Analysis and Evaluation of the Theory of Planned Behavior

The Theory of Planned Behavior was developed to explain human behaviors. The theory has been broadly applied to health-related behaviors in nursing science but has not been examined in depth based on a critical nursing framework. This article systematically analyzes and evaluates the theory based on Fawcett and DeSanto-Madeya's 2013 framework. The theory reflects nursing metaparadigm concepts and has both social and theoretical significance as well as pragmatic adequacy, and its testability is supported by abundant empirical evidence. However, the theory's internal consistency and clarity could be improved with use of consistent terms for its concepts and relationships.

A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral

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.

Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data

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.

'This is a forever project': supporting lifestyle changes in a regional Queensland community-based cardiac rehabilitation program

Cardiac rehabilitation programs throughout the world have struggled for several years to attract more participants and facilitate behaviour changes in these clients. Over the past few years, there has been an increased level of attention in the role that self-efficacy and social support may play in this respect. The main aim of this study was to explore self-efficacy and social support within a regional, community-based cardiac rehabilitation program that does not adhere to traditional cardiac rehabilitation structures. Twelve participants were interviewed and two major themes emerged from the thematic analysis of the interview transcripts: making personal lifestyle changes; and supportive environment for lifestyle changes. Although this study is exploratory in nature, it has highlighted the significance of social support from within a program as opposed to participants' friends and family, the subject of most social-support research. It also contributes to the challenges others are starting to make regarding the limited timeframes associated with traditional cardiac rehabilitation programs, suggesting more time may be needed to build firmer psychosocial foundations for behaviour change after cardiac events.

Cardiac rehabilitation outcomes in a conventional versus telemedicine-based programme

We studied patients who were eligible for phase II cardiac rehabilitation. Rehabilitation was delivered either conventionally or by telemedicine using videoconferencing. There were 226 participants: 173 at the conventional site and 53 at the telemedicine site. At baseline, blood pressure, anthropometric measurements, lipid profiles, activity levels, dietary intake and behaviours were assessed. Assessments at baseline were repeated after 12 weeks, at the end of the rehabilitation programme. There were no significant differences ( P > 0.05) in the change from baseline to post-programme values between the conventional and the telemedicine groups. The results show the suitability of telemedicine for delivering cardiac rehabilitation for risk factor modification and exercise monitoring to patients who otherwise would not have access to it.

Using interpretative phenomenological analysis to inform physiotherapy practice: an introduction with reference to the lived experience of cerebellar ataxia

Qualitative research methods that focus on the lived experience of people with health conditions are relatively underutilised in physiotherapy research. This article aims to introduce interpretative phenomenological analysis (IPA), a research methodology oriented toward exploring and understanding the experience of a particular phenomenon (e.g., living with spinal cord injury or chronic pain, or being the carer of someone with a particular health condition). Researchers using IPA try to find out how people make sense of their experiences and the meanings they attach to them. The findings from IPA research are highly nuanced and offer a fine grained understanding that can be used to contextualise existing quantitative research, to inform understanding of novel or underresearched topics or, in their own right, to provoke a reappraisal of what is considered known about a specified phenomenon. We advocate IPA as a useful and accessible approach to qualitative research that can be used in the clinical setting to inform physiotherapy practice and the development of services from the perspective of individuals with particular health conditions.