The results of a Journal of Cardiovascular Nursing study suggest motivation is the key driver of adherence to secondary prevention measures among women who have coronary heart disease (CHD) and have undergone a percutaneous coronary intervention (PCI).
Outi Kahkonen, PhD, RN, et al.’s research included a study population of 416, but focused on a subset of 102 women with CHD and a recent history of PCI. The authors said that while CHD was historically viewed as a public health problem for men and ensuing research focused largely on male patients, the burden of CHD among women rose, eventually eclipsing that of men.
CHD now accounts for 49% of all deaths in women and 40% of all deaths in men in Europe, and that trend is only expected to continue as more older women live longer. And women face unique challenges when it comes to CHD—they present with the condition roughly a decade later than men and struggle with both conventional risk factors and sex-specific confounders like gestational diabetes and preeclampsia.
Kahkonen, a physician, teacher and postdoctoral researcher at the University of Oulu in Finland, and her team studied 416 patients’ responses to a cross-sectional, explanatory survey in an attempt to uncover what drives women to adhere to secondary prevention techniques after PCI. The researchers considered adherence not just to a medication regimen but also to a healthy lifestyle, basing their work on the Kyngas theory of people with chronic disease.
The original Kyngas model calls for 38 individual items to measure adherence to any given treatment, but the idea revolves around nine major variables: responsibility, motivation, cooperation, results of care, fear of complications, sense of normality and support from next of kin, nurses and physicians. Kahkonen et al. also considered individual factors like exercise, vegetable consumption, alcohol use and mental health in their calculations.
The mean standard deviation value of adherence to treatment among the women in the study was 87.2, which was lower than adherence among the whole sample (87.8) but didn’t represent a statistically significant difference. Of the female patients, 13.7% were smokers, 52.9% consumed more than two portions of alcohol per day, 14.7% engaged in half an hour of exercise at least three times a week and 19.8% consumed vegetables in their diet.
The authors said motivation was the strongest predictor of women’s perceived adherence to treatment, with informational support, physician support, perceived health and physical activity indirectly, but significantly, feeding that perception. Exercise was also positively linked to perceived health, while anxiety and depression were negatively associated with it.
“Our findings indicated that female patients perceived their adherence to treatment to be high,” Kahkonen and colleagues wrote. “However, there was a conflict between respondents’ perceived adherence to treatment and the health behaviors they reported. Therefore, it is of paramount importance to focus on the issues that are known to contribute to women’s adherence to treatment, rather than informational support or knowledge only.”
The authors wrote that insufficient informational support as a form of counseling is a “major reason” for patients’ reduced understanding of the risk factors and seriousness of CHD, leading to reduced motivation for self-care. They suggested nurses be trained in motivational interviewing, which they can tailor to support individual patients.
“Secondary prevention programs and patient education have to take into account individual or unique differences,” Kahkonen and co-authors said. “It is important to pay attention to issues that are known to contribute to motivation rather than to rely on education alone to improve adherence.”