Illness perception among Chinese patients with acute myocardial infarction

Illness perception, health literacy, self-efficacy, adherence and quality of life in patients with intermittent claudication - a longitudinal cohort study

BACKGROUND

Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication.

AIM

to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication.

METHODS

A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life.

RESULTS

In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy..

CONCLUSION

Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

Illness perceptions as a mediator between emotional distress and management self-efficacy among Chinese Americans with type 2 diabetes

Objectives: Emotional distress and illness perceptions have been linked to patients' self-efficacy for diabetes management. This study, guided by Leventhal's Self-Regulatory Model, explores the direct effects of emotional distress (diabetes distress and depressive symptoms) on diabetes management self-efficacy, and the indirect effects through illness perceptions among Chinese Americans with type 2 diabetes (T2DM).Design: Data were obtained from a cross-sectional study of Chinese Americans with T2DM recruited from health fairs and other community settings (N = 155, 47.1% male, mean age 69.07 years). Data analyses including descriptive statistics, correlation, and PROCESS mediation models were used to examine the mediation effects of illness perceptions.Results: Diabetes distress and depressive symptoms had direct negative effects on self-efficacy. Perceived treatment control mediated the association between diabetes distress and self-efficacy, while none of the illness perceptions dimensions impacted the relationship between depressive symptoms and self-efficacy.Conclusion: Improved perceptions of treatment control can ameliorate diabetes distress and improve diabetes management self-efficacy among Chinese Americans. Health providers should elicit patients' illness perceptions as a first step in evaluating their diabetes management self-efficacy and provide appropriate culturally-tailored interventions.

Computational and Theoretical Analysis of the Association Between Gender and HSV-2 Treatment Adherence

Herpes simplex virus type 2 (HSV-2) is the most prevalent sexually transmitted infection in the world, despite the availability of effective anti-viral treatments. A mathematical model to explore the association between gender and HSV-2 treatment adherence is developed. Threshold parameters are determined and stabilities analyzed. Sensitivity analysis of the reproduction number and the numerical simulations suggest that treatment adherence for both females and males are equally important in keeping the reproduction as low as possible. The basic model is then extended to incorporate time-dependent intervention strategies. The Pontryagin's Maximum Principle is used to characterize the optimal level of the controls, and the resulting optimality system is solved numerically.

Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review

BACKGROUND

Since the knowledge of the symptoms of acute myocardial infarction (AMI) may reduce the decision time for patients to seek help in case of an AMI, we aimed to summarize evidence on the knowledge of the AMI symptoms and the symptom attribution in case of an acute coronary syndrome (ACS).

METHODS

Therefore, we systematically searched the databases PubMed, CINAHL, Embase, and Cochrane Library for relevant studies published between January 1, 2008 and 2019 (last search August 1, 2019).

RESULTS

A total of 86 studies were included, with a composite sample size of 354,497 participants. The weighted mean of the knowledge scores for the symptoms of AMI of 14,420 participants from the general population, was 42.1% (when maximum score was considered 100%) and 69.5% for 7642 cardiac patients. There was a substantially better level of knowledge for six symptoms ('chest pain or discomfort', 'shortness of breath', 'pain or discomfort in arms or shoulders', 'feeling weak, lightheaded, or faint', 'pain or discomfort in the jaw, neck, or back', and 'sweating') (49.8-88.5%) compared to the four less obvious/atypical symptoms 'stomach or abdominal discomfort', 'nausea or vomiting', 'headache', and 'feeling of anxiety' (8.7-36.7%). Only 45.1% of 14,843 patients, who experienced ACS, have correctly attributed their symptoms to a cardiac cause.

CONCLUSION

In conclusion, we found a moderate to good knowledge of "classic" and insufficient knowledge of less obvious symptoms of AMI. This might suggest that increasing knowledge about less obvious symptoms of AMI could be beneficial. It appears also important to address cardiac attribution of symptoms.

Adaptation and psychometric testing of the Chinese version of the Revised Illness Perception Questionnaire for cervical cancer patients

PURPOSE

Illness perception is an important factor that influences psychological distress, coping behaviors, and illness outcomes, and this factor is often assessed by the Revised Illness Perception Questionnaire (IPQ-R). Data regarding illness perception among cervical cancer patients are limited, especially in China. The study aimed to adapt and psychometrically test the Chinese version of the IPQ-R for Cervical Cancer (CIPQ-R-CC).

METHODS

This was a methodological study. Before the survey, the identity and causal subscales (originally 14 and 18 items, respectively) were adapted. Data were collected from 220 cervical cancer patients (N = 220) from June 2018 to February 2019. Psychometric properties were assessed using explanatory factor analysis, confirmatory factor analysis, Pearson correlation coefficients, one-way analysis of variance, t-tests and Cronbach's alpha coefficients.

RESULTS

Eight identity items and twenty-six causal items were included in the CIPQ-R-CC, which showed acceptable content validity (I-CVI = 0.78-1.00, S-CVI = 0.97-0.99). A five-factor solution was obtained from the cause subscale by explanatory factor analysis, and these factors explained 60.19% of the total variance. For Part III of the CIPQ-R-CC, after deleting nine items and respecifying five error covariances, the proposed seven-factor model was confirmed. There were low to moderate correlations between the latent factors (r＜0.52). Known-group validity was demonstrated in some groups with different demographic characteristics. The Cronbach's alpha coefficients were also acceptable (0.60-0.88).

CONCLUSION

The CIPQ-R-CC is a reliable and valid tool for assessing illness perception among Chinese cervical cancer patients. Future studies are needed to verify its factor structure and to confirm its theoretical connotation.

Illness Perception After Heart Valve Surgery: Differences Among Men and Women

BACKGROUND

Illness perception is composed of thoughts, ideas, and beliefs about illness, and a negative illness perception is known to be associated with poor outcomes. Among men and women, clinical outcomes after heart valve surgery are known to differ, but knowledge about differences in illness perception is sparse.

OBJECTIVES

The aim of this study is to describe the differences in illness perception among men and women after open heart valve surgery and to identify sociodemographic and clinical characteristics associated with worse illness perception in men and women.

METHODS

In a national cross-sectional study combined with register-based clinical and sociodemographic information, data on illness perception were collected with the Brief Illness Perception Questionnaire. Worse illness perception was defined as the worst quartile of each item of the Brief Illness Perception Questionnaire. Multiple logistic regression analyses were conducted to explore characteristics associated with worse illness perception.

RESULTS

Of 1084 eligible patients, 32% (n = 349) completed the questionnaire (67% men; mean age, 68 years). Compared with men, women reported significantly worse scores of illness perception in 6 of 8 items. Furthermore, being female, age, length of stay, and comorbidity were associated with worse illness perception (worse quartile of scores). Age, higher educational level, and comorbidity were found to be associated with worse illness perception for men and length of stay for women.

CONCLUSION

After open heart valve surgery, illness perception differs among men and women, with women having worse illness perception. Among the total population, being female, age, a longer length of stay, and comorbidity were also associated with worse illness perception.

The dissimilarity between myocardial infarction patients' and spouses' illness perception and its relation to patients' lifestyle

AIM AND OBJECTIVES

To examine the dissimilarity between Chinese myocardial infarction (MI) patients' and spouses' illness perceptions (IPs), and to explore the relationship between patients' IP, differences in couples' IP and patients' lifestyle after discharge.

BACKGROUND

An individual's IP is affected and moderated by several factors, including the social context. One of the most influential members of the social network of patients is the spouse.

DESIGN

Cross-sectional design.

METHODS

From April 2016-April 2017, 111 MI patients and their spouses were recruited. Before discharge from hospital, revised Illness Perception Questionnaire was administered to MI patients and their spouses separately. Two months after discharge, patients' lifestyle was assessed using Health Promoting Lifestyle Profile II. The manuscript was organised according to STROBE guidelines.

RESULTS

Spouses were more likely to believe that the illness would last for a long time, and patients perceived MI as being more controllable than their spouses did. The patient-spouse dissimilarity in the perception of consequences was negatively correlated with both nutrition and stress control behaviours. Patients in couples with more dissimilar perception of environmental factors as a cause were more likely to choose a healthy diet, while patients in couples with more dissimilar perceived treatment control were more able to control stress.

CONCLUSION

There are both similarities and dissimilarities between MI patients' and spouses' IP, and these dissimilarities contributed the majority of the explained variance in patients' lifestyle after discharge.

RELEVANCE TO CLINICAL PRACTICE

We should consider both couples when examining how a patient copes with a chronic illness.

Illness perceptions as predictors of psychological distress among head and neck cancer survivors: a longitudinal study

BACKGROUND

Leventhal's commonsense model implies illness perceptions influence illness outcomes. This study examined illness perceptions among head and neck cancer survivors, and whether these predicted subsequent psychological distress.

METHODS

A total of 124 survivors of head and neck cancer (87% nasopharyngeal carcinoma; NPC) completed measures of psychological distress (Hospital Anxiety and Depression Scale; HADS), illness perceptions (Brief Illness Perception Questionnaire; B-IPQ), dispositional optimism (revised Chinese version of the Life Orientation Test; C-LOT-R), and clinical and demographic data approximately12.9 months after diagnosis (T1). Six months later (T2) psychological distress (HADS) was again measured. Adjusted multivariate analyses tested whether illness perceptions predicted T2 HADS scores.

RESULTS

Illness perception dimensions were significantly intercorrelated (0.01-0.68), explaining 8.0% of anxiety and 4.8% of depression symptom variability at T2. After adjustment for T1 distress, illness identity (β = 0.270, P < .01) and sex identification as a woman (β = 0.275, P < .01) predicted T2 anxiety symptoms while illness identity (β = 0.195, P < .05), unemployment (β = 0.195, P < .05), and pessimism (β = -0.227, P < .01) predicted T2 depression symptoms.

CONCLUSION

Perceived illness identity predicted psychological distress, accounting for modest levels of distress variance. Unresolved symptoms may exacerbate distress.

Psychometric evaluation of the Chinese version of the revised illness perception questionnaire for breast cancer-related lymphedema

The aim of this study was to modify and test the Chinese version of the Revised Illness Perception Questionnaire to measure the illness perception of breast cancer-related lymphedema among breast cancer survivors. Before the investigation, identity and causal subscales were modified and the wording of the remaining scales was also adjusted. The psychometric properties of this instrument was evaluated using the technique of explore and confirmatory factor analysis. Data from 203 breast cancer survivors was entered into factor analysis. Five causal factors were extracted after removing one item, accounting for 68.02% of the variance in total. An acceptable fit with the data for the proposed seven-factor model was obtained after eliminating three items and resetting seven error covariances. The Cronbach's α values and composite reliability coefficients were acceptable. This measurement is reliable and valid for measuring illness perceptions of breast cancer-related lymphedema in Chinese breast cancer survivors. It could be helpful for further studies that examine the effect of illness perceptions on health-related behaviours, such as lymphedema risk-reduction behaviours in the Chinese cultural context.

Illness Perception of Patients with Functional Gastrointestinal Disorders

OBJECTIVE

To investigate the illness perception characteristics of Chinese patients with functional gastrointestinal disorders (FGID), and the mediating role between symptoms, psychopathology, and clinical outcomes.

METHODS

Six illness groups from four outpatient departments of a general hospital in China were recruited, including the FGID patient group. The modified and validated Chinese version of the illness perception questionnaire-revised was utilized, which contained three sections: symptom identity, illness representation, and causes. The 12-item short-form health survey was utilized to reflect the physical and mental health-related quality of life (HRQoL). The Toronto alexithymia scale was used to measure the severity of alexithymia. Additional behavioral outcome about the frequency of doctor visits in the past 12 months was measured. Pathway analyses with multiple-group comparisons were conducted to test the mediating role of illness perception.

RESULTS

Overall, 600 patients were recruited. The illness perceptions of FGID patients were characterized as with broad non-gastrointestinal symptoms (6.8 ± 4.2), a negative illness representation (more chronic course, worse consequences, lower personal and treatment control, lower illness coherence, and heavier emotional distress), and high numbers of psychological and culture-specific attributions. Fit indices of the three hypothesized path models (for physical and mental HRQoL and doctor-visit frequency, respectively) supported the mediating role of illness perceptions. For example, the severity of alexithymia and non-gastrointestinal symptoms had significant negative effect on mental quality of life through both direct (standardized effect: -0.085 and -0.233) and indirect (standardized effect: -0.045 and -0.231) influence via subscales of consequences, emotional representation, and psychological and risk factor attributions. Multi-group confirmatory factor analysis showed similar psychometric properties for FGID patients and the other disease group.

CONCLUSION

The management of FGID patients should take into consideration dysfunctional illness perceptions, non-gastrointestinal symptoms, and emotion regulation.

Confirmatory factor analysis of the causal illness attribution scale in Chinese patients with multiple somatic symptoms

Causal illness attributions influence how individuals cope with somatic symptoms and illnesses. Dimensions of causal symptom attributions have been examined in Western cultures with the subscale 'causes' of the revised Illness Perception Questionnaire (IPQ-R). Some previous studies have identified a stronger somatic attribution style in Asian patients. In this study it was examined if the factorial structure of causal attributions identified in Western populations can be identified in a large Chinese sample of patients presenting with somatic symptoms. We recruited 665 patients aged at least 18 who were visiting the hospital for reasons of treatment from departments of traditional Chinese medicine (TCM), neurology (Biomedicine), and psychosomatic medicine in six hospitals across China. All subjects completed the Patient Health Questionnaire (PHQ) and the causes subscale of the IPQ-R. We split the data-set by chance in two parts. On the first subsample, we conducted a confirmatory factor analysis (CFA) to check the fit of the originally proposed 4-factor structure and an exploratory factor analysis (EFA). The factor structure indentified in the EFA was rechecked with a CFA in the second subsample. The originally proposed 4-factor-model of the IPQ-R subscale causes showed no adequate fit in the first subsample. The EFA revealed two factors, psychological attributions and risk factors. The CFA in the second sample showed mediocre fit indices (RMSEA = .098, CFI = .923). For the Chinese sample we propose a two-factor structure for IPQ-R causes scale. As in other studies, we identified the relatively stable factor psychological attributions, indicating no fundamental differences in illness attributions between Western and Chinese samples.

Another Chance at Life: Jordanian Patients' Experience of Going Through a Myocardial Infarction

BACKGROUND AND PURPOSE

Myocardial infarction (MI) is a life-threatening health condition that has physical, spiritual, emotional, and social changes. Understanding feelings and thoughts of patients who suffered MI attacks is essential to recovery. Among Jordanian patients who suffered an acute attack of MI, the aim of the study was to describe the experiences and the varied meanings that they assign to their experiences.

METHODS

A qualitative hermeneutic phenomenological research design was used. Five participants were engaged in in-depth semistructured interviews. The participants were identified using a purposeful sampling technique, after being admitted at a coronary care unit in a university hospital located in Amman, the capital city of Jordan. The hospital provides a full range of cardiovascular medical and surgical care for patients admitted from different socioeconomic levels. Transcribed data were analyzed following inductive qualitative content analysis method.

RESULTS

The experience of MI was a traumatizing event characterized by life-threatening symptoms, and participants feared they would not come back home. However, cultural values and religiosity among the Jordanian patients played a major role in facilitating their positive coping during and after the MI attack. The participants' recount of their experience was summed-up into 5 major themes: frightening experience, needed support, religiosity, experiencing changes, and lifestyle modifications. After the MI attack, most of the participants felt that they had given another chance to live, showing a pressing need to make healthier lifestyle modifications to avoid another MI attack.

IMPLICATIONS FOR PRACTICE

Health care workers should need not only pay attention on physical and physiological caring aspects but should also consider other patients' needs, while supporting the patients and their family members.

Development and Validation of a Questionnaire to Assess Knowledge, Threat and Coping Appraisal, and Intention to Practice Healthy Behaviors Related to Non-Communicable Diseases in the Thai Population

Non-communicable diseases (NCDs) are important issues in Thailand and health sectors are now focusing on modifiable risks that include cognitive, affective and behavioral factors. This study aimed to develop and validate a questionnaire to assess knowledge about NCDs, threat appraisal, coping appraisal and intention to practice based on protection motivation theory. Content validity was determined by the mean of the item content validity index (I-CVI) from five experts. The questionnaire was pilot tested for difficulty of knowledge items and reliability test using the Kuder-Richardson (KR)-20 and Cronbach’s alpha coefficient among 30 Thai adult subjects in the health office for two sub-districts. The mean I-CVI ranged from 0.90–1.00 and difficulty of knowledge ranged from 0.3–0.9. The reliability test of knowledge by KR-20 ranged from 0.648–0.799, while Cronbach’s alpha coefficients of threat and coping appraisal and intention to practice ranged from 0.70–0.843. We compared sociodemographic data, knowledge about NCDs, threat appraisal, coping appraisal and intention to practice between 50 diabetic type 2 cases and 50 controls. T2DM cases had higher age, knowledge scores on diabetes and hypertension, threat appraisal scores on hypertension and cardiovascular disease when compared with control (p < 0.05). The questionnaire was valid and sufficiently reliable to use for data collection.

Efficacy of illness perception focused intervention on quality of life, anxiety, and depression in patients with myocardial infarction

Background:

Myocardial infarction (MI) is one of the major causes of death and disability worldwide, which can reduces quality of life in patients. Some disabilities are depression and anxiety which delay returning to work. The aim of this study was to evaluate the effect of illness perception focused intervention on quality of life, anxiety, and depression in MI patients.

Materials and Methods:

A randomized controlled trial study of 48 recently hospitalized MI patients was conducted (24 in intervention group and 24 in control group). Intervention group was trained to understand the disease by a mental health counselor in three half-an-hour sessions for three consecutive days. Data were collected from three questionnaires: hospital anxiety and depression scale, the World Health Organization Quality of Life Questionnaire (short form), and Illness Perceptions Questionnaire Brief at admission, 1.5, and 3 months postdischarge. Data were analyzed with ANOVA repeated measure.

Results:

The mean duration of returning to work was 28.7 ± 8.1 days in intervention groups and 46 ± 7.6 days in control group which was statistically significant (P < 0.001). Moreover, anxiety, depression, and illness perceptions score were significantly decreased in intervention groups which were 8.3 ± 3.3, 6.8 ± 3.5, and 36.5 ± 5 in intervention groups and 15.8 ± 2.1(P < 0.001), 17.1 ± 2.3 (P < 0.001), and 41.9 ± 4 (P < 0.001) in control group, respectively. Mean of quality of life subscales scores just physical health subscale showed a significant reduction after 3 months in the control group.

Conclusion:

Training MI patients to understand the disease in three half-an-hour sessions for 3 consecutive days can decrease the duration of returning to work, anxiety and depression, and increase illness perceptions which can make a better outcome.

Illness perception in patients with coronary artery disease: A systematic review

The aim of this study was to conduct a systematic review that investigates the differences in illness perception with age and gender in patients diagnosed with coronary artery disease. Previous studies show some discrepancies regarding the influence of age and gender on the specific dimensions of coronary artery disease patients' illness perception. A systematic review using a narrative synthesis process included preliminary synthesis, exploration of relationships and assessment of the robustness of the synthesis and findings was conducted. Search terms were used to identify research studies published between 1996 and December 2014 across four key databases: CINAHL, Medline, PsycINFO and Web of Science. A total of 14 studies met the inclusion criteria of the review. The review found that men had a stronger perception that their own behaviour had caused their illness than women. In addition, older patients had lower perceptions of the consequences and chronicity of their illness. This analysis concludes that some dimensions of illness perception vary according to age and gender of patients with coronary artery disease. These differences should be taken into consideration, particularly when providing health education and cardiac rehabilitation.

Perception of illness symptoms in patients with acute coronary syndrome: a need to improve

BACKGROUND

Interpretation of the symptoms of acute coronary syndrome (ACS) can influence the time of hospital admission and negatively affect patients' prognosis. We decided to explore illness perception and its predictors among patients with ACS.

METHODS

We conducted a retrospective analysis of all consecutive patients with ACS admitted to the cardiology department of a tertiary hospital between January and September 2011. Data were obtained from patients' medical records and telephone interviews.

RESULTS

One hundred and eighty-six patients with ACS (mean age 64 ± 12 years; 70% male) were included. The majority (62.6%) had no perception of ACS until informed by their doctor. Only 26% of patients with ST-segment elevation myocardial infarction had perception of cardiac disease. Among those who had perception, 82.6% were men and 58% had a previous diagnosis of ischemic heart disease (IHD). Gender and previous diagnosis of IHD were independent predictors of ACS perception, with male gender and patients with previous IHD having greater illness perception. No association was found between ACS perception and age or residence area (rural vs. urban).

CONCLUSIONS

The illness perception of ACS patients needs to be improved, independently of sociodemographic factors. An educational program for the general population, but particularly for women and individuals without a past history of IHD, focusing on the alert signs for ACS, may help to improve illness perception in this setting.

Understanding patients' perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review

INTRODUCTION

Dyslipidaemia leads to atherosclerosis and is a major risk factor for cardiovascular diseases. In clinical trials, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been shown to effectively reduce dyslipidaemia. Despite the availability and accessibility of statins, myocardial infarctions and cerebrovascular accidents remain among the top causes of mortality in developed countries, including Singapore. This enigma could be attributed to suboptimal adherence to statin therapy. The present literature review aimed to evaluate patients' perceptions of statin therapy.

METHODS

We searched PubMed and other databases for articles published in English from October 1991 to May 2012 containing keywords such as 'patient', 'views', 'perceptions', 'adherence', 'statin' and 'dyslipidaemia'. Of the 122 eligible studies retrieved, 58 were reviewed. The findings were categorised and framed in accordance with the Health Belief Model.

RESULTS

Patients with dyslipidaemia appeared to underestimate their susceptibility to dyslipidaemia-related complications, partly due to their demographic profiles. Failure to appreciate the severity of potential complications was a major hindrance toward adherence to statin therapy. Other factors that affected a patient's adherence included lack of perceived benefits, perceived side effects, the cost of statins, poor physician-patient relationship, and overestimation of the effectiveness of diet control as a treatment modality.

CONCLUSION

Existing evidence suggests that the cause of poor adherence to statin therapy is multifactorial. The use of the Health Belief Model to present the results of our literature review provides a systematic framework that could be used to design a patient-centric approach for enhancing adherence to statin therapy.

Factors associated with gender differences in medication adherence: a longitudinal study

AIMS

To examine gender differences in the medication adherence of patients with hypertension by applying a longitudinal follow-up.

BACKGROUND

Patient views of illness affect their adherence to therapeutic regimens. However, few studies have explored these issues by using a longitudinal design or from a gender perspective.

DESIGN

This study used a longitudinal, correlational design.

METHODS

A purposive sampling of 118 patients were recruited from cardiovascular clinics of a teaching hospital in Central Taiwan in 2007-2009. Data were collected using the Chinese Illness Perception Questionnaire-Revised and the Medication Adherence Inventory at three time points: at the first clinic visit, 6 and 12 months after the initial survey. Generalized estimating equations were calculated using the STATA software for data analysis.

RESULTS

The findings revealed that male patients adhere more effectively to medications than female patients do. The interaction between systolic blood pressure and gender emerged as a significant predictor of adherence. Factors associated with adherence in male patients included less causal attribution to culture, more attribution to risk factors, fewer symptoms and uncertain symptoms related to high blood pressure, lower scores for timeline-cyclical and higher scores for illness consequences and coherence. Medication adherence for female patients was significantly related to more causal attribution to balance and risk factors, less personal control and enhanced illness coherence.

CONCLUSION

Factors associated with adherence to antihypertensive medication were relatively gender-specific. Awareness of the differences is crucial for health professionals to provide appropriate advice for patients to cope effectively with their health threat.

The effect of a telephone follow-up intervention on illness perception and lifestyle after myocardial infarction in China: a randomized controlled trial

BACKGROUND

Lifestyle modification is an integral component of cardiac secondary prevention, while it has been confirmed that myocardial infarction (MI) patients' health-related behaviors are heavily influenced by their illness perception.

OBJECTIVES

To evaluate the effect of a telephone follow-up intervention for improving MI patients' illness perception and lifestyle.

DESIGN

A randomized controlled trial, longitudinal research design was employed.

SETTINGS

Cardiac care units in four major general hospitals in Guangzhou, China.

PARTICIPANTS

Inclusion criteria were being diagnosed with an initial acute MI, being able to communicate orally in Mandarin or Cantonese and read in Chinese, and living in Guangzhou. Exclusion criteria were with continuing uncontrolled arrhythmias or heart failure, being illiteracy, or with a history of major psychiatric illness, exercise-induced asthma, uncontrolled diabetes, or evidence of dementia.

METHOD

124 patients admitted with the first acute MI were randomized to receive either routine care or routine care plus a telephone follow-up intervention, which consist of a pre-discharge education and three telephone follow-up instructions. Data were collected before discharge, at the 6th and the 12th week after discharge from hospital, respectively.

RESULTS

At the 6th and the 12th week after discharge, patients in the intervention group had significantly positive perceptions about symptoms of MI (mean difference 3.27, 95% confidence interval 2.48-4.07, p<.001; mean difference 2.12, 95% confidence interval 1.34-2.89, p<.001 respectively) and how long their illness would last (mean difference -0.69, 95% confidence interval -0.91 to -0.47, p<.001; mean difference -0.74, 95% confidence interval -0.96 to -0.51, p<.001 respectively) compared with the control group. The intervention group also had more positive beliefs about the controllability (F=4.23, p=.04) and more improved beliefs about the causes of MI than the control group. Moreover, the intervention improved the patients' nutrition (F=5.16, p=.03) and physical activity at the 12-week follow-up (mean difference 0.37, 95% confidence interval 0.17-0.58, p<.001).

CONCLUSION

This telephone follow-up intervention can result in improved illness perception and lifestyle after MI. It could be incorporated into current hospital treatment regimens for MI to improve patients' quality of life.