Motivation and Participation in a Phase III Cardiac Rehabilitation Programme: An Application of the Health Action Process Approach (original) (raw)
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BMC Primary Care, 2022
Background Insufficient physical activity (PA) is a leading risk factor for premature death worldwide. Ireland’s public healthcare system, the Health Service Executive (HSE), has supported the development of the National Exercise Referral Framework (NERF) to tackle low levels of PA amongst those with non-communicable diseases (NCDs). ‘NERF centres’ are medically supervised PA programmes across Ireland that have established referral pathways with local hospitals and general practitioners. ULMedX is one such NERF centre offering exercise-based cardiac rehabilitation (EBCR) with the aim of intervention development to reduce early drop-out and maximise adherence for optimal health benefits. Aim The purpose of this research was to identify the major factors influencing participants’ adherence and early drop-out at ULMedX. Exploring areas for future development were also prioritised. Design & setting Qualitative interviews were conducted with long-term attenders and people who have droppe...
Motivation for Cardiac Rehabilitation Attendance: Creating an Evidence-based Strategy
Cardiac rehabilitation is a long-term plan of care that is based on the motivation of patients to attend rehabilitation. The purpose of the review was to synthesize existing evidence on motivational methods to attend outpatient cardiac rehabilitation; in order to create an evidence-based strategy addressing patient education, psychologic issues and guide healthcare professional action.
Promoting participation in cardiac rehabilitation: patient choices and experiences
Journal of Advanced Nursing, 2004
Promoting participation in cardiac rehabilitation: patient choices and experiences Background. Cardiac rehabilitation can be an effective means for the secondary prevention of coronary heart disease, but a majority of eligible individuals fail to attend or drop out prematurely. Little research has examined patients' decisions about attendance. Aims. This paper reports a study examining patients' beliefs and decision-making about cardiac rehabilitation attendance. Methods. A purposive sample of patients from a mixed urban-rural region of Scotland was studied in 2001 using focus groups. Those who were eligible for a standardized 12-week cardiac rehabilitation programme were compared, with separate focus groups held for individuals with high attendance (>60% attendance; n ¼ 27), high rates of attrition (<60% attendance; n ¼ 9) and non-attendance (0% attendance; n ¼ 8). A total of 44 patients (33 men; 11 women) took part in eight focus groups. Results. Participants from all groups held sophisticated and cohesive frameworks of beliefs that influenced their attendance decisions. These beliefs related to the self, coronary heart disease, cardiac rehabilitation, other attending patients, and health professionals' knowledge base. An enduring embarrassment about group or public exercise also influenced attendance. Those who attended reported increased faith in their bodies, a heightened sense of fitness and a willingness to support new patients who attended. Conclusions. Reassurance to ease exercise embarrassment should be given before and during the early stages of programmes, and this could be provided by existing patients. Strategies to promote inclusion should address the inhibiting factors identified in the study, and should present cardiac rehabilitation as a comprehensive programme of activities likely to be of benefit to the individual irrespective of personal characteristics, such as age, sex or exercise capacity.
Motivational factors of adherence to cardiac rehabilitation
Iranian journal of nursing and midwifery research, 2012
Main suggested theories about patients' adherence to treatment regimens recognize the importance of motivation in positive changes in behaviors. Since cardiac diseases are chronic and common, cardiac rehabilitation as an effective prevention program is crucial in management of these diseases. There is always concern about the patients' adherence to cardiac rehabilitation. The aim of this study was to describe the motivational factors affecting the patients' participation and compliance to cardiac rehabilitation by recognizing and understanding the nature of patients' experiences. The participants were selected among the patients with cardiac diseases who were referred to cardiac rehabilitation in Isfahan Cardiovascular Research Center, Iran. The purposive sampling method was used and data saturation achieved after 8 semi-structured interviews. The three main concepts obtained from this study are "beliefs", "supporters" and "group cohesion&quo...
Despite a decreasing trend in incidence and mortality, Cardiovascular Diseases (CVDs) still represent important causes of death and disability in developed countries, significantly affecting individuals’ quality of life and healthcare costs . Unhealthy lifestyle behaviors, such as poor diet, lack of physical activity and smoking status, constitute a challenge in contrasting the disease. Alternatively to the medical model, which rely on the traditional approach of information and advicegiving, evidence to date indicate the need of psychological actions able to address patients’ beliefs and concerns about their health status as well as to enhance confidence in their abilities to overcome barriers to adherence and achieve life‐style modifications in the long term. Even if the World Health Organization (WHO) Expert Committee stated that Cognitive‐Behavioural Therapy (CBT) is an important component of Cardiac Rehabilitation (CR) programs, it does not specifically focus on eliciting patients’ motivation, leading to the development of interventions aimed at enhancing health behavior change and among which Motivational Interviewing (MI) has obtained varying degrees of success. Also, the new mHealth (mobile health) approach could represent an important strategy in order to move motivational psychological support where necessary (outpatient settings), maximizing the results obtained from the CR in a long term among people suffering from CVD and other chronic conditions.
Participating or not in a cardiac rehabilitation programme: factors influencing a patient's decision
European journal of preventive cardiology, 2013
International research indicates that attendance of patients to a proposed cardiac rehabilitation (CR) programme varies between 21% and 75%. Addressing the reasons why cardiac patients are not participating will improve accessibility to CR. The objective of this study was to investigate patient compliance with cardiac rehabilitation and the reasons of refusing or abandoning the programme. Twenty hospital centres were recruited to participate. Each centre was asked to recruit patients from three patient groups, namely: percutaneous coronary intervention patients, patients that underwent major cardiac surgery, and patients being admitted because of an acute myocardial infarction and not belonging to the other two groups. Patients were asked to fill out a questionnaire during a follow-up outpatient consultation after the cardiac intervention. In total, 226 patients participated in the survey. Most patients were proposed (86%) and accepted (81% out of proposed) to attend a CR programme....
International Journal of Physiotherapy and Research, 2016
Background and objective: Cardiac Rehabilitation is an effective tool for the care of patients with heart disease. The objective of the present study was to identify the barriers to follow up and participation in phase 2 cardiac rehabilitation in post CABG subjects. Material and Methods: A total of two eighty eight (288) subjects both male and female were included the study. The demographic data of each subject was recorded and they were administered with
Motivating patients in cardiac rehabilitation programs: A multicenter randomized controlled trial
International Journal of Telerehabilitation, 2021
Concerns have been raised about motivation and psychological distress when implementing telerehabilitation in patients with heart failure. The current study compared conventional and telerehabilitation in two groups (n=67; n=70) of patients with heart failure at 0, 6, and 12 months on measures of motivation (Self-Determination Theory measures) and psychological distress (Hospital Anxiety and Depression scale). We found no significant changes in motivation across groups, although our telerehabilitation group had a slightly lower level of controlled motivation and higher levels of relatedness. In addition, there were no differences between groups with regard to psychological distress. This study demonstrates that telerehabilitation motivates patients with heart failure to the same degree as conventional rehabilitation, and that telerehabilitation is not associated with increased psychological distress. As such, telerehabilitation offers an alternative to conventional rehabilitation an...
Objectives: To (1) test the effect of a health action process approach (HAPA) theory-based education program in cardiac rehabilitation (CR) compared to traditional education on patient knowledge and HAPA constructs; and, (2) investigate the theoretical correlates of exercise behavior among CR patients receiving theory-based education. Methods: CR patients were exposed to an existing or HAPA-based 6 month education curriculum in this quasi-experimental study. Participants completed a survey assessing exercise behavior, HAPA constructs, and knowledge pre and post-program. Results: 306 patients consented to participate, of which 146 (47.7%) were exposed to the theory-based educational curriculum. There was a significant improvement in patients' overall knowledge pre-to post-CR, as well as in some HAPA constructs and exercise behavior, regardless of curriculum (p < 0.05). Path analysis revealed that knowledge was significantly related to intention formation, and intentions to engage in exercise were not directly related to behavior, which required action planning. Conclusions: The theoretically-informed education curriculum was not associated with greater knowledge or exercise behavior as expected. Education in CR improves knowledge, and theoretical constructs related to exercise behavior. Practice implications: Educational curricula should be designed to not only increase patients' knowledge, but also enhance intentions, self-efficacy, and action planning. ß