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Nissen NK, Guldin MB, Nielsen CP, Ørtenblad L. Do Interventions Meet the Needs of Caregivers of Cardiac Patients?: A Scoping Review. J Cardiovasc Nurs 2024:00005082-990000000-00211. [PMID: 39039633 DOI: 10.1097/jcn.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Interventions targeting the needs of caregivers of cardiac patients are few, and in most cases, no effect is found on caregivers' well-being. A closer look at the existing interventions will provide a solid foundation for future efforts to develop effective interventions targeted at caregivers of cardiac patients. OBJECTIVE The study's objective was to scrutinize and discuss interventions targeting caregivers of cardiac patients and contribute to reflections that will improve future interventions. METHODS Systematic scoping of the literature within the field was conducted through a literature search in PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library from January 2011 to May 2022. The development of search terms and inclusion criteria was inspired by the Patient problem/population, Intervention, Comparison/Control, and Outcome approach, and the Medical Research Council framework for developing and evaluating complex interventions served as the underlying basis for the analysis. RESULTS Eleven articles were included. The interventions reported in the articles were generally not systematically developed and did not include field-specific, methodological, and theoretical reflections. Furthermore, the development process behind the studies seemed not to be transparent. CONCLUSIONS Lack of systematic methodology and methodological transparency in the reviewed studies hinders further testing of interventions and might explain lack of evidence for effective interventions within the field. More systematic, needs-based, and well-documented interventions targeting caregivers of various kinds of cardiac patients are needed to develop the field to the benefit of caregivers, patients, and society.
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Zhang Q, Han H, Yang S, Liu W. Facilitators and barriers of initiation and maintenance of physical activity among people with coronary heart disease: a qualitative study. Disabil Rehabil 2024:1-10. [PMID: 38324455 DOI: 10.1080/09638288.2024.2309512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease. METHODS A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. RESULTS Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control). CONCLUSIONS This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population.
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Affiliation(s)
| | - Hongya Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shupeng Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China
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Brust M, Gebhardt WA, van Bruggen S, Janssen V, Numans ME, Kiefte-de Jong JC. Making sense of a myocardial infarction in relation to changing lifestyle in the five months following the event: An interpretative phenomenological analysis. Soc Sci Med 2023; 338:116348. [PMID: 37922741 DOI: 10.1016/j.socscimed.2023.116348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Previous research has shown that experiencing an acute cardiac event, such as a myocardial infarction (MI), can lead to lifestyle changes. This study aimed to explore the potential of a MI as a 'teachable moment' (TM) for positive lifestyle changes and to identify psychosocial sensemaking processes that facilitate or hinder the presence of a TM. METHOD We conducted semi-structured interviews with 14 patients who suffered their first MI and were hospitalized in a larger Dutch city. Participants were interviewed twice, respectively one and five months after their hospitalization. They were encouraged to explain how they experienced their MI and how this had affected their lifestyle. We used an Interpretative Phenomenological Analysis approach to the data collection and analysis. FINDINGS The participants varied in their willingness to adopt a healthy lifestyle due to their MI. Most participants experienced their event as a TM for changing specific health behaviors, for example facilitated by reflecting on self-concept or social roles and by constructing and comprehending a personal narrative of their MI. Some participants struggled to follow through on their intentions to change their behavior, for example because of a negative attitude towards a healthy behavior or because they perceived it as incongruent to their identity. Only three participants maintained most former health behaviors, for example because they failed to acknowledge their MI as severe or because of earlier life events that elicited more blunted cognitive responses. CONCLUSION Cardiac patients may experience a TM, which is the consequence of interrelated processes of psychosocial sensemaking. As this does not occur at a singular time point, we suggest using the term 'teachable window' rather than 'moment'. Given these findings, there is a window of opportunity to provide continuous psychosocial and lifestyle support during and after hospitalization for acute cardiac events.
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Affiliation(s)
- Michelle Brust
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands.
| | - Winifred A Gebhardt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.
| | - Sytske van Bruggen
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands; Haaglandse Dokters, The Hague, the Netherlands.
| | - Veronica Janssen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Mattijs E Numans
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands.
| | - Jessica C Kiefte-de Jong
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands.
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Kang J, Zhu X, Kan Y, Zhuang S. Application of the Knowledge, Attitude, and Practice model combined with motivational interviewing for health education in female patients with systemic lupus erythematosus. Medicine (Baltimore) 2023; 102:e33338. [PMID: 36961155 PMCID: PMC10036024 DOI: 10.1097/md.0000000000033338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
To explore the application effect of the Knowledge, Attitude, and Practice (KAP) model combined with motivational interviewing for health education in the chronic disease management of female patients with systemic lupus erythematosus (SLE). In this study, 84 women with SLE who were admitted to a tertiary hospital in Tianjin from July 2021 to April 2022 were enrolled in this study and divided into observation (n = 42) and control groups (n = 42). The control group received routine health education and treatment for chronic diseases. Based on the control group, the KAP method and questionnaire survey were adopted. Health literacy and compliance in the 2 groups were compared in the first and third months after the intervention. The observation group had a higher total score of health literacy in the third month than the control group. From before the intervention to the first and third months, improvement in the observation group was compared with that in the control group (F = 36.543, P 6..001; F = 4.884, P = .03; F = 23.881, P 3..001). The observation group had a higher total compliance score in the third month than the control group (t = 5.101, P = .007). From before the intervention to the first and third months of the intervention, the improvement in the observation group demonstrated an interaction with the time group compared with that in the control group (F = 68.116, P 8..001; F = 4.884, P = .032; F = 24.789, P < .001). Motivational interviewing based on the KAP model is effective in the short-term overall health literacy of female patients with SLE, especially in terms of communication, health improvement, and information acquisition; after 3 months, it can influence and maintain high patient compliance.
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Affiliation(s)
- Juan Kang
- Department of Nursing, Tianjin Medical University, Tianjin, China
| | - Xinran Zhu
- Department of Nursing, Tianjin Medical University, Tianjin, China
| | - Yan Kan
- Department of Rheumatology and Immunology, Tianjin First Central Hospital, Tianjin, China
| | - Shumei Zhuang
- Department of Nursing, Tianjin Medical University, Tianjin, China
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Kim Y, Tian X, Solomon DH. Coping with COVID-19 at the community level: Testing the predictors and outcomes of communal coping. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2790-2807. [PMID: 35032396 PMCID: PMC9015577 DOI: 10.1002/jcop.22797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic is a socially shared health issue that has had profound impacts on all aspects of community life and requires collaborative coping responses. Drawn from the extended theoretical model of communal coping, we examined (a) factors that promote community members' communal coping and (b) the influence of communal coping on perceived stress and positive adaptation in the context of COVID-19. An empirical test based on the survey of participants (N = 257) living in the state of New York showed that strong community identity, but not the length of residency in the same community and integrated connectedness to communication resources of the community, was positively associated with communal coping orientation. Having a higher communal coping orientation was not related to perceived stress, but it was positively related to engagement in COVID-19 preventive behaviors. The implications of these findings for understanding communal coping at the community level and future directions are discussed.
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Affiliation(s)
- Youllee Kim
- Department of Communication StudiesUniversity of DenverDenverColoradoUSA
| | - Xi Tian
- Department of Communication StudiesHong Kong Baptist UniversityKowloon TongHong Kong
| | - Denise H. Solomon
- Department of Communication Arts & SciencesThe Pennsylvania State UniversityState CollegePennsylvaniaUSA
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Blakoe M, Berg SK, Højskov IE, Palm P, Bernild C. One size does not fit all: A qualitative study exploring preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease. Nurs Open 2022; 9:1114-1125. [PMID: 34978762 PMCID: PMC8859028 DOI: 10.1002/nop2.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/03/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
Aim To explore preferences and barriers towards the design of a loneliness reduction intervention in patients treated for coronary heart disease who experience loneliness. Design A qualitative study using patient involvement methodology. Methods Seventeen patients participated in either focus groups or individual interview sessions. The interview guide was based on patient involvement methodology. Interviews were analysed using deductive content analysis. Results Four overall findings emerged as follows: (a) An intervention involving a social network member must comply with patients perceived social norms; (b) An intervention involving a peer provides benefits from reciprocity and shared experiences, but also requires surplus mental energy; (c) The history of an existing relationship can act as both provider and barrier for confidentiality and (d) Start‐up, timeframe and structure of the intervention should be individually tailored to the patient's preferences. Findings illuminated preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease.
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Affiliation(s)
- Mitti Blakoe
- Rigshospitalet, The Heart Center, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Rigshospitalet, The Heart Center, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Elisabeth Højskov
- Rigshospitalet, The Heart Center Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille Palm
- Rigshospitalet, The Heart Center, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Bernild
- Rigshospitalet, The Heart Center, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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James A, Lawrence B, O’Connor M. Healthy Eating as a New Way of Life: A Qualitative Study of Successful Long-Term Diet Change. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221090397. [PMID: 35418258 PMCID: PMC9016560 DOI: 10.1177/00469580221090397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving diet quality has been shown to be an effective way to improve
health and well-being. Yet information on how to assist those wanting to
transition to and maintain a healthier diet is still limited. The aim of
this study was to explore what motivated people to initiate and maintain a
healthy diet. Methods Semi-structured interviews were conducted with 20 participants (all
Australian residents) who had made significant improvements to their diets
and had maintained these changes for a minimum of two years
(nfemale = 15, nmale = 5, Mage = 37.7, SD = 12.4). The transcripts were analysed
using thematic analysis which identified five overarching themes: A desire
to feel better, investigation and learning, helpful habits, benefits, and
values. Results Participants reported a strong wish to feel better and investigated the role
of diet as a possible way to improve well-being. Through daily habits and
continuous engagement with the topic, healthy eating became a way of life
for many participants. Experiencing the benefits of a healthier diet and
having developed strong values regarding diet and health supported long-term
maintenance. Conclusions Findings from the present study contribute to the literature in highlighting
the importance of internal motivation and autonomy for health behaviours.
Findings may inform the development of healthy eating interventions.
Encouraging autonomy, fostering values aligned with a healthier diet, and
helping individuals establish daily habits is likely to support change.
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Affiliation(s)
- Anna James
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Blake Lawrence
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Moira O’Connor
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
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Verweij L, Jørstad HT, Minneboo M, Ter Riet G, Peters RJG, Scholte Op Reimer WJM, Snaterse M. The influence of partners on successful lifestyle modification in patients with coronary artery disease. Int J Cardiol 2021; 332:195-201. [PMID: 33823215 DOI: 10.1016/j.ijcard.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Marital status is associated with prognosis in patients with cardiovascular disease (CVD). However, the influence of partners on successful modification of lifestyle-related risk factors (LRFs) in secondary CVD prevention is unclear. Therefore, we studied the association between the presence of a partner, partner participation in lifestyle interventions and LRF modification in patients with coronary artery disease (CAD). METHODS In a secondary analysis of the RESPONSE-2 trial (n = 711), which compared nurse-coordinated referral to community-based lifestyle programs (smoking cessation, weight reduction and/or physical activity) to usual care in patients with CAD, we investigated the association between the presence of a partner and the level of partner participation on improvement in >1 LRF (urinary cotinine <200 ng/l, ≥5% weight reduction, ≥10% increased 6-min walking distance) without deterioration in other LRFs at 12 months follow-up. RESULTS The proportion of patients with a partner was 80% (571/711); 19% women (108/571). In the intervention group, 48% (141/293) had a participating partner in ≥1 lifestyle program. Overall, the presence of a partner was associated with patients' successful LRF modification (adjusted risk ratio (aRR) 1.93, 95% confidence interval (CI) 1.40-2.51). A participating partner was associated with successful weight reduction (aRR 1.73, 95% CI 1.15-2.35). CONCLUSION The presence of a partner is associated with LRF improvement in patients with CAD. Moreover, patients with partners participating in lifestyle programs are more successful in reducing weight. Involving partners of CAD patients in weight reduction interventions should be considered in routine practice.
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Affiliation(s)
- Lotte Verweij
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands.
| | - Harald T Jørstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands
| | - Madelon Minneboo
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands
| | - Gerben Ter Riet
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
| | - Ron J G Peters
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands
| | - Wilma J M Scholte Op Reimer
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands; University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, the Netherlands
| | - Marjolein Snaterse
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
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Liu Y, Wei M, Guo L, Guo Y, Zhu Y, He Y. Association between illness perception and health behaviour among stroke patients: The mediation effect of coping style. J Adv Nurs 2021; 77:2307-2318. [PMID: 33481272 DOI: 10.1111/jan.14761] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/14/2020] [Accepted: 12/16/2020] [Indexed: 12/26/2022]
Abstract
AIMS This study aims to explore illness perception and coping style in relation to health behaviour and the mediating role of coping style between illness perception and health behaviour among stroke patients. DESIGN Cross-sectional study. METHODS This survey was conducted with 515 stroke patients aged ≥18 years from September 2019 to January 2020 in Zhengzhou, China. The demographic and clinical characteristics questionnaire, Stroke Illness Perception Questionnaire-Revised, Simplified Coping Style Questionnaire, and Health Behavior Scale for Stroke Patients were included in this study. Data analysis was performed by correlation analysis, multiple linear regression analysis, and structural equation modelling. RESULTS The valid questionnaires were 495 (effective response rate: 96.1%). Low negative illness perception, high positive coping style, and low negative coping style are related to high level of health promoting behaviour (all p < 0.01). The results revealed that the effect of illness perception on health behaviour was partly mediated by coping style. It also confirmed that the mediation effect accounts for 43.7% (-0.169/-0.387) of the total effect. CONCLUSION Illness perception may influence health behaviour partly because of coping style. IMPACT This study implies that targeted interventions for stroke patients' illness perception are needed to motivate them to take proactive coping strategy to ultimately improve their health behaviours.
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Affiliation(s)
- Yanjin Liu
- Department of Nursing, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Miao Wei
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lina Guo
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuanli Guo
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yiru Zhu
- Pediatric Development and Behavior Department, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yv He
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Köhler AK, Jaarsma T, Tingström P, Nilsson S. The effect of problem-based learning after coronary heart disease - a randomised study in primary health care (COR-PRIM). BMC Cardiovasc Disord 2020; 20:370. [PMID: 32795267 PMCID: PMC7427729 DOI: 10.1186/s12872-020-01647-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients' empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD. METHODS Patients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age. 68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n = 79) or home-sent patient information (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year. RESULTS At one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [- 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body weight [- 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring the experimental group compared to controls. CONCLUSIONS The problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information. TRIAL REGISTRATION NCT01462799 (February 2020).
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Affiliation(s)
- Anita Kärner Köhler
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Pia Tingström
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Staffan Nilsson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Primary Health Care Centre in Vikbolandet, 610 24 Vikbolandet, Sweden
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Tulloch H, Bouchard K, Clyde MJ, Madrazo L, Demidenko N, Johnson S, Greenman P. Learning a new way of living together: a qualitative study exploring the relationship changes and intervention needs of patients with cardiovascular disease and their partners. BMJ Open 2020; 10:e032948. [PMID: 32381534 PMCID: PMC7223018 DOI: 10.1136/bmjopen-2019-032948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/09/2020] [Accepted: 03/30/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) not only affects the patient, but has implications for the partner. Emerging evidence suggests that supportive couple relationships enhance CVD outcomes and reduce patient and partner distress. To date, however, little research has been done to address the couple relationship as a potentially important component of cardiac care. This article examines the impact of CVD on the couple relationship and assesses the perceived needs and desired intervention components of patients with CVD and their partners. DESIGN Qualitative study using directed and conventional content analysis. SETTING Single-centre, tertiary cardiac care hospital that serves a population of 1.4 million in the Champlain region of Ontario, Canada. PARTICIPANTS Patients with CVD and their partners (n=32, 16 couples) participated in focus groups. Patients were mainly male (75%), white (87.5%), aged 64.4 years (range 31-81 years), with varied cardiac diagnoses (50% coronary artery disease; 18.75% valve disease; 18.75% heart failure; 12.5% arrhythmia). RESULTS Five categories were generated from the data reflecting changes within the couple relationship as a result of CVD: (1) emotional and communication disconnection; (2) overprotection of the patient; (3) role changes; (4) adjustment to lifestyle changes; and (5) positive relationship changes. Three categories were constructed regarding intervention needs and desired resources: (1) practical resources; (2) sharing with peers; and (3) relationship enhancement. CONCLUSIONS Overall, the data suggest that there were profound changes in the couple relationship as a result of CVD, and that there is considerable need to better support the caregiving spouses and the couple as a unit. These results call for interventions designed to provide instrumental support, peer-sharing opportunities and relationship quality enhancement to help couples cope with CVD. Future studies should examine whether couples-based programming embedded into cardiac rehabilitation can be effective at improving relationship quality and reducing patient and partner stress in the aftermath of a cardiac event.
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Affiliation(s)
- Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew J Clyde
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Susan Johnson
- Ottawa Couple and Family Institute, Ottawa, Ontario, Canada
| | - Paul Greenman
- Département de Psychoéducation et de Psychologie, Universite du Quebec en Outaouais, Gatineau, Quebec, Canada
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Personalized eHealth Program for Life-style Change: Results From the "Do Cardiac Health Advanced New Generated Ecosystem (Do CHANGE 2)" Randomized Controlled Trial. Psychosom Med 2020; 82:409-419. [PMID: 32176191 DOI: 10.1097/psy.0000000000000802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Unhealthy life-style factors have adverse outcomes in cardiac patients. However, only a minority of patients succeed to change unhealthy habits. Personalization of interventions may result in critical improvements. The current randomized controlled trial provides a proof of concept of the personalized Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) 2 intervention and evaluates effects on a) life-style and b) quality of life over time. METHODS Cardiac patients (n = 150; mean age = 61.97 ± 11.61 years; 28.7% women; heart failure, n = 33; coronary artery disease, n = 50; hypertension, n = 67) recruited from Spain and the Netherlands were randomized to either the "Do CHANGE 2" or "care as usual" group. The Do CHANGE 2 group received ambulatory health-behavior assessment technologies for 6 months combined with a 3-month behavioral intervention program. Linear mixed-model analysis was used to evaluate the intervention effects, and latent class analysis was used for secondary subgroup analysis. RESULTS Linear mixed-model analysis showed significant intervention effects for life-style behavior (Finteraction(2,138.5) = 5.97, p = .003), with improvement of life-style behavior in the intervention group. For quality of life, no significant main effect (F(1,138.18) = .58, p = .447) or interaction effect (F(2,133.1) = 0.41, p = .67) was found. Secondary latent class analysis revealed different subgroups of patients per outcome measure. The intervention was experienced as useful and feasible. CONCLUSIONS The personalized eHealth intervention resulted in significant improvements in life-style. Cardiac patients and health care providers were also willing to engage in this personalized digital behavioral intervention program. Incorporating eHealth life-style programs as part of secondary prevention would be particularly useful when taking into account which patients are most likely to benefit. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03178305.
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Implementing a healthy postpartum lifestyle after gestational diabetes or preeclampsia: a qualitative study of the partner's role. BMC Pregnancy Childbirth 2020; 20:66. [PMID: 32005183 PMCID: PMC6995219 DOI: 10.1186/s12884-020-2769-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/27/2020] [Indexed: 01/13/2023] Open
Abstract
Background Women with preeclampsia (PE) and gestational diabetes mellitus (GDM) are at increased risk for later cardiovascular disease, and lifestyle measures are recommended to prevent subsequent disease. Partner support has been shown to be important in lifestyle modification in other diseases, but there is a lack of knowledge of partner involvement in PE and GDM. The aim of this study was to explore the partner’s experiences and knowledge of gestational diseases, and how the partner wishes to contribute to lifestyle change. Methods A qualitative study with one focus group interview and seven in-depth individual interviews, involving eleven partners of women with a pregnancy complicated by GDM or PE. The interview data were inductively analysed using four-step systematic text condensation, supported by interdependence theory. Results Partners experienced a strong “we-feeling” and wanted to support the woman in lifestyle changes. At the same time, they felt insecure, worried, foolish and left out and they missed information from clinicians. The partners felt that their involvement was crucial to lasting lifestyle changes and expected that the clinicians would routinely invite them to discuss lifestyle change. Conclusions Partners considered themselves an important resource for lifestyle changes for women with PE and GDM, but missed being more directly invited, informed and included in maternity care and wanted to participate in the care that followed the gestational disease. This study can help health professionals to realize that partners are an overlooked resource that can make important contributions to improve the health of the whole family if they are involved and supported by health services.
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Wooldridge JS, Gray C, Pukhraj A, Geller J, Trivedi RB. Understanding communal coping among patients and informal caregivers with heart failure: A mixed methods secondary analysis of patient-caregiver dyads. Heart Lung 2019; 48:486-495. [PMID: 31171368 DOI: 10.1016/j.hrtlng.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dyads that view illnesses as shared stressors ("shared appraisal"), and collaboratively respond to it, have better outcomes. This process, known as communal coping, has received little attention in heart failure (HF). OBJECTIVES To examine communal coping among patient-caregiver dyads managing HF. METHODS We conducted semi-structured interviews with 34 dyads. Shared appraisal was measured using we-ratio, as calculated with Linguistic Inquiry Word Count. We-ratio was divided into "high" and "low" for patients and caregivers, and concordance was examined. Thematic analyses were used to explore collaboration. RESULTS Caregivers had higher we-ratios than patients (p=.005); 29.6% and 33.3% dyads were concordant on high and low "we-ratio," respectively. In thematic analyses, we found that 1) dyads collaborated around diet, appointments, and medications, but less around physical activity; 2) dyads collaborated across all illnesses, not just HF; and 3) dyads concordant on high we-ratio reported stronger collaborations. CONCLUSIONS Communal coping varied by shared appraisal and collaboration. Understanding this variability may help develop tailored self-management interventions.
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Affiliation(s)
- Jennalee S Wooldridge
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States.
| | - Caroline Gray
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States
| | - Ambri Pukhraj
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States
| | - Jessica Geller
- Denver-Seattle Center of Innovation, Department of Veterans Affairs, Aurora, CO, United States
| | - Ranak B Trivedi
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States; Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
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Dinesen B, Nielsen G, Andreasen JJ, Spindler H. Integration of Rehabilitation Activities Into Everyday Life Through Telerehabilitation: Qualitative Study of Cardiac Patients and Their Partners. J Med Internet Res 2019; 21:e13281. [PMID: 30985284 PMCID: PMC6487348 DOI: 10.2196/13281] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/21/2019] [Accepted: 03/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background Implementation of cardiac rehabilitation has not been optimal, with patient participation rates below 50%. Factors that contribute to cardiac patients’ lack of participation in rehabilitation programs are patient motivation, logistical difficulties in getting to the rehabilitation facilities, lack of psychosocial elements, and individualization of activities in the rehabilitation programs. Telerehabilitation has been proposed as a new way to address the challenge of engaging and motivating cardiac patients and their partners to participate in rehabilitation. Objective The aim of this study was to explore the experiences of cardiac patients and their partners of participating in the Teledialog Telerehabilitation Program (TTP). The Teledialog program consisted of a digital rehabilitation plan, transmission of health data from patient’s home to hospital and health care center, and an interactive Web portal with information and training videos. Methods This case study used a theoretical approach combining the “community of practice” approach and self-determination theory. A triangulation of data collection techniques was used, including documents, participant observation (72 hours), and qualitative interviews with cardiac patients and their partners enrolled in the telerehabilitation group. A total of 14 cardiac patients, 12 patient spouses/partners, and 1 son participated in the study. The participants were interviewed at enrollment in the telerehabilitation program and after 12 weeks of participation in the program. Interview data were analyzed using NVivo 11.0. Results Patients and their partners found the Web portal ActiveHeart.dk and the electronic rehabilitation (e-rehabilitation) plan to be helpful tools for health education, coordinating rehabilitation goals, creating an overview of the data, and ensuring continuity in the rehabilitation process. The patients felt that the TTP treated them as individuals, gave them a sense of autonomy, and provided enhanced relatedness to health care professionals and partners and a sense of competence as active participants in their own rehabilitation process. Some patients missed being part of a community of practice with other cardiac patients and did not use the Web forum. Patients’ partners found that the telerehabilitation program gave them a sense of security and helped them balance their involvement as a partner to the patient and not push the patient too hard. Conclusions Cardiac patients and their partners found telerehabilitation technologies a useful digital toolbox in the rehabilitation process. Telerehabilitation motivated the patients to integrate rehabilitation activities into their work schedule and everyday life and made them feel like unique individuals. Participating in the Teledialog Telerehabilitation Program might not be a suitable strategy for all cardiac patients. Being a patient’s partner in the telerehabilitation program was associated with a heightened sense of security, navigation between active involvement in the rehabilitation process, being an equal partner, and not pushing the patient too hard.
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Affiliation(s)
- Birthe Dinesen
- Laboratory of Welfare Technologies - Telehealth and Telerehabilitation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Gitte Nielsen
- Department of Cardiology, Region Hospital North Jutland, Hjoerring, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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