Causal beliefs and behaviour change post-myocardial infarction: How are they related?

Classification of illness attributions in patients with coronary artery disease

OBJECTIVE

To examine patient-reported causal attributions in patients with coronary artery disease and classify them according to attribution theory.

DESIGN

Patients with angiographically verified coronary artery disease (n = 459) were asked to report causal attributions by answering the respective open-ended item of the Brief Illness Perception Questionnaire.

MAIN OUTCOME MEASURES

Groups resulting from classifications were characterised with regard to sociodemographic and clinical variables, Quality of Life (SF-12), depression (PHQ-9), anxiety (GAD-7), and illness perception (BIPQ).

RESULTS

Stress emerged as the single most important attribution followed by various behavioural factors and genetic predisposition. There was a remarkable mismatch between the presence of modifiable risk factors (smoking, obesity) and patient-reported illness attributions. Based on the results of the descriptive categorisation of illness attributions we developed a transparent, easily reproducible scheme for dimensional classification of the fifteen most common responses according to attribution theory. The classification resulted in four groups: Behaviour/Emotional State, Past Behaviour/Emotional State, Physical/Psychological Trait and External.

CONCLUSION

We found a pattern of illness attributions largely in line with previous trials. The dimensional classification resulted in four groups and highlighted potential entry points for physician-patient communication aimed at establishing beneficial disease self-management.

Development and Validation of the Parkinson's Disease Medication Beliefs Scale (PD-Rx)

BACKGROUND

Medication non-adherence is common in Parkinson's disease (PD) and is associated with increased disability and healthcare costs. Individuals' beliefs regarding their medical conditions and treatments impact medication adherence. While instruments exist to measure patients' beliefs about medications in general, no such tool exists for PD.

OBJECTIVES

Create an instrument eliciting medication beliefs of persons with PD; identify demographic and clinical characteristics associated with beliefs; and examine whether beliefs are associated with dopaminergic therapy adherence.

METHODS

We developed the Parkinson's Disease Medication Beliefs Scale (PD-Rx) in four phases: focus groups of patients and caregivers to generate items, scale development, expert and patient revision of items, and a cross-sectional validation sample (n = 75). Adherence was calculated using two approaches incorporating self-reported medication lists.

RESULTS

The PD-Rx consists of 11 items covering benefits and risks of PD pharmacotherapies. The scale covers motor improvement, current adverse effects, and future concerns. Higher scores indicate more positive beliefs. Internal consistency was acceptable (Cronbach's alpha = 0.67). Test-retest reliability was 0.47. Quality of life was associated with PD-Rx scores, and lower scores were associated with non-adherence.

CONCLUSIONS

Negative beliefs about PD treatments are associated with lower quality of life and may be related to medication non-adherence. Further study of any causal relationship between beliefs and medication non-adherence in PD will inform the design of future patient-centered interventions to improve adherence.

Understanding smoking after acute illness: An application of the sentinel event method

The sentinel event theory provides a stepwise approach for building models to understand how negative events can spark health behaviour change. This study tested a preliminary model using the sentinel events method in a sample (N = 300) of smokers who sought care for acute cardiac symptoms. Patients completed measures on: smoking-related causal attribution, perceived severity of the acute illness event, illness-related fear and intentions to quit smoking. Patients were followed up one week after the health event and a seven-day timeline follow back was completed to determine abstinence from tobacco. Structural equation models were performed using average predictor scale scores at baseline, as well as three different time anchors for ratings of illness severity and illness-related fear. Quit intentions, actual illness severity and age were the consistent, positive and independent predictors of seven-day point prevalence abstinence. Additional research on the influences of perceptions and emotional reactions is warranted.

Risk factor awareness in a coronary population and the association with health-related quality of life outcomes

OBJECTIVES

The purpose of this study was to investigate the risk factor level awareness in coronary patients and to assess its associations with health-related quality of life (HRQoL)/psychological distress.

METHODS

Data on 8,743 coronary patients from 22 European countries, interviewed and examined at least 6 months after their acute event was available.

RESULTS

81.7% of patients indicated to be aware of their own blood pressure level, whereas only 46.6% of patients indicated to be aware of their cholesterol level. Furthermore, 43.7% of patients were aware of their blood glucose level, whereas in diabetes patients blood glucose level awareness reached 81.8%. Risk factor level awareness was significantly associated with HRQoL/psychological distress, with patients being unaware of their risk factor levels having worse outcomes. The relationship between awareness and HRQoL/psychological distress seemed to be partly mediated by the attempt of patients to adopt a healthier behaviour.

CONCLUSIONS

Health care workers should be encouraged to inform their patients about the importance of their coronary risk factors, the actual level and their personal target.

Sense of coherence as a predictor of health-related behaviours among patients with coronary heart disease

AIMS

A high sense of coherence (SOC) has been found to be associated with favourable health-related behaviours. However, evidence is for the most part lacking on the influence of SOC on health-related behaviours among coronary heart disease patients. The aim of this study was to explore the association between SOC at baseline and smoking status, nutrition behaviour, physical exercise and alcohol consumption of coronary heart disease patients 12-28 months after they had undergone different cardiac treatments.

METHODS

A total of 179 coronary heart disease patients (mean age 58.32±6.54 years, 19% female) were interviewed before coronary angiography and 12-28 months after. Self-report data about health-related behaviours were obtained via a structured interview. SOC was measured using the 13-item Orientation to Life Questionnaire. The relationship between SOC and health-related behaviours was examined using regression and cross-lagged path analyses.

RESULTS

SOC at baseline predicted non-smoking and quitting smoking: odds ratio (OR) (95% confidence interval (CI)) per unit increase (over range 38-91) was 1.11 (1.03-1.19) and 1.09 (1.01-1.17), respectively. Moreover, baseline SOC predicted healthy nutrition behaviour among percutaneous coronary intervention patients: the OR per unit increase was 1.08 (95% CI: 1.01-1.15). Lastly, SOC at baseline predicted improvement in alcohol consumption at follow-up among coronary artery bypass grafting patients (standard score result: -0.15, p<0.05).

CONCLUSION

Coronary heart disease patients with a low SOC before treatment are less likely to improve health behaviours after cardiac treatment and should thus get additional attention in health promotion.

Causal attributions among patients undergoing coronary artery bypass surgery: gender aspects and relation to depressive symptomatology

Causal attributions made by patients for their coronary heart disease may contribute to gender differences in emotional adjustment. The purpose of this study was to determine gender differences in causal attributions and to analyze the associations between causal attributions and depressive symptomatology in patients undergoing coronary artery bypass graft (CABG) surgery. Nine hundred and seventy-nine patients (mean age 66.8 years, 19.9% women) completed a modified version of the Illness Perception Questionnaire (IPQ) and the depression module of the Patient Health Questionnaire (PHQ-9) 1-3 days before CABG-surgery and 1 year after surgery. Men were more likely to name their health behavior (men: 40.2%, women: 26.9%, P < .001) as a cause of disease, whereas women were more likely to cite destiny (women: 34.7%, men: 25.7%, P = .012). Regression analyses showed cross-sectional and longitudinal associations of attributions with depressive symptomatology which were independent of gender, sociodemographic and clinical variables. Attribution to personality and stress were associated with an increase in depressive symptomatology. Causal attributions may present a valuable approach for identifying patients at risk for depression and the implementation of targeted interventions.

Can an illness perception intervention reduce illness anxiety in spouses of myocardial infarction patients? A randomized controlled trial

OBJECTIVE

To investigate whether a brief in-hospital illness perception intervention for myocardial infarction (MI) patients and their spouses could change spouses' illness perceptions and reduce spouses' anxiety about the illness.

METHODS

Fifty-seven spouses participated in a randomized controlled trial of an illness perception intervention for MI patients. Spouses of patients randomized to the intervention attended one half-hour patient-and-spouse session with a psychologist in addition to standard care. Spouses completed measures of illness perceptions, expectations, and illness anxiety at admission and at 1 week following discharge, and spouses' illness worry was rated by the patients at 3 months. The main outcome for spouses was differences in anxiety between intervention and control groups.

RESULTS

One week following discharge, spouses in the intervention group had higher illness understanding, lower concern, stronger causal attributions to hereditary factors, and fewer questions about their partner's heart condition compared to the control group. Intervention group spouses reported more positive expectations about the ability of the patient's heart to recover, and lower perceived likelihood of another MI. They had lower anxiety about the patient doing physical activity and about the patient's medications, and lower distress about the patient's symptoms. Spouses in the intervention group were rated as less worried about the illness at 3 months.

CONCLUSION

Spouses of patients represent a new target for illness perception interventions and these results demonstrate that a brief illness perception intervention can change illness perceptions and reduce anxiety about the illness in spouses of MI patients.

Further development of an illness perception intervention for myocardial infarction patients: a randomized controlled trial

OBJECTIVE

To further develop and trial a brief in-hospital illness perception intervention for myocardial infarction (MI) patients.

METHODS

One hundred and three patients admitted with acute MI were randomized to receive either standard care or standard care plus an illness perception intervention, which consisted of three half-hour patient sessions and one half-hour patient-and-spouse session delivered in hospital. Patients were followed up to 6 months. The main outcome was the difference between groups in rate of return to work.

RESULTS

The intervention group had a faster rate of return to work than the control group, and more patients in the intervention group had returned to full time work by 3 months than in the control group. At discharge, patients in the intervention group demonstrated changes in causal attributions regarding their MI and higher perceived understanding of their condition, which remained at the 6-month follow-up. They also reported a better understanding of the information given in hospital, higher intentions to attend cardiac rehabilitation classes, lower anxiety about returning to work, greater increases in exercise, and made fewer phone calls to their general practitioner about their heart condition at follow-up.

CONCLUSION

This study replicates the findings of an earlier trial that a brief in-hospital illness perception intervention can change perceptions and improve rates of return to work in MI patients. It increases the generalizability of the intervention to the current broader definition of MI and to patients who have had previous infarcts.

Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans

Hypertension, particularly among African Americans, has been increasing in importance in the past 10 years. One aspect of this problem is poor disease management. This study examined illness beliefs, behaviors, and hypertension control among 102 African American outpatients. Participants were interviewed about their commonsense beliefs concerning hypertension and its management in accordance with Leventhal's commonsense model of self-regulation (CSM). Also assessed were medication adherence, stress-reducing behaviors, and lifestyle behaviors recommended for blood pressure control. Blood pressure was measured at about the time of interviewing. Results indicated that endorsement of a medical belief model of hypertension (i.e., caused and controlled by factors such as diet, age, and weight) was cross-sectionally associated with lower systolic blood pressure, a relationship that was statistically mediated by lifestyle behaviors (e.g., cut down salt, exercise). Endorsement of a stress belief model (i.e., stress is the main factor in hypertension cause and control) was associated with engagement in stress-related behaviors but not with blood pressure. These results further support the utility of the CSM for understanding patients' disease management behaviors.