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Knowles SR, Apputhurai P, Jenkins Z, O'flaherty E, Ierino F, Langham R, Ski CF, Thompson DR, Castle DJ. Impact of chronic kidney disease on illness perceptions, coping, self-efficacy, psychological distress and quality of life. PSYCHOL HEALTH MED 2023; 28:1963-1976. [PMID: 36794381 DOI: 10.1080/13548506.2023.2179644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Chronic kidney disease (CKD) negatively impacts psychological well-being and quality of life (QoL). Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of self-efficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. Participants were 147 people with stage 3-5 kidney disease. Measures included eGFR, illness perceptions, coping styles, psychological distress, self-efficacy and QoL. Correlational analyses were performed, followed by regression modelling. Poorer QoL was associated with greater distress, engagement in maladaptive coping, poorer illness perceptions and lower self-efficacy. Regression analysis revealed that illness perceptions predicted QoL, with psychological distress acting as a mediator. The proportion of variance explained was 63.8%. These findings suggest that psychological interventions are likely to enhance QoL in CKD, if they target the mediating psychological processes associated with illness perceptions and psychological distress.
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Affiliation(s)
- Simon R Knowles
- School of Health Sciences, Swinburne University, Melbourne, Australia
| | | | - Zoe Jenkins
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
| | - Emmet O'flaherty
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Francesco Ierino
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Robyn Langham
- St. Vincent's Hospital, University of Melbourne Department of Medicine, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - David R Thompson
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David J Castle
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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2
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Truong DM, Mire SS, Day SX, Ni L, Keller-Margulis M. A cross-cultural comparison of a measure of parent perceptions among families of children with autism in Vietnam. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:997-1010. [PMID: 36510836 DOI: 10.1177/13623613221141262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
LAY ABSTRACT Raising an autistic child can affect many aspects of families' lives. Parents are responsible for many decisions, from initiating evaluation to selecting and implementing treatments. How parents conceptualize the course and nature of their child's diagnosis influences these processes and parents' own well-being. Parents' perceptions about their children's autism are also affected by cultural contexts and understanding of autism. The Illness Perception Questionnaire-Revised (IPQ-R) is widely used to study cognitions in chronic health research and has been adapted and validated to measure parents' perceptions and beliefs about their children's ASD (IPQ-R-ASD). However, such studies are mostly conducted in high-income countries (HICs) with western, individualistic cultural values (e.g. United States, Canada). Therefore, it is unclear whether the IPQ-R-ASD is a useful instrument in understanding parents' perceptions of autism in Vietnam, a lower- and middle-income country (LMIC) with collectivistic Asian cultural values. These differences suggest that parents in Vietnam may have cognitive representations of their children's autism that differ from those of parents living in HIC, western countries. The purpose of this study was to examine the usability of the translated Vietnamese IPQ-R-ASD that may, ultimately, help explore Vietnamese parents' autism perceptions. While the study's result indicated the usability of the translated measure in Vietnam, when interpreted with Vietnamese norms, results also highlighted notable differences between Vietnamese and North American parents' perceptions of autism that warrant further research.
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Affiliation(s)
| | | | | | - Lan Ni
- University of Houston, USA
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3
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Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal. J Cardiovasc Dev Dis 2022; 9:jcdd9100344. [PMID: 36286296 PMCID: PMC9604186 DOI: 10.3390/jcdd9100344] [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: 08/30/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p < 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p < 0.01). Patients enrolled in CR were more likely to be treated with sacubitril/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p < 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1.04; 95% CI 1.01−1.07), higher education level (adjusted OR 3.31; 95% CI 1.63−6.70), stroke (adjusted OR 3.29; 95% CI 1.06−10.27), COPD (adjusted OR 4.82; 95% CI 1.53−15.16), and no ICD status (adjusted OR 2.68; 95% CI 1.36−5.26) were independently associated with CR non-enrollment. The main reasons for not being enrolled in CR were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Despite the relatively high proportion (35%) of HFrEF patients who underwent CR, the enrollment rate can be further improved. Innovative multi-level strategies addressing physicians’ awareness, patients’ comorbidities, and geographical issues should be pursued.
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Middleton WA, Savage PD, Khadanga S, Rengo JL, Ades PA, Gaalema DE. Benchmarking Depressive Symptoms in Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:163-171. [PMID: 34840245 PMCID: PMC9058142 DOI: 10.1097/hcr.0000000000000657] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Depression affects cardiac health and is important to track within cardiac rehabilitation (CR). Using two depression screeners within one sample, we calculated prevalence of baseline depressive symptomology, improvements during CR, and predictors of both. METHODS Data were drawn from the University of Vermont Medical Center CR program prospectively collected database. A total of 1781 patients who attended between January 2011 and July 2019 were included. Two depression screeners (Geriatric Depression Scale-Short Form [GDS-SF] and Patient Health Questionnaire-9 [PHQ-9]) were compared on proportion of the sample categorized with ≥ mild or moderate levels of depressive symptoms (PHQ-9 ≥5, ≥10; GDS-SF ≥6, ≥10). Changes in depressive symptoms by screener were examined within patients who had completed ≥9 sessions of CR. Patient characteristics associated with depressive symptoms at entry, and changes in symptoms were identified. RESULTS Within those who completed ≥9 sessions of CR with exit scores on both screeners (n = 1201), entrance prevalence of ≥ mild and ≥ moderate depressive symptoms differed by screener (32% and 9% PHQ-9; 12% and 3% GDS-SF; both P< .001). Patients who were younger, female, with lower cardiorespiratory fitness (CRF) scores were more likely to have ≥ mild depressive symptoms at entry. Most patients with ≥ mild symptoms decreased severity by ≥1 category by exit (PHQ-9 = 73%; GDS-SF = 77%). Nonsurgical diagnosis and lower CRF were associated with less improvement in symptoms on the PHQ-9 (both P< .05). CONCLUSION Our results provide initial benchmarks of depressive symptoms in CR. They identify younger patients, women, patients with lower CRF, and those with nonsurgical diagnosis as higher risk groups for having depressive symptoms or lack of improvement in symptoms.
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Affiliation(s)
- William A Middleton
- Vermont Center on Behavior and Health, Burlington (Mr Middleton and Drs Ades and Gaalema); Departments of Psychiatry (Dr Gaalema) and Psychology (Mr Middleton and Dr Gaalema), University of Vermont, Burlington; and Division of Cardiology, University of Vermont College of Medicine, Burlington (Messrs Savage and Rengo and Drs Khadanga and Ades)
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Daw P, Withers TM, van Zanten JJCSV, Harrison A, Greaves CJ. A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure. BMC Health Serv Res 2021; 21:1267. [PMID: 34814927 PMCID: PMC8611948 DOI: 10.1186/s12913-021-07174-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences. Methods A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources. Results Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were ‘the organisation of healthcare system’, ‘the organisation of cardiac rehabilitation programmes’, ‘healthcare professional’ factors and ‘guidelines’. The most frequent themes included ‘lack of resources: time, staff, facilities and equipment’ and ‘professional’s knowledge, awareness and attitude’. Conclusions Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07174-w.
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Affiliation(s)
- Paulina Daw
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Thomas M Withers
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | | | - Colin J Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Rodrigo SF, Van Exel HJ, Van Keulen N, Van Winden L, Beeres SLMA, Schalij MJ. Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned. IJC HEART & VASCULATURE 2021; 36:100858. [PMID: 34466654 PMCID: PMC8382985 DOI: 10.1016/j.ijcha.2021.100858] [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: 04/11/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) after hospitalization for acute coronary syndrome (ACS) has shown to reduce mortality, readmissions, and improve quality of life. CR is recommended by international guidelines but previous studies have shown low participation rates. Systematic CR referral might improve CR participation. METHODS The present study evaluates CR referral and CR participation of patients hospitalized for ACS in 2017 and treated according to local protocol, which includes systematic CR referral. Participation rate was divided into a group that finished the CR program and drop outs. In addition, factors associated with CR referral and participation rate were evaluated. RESULTS A total of 469 patients eligible for CR were included in the study, of which 377 (80%) were referred for CR and 353 (75%) participated in CR. Ninety percent of participants completed the CR program. Factors independently associated with CR referral included age (50-60 year vs. > 70 year: odds ratio [OR] 4.7, 95% confidence interval [CI] 1.98-11.2), diagnosis (ST-elevation myocardial infarction vs. unstable angina: OR 17.7, CI 7.59-41.7), previous cardiovascular disease (OR 0.4, CI 0.19-0.73) and left ventricular dysfunction vs. normal function (OR 2.2, CI 1.11-4.52). A larger distance to the CR center was associated with lower CR participation (<5km vs. > 20 km: OR 3.1, CI 1.20-7.72). CONCLUSIONS Systematic CR referral in ACS patients results in high CR referral (80%) and participation (75%) rates. CR adherence might be further improved by increasing CR referral, especially in older patients and patients with NSTEMI or unstable angina.
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Key Words
- ACS, Acute coronary syndrome
- CI, Confidence interval
- CR, Cardiac rehabilitation
- CVA, Cerebrovascular accident
- Cardiac rehabilitation
- DBC, Diagnosis treatment combination (Diagnose behandel combinatie)
- EPD, Electronic patient dossier
- LV, Left ventricular
- NSTEMI, Non ST-elevation myocardial infarction
- OR, Odds ratio
- Patient participation
- Referral
- SES, Socio-economic status
- STEMI, ST-elevation myocardial infarction
- Secondary prevention
- TIA, Transient ischemic attack
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Affiliation(s)
- Sander F Rodrigo
- Basalt Rehabilitation, Leiden, the Netherlands
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nicole Van Keulen
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Loes Van Winden
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia L M A Beeres
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J Schalij
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Rezaei S, Hoseini nia M, Vakilian M. The mediating role of illness perception in the relationship between psychological hardiness and the health status of covid-19 (coronavirus disease) survived patients. Health Psychol Res 2021; 9:24839. [DOI: 10.52965/001c.24839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022] Open
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Friedrich O, Kunschitz E, Pongratz L, Wieländer S, Schöppl C, Sipötz J. Classification of illness attributions in patients with coronary artery disease. Psychol Health 2021; 36:1368-1383. [PMID: 33410711 DOI: 10.1080/08870446.2020.1851688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine patient-reported causal attributions in patients with coronary artery disease and classify them according to attribution theory. DESIGN Patients with angiographically verified coronary artery disease (n = 459) were asked to report causal attributions by answering the respective open-ended item of the Brief Illness Perception Questionnaire. MAIN OUTCOME MEASURES Groups resulting from classifications were characterised with regard to sociodemographic and clinical variables, Quality of Life (SF-12), depression (PHQ-9), anxiety (GAD-7), and illness perception (BIPQ). RESULTS Stress emerged as the single most important attribution followed by various behavioural factors and genetic predisposition. There was a remarkable mismatch between the presence of modifiable risk factors (smoking, obesity) and patient-reported illness attributions. Based on the results of the descriptive categorisation of illness attributions we developed a transparent, easily reproducible scheme for dimensional classification of the fifteen most common responses according to attribution theory. The classification resulted in four groups: Behaviour/Emotional State, Past Behaviour/Emotional State, Physical/Psychological Trait and External. CONCLUSION We found a pattern of illness attributions largely in line with previous trials. The dimensional classification resulted in four groups and highlighted potential entry points for physician-patient communication aimed at establishing beneficial disease self-management.
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Affiliation(s)
- Oliver Friedrich
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria
| | - Evelyn Kunschitz
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria.,II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Lisa Pongratz
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Sophia Wieländer
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Christine Schöppl
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Johann Sipötz
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria.,II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
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Psychiatric provider comfort and perception regarding psychogenic nonepileptic seizures. Epilepsy Behav 2020; 113:107524. [PMID: 33099257 DOI: 10.1016/j.yebeh.2020.107524] [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: 08/17/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/21/2022]
Abstract
The treatment of psychogenic nonepileptic seizures (PNES) involves psychotherapy: yet there is a gap in the understanding of the perceptions and comfort of therapy providers regarding PNES. In this study, we surveyed providers of therapy, including psychiatrists, psychiatric nurse practitioners, physician assistants, psychologists, and social workers, to collect information regarding their comfort and perceptions in caring for individuals with PNES. This study identified differences between physician and non-physician groups in training about PNES and in exposure to patients with PNES. While 26.7% of non-physician providers describe prior training in PNES, 48.3% endorse feeling comfortable treating PNES, suggesting that comfort is based in areas other than prior training. And while providers (83.8% of physicians and 82.1% of non-physicians) deny concern about patients having an in-appointment episode, 36.1% of physicians and 51.7% of non-physicians are concerned that they would not be able to tell apart a nonepileptic versus epileptic episode. While physicians and non-physician providers were similar in their views regarding chronicity, cyclicality, effect of treatment, and illness coherence of PNES, physicians noted significantly greater perceptions of the negative consequences and patient control ability. While both groups viewed PNES as improving with treatment, 83.8% of physicians and 89.7% of non-physicians agreed or strongly agreed that more training in PNES would increase their comfort.
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Desveaux L, Saragosa M, Russell K, McCleary N, Presseau J, Witteman HO, Schwalm JD, Ivers NM. How and why a multifaceted intervention to improve adherence post-MI worked for some (and could work better for others): an outcome-driven qualitative process evaluation. BMJ Open 2020; 10:e036750. [PMID: 32883724 PMCID: PMC7473621 DOI: 10.1136/bmjopen-2019-036750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To explore (1) the extent to which a multicomponent intervention addressed determinants of the desired behaviours (ie, adherence to cardiac rehabilitation (CR) and cardiovascular medications), (2) the associated mechanism(s) of action and (3) how future interventions might be better designed to meet the needs of this patient population. DESIGN A qualitative evaluation embedded within a multicentre randomised trial, involving purposive semistructured interviews. SETTING Nine cardiac centres in Ontario, Canada. PARTICIPANTS Potential participants were stratified according to the trial's primary outcomes of engagement and adherence, resulting in three groups: (1) engaged, adherence outcome positive, (2) engaged, adherence outcome negative and (3) did not engage, adherence outcome negative. Participants who did not engage but had positive adherence outcomes were excluded. Individual domains of the Theoretical Domains Framework were applied as deductive codes and findings were analysed using a framework approach. RESULTS Thirty-one participants were interviewed. Participants who were engaged with positive adherence outcomes attributed their success to the intervention's ability to activate determinants including behavioural regulation and knowledge, which encouraged an increase in self-monitoring behaviour and awareness of available supports, as well as reinforcement and social influences. The behaviour of those with negative adherence outcomes was driven by beliefs about consequences, emotions and identity. As currently designed, the intervention failed to target these determinants for this subset of participants, resulting in partial engagement and poor adherence outcomes. CONCLUSION The intervention facilitated CR adherence through reinforcement, behavioural regulation, the provision of knowledge and social influence. To reach a broader and more diverse population, future iterations of the intervention should target aberrant beliefs about consequences, memory and decision-making and emotion. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry; NCT02382731.
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Affiliation(s)
- Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Kirstie Russell
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Nicola McCleary
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada
| | - J-D Schwalm
- Translation and Health Systems Research Program, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Noah Michael Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Kube T, Meyer J, Grieshaber P, Moosdorf R, Böning A, Rief W. Patients’ pre- and postoperative expectations as predictors of clinical outcomes six months after cardiac surgery. PSYCHOL HEALTH MED 2019; 25:781-792. [DOI: 10.1080/13548506.2019.1659986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Julia Meyer
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, Justus-Liebig-University Giessen, Gießen, Germany
| | - Rainer Moosdorf
- Department of Cardiovascular Surgery, Heart Centre, Philipps-University of Marburg, Marburg, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, Justus-Liebig-University Giessen, Gießen, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
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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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13
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Jones MC, Smith K, Herber O, White M, Steele F, Johnston DW. Intention, beliefs and mood assessed using electronic diaries predicts attendance at cardiac rehabilitation: An observational study. Int J Nurs Stud 2018; 88:143-152. [PMID: 30296634 DOI: 10.1016/j.ijnurstu.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiac rehabilitationis effective in promoting physical/psychological recovery following acute coronary syndrome. Yet, rates of attendance at outpatient cardiac rehabilitation by eligible patients are low. OBJECTIVES This study examined the determinants of attendance at outpatient cardiac rehabilitation in acute coronary syndrome patients following discharge until cardiac rehabilitation commencement. DESIGN A weekly electronic diary measured cardiac-related cognitions and mood and examined their relation to attendance at outpatient cardiac rehabilitation. SETTINGS Three United Kingdom National Health Service secondary care settings in two Health Board areas in Scotland. PARTICIPANTS Acute coronary syndrome patients were recruited from March 2012 to June 2013 prior to hospital discharge. Of 488 eligible patients referred for cardiac rehabilitation, 214 consented. METHODS Consecutive patients completed a pre-hospital discharge questionnaire targeting age, diagnosis, social class and smoking history. Acute coronary syndrome patients then completed a weekly electronic diary from the first week of discharge until the start of cardiac rehabilitation. Multilevel structural equation models estimated the effects of initial, i.e. baseline and rate of change in cardiac-related cognition and mood on attendance. Intention to attend cardiac rehabilitation was reflected, log transformed, reported thereafter as "do not intend". The role of "do not intend" was explored as a mediator of the relationship between cardiac-related cognition and mood on attendance. RESULTS 166 participants provided, on average, 5 weeks of diary entries before cardiac rehabilitation commenced. High intention (i.e. low "do not intend") to attend CR and its rate of increase over time predicted attendance. Low negative emotional representation, high perceived necessity, high confidence in maintaining function, low negative affect, and high positive affect following discharge predicted attendance at cardiac rehabilitation. The rate of change in cardiac-related mood and these cognitions was not predictive. Baseline and rate of change in "do not intend" entirely mediated relationships between a) perceived necessity, b) negative affect and attendance at cardiac rehabilitation. CONCLUSIONS Negative affect in the first weeks following discharge represents the key challenge to a patient maintaining their intention to attend cardiac rehabilitation. Intervention to improve attendance should focus on improving intention to attend following discharge and during recovery by improving patient understanding of cardiac rehabilitation and reducing negative affect.
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Affiliation(s)
- Martyn C Jones
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom.
| | - Karen Smith
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom; NHS Tayside, Dundee, Scotland, United Kingdom.
| | - Oliver Herber
- Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Myra White
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom.
| | - Fiona Steele
- London School of Economics and Political Science, London, England, United Kingdom.
| | - Derek W Johnston
- School of Psychology, University of Aberdeen, Aberdeen, Scotland.
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Kumthekar A, Johnson B. Improvement of appointment compliance in an underserved lupus clinic. BMC Health Serv Res 2018; 18:610. [PMID: 30081907 PMCID: PMC6080390 DOI: 10.1186/s12913-018-3429-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022] Open
Abstract
Background To identify major obstacles to appointment compliance and quantify a measurable effect of a simple phone call intervention on the clinic show rate. Methods We retrospectively looked at the show rates from November 1st, 2013 to June 30th, 2014 at our Lupus clinic, which is located in Bronx, NY. The scheduled patient chart was crosschecked if the patient made it to the appointment by verifying the provider note. A patient survey was implemented over a period of 8 weeks from July 1st, 2014 to August 12th, 2014. A reminder phone call intervention 2–3 days prior to the visit was planned. The intervention was implemented from September 1st, 2014 to April 30th, 2015. Data was analyzed after the end of the intervention period. Results In the pre-intervention period, our clinic show-rate was 207/352 (58.8%) The pilot survey had a total of 43 responses. The most common reason for a missed appointment was ‘forgot about the appointment’ (45.5%). Reminder phone calls were the preferred intervention (76.74%), which patients’ thought might help to keep scheduled appointments. In the intervention period, 283 of the scheduled 378 appointments were completed (74.8) in the lupus clinic. The difference in the show rate before and after the intervention by Pearson’s Chi-squared test with Yates continuity correction was statistically significant with a p-value of 0.0062. Conclusion A simple telephone call reminder significantly improves clinic show rates in an underserved Lupus clinic, which can help improve health parameters in the Lupus population.
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Affiliation(s)
- Anand Kumthekar
- Division of Rheumatology, Montefiore Medical Center/ Albert Einstein College of Medicine, 1776 Eastchester Road, Fl. 2, Suite 260, Bronx, NY, 10461, USA.
| | - Beverly Johnson
- Division of Rheumatology, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway, 3N21, Bronx, NY, 10461, USA
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15
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Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study. Dev Psychopathol 2018; 29:1573-1587. [PMID: 29162171 DOI: 10.1017/s0954579417001249] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The quality of prenatal maternal mental health, from psychological stress and depressive symptoms to anxiety and other nonpsychotic mental disorders, profoundly affects fetal neurodevelopment. Despite the evidence for the influence of positive mental well-being on health, there is, to our knowledge, no research examining the possible effects of positive antenatal mental health on the development of the offspring. Using exploratory bifactor analysis, this prospective study (n = 1,066) demonstrated the feasibility of using common psychiatric screening tools to examine the effect of positive maternal mental health. Antenatal mental health was assessed during 26th week of pregnancy. The effects on offspring were assessed when the child was 12, 18, and 24 months old. Results showed that positive antenatal mental health was uniquely associated with the offspring's cognitive, language and parentally rated competences. This study shows that the effects of positive maternal mental health are likely to be specific and distinct from the sheer absence of symptoms of depression or anxiety.
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Aberkane S. Psychometric Testing of an Arabic Translation of the Revised-Illness Perception Questionnaire (IPQ-R) for Chronic Illness Patients. Malays J Med Sci 2017; 24:74-85. [PMID: 28951692 DOI: 10.21315/mjms2017.24.4.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/06/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Researchers lack a properly validated instrument to measure perceptions of chronic disease in Arabic language contexts. This study aimed to adapt and validate the Revised-Illness Perception Questionnaire (IPQ-R) for Arabic speaking chronic illness patients. METHODS A cross-sectional design was conducted to examine the psychometric properties of the adapted English version of the IPQ-R for Arabic speaking chronic illness patients. The study instrument was an Arabic version of the IPQ-R prepared through a translation process. The reliability and validity of the instrument were assessed using exploratory and confirmatory factor analysis and Cronbach's alpha coefficient. Three hundred and sixteen participants (ages 16-79) from the Batna region in Algeria completed the IPQ-R. RESULTS A total of 316 (100%) patients responded to this study. Regarding internal consistency, Cronbach's alpha a coefficient was consistently higher than 0.45. Several areas of fit were identified and substantial changes to the measurement model were made, such as the deletion of 22 items from the original 38-item IPQ-R and two items from the original 18 causal items this accounted for 64.63% of the total variance, and the respecification of indicators had to be applied to achieve acceptable model fit. The final model consists of two sections: The 16-item Arabic IPQ-R, which had a good fit; (CMIN/Df = 1.30, P < 0.001, CFI = 0.93, RMSEA = 0.08, SRMR = 0.03), and was similar to the Arabic 16 causal items (CMIN/DF = 1.11, P < 0.001, CFI = 0.95, RMSEA = 0.080, SRMR = 0.02). CONCLUSION The factor structure concurred with prior finding despite differences to the type of sample and cultural considerations that might explain these findings. Replication of this study in Algerian patients with specific illness, such as silicosis, breast cancer and multiple sclerosis. Further psychometric testing on other large samples is recommended.
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Affiliation(s)
- Salah Aberkane
- Department of Psychology, Faculty of Human and Social Sciences, University of Khenchela, Algeria
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Waite J, Rose J, Wilde L, Eden K, Stinton C, Moss J, Oliver C. Associations between behaviours that challenge in adults with intellectual disability, parental perceptions and parental mental health. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:408-430. [PMID: 28801992 DOI: 10.1111/bjc.12146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 05/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examined parental perceptions of behaviours that challenge (CB) in their adult children with intellectual disability (ID), and explored whether perceptions mediated associations between CB and parental psychological distress. DESIGN A within-group correlational design was employed. METHODS Sixty-five parents reported on individuals with genetic syndromes and ID who had chronic CB. Parents completed the Illness Perception Questionnaire-Revised (IPQ-R) adapted to measure perceptions of self-injury, aggression or property destruction, alongside assessments of parental locus of control, attributions about behaviour, parental psychological distress, and CB. RESULTS A high proportion of parents evidenced anxiety and depression at clinically significant levels (56.9% and 30.8%, respectively). Contrary to predictions, psychological distress was not significantly associated with CB. The perception that the adult with ID exerted control over the parent's life mediated the association between CB and parental psychological distress. Few parents endorsed operant reinforcement as a cause of CB (< 10%). CONCLUSIONS The high levels of psychological distress in parents is notable and of concern. Further research should consider the reasons why parents have causal attributions that might be inconsistent with contemporary interventions. PRACTITIONER POINTS Parents experience high levels of psychological distress while supporting adults with ID who engage in chronic behaviours that challenge. A stronger belief that the adult with ID exerts control over the parent's life may mediate an association between CB exhibited by the individual with ID and parental psychological distress. Few parents endorsed operant reinforcement as a cause of behaviours that challenge.
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Affiliation(s)
- Jane Waite
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, UK
| | - John Rose
- School of Psychology, University of Birmingham, UK
| | - Lucy Wilde
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, UK
| | - Kate Eden
- Department of Psychology, University of Bath, UK
| | - Chris Stinton
- Health Sciences Research Institute, University of Warwick, Coventry, UK
| | - Jo Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, UK.,Institute of Cognitive Neuroscience, University College London, UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, UK
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Frost L, Jenkins LS, Emmink B. Improving access to health care in a rural regional hospital in South Africa: Why do patients miss their appointments? Afr J Prim Health Care Fam Med 2017; 9:e1-e5. [PMID: 28397521 PMCID: PMC5387369 DOI: 10.4102/phcfm.v9i1.1255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/30/2016] [Accepted: 11/18/2016] [Indexed: 11/24/2022] Open
Abstract
Background Access to health services is one of the Batho Pele (‘people first’) values and principles of the South African government since 1997. This necessitated some changes around public service systems, procedures, attitudes and behaviour. The challenges of providing health care to rural geographically spread populations include variations in socio-economic status, transport opportunities, access to appointment information and patient perceptions of costs and benefits of seeking health care. George hospital, situated in a rural area, serves 5000 outpatient visits monthly, with non-attendance rates of up to 40%. Objectives The aim of this research was to gain a greater understanding of the reasons behind non-attendance of outpatient department clinics to allow locally driven, targeted interventions. Methods This was a descriptive study. We attempted to phone all patients who missed appointments over a 1-month period (n = 574). Only 20% were contactable with one person declining consent. Twenty-nine percent had no telephone number on hospital systems, 7% had incorrect numbers, 2% had died and 42% did not respond to three attempts. Results The main reasons for non-attendance included unaware of appointment date (16%), out of area (11%), confusion over date (11%), sick or admitted to hospital (10%), family member sick or died (7%), appointment should have been cancelled by clerical staff (6%) and transport (6%). Only 9% chose to miss their appointment. The other 24% had various reasons. Conclusions Improved patient awareness of appointments, adjustments in referral systems and enabling appointment cancellation if indicated would directly improve over two-thirds of reasons for non-attendance. Understanding the underlying causes will help appointment planning, reduce wasted costs and have a significant impact on patient care.
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Affiliation(s)
| | - Louis S Jenkins
- George Regional Hospital, Western Cape Government, South Africa and Division of Family Medicine and Primary Care, Stellenbosch University.
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19
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Pietrabissa G, Manzoni GM, Rossi A, Castelnuovo G. The MOTIV-HEART Study: A Prospective, Randomized, Single-Blind Pilot Study of Brief Strategic Therapy and Motivational Interviewing among Cardiac Rehabilitation Patients. Front Psychol 2017; 8:83. [PMID: 28223950 PMCID: PMC5293749 DOI: 10.3389/fpsyg.2017.00083] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/13/2017] [Indexed: 01/09/2023] Open
Abstract
Background: Psychological distress, biomedical parameters, and unhealthy lifestyles contribute to a poorer prognosis for cardiac disease. Public health's challenge is to motivate patients to utilize self-care. Objective: This prospective, randomized, single-blind pilot study aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond those of the stand-alone BST in a residential Cardiac Rehabilitation (CR) program. Method: Fourty-two inpatients (17 females), enrolled in a 1-month CR program, were randomly allocated into two conditions: (a) Three sessions of BST and (b) Three sessions of BST plus MI. Data were collected at baseline, discharge, and after 3 months through phone interviews. Results: At discharge, no significant between-group difference was found in any outcome variable. Changes from pre- to post-treatment within each condition showed significant improvements only in the BST group, where the level of external regulation diminished, and both the participants' self-regulation (Relative Autonomous Motivation Index, RAI) and willingness to change improved. At the 3-month follow-up, within-group analyses on responders (BST = 9; BST + MI = 11) showed a statistically significant improvement in the level of systolic blood pressure in both groups. Discussion: Findings showed no evidence of the incremental efficacy of combining BST and MI over and beyond BST alone on either selected biomedical or psychological outcomes among CR patients. Conclusions: Ends and limitations from the present pilot study should be considered and addressed in future investigations.
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Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Alessandro Rossi
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCS Verbania, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy
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20
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Matata BM, Williamson SA. A Review of Interventions to Improve Enrolment and Adherence to Cardiac Rehabilitation Among Patients Aged 65 Years or Above. Curr Cardiol Rev 2017; 13:252-262. [PMID: 28699488 PMCID: PMC5730958 DOI: 10.2174/1574884712666170710094842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This review provides an overview and quality assessment of existing interventions, assessing the intervention types that are most effective at increasing enrolment and adherence to cardiac rehabilitation in older patients aged ≥65 years Methods: The review of the literature was performed using electronic databases to search for randomised controlled trials that aimed to increase enrolment and/or adherence to cardiac rehabilitation in older patients aged ≥65 years. The main key words were cardiac rehabilitation, enrolment, adherence and older patients. Studies were included if; (1) the intervention targeted improving enrolment and/or adherence to at least one of the following components of the cardiac rehabilitation programme: exercise, education or maintaining lifestyle changes; (2) assess the effectiveness of an intervention on increasing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (3) include measures for assessing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (4) the study included patients with a mean age of ≥65 years who were deemed eligible to participate in a cardiac rehabilitation programme. Included studies could be published in any language and there were no date restrictions for included studies. Studies focusing on pharmaceutical adherence were not included for the purpose of this review. RESULTS Seven studies were included, with four investigating enrolment (1944 participants) and three assessing adherence to intervention programmes (410 participants). Three studies (1919 participants) reported higher enrolment to cardiac rehabilitation in the intervention group. Two studies that reported increases in enrolment to cardiac rehabilitation were deemed to have an unclear or high risk of bias. All three studies (410 participants) reported better adherence to cardiac rehabilitation in the intervention group when compared to the control group. Two studies that reported better completion of cardiac rehabilitation were deemed to have an unclear or high risk of bias. No formal meta-analysis was conducted due to the observed multiple heterogeneity among outcome measures, the low number of included studies and variability in study designs. CONCLUSION This review found only weak evidence to suggest that interventions can increase enrolment or adherence to cardiac rehabilitation programmes for patients aged ≥65 years, therefore no practice recommendations could be made and further high-quality research is needed in this population group.
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Affiliation(s)
- Bashir M. Matata
- Liverpool Heart & Chest Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
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21
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Predictors of Cardiac Rehabilitation Initiation and Adherence in a Multiracial Urban Population. J Cardiopulm Rehabil Prev 2017; 37:30-38. [DOI: 10.1097/hcr.0000000000000226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Worcester MUC, Murphy BM, Mee VK, Roberts SB, Goble AJ. Cardiac rehabilitation programmes: predictors of non-attendance and drop-out. ACTA ACUST UNITED AC 2016; 11:328-35. [PMID: 15292767 DOI: 10.1097/01.hjr.0000137083.20844.54] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite evidence of its benefits, attendance at cardiac rehabilitation (CR) programmes is poor. Past studies to identify predictors of non-attendance have been limited by their small sample size, particularly for female patients. The present study was designed to identify socio-demographic and clinical predictors of non-attendance and drop-out separately for men and women automatically referred to CR programmes. METHOD AND SUBJECTS Prospective study of CR programme attendance amongst 808 patients consecutively admitted over an 11-month period to one of two hospitals in Melbourne, Australia, after acute myocardial infarction (AMI), or to undergo coronary artery bypass graft surgery (CABGS) or percutaneous coronary intervention (PCI). RESULTS Of the 652 eligible patients, 573 (88%) were successfully tracked at 4 months. Of these, 284 (49.6%) had attended a CR programme, while 272 (47.5%) had not. Using logistic regression, the significant predictors of programme non-attendance among men were having had a PCI, being a non-driver, and being aged 70 or more. The only factor predictive of non-attendance for women was being aged 70 or more. Amongst attenders, 67 (23.6%) patients discontinued the programme. Being a smoker, having diabetes and being unemployed at the time of hospital admission were predictive of programme drop-out by men. Being physically inactive at admission was predictive of programme drop-out by women. CONCLUSIONS The present study demonstrated a relatively high rate of CR programme attendance. Special attention needs to be directed towards males who are older, PCI patients, smokers, unemployed or non-drivers, and females who are older or inactive.
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Cooper AF, Jackson G, Weinman J, Horne R. A qualitative study investigating patients' beliefs about cardiac rehabilitation. Clin Rehabil 2016; 19:87-96. [PMID: 15704513 DOI: 10.1191/0269215505cr818oa] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: The opportunity to attend a cardiac rehabilitation course is usually offered to patients who have suffered a myocardial infarction. However, despite referral, many patients fail to attend. Objective: To elicit patients' beliefs about the role of the cardiac rehabilitation course following myocardial infarction. Design: Qualitative study using in-depth semi-structured interviews. Setting: London Teaching Hospital. Subjects: Thirteen patients were interviewed after discharge from hospital following myocardial infarction, but prior to attendance at cardiac rehabilitation. Main outcome measures: Patients' beliefs about cardiac rehabilitation that may act as barriers to attendance. Results: Themes identified included: the content of cardiac rehabilitation, perceptions of exercise, benefits of cardiac rehabilitation, explicit barriers to attendance and cardiac knowledge. Whilst some patients viewed cardiac rehabilitation as an important and necessary part of recovery others expressed doubt that it was appropriate for them. Some patients were uncertain of the course content and misunderstood the role of exercise and its perceived effects. Misconceptions with regard to cardiac knowledge were also apparent. The combination of erroneous beliefs about cardiac rehabilitation and cardiac misconceptions seemed to result in doubts regarding attendance. Conclusions: Prior to course attendance some patients hold erroneous beliefs about the course content, especially the exercise component. Co-existent cardiac misconceptions are also apparent. Further research is needed to clarify the extent to which these beliefs may contribute to the decision not to attend cardiac rehabilitation.
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Affiliation(s)
- A F Cooper
- Cardiothoracic Centre, St Thomas' Hospital, London, UK.
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24
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Zrinyi M, Horvath T. Impact of Satisfaction, Nurse–Patient Interactions and Perceived Benefits on Health Behaviors Following a Cardiac Event. Eur J Cardiovasc Nurs 2016; 2:159-66. [PMID: 14622641 DOI: 10.1016/s1474-5151(03)00032-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aims: To describe patient perceptions of quality and satisfaction with nursing care, nurse–patient interactions and barriers to and benefits of implementing a healthy lifestyle. Methods: A pretest–posttest cross-sectional correlational research design was used. Subjects were randomly selected between November 2001 and January 2002 from patients admitted to the National Institute of Cardiology in Budapest, Hungary. Participants completed 3 self-reported measures and a demographic survey, which assessed individual lifestyle behaviors (e.g. frequency of smoking, physical activity, stress and unhealthy dieting). Results: Satisfaction with nursing care and nurse–patient interactions influenced both perceived benefits and barriers. Patient satisfaction and perceived benefits at discharge were associated with more frequent exercising and less smoking. Among other factors, perceived benefits at discharge were predicted by attentive nurse behaviors toward patients and by patients’ ability to initiate discussion with nurses. Conclusions: Findings support effects of patient satisfaction and nurse–patient relationships on perceived benefits/barriers. Compared to barriers, perceived benefits more importantly determined health behaviors. Attentive nursing care and the patient's ability to discuss health concerns with nurses appear more influential in modifying patient perceptions. Exploring nursing interventions to maximize perceived benefits during hospitalization is suggested.
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Worcester MUC, Stojcevski Z, Murphy B, Goble AJ. Factors Associated with Non-Attendance at a Secondary Prevention Clinic for Cardiac Patients. Eur J Cardiovasc Nurs 2016; 2:151-7. [PMID: 14622640 DOI: 10.1016/s1474-5151(03)00031-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: A randomised controlled trial was undertaken to test the effectiveness of a secondary prevention clinic. Secondary prevention programs can improve prognosis after an acute cardiac illness. It is therefore important to encourage high participation rates. Aim: The present study was a post-hoc analysis to identify factors associated with patients’ non-attendance at the clinic. Methods: We compared the baseline socio-demographic and clinical characteristics of 83 (73.5% male) non-attending patients and a random sample of 96 (85.4% male) attending patients. Self-reported data were gathered during interviews conducted on an average of 30 months after hospital admission to investigate long-term outcomes of the clinic. Results: Using logistic regression analysis, we found that non-attendance was significantly and independently associated with being female, being under 60 years of age, having no history of high cholesterol and having no angina prior to the event. In bivariate analyses, non-attendance was also associated with being born overseas and not having private health insurance. Conclusions: Likely non-attending patients should be identified early and more effective strategies should be devised to facilitate their participation in secondary prevention programs.
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Clarke AL, Yates T, Smith AC, Chilcot J. Patient's perceptions of chronic kidney disease and their association with psychosocial and clinical outcomes: a narrative review. Clin Kidney J 2016; 9:494-502. [PMID: 27274839 PMCID: PMC4886910 DOI: 10.1093/ckj/sfw014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/17/2016] [Indexed: 12/13/2022] Open
Abstract
Patients with chronic kidney disease (CKD) form organized beliefs regarding their illness and treatment. These perceptions influence the coping strategies employed by an individual to manage his/her illness and may act as a predictor for his/her willingness to engage in self-management behaviours. While illness perceptions have been identified as predictors of non-adherence, depression and mortality in dialysis patients, there is a paucity of research in CKD patients not requiring renal replacement therapy. This narrative review synthesizes the existing literature regarding the role of illness perceptions and associated clinical and psychosocial outcomes in non-dialysis CKD patients. Studies were identified following database searches of AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsycINFO and Google Scholar in January 2016. Despite the small evidence base, existing studies indicate that negative illness perceptions are associated with disease progression and a number of psychosocial outcomes in non-dialysis CKD patients. Evidence from other clinical populations suggests that illness perceptions are modifiable through psychological intervention, which may be most effective if delivered early before beliefs have the chance to become more established. Therefore, targeting illness perceptions in the earlier stages of CKD may be optimal. Further studies are now required to ascertain the mechanisms through which illness perceptions predict psychosocial and clinical outcomes in CKD patients and to ultimately test the efficacy of illness perception–based interventions.
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Affiliation(s)
- Amy L Clarke
- Leicester Kidney Exercise Team, Department of Renal Medicine, University Hospitals of Leicester, Leicester, UK; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology , University of Leicester , Leicester , UK
| | - Alice C Smith
- Leicester Kidney Exercise Team, Department of Renal Medicine, University Hospitals of Leicester, Leicester, UK; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
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Aujla N, Walker M, Sprigg N, Abrams K, Massey A, Vedhara K. Can illness beliefs, from the common-sense model, prospectively predict adherence to self-management behaviours? A systematic review and meta-analysis. Psychol Health 2016; 31:931-58. [PMID: 26911306 DOI: 10.1080/08870446.2016.1153640] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management behaviours (including, attendance, medication, diet and exercise) in adults with acute and chronic physical illnesses. DESIGN AND MAIN OUTCOME MEASURES Electronic databases were searched in September 2014, for papers specifying the use of the 'CSM' in relation to 'self-management', 'rehabilitation' and 'adherence' in the context of physical illness. Six hundred abstracts emerged. Data from 52 relevant studies were extracted. Twenty-one studies were meta-analysed, using correlation coefficients in random effects models. The remainder were descriptively synthesised. RESULTS The effect sizes for individual illness belief domains and adherence to self-management behaviours ranged from .04 to .13, indicating very weak, predictive relationships. Further analysis revealed that predictive relationships did not differ by the: type of self-management behaviour; acute or chronic illness; or duration of follow-up. CONCLUSION Individual illness belief domains, outlined by the CSM, did not predict adherence to self-management behaviours in adults with physical illnesses. Prospective relationships, controlling for past behaviour, also did not emerge. Other factors, including patients' treatment beliefs and inter-relationships between individual illness beliefs domains, may have influenced potential associations with adherence to self-management behaviours.
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Affiliation(s)
- N Aujla
- a Division of Primary Care, University of Nottingham , Nottingham , UK.,b Division of Rehabilitation and Ageing , University of Nottingham , Nottingham , UK.,d Division of Clinical Neurosciences, Stroke , University of Nottingham , Nottingham , UK
| | - M Walker
- b Division of Rehabilitation and Ageing , University of Nottingham , Nottingham , UK
| | - N Sprigg
- d Division of Clinical Neurosciences, Stroke , University of Nottingham , Nottingham , UK
| | - K Abrams
- e Department of Health Sciences , University of Leicester , Leicester , UK
| | - A Massey
- c School of Clinical Sciences , University of Nottingham , Nottingham , UK
| | - K Vedhara
- a Division of Primary Care, University of Nottingham , Nottingham , UK
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Rashid S, Simms A, Batin P, Kurian J, Gale CP. Inequalities in care in patients with acute myocardial infarction. World J Cardiol 2015; 7:895-901. [PMID: 26730295 PMCID: PMC4691816 DOI: 10.4330/wjc.v7.i12.895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/24/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023] Open
Abstract
Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction (AMI), yet despite these, significant inequalities exist in the care of these patients. The elderly, deprived socioeconomic groups, females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI, thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group, i.e., low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.
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Affiliation(s)
- Shabnam Rashid
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - Alexander Simms
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - Phillip Batin
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - John Kurian
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
| | - Chris P Gale
- Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom
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Gaalema DE, Cutler AY, Higgins ST, Ades PA. Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence. Prev Med 2015; 80:67-74. [PMID: 25900804 PMCID: PMC4592377 DOI: 10.1016/j.ypmed.2015.04.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence. METHODS A systematic literature search was conducted examining associations between smoking status and CR referral, attendance and completion in peer-reviewed studies published through July 1st, 2014. For inclusion, studies had to report data on outpatient CR referral, attendance or completion rates and smoking status had to be considered as a variable associated with these outcomes. RESULTS Fifty-six studies met inclusion criteria. In summary, a history of smoking was associated with an increased likelihood of referral to CR. However, smoking status also predicted not attending CR and was a strong predictor of CR dropout. CONCLUSION Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | - Alexander Y Cutler
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, USA
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Greco A, Steca P, Pozzi R, Monzani D, Malfatto G, Parati G. The influence of illness severity on health satisfaction in patients with cardiovascular disease: the mediating role of illness perception and self-efficacy beliefs. Behav Med 2015; 41:9-17. [PMID: 24965513 DOI: 10.1080/08964289.2013.855159] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The importance of psychological factors in improving conditions of cardiovascular disease (CVD) patients is stressed by the guidelines for their prevention and rehabilitation, but little is known about the impact of illness severity on patients' well-being, and on the psychosocial variables that may mediate this association. The aim of this study was to investigate the role of illness perception and self-efficacy beliefs on the relationship between illness severity and health satisfaction in 75 CVD patients undergoing rehabilitation (80% men; mean age = 65.44) at the St. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. Illness severity was measured in terms of left ventricular ejection fraction; psychological factors were assessed at the beginning and end of rehabilitation. Results from path analyses showed that the relationships among CVD severity and health satisfaction were mediated by illness perception and self-efficacy beliefs. Findings underscored the importance of considering illness representations and self-efficacy beliefs to improve well-being in CVD patients.
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Riley GA, Hough A, Meader LM, Brennan AJ. The course and impact of family optimism in the post-acute period after acquired brain injury. Brain Inj 2015; 29:804-12. [DOI: 10.3109/02699052.2015.1004754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Exploring the relationships between health status, illness perceptions, coping strategies and psychological morbidity in a chronic kidney disease cohort. Am J Med Sci 2015; 348:271-6. [PMID: 24751421 DOI: 10.1097/maj.0000000000000242] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Using the common sense model of illness adjustment, this study aimed to explore the impact of chronic kidney disease (CKD) on individual illness perceptions, coping styles and psychological well-being. METHODS Eighty individuals (50 men and 30 women) with an average age of 62.66 years (standard deviation, 11.98) were included in the study. All participants were under the care of the Renal Unit of a metropolitan tertiary referral hospital. Twenty-nine patients (36%) had CKD stage 3b-4, and 51 (64%) had CKD stage 5 (or end stage kidney disease [ESKD]). Disease severity was evaluated using the health perceptions questionnaire, coping styles assessed with the Carver brief COPE scale, illness perceptions explored with the brief illness perceptions questionnaire and anxiety and depression measured using the hospital anxiety and depression scale. RESULTS The hospital anxiety and depression scale assessment revealed 13 patients (16.3%) with moderate or severe anxiety and 6 (7.5%) with moderate depression. Consistent with the common sense model, disease activity had a significant direct influence on illness perceptions, while, in turn, illness perceptions had a significant direct influence on depression and anxiety. Adaptive and maladaptive coping were found to mediate the relationship between illness perceptions, and anxiety and depression. CONCLUSIONS The results provide evidence that it is the perception of an illness rather than the actual symptoms themselves that best account for adaption to CKD. These findings suggest that intervention strategies aimed at increasing psychological well-being need to focus on changing illness perceptions rather than improving symptoms of CKD or coping mechanisms.
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Figueiras MJ, Maroco J, Caeiro R, Monteiro R, Trigo M. The relationship between illness perceptions and cardiac misconceptions after Myocardial Infarction. PSYCHOL HEALTH MED 2014; 20:570-81. [PMID: 25531149 DOI: 10.1080/13548506.2014.993662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Research about cardiac misconceptions has focused on identifying the most common erroneous beliefs and understanding their impact on patients' outcomes. However, less is known about the underlying structure of cardiac misconceptions and how they relate to other belief dimensions. The aims of the present study were: (a) to characterize illness perceptions and cardiac misconceptions in a sample of Myocardial Infarction (MI) patients; (b) to analyse the structure of an experimental Portuguese version of the York Cardiac Beliefs Questionnaire (YCBQ); and (c) to examine whether illness perceptions are likely to influence cardiac misconceptions. This cross-sectional study included 127 first-MI patients from both sexes, aged up to 70 years old. Confirmatory factor analysis and structural equation modelling were performed with AMOS. The main results showed that a two-dimension (stress avoidance and exercise avoidance) version of the YCBQ offered the best fit to the data. A significant impact of psychological attributions was observed on cardiac misconceptions, as well as a moderate impact of emotional response explaining 26% of the variance. Although exploratory, this study gives a significant contribution to research in this field, as clarification on the different concepts and the way they relate is needed. Our findings suggest that further investigation into the concepts of cardiac knowledge and cardiac misconceptions may have an important role in understanding health behaviours in the context of heart disease.
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Mosleh SM, Almalik MMA. Illness perception and adherence to healthy behaviour in Jordanian coronary heart disease patients. Eur J Cardiovasc Nurs 2014; 15:223-30. [DOI: 10.1177/1474515114563885] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/20/2014] [Indexed: 11/16/2022]
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Thongsai S. Do illness perceptions predict the attendance rate at diabetic outpatient clinic? Glob J Health Sci 2014; 7:254-62. [PMID: 25716379 PMCID: PMC4796371 DOI: 10.5539/gjhs.v7n2p254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/30/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify predictors of non-attendance and to investigate the influence of illness perceptions on attendance at diabetic outpatient clinics. Research method and design: This is a descriptive study of 442 participants who were enrolled in a Diabetic Outpatient Clinic at Lerdsin Hospital, Thailand. Illness perceptions were derived from a Thai version of the IPQ-R questionnaire consisting of the same 3 sections as the original Illness perception- Revised with the distinction that it had 68 items. Test for validity was performed and the Cronbach's alpha reliability coefficient value was 0.87. Data were analysed by using independent t-tests. Binary logistic regression was used in order to assess the impact of illness perception scores on attendance among diabetic patients at the Outpatient Clinic. RESULTS The results of the study were as follows: Demographic data showed that all respondents were of Thai ethnic origin and two-thirds of the respondents were women. The average age was 60 years. The majority of the participants had completed primary school (7-12 years old), was married and were Buddhist. The IPQ-R revealed the following findings: The illness perceptions at baseline and 6 months later showed that it illness perception had no effect on the participants' illness perception and attendance rate at the diabetic outpatient clinic. Participants who hold negative illness perceptions were more likely to attend diabetes clinics than those participants who had positive illness perceptions. A conceivable explanation for the non-significant findings in the study is the finding that during 6 month period there were some factors that have contributed to the failure of the participants to attend to their appointments. This is beyond the scope of the socio-demographic and illness perception factors. CONCLUSION Thus, a plausible explanation for the non-significant findings in the study is that during 6 month period there were some factors that may have contributed to the appointment keeping among these patients beyond the scope of socio-demographic and illness perception factors.
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Smith A, Fortune Z, Phillips R, Walters P, Lee GA, Mann A, Tylee A, Barley EA. UPBEAT study patients’ perceptions of the effect of coronary heart disease on their lives: A cross-sectional sub-study. Int J Nurs Stud 2014; 51:1500-6. [DOI: 10.1016/j.ijnurstu.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
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Risk perception is not associated with attendance at a preventive intervention for type 2 diabetes mellitus among South Asians at risk of diabetes. Public Health Nutr 2014; 18:1109-18. [PMID: 24913375 DOI: 10.1017/s1368980014001086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the association between risk perception and attendance in a diabetes prevention programme among South Asians with a high risk for diabetes. DESIGN An observational study. We measured risk perception during the baseline interview with causal beliefs, perceived susceptibility and perceived controllability. We used logistic regression to examine the relationship between risk perception and attendance. We adjusted for relevant sociodemographic factors, screening results and psychosocial factors. SETTING The Hague, the Netherlands. SUBJECTS Five hundred and thirty-five Hindustani Surinamese (South Asians) aged 18-60 years from a lifestyle-versus-control intervention for the prevention of diabetes. RESULTS In total, 68·2% attended the lifestyle or control intervention. Participants perceived lifestyle and heredity to increase the risk of diabetes and perceived increasing physical activity to decrease it. Only 44·2% of the participants perceived themselves as susceptible to diabetes and only those who perceived a family history of diabetes as a cause of diabetes appeared to be more inclined to attend. However, after adjustment for confounding, the association was not statistically significant. CONCLUSIONS Risk perception was not significantly associated with attendance. The results suggest that increasing the risk perception alone in this South Asian population is unlikely to increase the attendance at a diabetes prevention programme.
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Gholizadeh L, Davidson PM, Heydari M, Salamonson Y. Heart Disease and Depression. J Transcult Nurs 2014; 25:290-5. [DOI: 10.1177/1043659614523453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This article seeks to review and discuss the evidence linking depression, coronary heart disease (CHD), and culture. Method: PsychInfo, CINAHL, PubMed, and Google were searched for pertinent evidence linking depression, culture, and CHD, and retrieved articles were analyzed using thematic content analysis. Findings: Identified themes were the followings: depression is a factor in development and prognosis of CHD and affects the capacity to self-manage and adhere to treatment recommendations; culture mediates mental health/illness representations and treatment-seeking behaviors; screening and assessment of depression can be affected by cultural factors; and there is a need for culturally appropriate screening and therapeutic strategies. Discussion and Conclusions: As depression is a predictor and moderating variable in the genesis and progression of CHD, understanding how factors such as culture affect screening and management of the disease is important to inform the development of culturally and linguistically competent strategies that ensure accurate screening, detection, and treatment of depression in cardiac patients in clinical practice.
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Affiliation(s)
| | | | - Mehrdad Heydari
- University of Technology, Sydney, New South Wales, Australia
| | - Yenna Salamonson
- University of Western Sydney, Sydney, New South Wales, Australia
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Prince DZ, Sobolev M, Gao J, Taub CC. Racial disparities in cardiac rehabilitation initiation and the effect on survival. PM R 2013; 6:486-92. [PMID: 24321413 DOI: 10.1016/j.pmrj.2013.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/04/2013] [Accepted: 11/23/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine predictors of initiation and adherence, identify racial disparities, and compare the survival benefit of cardiac rehabilitation between a white and a unique predominantly non-white minority in an urban environment. DESIGN A retrospective cohort study. SETTING The outpatient cardiac rehabilitation program at Montefiore Medical Center, Bronx, New York. PATIENTS Consecutive patients (n = 822) referred to outpatient cardiac rehabilitation were evaluated. METHODS Baseline characteristics and outcomes were ascertained from medical records. Multivariate logistic regression was used to examine the association among initiation, age, gender, race, reason for referral, and copayment. Kaplan-Meier analysis was performed to evaluate mortality outcomes. MAIN OUTCOME MEASUREMENTS Racial disparities in rates of initiation, adherence and completion, and survival benefit associated with cardiac rehabilitation. RESULTS Among 822 patients referred (51.5% non-white minorities, 61.1% male), 59.4% initiated cardiac rehabilitation. Non-white minorities initiated cardiac rehabilitation less often than did white patients (54.4% versus 65.2%, P = .003). After adjustment, white patients were 77.5% more likely to initiate cardiac rehabilitation (odds ratio 1.78; 95% confidence interval 1.13-2.80). Both white populations and non-white minorities who participated in cardiac rehabilitation had a lower risk of death (P = .0022). CONCLUSIONS In a predominantly minority population, racial disparities exist among cardiac rehabilitation participants. Minorities were less likely to initiate cardiac rehabilitation. Gender, referral patterns, and the presence of copayment did not influence initiation. Cardiac rehabilitation initiation was associated with decreased mortality.
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Affiliation(s)
- David Z Prince
- The Arthur S. Abramson Department of Rehabilitation Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(∗)
| | - Maria Sobolev
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(†)
| | - Ju Gao
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(‡)
| | - Cynthia C Taub
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, 1825 Eastchester Road, Room WT120, Bronx, NY 10461(§).
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Reges O, Vilchinsky N, Leibowitz M, Khaskia A, Mosseri M, Kark JD. Illness cognition as a predictor of exercise habits and participation in cardiac prevention and rehabilitation programs after acute coronary syndrome. BMC Public Health 2013; 13:956. [PMID: 24119027 PMCID: PMC3852800 DOI: 10.1186/1471-2458-13-956] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/08/2013] [Indexed: 12/21/2022] Open
Abstract
Background Despite well-established medical recommendations, many cardiac patients do not exercise regularly either independently or through formal cardiac prevention and rehabilitation programs (CPRP). This non-adherence is even more pronounced among minority ethnic groups. Illness cognition (IC), i.e. the way people perceive the situation they encounter, has been recognized as a crucial determinant of health-promoting behavior. Few studies have applied a cognitive perspective to explain the disparity in exercising and CPRP attendance between cardiac patients from different ethnic backgrounds. Based on the Health Belief Model (HBM) and the Common Sense Model (CSM), the objective was to assess the association of IC with exercising and with participation in CPRP among Jewish/majority and Arab/minority patients hospitalized with acute coronary syndrome. Methods Patients (N = 420) were interviewed during hospitalization (January-2009 until August- 2010) about IC, with 6-month follow-up interviews about exercise habits and participation in CPRP. Determinants that predict active lifestyle and participation in CPRP were assessed using backward stepwise logistic regression. Results Perceived susceptibility to heart disease and sense and personal control were independently associated with exercising 6 months after the acute event (OR = 0.58, 95% CI: 0.42-0.80 and OR = 1.09, 95% CI: 1.02-1.17, per unit on a 5-point scale). Perceived benefits of regular exercise and a sense of personal control were independently associated with participation in CPRP (OR = 1.56, 95% CI: 1.12-2.16 and OR = 1.08, 95% CI: 1.01-1.15, per unit on a 5-point scale). None of the IC variables assessed could explain the large differences in health promoting behaviors between the majority and minority ethnic groups. Conclusions IC should be taken into account in future interventions to promote physical activity and participation in CPRP for both ethnic groups. Yet, because IC failed to explain the gap between Arab and Jewish patients in those behaviors, other explanatory pathways such as psychological state or cultural views should be considered as potential areas for further research.
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Affiliation(s)
- Orna Reges
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel.
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Steca P, Greco A, Monzani D, Politi A, Gestra R, Ferrari G, Malfatto G, Parati G. How does illness severity influence depression, health satisfaction and life satisfaction in patients with cardiovascular disease? The mediating role of illness perception and self-efficacy beliefs. Psychol Health 2013; 28:765-83. [DOI: 10.1080/08870446.2012.759223] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Blair J, Angus NJ, Lauder WJ, Atherton I, Evans J, Leslie SJ. The influence of non-modifiable illness perceptions on attendance at cardiac rehabilitation. Eur J Cardiovasc Nurs 2013; 13:55-62. [DOI: 10.1177/1474515113477272] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Julie Blair
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - Neil J Angus
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - William J Lauder
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - Iain Atherton
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - Josie Evans
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
| | - Stephen J Leslie
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
- Cardiac Unit, Raigmore Hospital, Inverness, UK
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Freeman D, Dunn G, Garety P, Weinman J, Kuipers E, Fowler D, Jolley S, Bebbington P. Patients' beliefs about the causes, persistence and control of psychotic experiences predict take-up of effective cognitive behaviour therapy for psychosis. Psychol Med 2013; 43:269-277. [PMID: 22781166 PMCID: PMC3544544 DOI: 10.1017/s0033291712001225] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is evidence that patients with schizophrenia benefit from standard cognitive behaviour therapy (CBT) only if active techniques are used ('full therapy'). By contrast, attending sessions but not proceeding beyond engagement and assessment strategies ('partial therapy'), or simply not attending sessions ('no therapy'), is not associated with better outcomes. The factors leading to full therapy are unknown. We hypothesized that patients' initial ideas about the nature and extent of their problems would predict use of CBT. A match between patients' views of their problems and the principles underlying treatment would lead to better outcomes. METHOD Ninety-two patients with a recent relapse of psychosis completed the Illness Perception Questionnaire (IPQ) before receiving CBT. We examined whether their illness perceptions predicted the take-up of therapy. RESULTS Patients who did not attend sessions believed their problems would not last as long as those who attended them. Those who attended sessions but did not proceed to full therapy had a lower sense of control over their problems and a more biological view of their causes. Patients who took up full therapy were more likely to attribute the cause of their problems to their personality and state of mind. The take-up of therapy was predicted neither by levels of psychiatric symptoms nor by insight. CONCLUSIONS People with psychosis who have psychologically orientated views of their problems, including the potential to gain control over them, may be more likely to engage fully and do well with standard CBT for psychosis, irrespective of the severity of their problems.
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Affiliation(s)
- D Freeman
- Department of Psychiatry, Oxford University, UK.
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45
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Psychometric testing of an Arabic version of the Illness Perception Questionnaire for heart disease. Heart Lung 2013; 42:51-8. [DOI: 10.1016/j.hrtlng.2012.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 08/24/2012] [Accepted: 08/25/2012] [Indexed: 01/18/2023]
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Murray J, Craigs CL, Hill KM, Honey S, House A. A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change. BMC Cardiovasc Disord 2012; 12:120. [PMID: 23216627 PMCID: PMC3522009 DOI: 10.1186/1471-2261-12-120] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes. METHODS A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework. RESULTS 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes. CONCLUSION There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support.
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Affiliation(s)
- Jenni Murray
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK.
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Herber OR, Jones MC, Smith K, Johnston DW. Assessing acute coronary syndrome patients' cardiac-related beliefs, motivation and mood over time to predict non-attendance at cardiac rehabilitation. J Adv Nurs 2012; 68:2778-88. [PMID: 22725949 DOI: 10.1111/j.1365-2648.2012.06066.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2012] [Indexed: 11/27/2022]
Abstract
AIM This research protocol describes and justifies a study to assess patients' cardiac-related beliefs (i.e. illness representations, knowledge/misconceptions, cardiac treatment beliefs), motivation and mood over time to predict non-attendance at a cardiac rehabilitation programme by measuring weekly/monthly changes in these key variables. BACKGROUND Heart disease is the UK's leading cause of death. Evidence from meta-analyses suggests that cardiac rehabilitation facilitates recovery following acute cardiac events. However, 30-60% of patients do not attend cardiac rehabilitation. There is some evidence from questionnaire studies that a range of potentially modifiable psychological variables including patients' cardiac-related beliefs, motivation and mood may influence attendance. DESIGN Mixed-methods. METHODS In this study, during 2012-2013, electronic diary data will be gathered weekly/monthly from 240 patients with acute coronary syndrome from discharge from hospital until completion of the cardiac rehabilitation programme. This will identify changes and interactions between key variables over time and their power to predict non-attendance at cardiac rehabilitation. Data will be analysed to examine the relationship between patients' illness perceptions, cardiac treatment beliefs, knowledge/misconceptions, mood and non-attendance of the cardiac rehabilitation programme. The qualitative component (face-to-face interviews) seeks to explore why patients decide not to attend, not complete or complete the cardiac rehabilitation programme. DISCUSSION The identification of robust predictors of (non-)attendance is important for the design and delivery of interventions aimed at optimizing cardiac rehabilitation uptake. Funding for the study was granted in February 2011 by the Scottish Government Chief Scientist Office (CZH/4/650).
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Piepoli MF, Corrà U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, Dendale P, Doherty P, Gaita D, Höfer S, McGee H, Mendes M, Niebauer J, Pogosova N, Garcia-Porrero E, Rauch B, Schmid JP, Giannuzzi P. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery. Eur J Prev Cardiol 2012; 21:664-81. [DOI: 10.1177/2047487312449597] [Citation(s) in RCA: 395] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Massimo F Piepoli
- Cardiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ugo Corrà
- Department of Cardiology, Fondazione Salvatore Maugeri, IRCCS Scientific Institute of Veruno, Veruno, Italy
| | | | - Werner Benzer
- Department of Interventional Cardiology, Academic Hospital, Feldkirch, Austria
| | | | - Margaret Cupples
- Department of General Practice, Centre of Excellence for Public Health, Queen’s University, Belfast, UK
| | - Paul Dendale
- Jessa Hospital and University of Hasselt, Hasselt, Belgium
| | | | - Dan Gaita
- 0Departamentul de Cardiologie, Universitatea de Medicina si Farmacie ‘Victor Babes’ din Timisoara, Romania
| | - Stefan Höfer
- 1Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | - Hannah McGee
- 2Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miguel Mendes
- 3Cardiology Department, CHLO-Hospital de Santa Cruz, Carnaxide, Portugal
| | - Josef Niebauer
- 4Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Nana Pogosova
- 5National Research Centre for Preventive Medicine, Moscow, Russian Federation
| | | | - Bernhard Rauch
- 7ZAR – Centre for Ambulatory Cardiovascular Rehabilitation at the Heart Centre Ludwigshafen, Germany
| | - Jean Paul Schmid
- 8Cardiovascular Prevention and Rehabilitation, Department of Cardiology, Bern University Hospital, and University of Bern, Switzerland
| | - Pantaleo Giannuzzi
- Department of Cardiology, Fondazione Salvatore Maugeri, IRCCS Scientific Institute of Veruno, Veruno, Italy
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49
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Goodman D, Morrissey S, Graham D, Bossingham D. The Application of Cognitive—Behaviour Therapy in Altering Illness Representations of Systemic Lupus Erythematosus. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.2005.22.3.156] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThere is evidence to suggest that illness representations are associated with chronic illness outcomes. Accordingly, several authors have recommended that interventions aimed at improving illness outcomes should include an illness-representations component. While a few researchers have attempted to develop such interventions for chronic illness and chronic pain, no such intervention has been developed for individuals with systemic lupus erythematosus (SLE), a chronic auto-immune illness which results in a variety of negative physical and psychological symptoms. This article reports on a pilot program that investigated the feasibility of a cognitive and behavioural—based intervention for treating SLE which included an illness-representations-change component. The effectiveness of the intervention compared to usual treatment for SLE was evaluated. Also investigated was whether changed illness representations had a beneficial effect on physical health and psychological wellbeing. It was found that the intervention did change participants' treatment control and emotional representations, and that perceived stress was reduced following the intervention. The importance of these findings is discussed, two rival hypotheses for the findings obtained are explored and directions for future research are suggested.
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50
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Patel S, Greasley K, Watson PJ. Barriers to rehabilitation and return to work for unemployed chronic pain patients: A qualitative study. Eur J Pain 2012; 11:831-40. [PMID: 17320437 DOI: 10.1016/j.ejpain.2006.12.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/28/2022]
Abstract
This paper explores the perceived barriers to return to work presented by unemployed patients with chronic musculoskeletal pain. The findings are based on one to one in depth semi-structured interviews conducted with patients from four sites in the UK. Interview data were recorded from 38 patients (15 male, 23 female) aged between 29 and 62 years the sample included patients who had participated in a vocational rehabilitation scheme, those who had refused to participate and a nai ve group. Patients were in receipt of long-term social welfare benefits (incapacity benefits) and recruited via local Job Centres. The mean duration of work absence was over 5 years. The data was transcribed and analysed by means of thematic analysis. Several themes were identified as barriers to return to work from the data including pain related issues, uncertainty (both financial and physical), the healthcare system, interaction with benefits providers, perceptions of employers and personal limitations. The uncertainty and the pain condition itself were the overarching barriers from which other obstacles stemmed. This is the first qualitative study of long term unemployed benefit recipients with chronic pain. Others authors have reported psychosocial factors as barriers to work among disabled populations however, this qualitative study has identified barriers specific to unemployed chronic pain patients. The themes identified will help with the planning and development of future initiatives for returning chronic pain patients to employment.
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Affiliation(s)
- Shilpa Patel
- Department of Health Sciences, Division of Anaesthesia and Pain Management, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
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