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Ilgaz A, Dagistan Akgöz A, Gözüm S. Impaired perception of cardiovascular risk and health literacy in individuals with high cardiovascular diseases risk from different socioeconomic levels in Antalya, Turkey. Aust J Prim Health 2024; 30:PY23178. [PMID: 38467076 DOI: 10.1071/py23178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND This study aimed to determine how the frequency of impaired perception of cardiovascular disease (CVD) risk is correlated with health literacy in individuals with high CVD risk in two regions with different socioeconomic levels. METHODS A descriptive study was conducted. The Systematic Coronary Risk Estimation, recommended by the European and Turkish Cardiology Societies, provides recommendations based on individuals' actual CVD risk levels. According to the Systematic Coronary Risk Estimation, participants suffering from diseases were identified as high and very high risk. The perception of risk was determined by subjectively assessing the risk level of the individuals. The European Health Literacy Survey Questionnaire was used. The Mann-Whitney U test, Chi-squared test and Spearman's correlation analysis were used to analyse the data. We also conducted a logistic regression analysis to identify factors contributing to impaired perception of CVD risk. RESULTS A total of 384 individuals, aged between 40 and 70years (with a mean age of 58.35±8.33years), were included in the study. These individuals had a high risk of CVD and were registered to family health centres from two different socioeconomic levels. Out of the 384 participants, 201 individuals belonged to the lower socioeconomic level region and 183 individuals belonged to the higher socioeconomic level region. A total of 61.7% of the participants with high CVD risk had an impaired perception of CVD risk. The health literacy level of 59.9% of individuals was either inadequate or problematic. The health literacy score of participants with impaired risk perception (29.59±9.07) was lower than those with correct risk perception (35.83±10.94; P <0.001). Factors that affected the perception of CVD risk included age, education level, working status, occupation, a family history of CVD, the CVD risk assessment by health professionals and the recommendation of health professionals to individuals for CVD screening. CONCLUSIONS It is necessary for health care professionals to make risk assessments and perform interventions to improve health literacy to raise the awareness of individuals with high CVD risk on their actual risk.
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Affiliation(s)
- Aysegül Ilgaz
- Akdeniz University, Faculty of Nursing, Dumlupinar Boulevard, Antalya 07058, Turkey
| | - Ayse Dagistan Akgöz
- Akdeniz University, Faculty of Nursing, Dumlupinar Boulevard, Antalya 07058, Turkey
| | - Sebahat Gözüm
- Akdeniz University, Faculty of Nursing, Dumlupinar Boulevard, Antalya 07058, Turkey
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Hjertvikrem N, Brørs G, Instenes I, Helmark C, Pettersen TR, Rotevatn S, Zwisler ADO, Norekvål TM. Use of health services and perceived need for information and follow-up after percutaneous coronary intervention. BMC Res Notes 2024; 17:20. [PMID: 38183067 PMCID: PMC10768322 DOI: 10.1186/s13104-023-06662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE Few patients achieve full control of their coronary artery disease (CAD) risk factors. Follow-up, such as cardiac rehabilitation, is important to increase adherence to lifestyle changes and treatment, to improve the patient's risk profile, and to treat established complications of CAD clinical events. However, the type of follow-up patients receive varies. Therefore, the aim of this research note was to describe and compare patients' self-reported use of health services, the type of follow-up patients reported to prefer, and the type of information patients reported to be important, in two countries with different follow-up practices after PCI. RESULTS We included 3417 patients in Norway and Denmark, countries with different follow-up strategies after PCI. The results showed large differences between the countries regarding health services used. In Denmark the most frequently used health services were consultations at outpatient clinics followed by visits to the general practitioner and visits to the fitness centre, whereas in Norway visits to the general practitioner were most common, followed by rehospitalisation and no follow-up used. However, patients found the same type of follow-up and information important in both countries. Patients' perceived need for follow-up and information decreased over time, suggesting a need for early follow-up when the patients are motivated. TRIAL REGISTRATION NCT03810612 (18/01/2019).
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Affiliation(s)
- Nina Hjertvikrem
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | - Gunhild Brørs
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ann Dorthe O Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- REHPA, Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Raisi A, Piva T, Myers J, Zerbini V, Mandini S, Zappaterra T, Mazzoni G, Tonet E, Pavasini R, Campo G, Grazzi G, Visintin EP. Experience and Perceptions among Older Outpatients after Myocardial Infarction following an Exercise Intervention: A Qualitative Analysis from the PIpELINe Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2196. [PMID: 36767563 PMCID: PMC9915135 DOI: 10.3390/ijerph20032196] [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: 11/16/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Traditional cardiac rehabilitation (CR) programs effectively improve physical performance and outcomes after myocardial infarction (MI). However, older patients are less likely to participate in such programs. The aim of this qualitative analysis was to investigate experiences and perceptions of cardiac outpatients enrolled in an innovative and exercise-based CR program and to identify possible barriers to improving adherence and quality of life. Semi-structured interviews were conducted on a sample of 31 patients (84% male; age 76 ± 6 years) from the Physical Activity Intervention in Elderly after Myocardial Infarction (PIpELINe) trial, after about six months of the event. Three main themes were identified: Personal feelings after the event; lifestyle change and perception of barriers; and relationships with familiars. Participants perceived sensations of fear at the time of their diagnosis and showed awareness of the importance of following specific health suggestions. They reported a significative change in previous habits and highlighted the need for periodic controls. Few of them felt insecure in carrying out daily activities or practicing exercise and reported an unnecessary protection from the family members. These findings will provide valuable insights for the development of a more feasible patient-centered CR model of intervention.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Valentina Zerbini
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Tamara Zappaterra
- Department of Humanities, University of Ferrara, 44121 Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, University of Illinois at Chicago, Chicago, IL 60612, USA
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
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Nascimento IDO, Assis MG, Ghisi GLDM, Britto RR. A qualitative study of patient's perceptions of two cardiac rehabilitation models. Braz J Phys Ther 2021; 25:552-562. [PMID: 33722508 DOI: 10.1016/j.bjpt.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/22/2021] [Accepted: 02/24/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Understanding patients' perceptions about rehabilitation can guide healthcare administrators on modifications of program elements, which can ultimately improve cardiac rehabilitation (CR) use, adherence of heart-health behaviors, and improvements in clinical outcomes. OBJECTIVE To examine the perception of patients about their participation in CR. METHODS Qualitative study using semi-structured interviews, performed in a public CR center in Brazil. Twenty-eight patients were interviewed 2-years following participation in two CR models: exercise-based and comprehensive CR. RESULTS Themes identified included: knowledge acquisition, improvement in functionality, and psychosocial well-being. It appeared that the perceived benefits of CR participation were overall positive and similar between the two models; however, those in the comprehensive CR identified additional subthemes: self-care need and knowledge transfer. CONCLUSIONS This study suggested that patients from two different CR models perceived in the long term that the CR participation positively impacted their disease-related knowledge, promoted functional gains, and improved psychosocial well-being. Structured educational interventions seemed to be associated with improved participants' perception about CR, which could contribute to long-term maintenance of heart-health behavior and better outcomes.
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Affiliation(s)
- Isabella de Oliveira Nascimento
- Post-Graduate Program Rehabilitation Science, Universidade Federal de Minas Gerais (UFMG), 63. Condomínio Pasárgada, CEP: 34.009-568. Nova Lima, Belo Horizonte, MG, Brazil
| | - Marcella Guimarães Assis
- Post-Graduate Program Rehabilitation Science, Universidade Federal de Minas Gerais (UFMG), 63. Condomínio Pasárgada, CEP: 34.009-568. Nova Lima, Belo Horizonte, MG, Brazil
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Raquel Rodrigues Britto
- Post-Graduate Program Rehabilitation Science, Universidade Federal de Minas Gerais (UFMG), 63. Condomínio Pasárgada, CEP: 34.009-568. Nova Lima, Belo Horizonte, MG, Brazil.
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Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: A review of published qualitative research studies. Int J Nurs Stud 2020; 110:103727. [PMID: 32823026 DOI: 10.1016/j.ijnurstu.2020.103727] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment plan adherence is recognized as a worldwide health issue, particularly important in the management of cardiovascular patients. Healthcare professionals are the primary sources of information and support for people diagnosed with CVD and those who have experienced a cardiac event, yet we know little about how healthcare professionals contribute to the process of adherence to treatment plans that aim to prevent and/or reduce disease and adverse events. Qualitative evidence that explores factors that influence adherence to treatment plans is limited. OBJECTIVE This systematic review identified and synthesised the best available evidence on factors that influence adherence to treatment plans amongst people living with cardiovascular disease. DESIGN Systematic review and qualitative synthesis. METHODS Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase- Non-Medline, Scopus, Cochrane Library, ProQuest Central (Grey Literature). Pre-defined keywords and MeSH terms were used to identify qualitative methods English-language studies published between 2001 and 2018. Quality appraisal of each paper was completed using the JBI Critical Appraisal Checklist and two reviewers extracted the data independently. RESULTS Twenty-two articles were included. Eight key themes were identified that related to facilitators and barriers to adherence to treatment plans. Facilitators were identified as engaging in exercise, having support and mentorship, lifestyle modification, and the perceived value of taking medication. Barriers were identified as a perceived lack of support, concerns about taking medication, and lack of engagement in exercise and lifestyle changes. CONCLUSIONS The findings highlight the factors that support adherence and healthcare professionals can build on also the areas that can be targeted to support and improve adherence to treatment plans. Nurses can play an important role in enhancing the provision of information pre hospital discharge and support in the community on taking medication, the value of physical activity and dietary changes.
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Mentrup S, Harris E, Gomersall T, Köpke S, Astin F. Patients' Experiences of Cardiovascular Health Education and Risk Communication: A Qualitative Synthesis. QUALITATIVE HEALTH RESEARCH 2020; 30:88-104. [PMID: 31729937 DOI: 10.1177/1049732319887949] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Coronary heart disease (CHD) has no cure, and patients with myocardial infarction are at high risk for further cardiac events. Health education is a key driver for patients' understanding and motivation for lifestyle change, but little is known about patients' experience of such education. In this review, we aimed to explore how patients with CHD experience health education and in particular risk communication. A total of 2,221 articles were identified through a systematic search in five databases. 40 articles were included and synthesized using thematic analysis. Findings show that both "what" was communicated, and "the way" it was communicated, had the potential to influence patients' engagement with lifestyle changes. Communication about the potential of lifestyle change to reduce future risk was largely missing causing uncertainty, anxiety, and, for some, disengagement with lifestyle change. Recommendations for ways to improve health education and risk communication are discussed to inform international practice.
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Affiliation(s)
| | - Emma Harris
- University of Huddersfield, Huddersfield, United Kingdom
| | - Tim Gomersall
- University of Huddersfield, Huddersfield, United Kingdom
| | | | - Felicity Astin
- University of Huddersfield, Huddersfield, United Kingdom
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
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Nabelsi V, Croteau S. An Evidence-Based Health Care Knowledge Integration System: Assessment Protocol. JMIR Res Protoc 2019; 8:e11754. [PMID: 30855235 PMCID: PMC6431825 DOI: 10.2196/11754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/17/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The rapid advancements in health care can make it difficult for general physicians and specialists alike to keep their knowledge up to date. In medicine today, there are deficiencies in the application of knowledge translation (KT) in clinical practice. Some medical procedures are not required, and therefore, no value is added to the patient's care. These unnecessary procedures increase pressures on the health care system's resources, reduce the quality of care, and expose the patients to stress and to other potential risks. KT tools and better access to medical recommendations can lead to improvements in physicians' decision-making processes depending on the patient's specific clinical situation. These tools can provide the physicians with the available options and promote an efficient professional practice. Software for the Evolution of Knowledge in MEDicine (SEKMED) is a technological solution providing access to high-quality evidence, based on just-in-time principles, in the application of medical recommendations for clinical decision-making processes recognized by community members, accreditation bodies, the recommendations from medical specialty societies made available through campaigns such as Choosing Wisely, and different standards or accreditive bodies. OBJECTIVE The main objective of this protocol is to assess the usefulness of the SEKMED platform used within a real working clinical practice, specifically the Centre intégré de santé et des services sociaux de l'Outaouais in Quebec, Canada. To achieve our main objective, 20 emergency physicians from the Hull and Gatineau Hospitals participate in the project as well as 20 patient care unit physicians from the Hull Hospital. In addition, 10 external students or residents studying family medicine from McGill University will also participate in our study. METHODS The project is divided into 4 phases: (1) orientation; (2) data synthesis; (3) develop and validate the recommendations; and (4) implement, monitor, and update the recommendations. These phases will enable us to meet our 6 specific research objectives that aim to measure the integration of recommendations in clinical practices, the before and after improvements in practices, the value attributed by physicians to recommendations, the user's platform experience, the educational benefits according to medical students, and the organizational benefits according to stakeholders. The knowledge gained during each phase will be applied on an iterative and continuous basis to all other phases over a period of 2 years. RESULTS This project was funded in April 2018 by the Fonds de soutien à l'innovation en santé et en services sociaux for 24 months. Ethics approval has been attained, the study began in June 2018, the data collection will be complete at the end of December 2019, and the data analysis will start in winter 2020. Both major city hospitals in the Outaouais region, Quebec, Canada, have agreed to participate in the project. CONCLUSIONS If results show preliminary efficacy and usability of the system, a large-scale implementation will be conducted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/11754.
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Affiliation(s)
- Véronique Nabelsi
- Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Sylvain Croteau
- Hôpital de Gatineau, Centre intégré de santé et des services sociaux de l'Outaouais, Gatineau, QC, Canada
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Nobre MRC, Domingues RZDL. Patient adherence to ischemic heart disease treatment. Rev Assoc Med Bras (1992) 2017; 63:252-260. [PMID: 28489132 DOI: 10.1590/1806-9282.63.03.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/02/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. Objective: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease. Method: A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency. Results: Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system. Conclusion: The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.
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Affiliation(s)
- Moacyr Roberto Cuce Nobre
- Director of the Clinical Epidemiology and Research Support Team - Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Rachel Zanetta de Lima Domingues
- Consultant at Cognos - Health Education. Collaborator for the Clinical Epidemiology and Research Support Team, InCor-HC-FMUSP, São Paulo, SP, Brazil
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Karataş T, Bostanoğlu H. Perceived social support and psychosocial adjustment in patients with coronary heart disease. Int J Nurs Pract 2017. [DOI: 10.1111/ijn.12558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tuğba Karataş
- Faculty of Health Sciences, Department of Nursing; Gazi University; Ankara Turkey
| | - Hatice Bostanoğlu
- Faculty of Health Sciences, Department of Nursing; Near East University; Nicosia Cyprus
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Svavarsdóttir MH, Sigurdardottir AK, Steinsbekk A. What is a good educator? A qualitative study on the perspective of individuals with coronary heart disease. Eur J Cardiovasc Nurs 2015; 15:513-521. [PMID: 26588939 DOI: 10.1177/1474515115618569] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient views are especially important in patient education, as patient involvement is essential. However, no empirical research clarifies what knowledge, skills and competencies are needed for health professionals to competently serve as a good educator according to the patients themselves. AIM To explore what qualities patients with coronary heart disease perceive in a good educator. METHODS A qualitative research method, with semi-structured individual interviews, was used in this study. Purposeful sampling was used to recruit participants from a general hospital in Iceland and in Norway. The data were analysed using systematic text condensation. RESULTS The participants included 17 patients who had been through a percutaneous coronary intervention and participated in formal patient education after discharge from hospital. The patients saw a good educator as one who they feel is trustworthy and who individualizes the education to patients' needs and context and translates general information to their personal situation in lay language. Building trust was dependent on the patients' perceiving the educator to be knowledgeable and good at connecting with the individual patient, so that the patients feel they are being treated as a whole person with equality and respect. CONCLUSIONS The patients perceived the capability of building trust and tailoring the education to the individual as the most prominent characteristics of a good educator. Training skills that facilitate patients' trust, being observant of the patient and his learning needs and adjusting the patient education to individual needs and situations should be key objectives in health professionals' training in patient education.
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Affiliation(s)
- Margrét H Svavarsdóttir
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway .,St Olavs Hospital, Trondheim University Hospital, Norway.,School of Health Sciences, University of Akureyri, Iceland
| | | | - Aslak Steinsbekk
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples' experiences. BMC Cardiovasc Disord 2014; 14:96. [PMID: 25097066 PMCID: PMC4134458 DOI: 10.1186/1471-2261-14-96] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples' experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience. METHODS A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings. RESULTS The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was 'familiar' to 'unfamiliar'. The transition process involved 'finding new limits and a life worth living' , 'finding support for self' and 'finding a new normal'. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of 'reassessing past, present and future lives' as participants considered their changed identity. Participants experienced a strong urge to get back to 'normal'. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider 'life' change that occurred. CONCLUSIONS The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within 'wider' life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity shifted and emotions that reflected the various stages of the grief process were evident in participants' accounts. The process of self-managing lifestyle took place through experiential learning; the level of engagement with lifestyle change reflected an individual's unique view of the balance needed to manage 'realistic change' whilst leading to a life that was perceived as 'worth living'. Findings highlight the importance of providing person centred care that aligns with both psychological and physical dimensions of recovery which are inextricably linked.
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Petriček G, Buljan J, Prljević G, Owens P, Vrcić-Keglević M. Facing the diagnosis of myocardial infarction: a qualitative study. Eur J Gen Pract 2014; 21:19-25. [PMID: 24874789 DOI: 10.3109/13814788.2014.907269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient experience is increasingly recognized as one of the three pillars of quality in health care, alongside clinical effectiveness and patient safety. However, little attention has been paid to the patients' experience from the point of view of health care delivery. OBJECTIVE To explore the initial experience of patients facing a new diagnosis of myocardial infarction (MI). METHODS Thirty semi-structured, individual interviews were performed. The Grounded Theory method was used. Atlas.ti qualitative data analysis software facilitated the analysis. RESULTS Three patterns of MI diagnosis experience were found: a close encounter with death, severe pain, and 'silent' MI. Newly-diagnosed MI patients who experienced a close encounter with death expected that, after necessary life-saving measures, their physician would not force immediate conversation, but leave them alone, simply to take pleasure in being alive. Newly-diagnosed MI patients who did not experience a close encounter with death expected that their physician would provide not only medical care but also immediate emotional support and opportunities to discuss in their own words their ideas, thoughts, concerns and fears. Six factors facilitated patients coping with a new diagnosis of MI: stay in hospital, completion of diagnostic tests, trust in physicians, the patient's previous expectation that he/she could have a heart attack, the patient's personality, and the need for solitude. CONCLUSION Physicians should be aware that different patterns of patient experience when facing MI could indicate patients' differing needs for immediate emotional support and communication.
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Affiliation(s)
- Goranka Petriček
- Department of Family Medicine, University of Zagreb, School of Medicine,'Andrija Štampar' School of Public Health , Zagreb , Croatia
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Rashid MA, Edwards D, Walter FM, Mant J. Medication taking in coronary artery disease: a systematic review and qualitative synthesis. Ann Fam Med 2014; 12:224-32. [PMID: 24821893 PMCID: PMC4018370 DOI: 10.1370/afm.1620] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Despite the compelling evidence supporting cardiovascular medications in the secondary prevention of coronary artery disease, many patients discontinue treatment. In this synthesis, we sought to understand from a patient perspective the factors that promote medication persistence. METHODS We systematically searched 7 databases (MEDLINE, Embase, PsycINFO, SCOPUS, CINAHL, ASSIA, and SSCI) for published qualitative research about the medication-taking experiences of patients with coronary artery disease and their partners. Articles were assessed for quality using a modified CASP (Critical Appraisal Skills Programme) checklist. Synthesis was undertaken using well-established meta-ethnographic approaches. RESULTS We included 17 articles in the final synthesis from the United Kingdom (6), Europe (5), United States (4), China (1), and Australia (1), with a total sample size of 391 patients. Analyses suggested that some patients hold fatalistic beliefs about their disease, whereas others believe they have been cured by interventions; both can lead to failure to take medication. Patients who adapt to being a "heart patient" are positive about medication taking. Some individuals dislike taking tablets generally and are wary of long-term effects. Relationships with prescribing clinicians are of critical importance for patients, with inaccessibility and insensitive terminology negatively affecting patients' perceptions about treatments. CONCLUSIONS Strategies to promote higher persistence of secondary prevention medications in patients with coronary artery disease need to recognize the key role of the prescribing clinician. Providing medication-specific information at the time of initiating therapy, improving the transition between secondary and primary care, and explaining the risk of disease recurrence may all help to modify patient attitudes toward drugs to prevent further cardiovascular disease.
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Affiliation(s)
- Mohammed A Rashid
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom
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Knudsen MV, Laustsen S, Petersen AK, Angel S. Lifestyle after Cardiac Rehabilitation: Did the Message Come across, and Was It Feasible? An Analysis of Patients’ Narratives. Health (London) 2014. [DOI: 10.4236/health.2014.619303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pryor T, Page K, Patsamanis H, Jolly KA. Investigating support needs for people living with heart disease. J Clin Nurs 2013; 23:166-72. [DOI: 10.1111/jocn.12165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 10/26/2022]
Affiliation(s)
- Tess Pryor
- Heart Foundation Victoria; Melbourne Vic. Australia
| | - Karen Page
- Heart Foundation Victoria; Melbourne Vic. Australia
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Murray J, Fenton G, Honey S, Bara AC, Hill KM, House A. A qualitative synthesis of factors influencing maintenance of lifestyle behaviour change in individuals with high cardiovascular risk. BMC Cardiovasc Disord 2013; 13:48. [PMID: 23829636 PMCID: PMC3716917 DOI: 10.1186/1471-2261-13-48] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 06/28/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Management of cardiovascular risk factors includes commitment from patients to adhere to prescribed medications and adopt healthy lifestyles. Unfortunately many fail to take up and maintain the four key healthy behaviours (not smoking, having a balanced diet, limiting alcohol consumption and being more active). Five factors (beliefs, knowledge, transport and other costs, emotions, and friends and family support) are known to predict uptake of lifestyle behaviour change. The key factors influencing maintenance of healthy lifestyles are not known but would be helpful to support the development of relapse prevention programmes for this population. Our review aimed to clarify the main patient perceived factors thought to influence maintenance of changed healthy lifestyles. METHODS We performed a systematic review of qualitative observational studies and applied the principles of content synthesis and thematic analysis to extract reported factors (barriers and facilitators) considered by individuals to be influential in maintaining changed healthy lifestyle behaviours. Factors were then organised into an existing framework of higher order categories which was followed by an analysis of the interrelationships between factors to identify key themes. RESULTS Twenty two studies met our inclusion criteria. Participants reported barriers and facilitators within 13 categories, the majority of which were facilitators. The most commonly reported influences were those relating to social support (whether provided formally or informally), beliefs (about the self or the causes and management of poor health, and the value of maintaining lifestyle behaviours), and other psychological factors (including attitude, thinking and coping styles, and problem solving skills). Physical activity was the most commonly investigated behaviour in four categories, but overall, the main barriers and facilitators were related to a range of behaviours. Through analysis of the interrelationships between factors within categories, 'social support', 'education and knowledge', and 'beliefs and emotions' were all considered key themes. CONCLUSIONS Our review suggests that for the most part, factors that influence lifestyle change are also important for maintaining healthy behaviours. This indicates that addressing these barriers and facilitators within lifestyle support programmes would also be of value in the longer-term.
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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
| | - Grania Fenton
- 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
| | - Stephanie Honey
- 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
| | - Ana Claudia Bara
- 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
| | - Kate Mary Hill
- 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
| | - Allan House
- 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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Luo G. Open issues in intelligent personal health record--an updated status report for 2012. J Med Syst 2013; 37:9943. [PMID: 23584758 DOI: 10.1007/s10916-013-9943-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/20/2013] [Indexed: 12/16/2022]
Abstract
To improve the capability and usability of the personal health record (PHR) as a tool to empower consumers in the management of their own health, we have proposed the concept of an intelligent PHR (iPHR) and built a prototype iPHR system with four functions. These four functions use various health knowledge and computer science techniques to automatically provide users with personalized healthcare information to facilitate their well-being. This paper discusses several open issues in iPHR, including two enhancements to an existing function and two potential new functions. The two enhancements are for automatically compiling relevant self-care activities for each health issue and automatically identifying contraindicated self-care activities, respectively. One potential new function is personalized search for individual healthcare providers. Another potential new function is personalized local search for health-related services to help maintain patients in their homes. We include some preliminary thoughts on how to address these open issues with the hope to stimulate future research work on iPHR.
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics, University of Utah, HSEB Room 5725B, 26 South 2000 East, Salt Lake City, UT, 84112, USA,
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Bentley D, Khan S, Oh P, Grace S, Thomas S. Physical activity behavior two to six years following cardiac rehabilitation: a socioecological analysis. Clin Cardiol 2012; 36:96-102. [PMID: 23280429 DOI: 10.1002/clc.22084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/13/2012] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) promotes long-term positive health behaviours, such as physical activity (PA), in patients following a cardiovascular event. We have limited knowledge of long-term PA and its correlates. Therefore, this research examined both PA behaviour and socioecological correlates among elderly graduates 2-6 years following CR. HYPOTHESIS CR graduates will have a moderate PA level in the long term. Greater PA will be associated with various multilevel correlates. METHODS This was a retrospective, cross-sectional study which quantified PA using the Physical Activity Scale for the Elderly (PASE) and collected information about socioecological correlates at the intrapersonal, interpersonal and health service levels. Both univariate and multivariate analyses assessed PA and PA correlates. RESULTS The majority of the 584 participants were older (69.8 ± 9.8), male (80.3%), and well educated (75.4% ≥ some post-secondary). Average time since CR graduation was 41.5 ± 11.5 months. Seventy five percent of CR graduates reported current weekly PA levels that met, or exceeded, Canadian PA guidelines (>150 minutes of moderate-vigorous PA). Univariate analyses identified 13 PASE score correlates. Multivariate analyses identified age, PA enjoyment, current work status, CR staff support, location of primary residence, and perceived health as significantly associated with higher PASE scores (p < 0.001). CONCLUSIONS Three and a half years post-CR graduates had high PA levels. Greater PA was associated with several modifiable multilevel correlates at all levels of influence. Understanding correlates of long-term PA behaviour among CR graduates will help identify groups at risk for nonadherence and assist with continued program development.
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Affiliation(s)
- Danielle Bentley
- Department of Exercise Science, University of Toronto, Toronto, Canada.
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Abstract
BACKGROUND Cardiac rehabilitation and secondary prevention programs can prevent heart disease in high-risk populations. However, up to half of all patients referred to these programs do not subsequently participate. Although age, sex, and social factors are common predictors of attendance, to increase attendance rates after referral, the complex range of factors and processes influencing attendance needs to be better understood. METHODS A systematic review using qualitative meta-synthesis was conducted. Ten databases were systematically searched using 100+ search terms until October 31, 2011. To be included, studies had to contain a qualitative research component and population-specific primary data pertaining to program attendance after referral for adults older than 18 years and be published as full articles in or after 1995. RESULTS Ninety studies were included (2010 patients, 120 caregivers, 312 professionals). Personal and contextual barriers and facilitators were intricately linked and consistently influenced patients' decisions to attend. The main personal factors affecting attendance after referral included patients' knowledge of services, patient identity, perceptions of heart disease, and financial or occupational constraints. These were consistently derived from social as opposed to clinical sources. Contextual factors also influenced patient attendance, including family and, less commonly, health professionals. Regardless of the perceived severity of heart disease, patients could view risk as inherently uncontrollable and any attempts to manage risk as futile. CONCLUSIONS Decisions to attend programs are influenced more by social factors than by health professional advice or clinical information. Interventions to increase patient attendance should involve patients and their families and harness social mechanisms.
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Neubeck L, Freedman SB, Clark AM, Briffa T, Bauman A, Redfern J. Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. Eur J Prev Cardiol 2012; 19:494-503. [PMID: 22779092 DOI: 10.1177/1741826711409326] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Participation in cardiac rehabilitation (CR) benefits patients with coronary heart disease (CHD), yet worldwide only some 15–30% of those eligible attend. To improve understanding of the reasons for poor participation we undertook a systematic review and meta-synthesis of the qualitative literature. METHODS Qualitative studies identifying patient barriers and enablers to attendance at CR were identified by searching multiple electronic databases, reference lists, relevant conference lists, grey literature, and keyword searching of the Internet (1990–2010). Studies were selected if they included patients with CHD and reviewed experience or understanding about CR. Meta-synthesis was used to review the papers and to synthesize the data. RESULTS From 1165 papers, 34 unique studies were included after screening. These included 1213 patients from eight countries. Study methodology included interviews (n = 25), focus groups (n = 5), and mixed-methods (n = 4). Key reasons for not attending CR were physical barriers, such as lack of transport, or financial cost, and personal barriers, such as embarrassment about participation, or misunderstanding the reasons for onset of CHD or the purpose of CR. CONCLUSIONS There is a vast amount of qualitative research which investigates patients’ reasons for non-attendance at CR. Key issues include system-level and patient-level barriers, which are potentially modifiable. Future research would best be directed at investigating strategies to overcome these barriers.
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Affiliation(s)
- Lis Neubeck
- Faculty of Medicine, University of Sydney, Sydney, Australia.
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Frick U, Gutzwiller FS, Maggiorini M, Christen S. A questionnaire on treatment satisfaction and disease specific knowledge among patients with acute coronary syndrome. II: Insights for patient education and quality improvement. PATIENT EDUCATION AND COUNSELING 2012; 86:366-371. [PMID: 21719236 DOI: 10.1016/j.pec.2011.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 03/22/2011] [Accepted: 06/04/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Secondary prevention for coronary heart disease is achieved by pharmaceutical control of risk factors and patients' own self management behaviour. To comply with longterm treatment patients need sufficient knowledge of their condition and should be satisfied with acute care. Therefore a questionnaire measuring both issues was constructed. METHODS AND RESULTS Latent class analysis applied in a sample of over 2000 patients suffering from acute coronary syndrome revealed 4 configurative patterns of knowledge and 5 distinct patterns of (dis-)satisfaction. Nearly 50% of all patients displayed insufficient knowledge upon discharge. Deficits clustered around misinformation on necessary lifestyle changes versus dysfunctional strategies for future emergency situations. Satisfaction and disease specific knowledge were interrelated in complex patterns. CONCLUSIONS Disease specific knowledge and satisfaction with treatment proved to be psychometrically valid indicators of the quality of the treatment process that might also have an impact on outcome. PRACTICE IMPLICATIONS A validated questionnaire is ready for routine administration after discharge of patients with acute coronary syndrome from acute hospital care. Patient education efforts and quality improvement in treatment centres might be effectively monitored using this questionnaire.
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Affiliation(s)
- Ulrich Frick
- Department of Healthcare Management, Carinthia University of Applied Sciences, Feldkirchen, Austria.
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Bergman E, Malm D, Berterö C, Karlsson JE. Does one's sense of coherence change after an acute myocardial infarction?: A two-year longitudinal study in Sweden. Nurs Health Sci 2011; 13:156-63. [DOI: 10.1111/j.1442-2018.2011.00592.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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