A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change

BMC Cardiovascular Disorders, Dec 2012

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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A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change

Jenni Murray 0 Cheryl Leanne Craigs 0 Kate Mary Hill 0 Stephanie Honey 0 Allan House 0 0 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. - 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)


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Jenni Murray, Cheryl Craigs, Kate Hill, Stephanie Honey, Allan House. A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change, BMC Cardiovascular Disorders, 2012, pp. 120, 12, DOI: 10.1186/1471-2261-12-120