Objective: Health behaviors (e.g., physical inactivity, poor diet) are associated with poor prognosis and mortality in cardiac patients. Changing these behaviors is challenging and only a minority of patients succeeds in this endeavor. Studies show that behavioral flexibility (defined as responding less habitually to stimuli and having a large behavioral repertoire) is a potentially important facilitator of health behaviors. The current study examines the association between behavioral flexibility and health behaviors (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management) in patients with cardiac disease. Method: A total of 387 patients with stable cardiac disease were recruited as part of the Do Cardiac Health: Advanced New Generation Ecosystem Trials. Behavioral flexibility (via the Do Something Different Questionnaire) was assessed at baseline and health behaviors including the above described six domains (HPLP-II at baseline, at 3 months, and at 6 months. Linear mixed models were used to answer the research question. Results: The sample consisted of predominantly male patients (n = 274/71%) with a mean age of 62 (SD = 10), diagnosed with hypertension (n = 198/51%), coronary artery disease (n = 114/30%), and/or heart failure (n = 75/19%). The analyses revealed a positive but small (r = .106–.270, B = .00–.31) association between behavioral flexibility and all self-reported health behaviors over time. Conclusions: This is the first study to examine the association between behavioral flexibility and health behaviors in cardiac patients. Current results showed a positive association between behavioral flexibility and health behaviors over time. More research is needed to further examine causal effects of behavioral flexibility on health behaviors.

No abstract

Background Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients’ medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR. Objective This scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients’ health and health care services. Methods We searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query. Results Of the 182 eligible papers, 37 (20%) provided sufficient information about patients’ data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients’ passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction. Conclusions The findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.

Enhancing lifestyle change in cardiac patients through the do change system ("Do cardiac health: Advanced new generation ecosystem"): Randomized controlled trial protocol. JMIR Research Protocols, 7(2), [e40].

BACKGROUND Promoting a healthy lifestyle (eg, physical activity, healthy diet) is crucial for the primary and secondary prevention of cardiac disease in order to decrease disease burden and mortality. OBJECTIVE The current trial aims to evaluate the effectiveness of the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) service, which is developed to assist cardiac patients in adopting a healthy lifestyle and improving their quality of life. METHODS Cardiac patients (ie, people who have been diagnosed with heart failure, coronary artery disease, and/or hypertension) will be recruited at three pilot sites (Badalona Serveis Assistencials, Badalona, Spain [N=75]; Buddhist Tzu Chi Dalin General Hospital, Dalin, Taiwan [N=100] and Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands [N=75]). Patients will be assisted by the Do Something Different (DSD) program to change their unhealthy habits and/or lifestyle. DSD has been developed to increase behavioral flexibility and subsequently adopt new (healthier) habits. In addition, patients’ progress will be monitored with a number of (newly developed) devices (eg, Fitbit, Beddit, COOKiT, FLUiT), which will be integrated in one application. RESULTS The Do CHANGE trial will provide us with new insights regarding the effectiveness of the proposed intervention in different cultural settings. In addition, it will give insight into what works for whom and why. CONCLUSIONS The Do CHANGE service integrates new technologies into a behavior change intervention in order to change the unhealthy lifestyles of cardiac patients. The program is expected to facilitate long-term, sustainable behavioral change. CLINICALTRIAL Clinicaltrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305 (Archived by WebCite at http://www.webcitation.org/6wfWHvuyU).