BACKGROUND/RATIONALE:
This study will investigate the associations among lay beliefs about coronary heart disease (CHD), modifiable risk behaviors and quality of life (QoL) in a diverse sample of veterans recovering from myocardial infarction (MI). A recent study by the PI found that post-MI patients often do not incorporate personally relevant behavioral risk factors into their representations of CHD; such non-veridical beliefs predicted non-adherence to recommendations regarding diet, exercise, and smoking cessation. One goal of the proposed research is to extend the investigation of lay beliefs and post-MI health behaviors to a more diverse sample of veterans; this is important because cardiac risk factors (e.g., smoking, hypertension) are very common among veterans in general and African American veterans in particular. Another goal is to prospectively follow the natural evolution of patients' CHD beliefs for 6-months during post-MI recovery in order to contribute to our understanding of the optimal timing for post-MI interventions. The proposed study would comprise a critical step in the PI's ongoing development of an intervention that targets the modification of non-veridical beliefs in patients' CHD representations (i.e., idiosyncratic beliefs about CHD symptoms, etiology, timeline, control/cure, and consequences). The long-term goal of this program of research is to facilitate healthy lifestyle behaviors, improve QoL, and reduce morbidity/mortality among post-MI patients.
OBJECTIVE(S):
(1) Describe and compare CHD representations in African American and Caucasian post-MI VHA patients. (2) Map the trajectory of CHD representations, and their associations with medical status and critical cognitive, affective, and sociocultural factors, for 6-months following discharge in African American and Caucasian post-MI VHA patients. (3) Model the implications of CHD representational trajectories for health outcomes, including health behaviors, QoL, and health services utilization for 6-months following discharge in African American and Caucasian post-MI VHA patients.
METHODS:
A prospective, correlational design will be used; 430 post-MI patients (50% African American) will be recruited from three clinical sites. IRB approval has been received at the Houston TX VAMC clinical site; IRB review is in process for clinical sites at the Durham NC and Cleveland OH sites. An IRB modification will be submitted to add the Durham and Cleveland sites after IRB approval has been received at those sites. 300 of these subjects are expected to complete each and every round of data collection. Data collection will be coordinated and performed from the central study site at the Iowa City IA VAMC. Telephone interviews and self-report questionnaires will be used to measure CHD representations, cognitive (cardiac self-efficacy, sense of control), affective (depression, anxiety, negative affect), and sociocultural variables (social support, ethnicity, SES), cardiac behavioral intentions, CHD health behaviors (exercise, diet, smoking, medication adherence), and CHD outcomes (QoL, health services utilization) at four time points during the 6-months following hospital discharge. Additional data regarding medical status, health services use and prescription refills (as a measure of adherence) will be obtained from participants' medical records.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The study will make a crucial contribution to the development of a nursing intervention that targets patients' CHD representations as a tool in facilitating health behaviors, improving QoL, and reducing post-MI morbidity and mortality.
PUBLICATIONS:
Journal Articles
- Litaker D, Watts B, Samaan R, Ober S, Lawrence RH. Are provider self-efficacy and attitudes related to cardiovascular prevention associated with better treatment outcomes? Translational research : the journal of laboratory and clinical medicine. 2007; 149(4): 165-72.
