G. Lindsay, J. Branney / International Journal of Cardiology 82 (2002) 115 – 116
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Editorial Comment
Strategies to improve advice and relaxation for patients with acute myocardial infarction: some theoretical considerations G. Lindsay*, J. Branney Nursing & Midwifery School, University of Glasgow, 59 – 61 Oakfield Avenue, Glasgow, Scotland G12 8 LW, UK Received 29 October 2001; accepted 21 November 2001
In the paper reported in the accompanying paper Lewin et al. [1], investigated the benefits of music relaxation tapes alone compared to the addition of tape-recorded standard advice tapes in addressing cardiac misconceptions, promoting positive lifestyle and rehabilitation behaviours and reducing anxiety. They found that there was a significant reduction in cardiac misconceptions in the advice and relaxation tape group but no difference in a range of short term outcome between the two intervention groups in terms of anxiety about their myocardial infarction, confidence in a good recovery and perceived general health status. Interestingly, the number of times the tape was listened to was higher in the music tape group perhaps indicating a more enjoyable source of relaxation. Behavioural outcomes at 6 months showed no differences in smoking status, return to work, cardiac related re-admissions, ‘tried to loose weight’ and undertaking vigorous exercise at least once a week. There was a small difference in ‘tried to increase amount of exercise’ in the advice tape group. These results are important for practitioners to understand and help inform patients on the purpose of these resources. Although standardised advice tapes have much merit, which the authors acknowledge, including access for family members, comprehensive inclusion of issues and the facility for repeated listening, they also have two main disadvantages for use in this *Corresponding author. Tel.: 144-141-330-6876; fax: 144-141-3303539. E-mail address:
[email protected] (G. Lindsay).
context. Firstly the information is not individualised to specific needs and opportunities for questions / clarification are not directly available. Secondly, in terms of motivating behavioural change, principles drawn from the cycle of change theory [2] have been advocated to structure and focus patient counselling. Information and advice giving should be tailored to an individual’s readiness to make changes, which is categories into five stages namely pre-contemplative (only occasional thought given to change), contemplative (beginning to consider change), planning / action, consolidation / maintenance. Relapse may occur at any stage but particularly a risk at the consolidation stage. Individuals should be guided through the stages of change but to do this an understanding of what stage they are at is required. Any counselling process should be guided by the stage of change and interventions designed on the basis of this assessment – that is, those who are willing to make changes will be helped to do so and those who are resistant to change or pre-contemplative will be given general advice and information. Individuals who are receptive to making changes are encouraged to evaluate the positive and negative aspects of their lifestyle and through endorsement of the positive aspects supported in making changes to less healthy behaviours. Perhaps a range of information tapes designed to provide information suitable for these different stages of change would be one way of refining this intervention to be closer to the theoretical principles described for successful behavioural change.
0167-5273 / 02 / $ – see front matter 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S0167-5273( 01 )00619-2
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G. Lindsay, J. Branney / International Journal of Cardiology 82 (2002) 115 – 116
Several studies have now reported the benefits for secondary prevention measures in cardiac patients using stage of change model. In a randomised controlled study conducted in primary care of nearly 900 men and women with at one or more modifiable risk factors [3]. The intervention group used brief behavioural counselling on the basis of the stage of change model. This was implemented by appropriately trained practice nurses who aimed to reduce smoking and dietary fat intake and to increase physical activity. Favourable differences were recorded in dietary fat intake, the taking of regular exercise and the number of cigarettes smoked per day, although there was no difference in smoking cessation rates or body mass index. In another study use of behavioural interventions for patients awaiting CABG surgery were shown to improve coronary risk factors, anxiety and depression levels and general health and well-being [4]. As an afterthought, in view of reported cardiac misconceptions held by nurses [5] it may be of value
to evaluate the effectiveness of the tapes in addressing this problem not only for patients but nurses also.
References [1] Lewin RJP, Thompson DR, Elton RA. Trial of the effects of an advice and relaxation tape given within the first 24 h of admission to hospital with acute myocardial infarction. Int J Cardiol 2002;82:107–14. [2] Prochaska JO, Diclemente CC. The transtheoretical approach: crossing traditional foundations of change. Don Jones, Irwin, Homewood, IL, 1984. [3] Steptoe A, Doherty S, Rink E, Kerry S, Kendrick T, Hilton S. Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. BMJ 1999;319:943–8. [4] McHugh F, Lindsay GM, Hanlon P, Hutton I, Brown MR, Morrison C, Wheatley DJ. Nurse-led shared care for patients on the waiting list for CABG: a randomised controlled trial. Heart 2001;86:317–23. [5] Newens AJ, McColl, Lewin R, Bond S. Cardiac misconceptions and knowledge in nurses caring for myocardial infarction patients. Coronary Health Care 1997;1:83–9.