Into the cognitive constructs related to adherence to treatment in CHD outpatients: the importance of accepting the disease limitations

Abstract

Background and aims: Poor adherence to clinical prescriptions has been recognized as a major problem in management of chronic diseases. Only few studies tried to identify which factors could be considered predictive of low adherence to pharmacological and non pharmacological prescriptions in Coronary Heart Disease (CHD) patients. The aims of our observational-longitudinal study were to assess in CHD outpatients admitted to a Cardiological Day Hospital (DH): self-reported knowledge and acceptance about illness, perceived self-efficacy in disease management and emotional status, and the possible relationships among these variables.Methods: Patients were assessed at baseline during the first days of DH and few days before discharge (follow-up) by the Adherence Schedule in Ischemic Heart Disease (ASI-HD) and by the Anxiety and Depression Scale (AD). The ASIHD is a tool specifically aimed at evaluating the cognitive, relational and behavioural antecedents of adherence to treatment of patients suffering CHD. The rehabilitation programme comprised: individualized physical training, nutrition monitoring, psychological assessment and psychoeducational interventions, when indicated. Baseline and follow-up clinical data, ASHID and AD scores were analysed both considering the whole sample (n=117) and the subgroup which met the clinical criteria for psychological counselling (n=35, psychologically treated group). Intracorrelation and intercorrelation coefficients of the whole sample baseline data were calculated among ASIHD, AD scores and socio-demographic data.Results: Our CHD outpatients (62.6±9.3 years) were mainly male, married and retired. They had 5,2 years of illness on the average, and only 9% of them were still smokers, whereas 62% had smoked in the past. Total and LDL cholesterol levels showed a significant reduction at follow up evaluation. Among ASIHD baseline item scores, many statistically significant intracorrelations emerged, in particular: disease limitations acceptance showed significant positive correlations with disease knowledge (r=.34, p=.0001), family/friend support (r=.27, p=.003), following dietary prescriptions (r=.38, p=.0001), exercise (r=.35, p=.0001), taking medicines punctually (r=.35, p=.0001), identifying physical/psychological fatigue (r=.45, p=.0001), monitoring clinical parameters (r=.42, p=.0001), management of stressful situations (r=.26, p=.006), and reducing stress sources (r=.34, p=.0001). Concerning the significant intercorrelations between AD and ASIHD scores, disease acceptance showed negative correlations with anxiety and depression (r=-.27, p=.004; r=-.26, p=.004 respectively).Conclusions: The pathway stemmed from our data enlights that in the area of cognitive and relational antecedents of adeherence, accepting the disease limitations can be considered a central issue in CHD patient's illness adjustment and prescriptions adherence. Moreover, the ASHID resulted a useful synthetic schedule of psychological/behavioural variables regarding perceived self-efficacy in disease manageme...

COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

“…The relations between DA, adaptation to behavioral limitations (DLA) and psychological, neuropsychological and functional (6MWT) factors point out the importance of intervening on subjective disease perception. 35 – 39 The higher the DA and adaptation, the lower the depression and anxiety and the better the levels of motor functionality and vice versa ( Figure 1 ).…”

Psychosocial and behavioral correlates of self-efficacy in treatment adherence in older patients with comorbid hypertension and type 2 diabetes

“…To date, research and clinical practice on adherence have principally focused on medication adherence-related behaviors ( Granata et al, 2020 ; Shiyanbola et al, 2018 ), more than behavioral, cognitive, social, and emotional antecedents related to treatment adherence ( Pierobon et al, 2016 , 2017; Xie et al, 2020 ; Zanatta et al, 2020 ). For this reason, the present research aimed to explore the interrelationship among specific psychosocial and behavioral factors and their simultaneous impact on self-efficacy associated with treatment adherence, in older patients suffering from comorbid hypertension and type 2 diabetes mellitus.…”

“…The administration of this schedule in the present study sample provided satisfactory reliability scores for each subscale (ASonA-A, α = .78; ASonA-SE, α = .74; ASonA-Aff, α = .68). The ASonA has already shown significant evidence in patients affected by chronic multimorbidity and hypertension ( Zanatta et al, 2020 ), and it belongs to a wider group of similar schedules used in prior works with patients affected by chronic obstructive pulmonary disease (COPD; Pierobon et al, 2017 ), coronary heart disease ( Pierobon et al, 2016 ), and chronic heart failure ( Granata et al, 2022 ). The Italian and Polish versions were administered and can be requested from the authors (for more information, see the English version provided as supplementary material).…”

Presentation of the Psycho-Cardiological Schedule and convergence levels analyses among the psycho-cardiological screening and the psychological assessment

“…Per gli aspetti psicologici dove la componente emotiva o cognitiva di elaborazione della malattia si fa più presente, pur rimanendo buoni i livelli di convergenza, aumentano i casi di falsi negativi ad evidenziare la necessità di una valutazione più specialistica per chiarire aspetti quali l'aderenza alle prescrizioni, la consapevolezza di malattia o maggiormente l'impatto di questa sull'assetto emotivo della persona [16][17][18][19]. I casi di falsi positivi trovati nei livelli di convergenza relativi ai disturbi neuropsicologici, per quanto in misura decisamente ridotta, ci permettono di affermare che la valutazione testistica specifica aiuta ad oggettivare e dettagliare o, come in questi casi, disconfermare la presenza di un problema che ecologicamente appariva evidente.…”