Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model

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The importance of couple‐oriented interventions in cardiac rehabilitation (CR) after an event of coronary heart disease (CHD) has been well described 1. There is a significant positive concordance between patients and spouses for the majority of coronary risk factors 6, for example for smoking, physical inactivity, hypercholesterolaemia and diabetes mellitus 5.
Despite the general concordance on coronary risk factors, data from the EUROASPIRE III survey showed that of patients with CHD followed up after 1.4 years, 38% lived with obesity (in Sweden more than 45%); 16% smoked (of those smoking before hospitalisation 51% still smoked); and almost 40% had hypertension7. These high figures might partly be explained by the current underuse of CR 8. About half of the patients received advice to attend CR 9 and only 36% of all patients with CHD benefitted from CR in Europe 8. Thus, a reasonable assumption is that even fewer spouses than patients do not take advantage of CR for their own health and/or in order to support the patient.
Although the knowledge that spousal concordance regarding coronary risk factors and lifestyle habits exists, there is little information on spouses’ support to the patient in daily life. We previously described five different roles of spousal support after a cardiac event. These roles were described as being participative, meaning that the spouse took a practical part in the lifestyle change; regulative, that is the spouse tried to influence the patient to change lifestyle habits; observational, that is the spouse was passive and compliant towards the patient's lifestyle change; incapacitated, which denoted an inability to be supportive; and dissociative, which entailed a reluctance to become involved in changes of lifestyle habits of the patient. No spouse took on the same supportive role in all situations. Instead, the spouse's supportive roles depended on the current situation 10. Reasons that spouses support the patient in different ways may be that spouses have diverse experiences of control over the partner's heart condition, and they lack understanding of the information they are given11. Illness beliefs have been identified as an important determinant of patients' changes in lifestyle after a cardiac event 13. Three key themes based on patients' reports were identified as factors associated with commitment and completion of change in lifestyle habits. These themes were the following: psychological beliefs, friends and family support, and transport and costs. The authors of the review conclude that these factors should be considered during consultations to promote a tailored approach to decision‐making about the most suitable type of education and level of support 14.
The Health Belief Model (HBM) is a framework that is extensively used to explain changes and maintenance of health‐related behaviours and as a guiding model for health behaviour interventions 15. HBM includes several key concepts and definitions: perceived susceptibility (one′s belief regarding the risk of getting a condition); perceived severity (one's belief about how serious a condition and its sequelae are); perceived benefits (one's belief in the efficacy of the advised action to reduce the risk or seriousness of impact); perceived barriers (one's belief about the tangible and psychological costs of the advised action); self‐efficacy (one's confidence in one's ability to take action) 15.
Although a concordance between patients and spouses regarding lifestyle habits exists, and patients report that changes in lifestyle habits depend on beliefs and family support, according to us, no study has qualitatively compared patients' and spouses’ health beliefs about lifestyle habits after a cardiac event. Such data might be helpful in explaining lifestyle changes and their maintenance, and in designing future targeted interventions.
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