A Systematic Review of the Instruments Used for Evaluating Causal Beliefs and Perceived Heart Risk Factors

Background: The etiologies and causal beliefs of heart disease are considered one of the 5 dimensions of health self-regulatory model. Thus, the present study aimed to review the literature and screen the appropriate tools for evaluating the causal beliefs and perceived heart risk factors (PHRFs). Methods: The review samples encompassed all published articles from 1992 to March 2017. A systematic search was conducted across 6 databases: the Web of Science, Scopus, Medline, EBSCO, ProQuest, PsycINFO, and Google Scholar. The qualitative evaluation of the articles was examined using the checklists of the Critical Appraisal Skills Programme (CASP) by 2 independent investigators. After the application of the criteria for inclusion in the study, 22 studies were obtained according to the PRISMA guidelines. Results: A total of 10 504 (50.5% male) patients at an average age of 57.85±10.75 years participated in 22 studies under review. The results of the systematic review showed that 22 tools were available to measure PHRFs. The instruments were categorized into 4 groups of valid scales (6 studies), invalid questionnaires (6 studies), checklists (3 studies), and open-ended single items (7 studies). Only 23.2% of the measuring instruments were sufficiently valid. Conclusion: The results of this systematic review showed that a limited number of valid tools were available to measure PHRFs. Considering the importance of studying cardiac patients' perception of the etiology of disease and the paucity of standards and valid grading scales, it seems necessary to design and provide tools with broader content that can cover all aspects of patients' beliefs.

Attributing heart attack and stroke to “Old Age”: Implications for subsequent health outcomes among older adults

This study assessed the extent to which older adults attribute a recent heart attack/stroke to “old age,” and examined consequences for subsequent lifestyle behavior and health-care service utilization. Community-dwelling adults ( N = 57, ages 73–98 years) were interviewed about their heart attack/stroke, and an objective health registry provided data on health-care utilization over a 3-year period. Endorsement of “old age” as a cause of heart attack/stroke negatively predicted lifestyle behavior change, and positively predicted frequency of physician visits and likelihood of hospitalization over the subsequent 3 years. Findings suggest the importance of considering “old age” attributions in the context of cardiovascular health events.

Recovery attributions: explicit endorsement of biomedical factors and implicit dominance of psycho-social factors

Two studies assessed lay people's bio-medical and psycho-social attributions for recovery, using implicit and explicit methods, and one of them, Study 2, also measured individual differences in health locus of control. Participants were presented with a vignette of a patient with a severe disease for which chances of recovery vary widely, who had high or low levels of medical care and high or low psycho-social resources. They estimated his chances to recover from his illness (implicit attributions), and then, imagining another patient with the same disease, evaluated the relative importance of medical, psycho-social and other factors for his chances for recovery (explicit method). Findings show a moderation effect by assessment method: the explicit method pointed to dominance of biomedical attributions and the implicit method indicated dominance of psycho-social attributions. In addition, internal health locus of control was positively correlated with psycho-social attributions and external health locus of control (powerful others and chance) was correlated with biomedical attributions for recovery. The findings are discussed in relation to dual-process models of reasoning and self-serving defensive processes.