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Su X, Zhang Y, Zhou H, Ma F, Jin X, Bai Y, Wei W, Zhang X, Zhou M. Perceived Determinants of Health-Related Behaviors Among Patients with Coronary Heart Disease After Percutaneous Coronary Intervention: A Longitudinal Qualitative Study. Patient Prefer Adherence 2024; 18:591-606. [PMID: 38463399 PMCID: PMC10924927 DOI: 10.2147/ppa.s452943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/24/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Studies had reported some influencing factors of health behavior among patients with coronary heart disease(CHD) after percutaneous coronary intervention(PCI). However, considering that human perceptions are complex, unrestricted and dynamically changing. A longitudinal qualitative study was conducted to explore the determinants of health-related behaviors of patients after PCI and dynamic changes of these determinants at the 1st, 3rd, and 6th months. Patients and Methods Using purposive sampling, 18 patients undergoing PCI were interviewed. The conventional content analysis method was used to identify categories and subcategories. Semi-structured, face-to-face or telephone in-depth interviews were conducted at the cardiology unit of a tertiary referral hospital in Yunnan Province, China from March 2022 to January 2023. Results Seven categories with some subcategories were constructed from the data, categorized into three domains. Firstly, individual factors include (i) Personal coping with healthy lifestyle requirements (tried but failed; I can do it), (ii) individual perception and feeling toward disease (knowing about the disease; belief of cure; fears of relapse), and (iii) personal benefits (improved health; meaning of life). Secondly, social factors include (i) social facilitators (family resources; healthcare support), (ii) social barriers (inconvenient medical care service; conflicting information). Finally, cultural factors include (i) way of living (dietary habits; key roles of yan (cigarette) and jiu (alcohol) in Chinese society), (ii) way of thinking (fatalism and Confucian familism). Conclusion The determinants of health-related behaviors of patients after PCI are multifaceted and dynamic. Different interventions should be formulated to promote patients' adherence to health behaviors. Moreover, priority should be given to the impact of traditional Chinese philosophy on the health behaviors of patients after PCI, and the health promotion program for these patients should be culturally sensitive. In addition, future research should further explore the determinants of health behaviors among diverse ethnic minorities after PCI, which has not been fully inquired in this study.
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Affiliation(s)
- Xu Su
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Yimei Zhang
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Huilin Zhou
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Fang Ma
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Xiaorong Jin
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Yangjuan Bai
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Wei Wei
- Digestive Surgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Xiong Zhang
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Min Zhou
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
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Buhr TJ, Reed CH, Wee OM, Lee JH, Yuan LL, Fleshner M, Valentine RJ, Clark PJ. The persistence of stress-induced physical inactivity in rats: an investigation of central monoamine neurotransmitters and skeletal muscle oxidative stress. Front Behav Neurosci 2023; 17:1169151. [PMID: 37273279 PMCID: PMC10237271 DOI: 10.3389/fnbeh.2023.1169151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Sedentary lifestyles have reached epidemic proportions world-wide. A growing body of literature suggests that exposures to adverse experiences (e.g., psychological traumas) are a significant risk factor for the development of physically inactive lifestyles. However, the biological mechanisms linking prior stress exposure and persistent deficits in physical activity engagement remains poorly understood. Methods The purpose of this study was twofold. First, to identify acute stress intensity thresholds that elicit long-term wheel running deficits in rats. To that end, young adult male rats were exposed to a single episode of 0, 50, or 100 uncontrollable tail shocks and then given free access to running wheels for 9 weeks. Second, to identify stress-induced changes to central monoamine neurotransmitters and peripheral muscle physiology that may be maladaptive to exercise output. For this study, rats were either exposed to a single episode of uncontrollable tail shocks (stress) or left undisturbed in home cages (unstressed). Eight days later, monoamine-related neurochemicals were quantified by ultra-high performance liquid chromatography (UHPLC) across brain reward, motor, and emotion structures immediately following a bout of graded treadmill exercise controlled for duration and intensity. Additionally, protein markers of oxidative stress, inflammation, and metabolic activity were assessed in the gastrocnemius muscle by Western blot. Results For experiment 1, stress exposure caused a shock number-dependent two to fourfold decrease in wheel running distance across the entire duration of the study. For experiment 2, stress exposure curbed an exercise-induced increase of dopamine (DA) turnover measures in the prefrontal cortex and hippocampus, and augmented serotonin (5HT) turnover in the hypothalamus and remaining cortical area. However, stress exposure also caused several monoaminergic changes independent of exercise that could underlie impaired motivation for physical activity, including a mild dopamine deficiency in the striatal area. Finally, stress potently increased HSP70 and lowered SOD2 protein concentrations in the gastrocnemius muscle, which may indicate prolonged oxidative stress. Discussion These data support some of the possible central and peripheral mechanisms by which exposure to adverse experiences may chronically impair physical activity engagement.
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Affiliation(s)
- Trevor J. Buhr
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
- Interdepartmental Neuroscience Program, Iowa State University, Ames, IA, United States
| | - Carter H. Reed
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Olivia M. Wee
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
| | - Ji Heun Lee
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Li-Lian Yuan
- Physiology and Pharmacology, Des Moines University, Des Moines, IA, United States
| | - Monika Fleshner
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, CO, United States
| | - Rudy J. Valentine
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Peter J. Clark
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
- Interdepartmental Neuroscience Program, Iowa State University, Ames, IA, United States
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Carrillo A, Huffman JC, Kim S, Massey CN, Legler SR, Celano CM. An Adaptive Text Message Intervention to Promote Well-Being and Health Behavior Adherence for Patients With Cardiovascular Disease: Intervention Design and Preliminary Results. J Acad Consult Liaison Psychiatry 2021; 62:617-624. [PMID: 34116259 PMCID: PMC8608707 DOI: 10.1016/j.jaclp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most individuals with heart disease struggle to adhere to cardiovascular health behaviors, despite their known health benefits. Text message interventions (TMIs) are a promising treatment modality for health behavior promotion, but existing TMIs typically deliver a fixed set of messages and do not target well-being constructs associated with adherence and cardiovascular health. OBJECTIVE To develop a 4-week TMI, which delivers daily messages to promote well-being and adherence to health behaviors and dynamically adapts based on participant feedback to deliver increasingly customized messages; and to assess its feasibility, acceptability, and preliminary efficacy in a single-arm, proof-of-concept trial in 14 individuals with coronary artery disease (age mean = 67.9, standard deviation = 8.7). METHODS Participants received daily text messages related to well-being, physical activity, or diet, rated each message's utility, and these ratings informed the TMI's choice of future text messages. Feasibility was assessed by the proportion of messages successfully sent, and acceptability was assessed by participant ratings of intervention burden and text message utility. Finally, the intervention's preliminary efficacy was explored by measuring pre-post changes in psychologic and behavioral outcomes. RESULTS The TMI was both feasible (93% of participants received all messages) and well-accepted (mean text message utility: 7.0 of 10 [standard deviation 2.5]; mean intervention utility: 6.4 of 10 [standard deviation 0.9]; mean intervention burden: 0.5 of 10 [standard deviation 0.9]). Participants reported that messages related to well-being were particularly helpful and that most messages led to an action (e.g., eating more vegetables, being kind to others). The TMI led to nonsignificant, small-to-medium effect size improvements in happiness, optimism, determination, depression, anxiety, self-rated health, and diet (d = 0.19-0.48), and, unexpectedly, small reductions in activity and physical function (d = -0.20 and -0.32). CONCLUSIONS The adaptive TMI was feasible, well-accepted, and associated with nonsignificant improvements in psychologic outcomes and mixed effects on behavioral outcomes. Larger, well-powered studies are needed to determine whether this TMI will be able to improve well-being and health-related outcomes in this high-risk population.
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Affiliation(s)
- Alba Carrillo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Sonia Kim
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Christina N Massey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Sean R Legler
- Department of Medicine, University of Minnesota, Rochester, MN
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
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Celano CM, Beale EE, Freedman ME, Mastromauro CA, Feig EH, Park ER, Huffman JC. Positive psychological constructs and health behavior adherence in heart failure: A qualitative research study. Nurs Health Sci 2020; 22:620-628. [PMID: 32125066 DOI: 10.1111/nhs.12704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022]
Abstract
Psychological well-being may play an important role in health behavior adherence and cardiovascular health, but there has been limited study of well-being in patients with heart failure. In this descriptive qualitative research study, we interviewed 30 patients with heart failure to explore their psychological experiences with heart failure and the perceived associations between positive psychological constructs and adherence to physical activity, diet, and medication recommendations. Interviews were transcribed, then coded in NVivo using directed and conventional content analysis, and the Consolidated Criteria for Reporting Qualitative Research checklist was applied to report our findings. Participants spontaneously reported positive psychological constructs both during an acute phase of illness and 3 months later. Participants most commonly experienced gratitude, acceptance, connectedness, and faith in the setting of heart failure. In contrast, pride, determination, and hope were identified most frequently as playing a role in health behavior adherence. Finally, participants reported a reinforcing relationship between positive constructs and health behavior engagement. These findings suggest that interventions to boost positive constructs have the potential to improve well-being and health behavior adherence in patients with heart failure.
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Affiliation(s)
- Christopher M Celano
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eleanor E Beale
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Melanie E Freedman
- Department of Psychology, Northwestern University, Chicago, Illinois, USA
| | - Carol A Mastromauro
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily H Feig
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeff C Huffman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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