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A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change
Jenni Murray
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Cheryl Leanne Craigs
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Kate Mary Hill
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Stephanie Honey
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Allan House
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Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds
,
Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ
,
UK
Background: Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes. Methods: A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework. Results: 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes. Conclusion: There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support.
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Background
Many developed countries are witnessing increasing
rates of diabetes and cardiovascular diseases. Evidence to
support adoption of healthy lifestyles in the prevention
and management of these and other long-term
conditions is strong [1-3]. As an approach to managing
cardiovascular disease risk, promotion of healthy lifestyles
is arguably the preferred first line option over
medication, which although effective in reducing cardiovascular
risk [4], frequently has side-effects [5] and offers benefits
only with continued adherence. A number of countries,
including the UK, [6] now offer cardiovascular health
checks through systematic screening programmes based
in primary care. A variety of modalities exist but
commonly they offer individuals a chance to modify their
lifestyle behaviours and so invest in their future health.
Despite its importance, many individuals fail to engage
in activities designed to help them to achieve a healthy
lifestyle. For example, only around one third of patients
experiencing a cardiac event take up cardiac
rehabilitation [7] and up to one quarter of participants in
commercial weight management programmes drop out [8].
The individual factors that can dissuade individuals from
achieving lifestyle change are multiple and inter-related
but broadly cluster as social, psychological and practical
barriers. Compounded by the physically addictive nature
of some behaviours, lifestyle change is challenging,
requiring support and personal determination. The
potential myriad of personal barriers to lifestyle change
presented to health care providers during consultations
are challenging to address [9]. Lack of skills and
knowledge combined with short consultation times [10,11]
have the potential to generate generic responses that fail
to meet individual needs. So, how can health care
services develop a more skilled and focused approach to
lifestyle behaviour change for individuals at high risk of
cardiovascular events?
One option is to systematically target individually
perceived key barriers to healthy lifestyles. Interventions
specifically aimed at increasing initiation of lifestyle
change [12-14] or uptake of associated programmes
[15,16], tend to address patient perceived barriers as
they arise in consultation and the concept of barrier
removal has been applied naively as a component of a
more complex approach. None have specifically
developed a barriers-based framework as the core of the
intervention. An alternative approach would be to use
knowledge of barriers and facilitators to tailor care
pathways such that existing resources were more closely
matched to individual need. Such an (...truncated)