improve lifestyle and clinical outcomes. METHODS A total of 120 people with CHD seeking help at a general hospital in Iran were randomly assigned to either the intervention or control group. Information was collected using an HBM-specific questionnaire and the Health Promoting Lifestyle II (HPLP-II) scale. Clinical outcomes (blood pressure, body mass index, and fasting blood sugar) were also measured. The intervention group received a tailored education based on HBM principles plus routine care, while those in the control group received only routine care. Three months after the intervention, both groups were reassessed using Student's t test and analysis of covariance. RESULTS All HBM subscale scores indicated significant improvements in the intervention group, in contrast to the control group, where scores worsened or stayed the same. Perceived severity and susceptibility were the dimensions that changed most. Total score on the HPLP-II improved significantly in the intervention group (p < 0.001, F = 747.5); however, subscale scores on spiritual growth and interpersonal relationships did not demonstrate significant between-group differences at follow-up. After adjustment for baseline scores, significant improvements in lifestyle subscales were also accompanied by significant improvements in clinical measures. CONCLUSIONS This HBM-based behavior modification program improved both lifestyle and clinical measures in patients with CHD. Utilizing this program in patients with other cardiovascular diseases may in the future demonstrate similar results.
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Affiliation(s)
- Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Hormoz Sanaeinasab
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hojat Rashidi-Jahan
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Fardin Aghazadeh
- Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mehdi Raei
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahmati
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Faten Al Zaben
- Division of Psychiatry, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Harold G Koenig
- Duke University Medical Center, Durham, NC, USA
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- School of Public Health, Ningxia Medical University, Yinchuan, China
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Regan-Moriarty J, Hardcastle S, McCallion M, Youell A, Collery A, McCarren A, Moyna N, Kehoe B. 'The illness isn't the end of the road'-Patient perspectives on the initiation of and early participation in a multi-disease, community-based exercise programme. PLoS One 2024; 19:e0291700. [PMID: 38551937 PMCID: PMC10980187 DOI: 10.1371/journal.pone.0291700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/14/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Exercise is the cornerstone of cardiac rehabilitation (CR). Hospital-based CR exercise programmes are a routine part of clinical care and are typically 6-12 weeks in duration. Following completion, physical activity levels of patients decline. Multi-disease, community-based exercise programmes (MCEP) are an efficient model that could play an important role in the long-term maintenance of positive health behaviours in individuals with cardiovascular disease (CVD) following their medically supervised programme. AIM To explore patients experiences of the initiation and early participation in a MCEP programme and the dimensions that facilitate and hinder physical activity engagement. METHODS Individuals with established CVD who had completed hospital-based CR were referred to a MCEP. The programme consisted of twice weekly group exercise classes supervised by clinical exercise professionals. Those that completed (n = 31) an initial 10 weeks of the programme were invited to attend a focus group to discuss their experience. Focus groups were transcribed and analysed using reflexive thematic analysis. RESULTS Twenty-four (63% male, 65.5±6.12yrs) patients attended one of four focus groups. The main themes identified were 'Moving from fear to confidence', 'Drivers of engagement,' and 'Challenges to keeping it (exercise) up'. CONCLUSION Participation in a MCEP by individuals with CVD could be viewed as a double-edged sword. Whilst the programme clearly provided an important transition from the clinical to the community setting, there were signs it may breed dependency and not effectively promote independent exercise. Another novel finding was the use of social comparison that provided favourable valuations of performance and increased exercise confidence.
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Affiliation(s)
- Joanne Regan-Moriarty
- Department of Health and Nutritional Science, Atlantic Technological University, Sligo, Ireland
| | - Sarah Hardcastle
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, United Kingdom
| | - Maire McCallion
- Department of Health and Nutritional Science, Atlantic Technological University, Sligo, Ireland
| | - Azura Youell
- Department of Health and Nutritional Science, Atlantic Technological University, Sligo, Ireland
| | | | - Andrew McCarren
- School of Computing, Dublin City University, Dublin, Ireland
| | - Niall Moyna
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Brona Kehoe
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
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Smith PJ, Whitson HE, Merwin RM, O’Hayer CV, Strauman TJ. Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW). Front Aging Neurosci 2023; 15:1256430. [PMID: 38076541 PMCID: PMC10702760 DOI: 10.3389/fnagi.2023.1256430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024] Open
Abstract
Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather E. Whitson
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Rhonda M. Merwin
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
| | - C. Virginia O’Hayer
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA, United States
| | - Timothy J. Strauman
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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Chong MS, Sit JWH, Choi KC, Suhaimi A, Chair SY. A Theory-Based, Technology-Assisted Intervention in a Hybrid Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Feasibility Study. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:180-190. [PMID: 37355035 DOI: 10.1016/j.anr.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To assess the feasibility of a technology-assisted intervention in a hybrid cardiac rehabilitation program among patients with coronary heart disease. METHODS This study was a two-arm parallel randomized controlled trial. Twenty-eight patients with coronary heart disease were randomly assigned to either the intervention group, receiving a 12-week technology-assisted intervention (n = 14), or the control group (n = 14), receiving usual care. Guided by the Health Belief Model, the intervention group received three center-based, supervised exercise training sessions, a fitness watch that served as a cue to action, six educational videos, and a weekly video call. The Self-efficacy for Exercise, exercise capacity, and Health Promoting Lifestyle Profile II were assessed at baseline and immediately post-intervention (12-weeks). RESULTS Among the 28 patients who participated in this study, 85.7% completed the program, with a relatively low attrition rate (14.3%). The number of exercise training sessions accomplished by the participants in the intervention group was 51.27 ± 19.41 out of 60 sessions (85.5%) compared to 36.46 ± 23.05 (60.8%) in the control group. No cardiac adverse events or hospitalizations were reported throughout the study. Participants in the intervention group showed greater improvement in health-promoting behaviors when compared with the control group at 12 weeks. Within-group effects demonstrated improvement in exercise self-efficacy and exercise capacity among participants in the intervention group. A participant satisfaction survey conducted immediately post-intervention revealed that participants were "very satisfied" (23.1%) and "satisfied" (76.9%) with the technology-assisted intervention. CONCLUSIONS The findings demonstrated that technology-assisted intervention in a hybrid cardiac rehabilitation program was feasible and suggested to be beneficial in improving exercise self-efficacy, exercise capacity, and health promoting behavior among patients with coronary heart disease. A full-scale study is needed to determine its effectiveness in the long term. TRIAL AND PROTOCOL REGISTRATION ClinicalTrials.gov NCT04862351. https://clinicaltrials.gov/ct2/show/NCT04862351.
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Affiliation(s)
- Mei Sin Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Janet Wing Hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anwar Suhaimi
- Department of Rehabilitation Medicine, University Malaya Medical Centre, Malaysia
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
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Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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6
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Freak-Poli R, Hu J, Phyo AZZ, Barker SF. Social Isolation and Social Support Influence Health Service Utilisation and Survival after a Cardiovascular Disease Event: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4853. [PMID: 36981761 PMCID: PMC10049557 DOI: 10.3390/ijerph20064853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Both cardiovascular disease (CVD) and social health carry high health and economic burdens. We undertook a systematic review to investigate the association between social isolation, low social support, and loneliness with health service utilisation and survival after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched for the period before June 2020. Two reviewers undertook the title/abstract screen. One reviewer undertook a full-text screen and data extraction. A second author checked data extraction. Of 756 records, 25 papers met our inclusion criteria. Included studies recruited 10-12,821 participants, aged 18-98 years, and the majority were males. Greater social support was consistently associated with better outcomes on four of the five themes (discharge destination, outpatient rehabilitation attendance, rehospitalisation and survival outcomes; no papers assessed the length of inpatient stay). Positive social health was consistently associated with better discharge designation to higher independent living. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies. Our systematic review demonstrates that social health is considered in cardiac care decisions and plays a role in how healthcare is being delivered (i.e., outpatient, rehabilitation, or nursing home). This likely contributes to our finding that lower social support is associated with high-intensity healthcare services, lower outpatient rehabilitation attendance, greater rehospitalisation and poorer survival. Given our evidence, the first step to improve cardiac outcomes is acknowledging that social health is part of the decision-making process. Incorporating a formal assessment of social support into healthcare management plans will likely improve cardiac outcomes and survival. Further research is required to assess if support person/s need to engage in the risk reduction behaviours themselves for outpatient rehabilitation to be effective. Further synthesis of the impact of social isolation and loneliness on health service utilisation and survival after a CVD event is required.
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Affiliation(s)
- Rosanne Freak-Poli
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3168, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Jessie Hu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Aung Zaw Zaw Phyo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - S. Fiona Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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7
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Denton F, Waddell A, Kite C, Hesketh K, Atkinson L, Cocks M, Jones H, Randeva H, Davenport N, Powell R, Clark C, Kyrou I, Harwood AE, McGregor G. Remote maintenance cardiac rehabilitation (MAINTAIN): A protocol for a randomised feasibility study. Digit Health 2023; 9:20552076231152176. [PMID: 36818155 PMCID: PMC9936404 DOI: 10.1177/20552076231152176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023] Open
Abstract
Background Long-term adherence to exercise is often poor for people with coronary heart disease (CHD) who have completed supervised, centre-based cardiac rehabilitation. The aim of this study is to assess the feasibility of a remotely prescribed, delivered and monitored cardiac rehabilitation intervention using a wearable device to support long-term adherence to exercise and physical activity during maintenance of cardiac rehabilitation. Methods After completing cardiac rehabilitation, 30 participants with CHD, will be randomised (1:1) to an intervention (n = 15) or a usual care group (n = 15) in a 12-month feasibility randomised controlled trial (RCT). The intervention will comprise of an exercise consultation, personalised exercise prescription delivered via a wearable activity monitor using biometric feedback, regular monitoring via check-ins, and feedback text-messages for 6-months. Participants will be assessed at baseline (following completion of cardiac rehabilitation) and at three-, six-, and 12-months post-randomisation. The primary outcome will be feasibility, including assessment of eligibility, recruitment, adherence, and acceptability. Secondary outcomes will include exercise capacity, physical activity behaviours, cardiovascular disease risk and quality of life. Semi-structured interviews will be conducted at three-, six-, and 12-months post-randomisation (and with those who drop-out) to explore the acceptability of the study intervention and procedures. A questionnaire will be offered to those who decline participation. Discussion The MAINTAIN study will evaluate the feasibility of conducting a future definitive multi-centre RCT testing a remotely prescribed and monitored long-term mHealth maintenance exercise programme, versus usual care, for people with CHD who have completed cardiac rehabilitation. Trial registration number ClinicalTrials.gov, NCT05292287. Registered on 22/03/2022.
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Affiliation(s)
- Francesca Denton
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Francesca Denton, Institute of Health and Wellbeing, Coventry University, Coventry, CV1 2DS, UK.
| | - Alexander Waddell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Chris Kite
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- School of Public Health Studies, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Katie Hesketh
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lou Atkinson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Matthew Cocks
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Helen Jones
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Harpal Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nathan Davenport
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Richard Powell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Cain Clark
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ioannis Kyrou
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Laboratory of Dietetics and Quality of Life, School of Food and Nutritional Sciences, Department of Food Science & Human Nutrition, Agricultural University of Athens, Athens, Greece
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy E Harwood
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Pinto R, Pires ML, Borges M, Pinto ML, Sousa Guerreiro C, Miguel S, Santos O, Ricardo I, Cunha N, Alves da Silva P, Correia AL, Fiúza S, Caldeira E, Salazar F, Rodrigues C, Cordeiro Ferreira M, Afonso G, Araújo G, Martins J, Ramalhinho M, Sousa P, Pires S, Jordão A, Pinto FJ, Abreu A. Digital home-based multidisciplinary cardiac rehabilitation: How to counteract physical inactivity during the COVID-19 pandemic. Rev Port Cardiol 2022; 41:209-218. [PMID: 34840415 PMCID: PMC8604709 DOI: 10.1016/j.repc.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/29/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction and Objectives Center-based cardiac rehabilitation (CR) programs have been forced to close due to COVID-19. Alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be considered. The aim of this study was to assess physical activity (PA) levels after completing a home-based digital CR program. Methods A total of 116 cardiovascular disease (CVD) patients (62.6±8.9 years, 95 male) who had been attending a face-to-face CR program were recruited and assessed (baseline and at three months) on the following parameters: PA, sedentary behavior, adherence, cardiovascular and non-cardiovascular symptoms, feelings toward the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted of a multidisciplinary digital CR program, including regular patient assessment, and exercise, educational and psychological group sessions. Results Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out rate). A favorable main effect of time was an increase in moderate to vigorous PA and a decrease in sedentary time at three months. Almost half of the participants completed at least one online exercise training session per week and attended at least one of the online educational sessions. No major adverse events were reported and only one minor event occurred. Conclusion During the pandemic, levels of moderate to vigorous PA improved after three months of home-based CR in CVD patients with previous experience in a face-to-face CR model. Diversified CR programs with a greater variety of content tailored to individual preferences are needed to meet the motivational and clinical requirements of CVD patients.
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Affiliation(s)
- Rita Pinto
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Madalena Lemos Pires
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Borges
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Liñan Pinto
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Sousa Guerreiro
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sandra Miguel
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Olga Santos
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Inês Ricardo
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Nelson Cunha
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Alves da Silva
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Luísa Correia
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sílvia Fiúza
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Edite Caldeira
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fátima Salazar
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Carla Rodrigues
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Cordeiro Ferreira
- Serviço de Psiquiatria e Saúde Mental, Unidade de Psicologia, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Gisela Afonso
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Graça Araújo
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Joana Martins
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Marta Ramalhinho
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Paula Sousa
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Susana Pires
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alda Jordão
- Serviço de Medicina III, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Abreu
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Zhang P, Zhu X, Yan J, Liu J. Identification of Immunosuppressive Medication Nonadherence Factors Through a Combined Theory Model in Renal Transplant Recipients: 6-12. Front Pharmacol 2021; 12:655836. [PMID: 34122077 PMCID: PMC8187913 DOI: 10.3389/fphar.2021.655836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Immunosuppressive medication (IM) nonadherence is associated with poor transplant outcomes. Therefore, it is of great importance to identify predictive factors with IM nonadherence. We aimed to improve the predicted capacity of the theory of planned behavior (TPB) by adding health belief model's (HBM) variables in renal transplant patients (RTPs). Methods: This cross-sectional study distributed questionnaires to patients who had undergone renal transplant and follow-up regularly in the transplant center of Third Xiangya Hospital in China. The self-developed questionnaire collected data in three aspects: general data questionnaire, TPB, HBM-specific questionnaire, and Basel Assessment of Adherence to Immunosuppressive Medications scale. Results: A total of 1,357 of 1,480 patients completed the survey, with a participation rate of 91.69% and IM nonadherence rate of 33.53%. The marital status, household income, preoperative drinking history, the time after transplantation, and religion showed independent predictive factors with IM nonadherence (p < 0.05). Strikingly, adding HBM variables to the TPB theory model significantly increased its prediction ability to IM nonadherence (52%). Also, HBM manifested the highest coefficient of effect (-0.620). Particularly, perceived barriers and perceived seriousness, the variables of the HBM model, played a vital influence on medication nonadherence (-0.284 and 0.256). Conclusion: Our study here reveals the first investigation of the combined effects of the TPB and HBM model on IM nonadherence in Chinese RTPs, which could significantly improve the predictive ability of any single model. Meanwhile, future interventions should be conducted to both increase perceived seriousness and reduce perceived barriers for taking IM, which will effectively decrease IM nonadherence rates and improve transplant outcomes.
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Affiliation(s)
- Pengpeng Zhang
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiao Zhu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jin Yan
- The Nursing Department, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Liu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China.,The Nursing School of Central South University, Changsha, China
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10
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Noroozi F, Eisapareh K, Bahadori A, Ghahremani L, Cousins R, Mokarami H. Development and validation of dust exposure prevention questionnaire for cardiovascular patients based on the health belief model. BMC Public Health 2020; 20:1779. [PMID: 33238926 PMCID: PMC7687849 DOI: 10.1186/s12889-020-09871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many cardiovascular patients suffer from respiratory failure. Environmental conditions can exacerbate symptomatology. It is necessary to prevent exposure to dust by taking educational steps to identify and modify patient behavior. This study aimed to develop and validate a dust exposure behavior questionnaire based on the Health Belief Model. METHODS A mixture of qualitative and quantitative methods was employed to design and develop the desired tool. Qualitative methods were used to identify the preventive behaviors needed by cardiovascular patients at risk of dust exposure using the opinions of two expert panels and a literature review. The quantitative phase of the research was performed to evaluate the psychometric properties of the research tool. The research population comprised 417 people with cardiovascular disease referred to a heart hospital in Bushehr, Iran in 2018. Consenting participants entered the study through consecutive sampling. RESULTS The final version of the questionnaire included 27 items across six domains, namely perceived susceptibility, perceived barriers, perceived severity, perceived benefits, cues to action, and self-efficacy. The mean values of the content validity ratio and content validity index were 0.93 and 0.9, respectively. In addition, all items had a good correlation with the total score of their parent domain (P < 0.01). The model fit was initially unsuitable, according to the related indices. Hence, to achieve a better model fit, the model was improved by releasing some parameters based on the modifications suggested by the AMOS software. The modified model featured an acceptable fit (χ2/df = 2.2, P < 0.001). Cronbach's alpha coefficients also confirmed appropriate reliability for all six domains. CONCLUSION The Dust Exposure Prevention questionnaire has desirable psychometric properties and appropriate validity to determine the behavioral factors involved in harm from dust exposure among cardiovascular disease patients. This marks an effective step toward evaluating the factors effective in preventing complications related to dust exposure among such patients.
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Affiliation(s)
- Farzaneh Noroozi
- Department of Health Education and Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kumars Eisapareh
- Department of Health Education and Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Leila Ghahremani
- Department of Health Education and Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rosanna Cousins
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Hamidreza Mokarami
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, PO Box 71645-111, Shiraz, Iran.
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11
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Kim JS, Kim GS, Kang SM, Chu SH. Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey. Eur J Cardiovasc Nurs 2020; 20:183–191. [PMID: 33611353 DOI: 10.1177/1474515120940534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/17/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors. AIMS The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention. METHODS A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees. RESULTS Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio=3.46; 95% confidence interval 1.45-8.27), followed by higher perceived socioeconomic status (odds ratio=2.90; 95% confidence interval 1.28-6.58), perceived susceptibility (odds ratio=1.22, 95% confidence interval 1.08-1.39), perceived benefits (odds ratio=1.09; 95% confidence interval 1.02-1.17) and perceived severity (odds ratio=1.04; 95% confidence interval 1.00-1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance. CONCLUSION This study provides evidence that educational programmes to help improve patients' perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.
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Affiliation(s)
- Ji-Su Kim
- College of Nursing, Yonsei University, Korea
| | - Gwang S Kim
- College of Nursing, Yonsei University, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Korea
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, College of Medicine, Yonsei University, Korea
| | - Sang H Chu
- College of Nursing, Yonsei University, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Korea
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12
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Ghanbari-Firoozabadi M, Mirzaei M, Vafaii Nasab M, Grace SL, Okati-Aliabad H, Madadizadeh F, Dadras H, Amrolahi N, Entezari M, Sadrbafghi SM. Cross-cultural adaptation and psychometric validation of the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P). BMJ Open 2020; 10:e034552. [PMID: 32565454 PMCID: PMC7311040 DOI: 10.1136/bmjopen-2019-034552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study aimed to translate, cross-culturally adapt and psychometrically validate a Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P) and to identify the main barriers in an Iranian setting. SETTING Afshar cardiac rehabilitation (CR) centre, affiliated with the Yazd University of Medical Sciences, in the centre of Iran. DESIGN This was a multimethod study, culminating in a cross-sectional survey. PARTICIPANTS Inpatient CR graduates who did not attend their initial outpatient CR appointment. METHOD The 21-item CRBS was translated and cross-culturally adapted in accordance with best practices; an expert panel considered the items and previous non-attending patients were interviewed via phone to refine the scale. Next, structural validity was assessed; participants were invited to complete the CRBS on the phone between March 2017 and February 2018. Using exploratory factor analysis (EFA) with principal component analysis extraction and oblique rotation. Second, confirmatory factor analysis (CFA) was used to verify the results; several goodness-of-fit indices were considered. The internal consistency and 3-week test-retest reliability of the scale (5% subsample) were evaluated using Cronbach's α and intraclass correlation (ICC), respectively. RESULTS Face, content and cross-cultural validity were established by the experts and patients (n=50). One thousand and one hundred (40.7%) of the 2700 patients completed the CRBS-P. Structural validity was established by EFA (Bartlett's test p<0.001; =0.759) and confirmed by the CFA; a four-factor solution with 18 items accounting for 61.256% of variance had the best fit (χ2/df=3.206, root mean square error of approximation=0.061 and Comparative Fit Index=0.959). The internal consistency and test-retest reliability (n=42) of the scale were acceptable (ICC=0.743 95% CI (0.502 to 0.868); overall α=0.797). The top barriers were not knowing about CR, cost and lack of encouragement from physicians. CONCLUSION The four-factor, 18-item CRBS-P had good psychometric properties, and hence can be reliably and validly used to measure CR barriers in Iran and other Persian-speaking populations.
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Affiliation(s)
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farzan Madadizadeh
- Research Center of Prevention and Epidemiology of Non-Communicable Disease, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hakimeh Dadras
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Najmeh Amrolahi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohamadmehdi Entezari
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Bakhshayeh S, Sarbaz M, Kimiafar K, Vakilian F, Eslami S. Barriers to participation in center-based cardiac rehabilitation programs and patients' attitude toward home-based cardiac rehabilitation programs. Physiother Theory Pract 2019; 37:158-168. [PMID: 31155986 DOI: 10.1080/09593985.2019.1620388] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: The mortality rate of cardiovascular diseases in such developing countries as Iran is on the rise. Despite sufficient evidence pointing to its efficacy, cardiac rehabilitation (CR) approach is only employed to a limited extent. In the present study, barriers to participation in center-based cardiac rehabilitation programs and patients' attitude toward home-based cardiac rehabilitation model were examined. Methods: In this study, 204 eligible patients for CR visiting an academic hospital were examined during the first three months of 2017. Patients had either abandoned rehabilitation programs midway through or had not attended one in the first place. Data about perceived barriers were collected using the modified Cardiac Rehabilitation Barriers Scale. Also, Patients' attitude toward home-based CR was collected using a pre-validated researcher-made questionnaire. Results: The results revealed that the most effective barriers were transportation problems (70%), travel costs (70%), considerable distance to the rehabilitation center (67%), and lack of insurance coverage for rehabilitation costs (64%), respectively. Patients with longer than 30-minute drive time were less likely to attend in training sessions in the center. In addition, the important patient expectations about home-based CR programs included: communication with specialists, training before entering the rehabilitation program, and making periodic visits to maintain motivation and adhere to the home-based CR programs. Conclusions: The results revealed that logistical factors were the major barriers to participation in rehabilitation programs. Alternative models such as home-based CR programs, positively evaluated by the participants, can be used to overcome these barriers.
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Affiliation(s)
- Samaneh Bakhshayeh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Students Research Committee, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Masoumeh Sarbaz
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Khalil Kimiafar
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Farveh Vakilian
- Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, University of Amsterdam , Amsterdam, Netherlands.,Pharmaceutical Research Center, Mashhad University of Medical Sciences , Mashhad, Iran
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14
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Bennett KK, Smith AJ, Harry KM, Clark JMR, Waters MA, Umhoefer AJ, Bergland DS, Eways KR, Wilson EJ. Multilevel Factors Predicting Cardiac Rehabilitation Attendance and Adherence in Underserved Patients at a Safety-Net Hospital. J Cardiopulm Rehabil Prev 2019; 39:97-104. [DOI: 10.1097/hcr.0000000000000383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Beliefs of Immunosuppressive Medication Among Chinese Renal Transplant Recipients, as Assessed in a Cross-Sectional Study With the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Transplant Proc 2019; 51:742-748. [PMID: 30979459 DOI: 10.1016/j.transproceed.2018.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adherence to immunosuppressive medication (IM) after renal transplantation is crucial to survival of patient and graft outcomes; whether beliefs about IM adherence and other sociodemographic factors affect IM adherence is debatable. OBJECTIVE This study aimed to examine the beliefs on IM and IM adherence in Chinese renal transplant recipients. METHODS Across-sectional survey was conducted. Self-developed IM beliefs questionnaire guided by health belief model was used to measure IM beliefs. The Basel Assessment of Adherence to Immunosuppressive Medications Scale was used to assess drug adherence. RESULTS The nonadherence rate to IM in 208 renal transplant recipients during outpatient follow-up was 44.2%. There were statistically significant associations between adherence and the marital status (P < .001). Perceived seriousness of not taking IM (P < .001) and perceived barriers of taking IM (P < .001) were significantly associated with IM adherence. After controlling other factors, married marital status, high levels of perceived seriousness of not taking IM, and lower levels of perceived barriers of taking IM (P = .007) were significantly associated with IM adherence. CONCLUSION Marital status and IM beliefs are closely association with IM adherence in Chinese renal transplant recipients.
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Mülhauser S, Bonhôte Börner M, Saner H, Zumstein-Shaha M. Auswirkung motivierender Gesprächsführung auf die Krankheitswahrnehmung bei stabiler koronarer Herzkrankheit. Eine randomisiert-kontrollierte Studie. Pflege 2018; 31:75-85. [DOI: 10.1024/1012-5302/a000595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung.Hintergrund: Koronare Herzkrankheit ist eine der häufigsten Todesursachen für Menschen > 60 Jahre. Vom Lebensstil abhängige Risikofaktoren sind wesentlich beteiligt. Kardiale Rehabilitation ist daher essenziell für eine optimale Behandlung. Leider verstehen die Betroffenen ihre Krankheit kaum. Motivierende Gesprächsführung kann die Krankheitswahrnehmung verbessern. Ziel / Methode: In einer randomisiert-kontrollierten Studie wurde die Wirksamkeit einer Intervention mit motivierender Gesprächsführung auf die Krankheitswahrnehmung untersucht. Personen mit stabiler koronarer Herzkrankheit wurden konsekutiv nach perkutaner transluminaler Koronarangioplastie (PTCA) in die Studie aufgenommen. Die Interventionsgruppe erhielt ein kurzes motivierendes Gespräch zur Erkrankung und den Risikofaktoren als Intervention. Die Kontrollgruppe erhielt die Standardbetreuung. Vor der Intervention und sechs Monate später wurden Daten zur Krankheitswahrnehmung (Illness Perception Questionnaire-Revised) erhoben. Ergebnisse: Total wurden 312 Personen (n = 148 Intervention, n = 164 Kontrollgruppe) in die Studie aufgenommen (Durchschnittsalter: 66,2 Jahre). Nach der Intervention zeigte sich eine signifikante Veränderung im Bereich der emotionalen Reaktionen auf die Erkrankung. Schlussfolgerung: Um die Krankheitswahrnehmung bei Personen mit stabiler koronarer Herzkrankheit zu verbessern, ist eine kurze Intervention mit motivierender Gesprächsführung möglicherweise wirksam. Ob eine Intensivierung der Intervention das Resultat weiter verbessert, muss noch untersucht werden.
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Affiliation(s)
- Sara Mülhauser
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern
| | | | - Hugo Saner
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern
| | - Maya Zumstein-Shaha
- Abteilung angewandte Forschung und Entwicklung Pflege, Departement Gesundheit, Berner Fachhochschule
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Galdas PM, Harrison AS, Doherty P. Gender differences in the factors predicting initial engagement at cardiac rehabilitation. Open Heart 2018; 5:e000764. [PMID: 29632680 PMCID: PMC5888444 DOI: 10.1136/openhrt-2017-000764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/11/2018] [Accepted: 03/06/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To determine whether there are gender differences in the factors that predict attendance at the initial cardiac rehabilitation baseline assessment (CR engagement) after referral. Methods Using data from the National Audit of Cardiac Rehabilitation, we analysed data on 95 638 patients referred to CR following a cardiovascular diagnosis/treatment between 2013 and 2016. Eighteen factors that have been shown in previous research to be important predictors of CR participation were investigated and grouped into four categories: sociodemographic factors, cardiac risk factors, patient medical status and service-level factors. Logistic binary regression models were built for male patients and female patients, assessing the likelihood for CR engagement. Each included predictors such as age, number of comorbidities and social deprivation score. Results There were no important differences in the factors that predict the likelihood of CR engagement in men and women. Seven factors associated with a reduced probability of CR engagement, and eight factors associated with increased probability, were identified. Fourteen of the 15 factors identified as predicting the likelihood for engagement/non-engagement were the same for both men and women. Increasing age, being South Asian or non-white ethnicity (other than Black) and being single were all associated with a reduced likelihood of attending an initial CR baseline assessment in both men and women. Male patients with diabetes were 11% less likely to engage with CR; however, there was no significant association in women. Results showed that the overwhelmingly important determinant of CR engagement observed in both men and women was receiving an invitation to attend an assessment session (OR 4.223 men/4.033women; p<0.05). Conclusions Consideration of gender differences in predictors of CR uptake should probably be more nuanced and informed by the stage of the patient care pathway.
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Affiliation(s)
- Paul Michael Galdas
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | | | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, York, UK
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Chia S, Wong XY, Toon ML, Seah Y, Yap AF, Lim C, Tay HY, Fong W, Low LL, Kwan YH. Patient preferences for types of community-based cardiac rehabilitation programme. HEART ASIA 2018; 10:e010976. [PMID: 29387175 DOI: 10.1136/heartasia-2017-010976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 11/03/2022]
Abstract
Introduction Cardiac rehabilitation (CR) improves mortality, morbidity and quality of life of cardiovascular patients. However, its uptake is poor especially in the hospitals due to long travel distances and office hours constraints. Community-based CR is a possible solution. Objectives To understand the type of community-based CR preferred and identify patient characteristics associated with certain programme combinations. Methods A cross-sectional survey was administered to a randomised list of patients at risk for or with cardiovascular diseases at two community-based CR centres. Participants were presented with nine hypothetical choice sets and asked to choose only one of the two alternative programme combinations in each choice set. Attributes include support group presence, cash incentives, upfront deposit and out-of-pocket cost. The counts for each combination were tallied and corrected for repeats. Chi-square test and logistic regression were performed to understand the characteristics associated with the preferred CR combination. Results After correcting for repeats, patients most (85.2%) prefer CR programmes with new group activities, support group, cash rewards, deposit and out-of-pocket cost, and few exercise equipment with physiotherapist presence without the need for monitoring equipment. Patients with more than three bedrooms in their house are less likely (OR 0.367; CI 0.17 to 0.80; P=0.011) to choose the choice with no physiotherapist and few equipment available. Conclusion This is the first study to explore patients' preferences for different types of community CR. Higher income patients prefer physiotherapist presence and are willing to settle for less equipment. Our study serves as a guide for designing future community-based CR programmes.
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Affiliation(s)
| | - Xin Yi Wong
- Department of Pharmacy, National University of Singapore, Singapore
| | - Min Li Toon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Seah
- Faculty of Dentistry, National University of Singapore, Singapore
| | | | - Cindy Lim
- Heart Wellness Centre, Singapore Heart Foundation, Singapore
| | - Hung Yong Tay
- Heart Wellness Centre, Singapore Heart Foundation, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Heart Wellness Centre, Singapore Heart Foundation, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Lee Y. Patients' perception and adherence to vaginal dilator therapy: a systematic review and synthesis employing symbolic interactionism. Patient Prefer Adherence 2018; 12:551-560. [PMID: 29695897 PMCID: PMC5905492 DOI: 10.2147/ppa.s163273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vaginal dilator (VD) therapy is often recommended for women receiving pelvic radiation therapy or experiencing pain and discomfort during intercourse, as well as for women with a congenital malformation of the vagina. VD use has both physical and psychological benefits; however, it often causes pain, discomfort, and adverse emotions, including embarrassment and loss of modesty, which often result in low adherence to therapy. OBJECTIVES The aims of this study were to explore the use and adherence of VD therapy in women, identify barriers and facilitators of therapy adherence, and suggest improvement strategies from the theoretical perspective of symbolic interactionism. METHODS A systematic review of the literature was conducted using PubMed, CINAHL, and Scopus databases, with no year restrictions. Articles addressing the experience of women using VD therapy, as well as barriers and facilitators of therapy adherence were selected and analyzed. Then, the theoretical perspective of symbolic interactionism was introduced and applied to synthesize the results. RESULTS A total of 21 articles were selected for the review. Most of the reviewed studies explored VD therapy in women who had undergone pelvic radiation therapy for gynecological cancer. Women's adherence to the therapy ranged between 25% and 89.2%, with great variance in definitions and methods for assessing therapy adherence. Among the five categories of identified barriers to therapy adherence, "unhelpful circumstances" and "negative perceptions toward the VD" were the two most frequently mentioned. The two most frequently reported facilitators of adherence among the six identified categories were "supportive interactions with health care providers" and "risk perception and positive outcome expectancies". On the basis of the perspective of symbolic interactionism, strategies for strengthening interactions with others (eg, health care providers, significant others, and support groups) are discussed in detail. CONCLUSION Strategic intervention regarding the decisive factors identified in the review can benefit women by enhancing their experience and adherence to VD therapy.
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Affiliation(s)
- Yaelim Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
- Correspondence: Yaelim Lee, Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea, Tel +82 10 9950 2731, Email
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Exploring Product-Specific Attributes of a Community Cardiac Rehabilitation Program in an Asian Urban City. Value Health Reg Issues 2017. [PMID: 28648316 DOI: 10.1016/j.vhri.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) has been proven to improve long-term outcomes for patients. Despite its benefits, its uptake throughout the world is poor. Factors affecting the motivation and barriers impeding an individual from participating in a CR program have been extensively studied. Nevertheless, knowledge of product-specific factors in affecting participation is lacking. OBJECTIVES To find out cultural-specific product attributes that are important to those contemplating participation in a community-based CR program using Consolidated criteria for Reporting Qualitative research (COREQ) as an anchor. METHODS Participants were recruited from attendees of the CR program at the Singapore Heart Foundation. A literature review was done to identify product-specific attributes that affected participation in CR programs. An interview guide was developed on the basis of the list of product attributes. The analysis was done by two independent analysts using NVivo version 11 (QSR International, Melbourne, Australia) via an inductive approach. Data analysis was carried out with recruitment and interviews ongoing until thematic saturation was reached. RESULTS In total, 13 male and 9 female participants (16 Chinese, 4 Indian, 1 Malay, and 1 Eurasian) aged between 47 and 89 years were interviewed. A total of 8 categories (System, Infrastructure, Environment, Monitoring, Activity, Program, Staff, and Companionship) with 30 subcategories were identified. New themes that have not been explored by previous studies were discovered under five different categories: System, Infrastructure, Environment, Program, and Companionship. CONCLUSIONS This study allows a better understanding of product-specific factors affecting participation in CR programs and serves as a springboard for further research to improve participation in community-based CR programs.
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Soule MC, Beale EE, Suarez L, Beach SR, Mastromauro CA, Celano CM, Moore SV, Huffman JC. Understanding motivations to participate in an observational research study: Why do patients enroll? SOCIAL WORK IN HEALTH CARE 2016; 55:231-246. [PMID: 26933943 PMCID: PMC4870048 DOI: 10.1080/00981389.2015.1114064] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients' perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-item questionnaire regarding motivations for study enrollment. Altruistic motivation ranked highest, while intellectual, health-related, and financial motivations rated lower. Four subgroups of participants emerged, each with distinct characteristics and different priorities for participating. These findings may help front-line clinicians to understand which motivations for participation apply to their clients who enroll in non-treatment-based research projects.
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Affiliation(s)
- Michael C. Soule
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Eleanor E. Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Laura Suarez
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Carol A. Mastromauro
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Shannon V Moore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, 25 Shattuck Street, Boston, MA 02115, United States of America
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