“It’s up to me”: the experience of patients at high risk of cardiovascular disease of lifestyle change

Lönnberg, Lena; Damberg, Mattias; Revenäs, Åsa

doi:10.1080/02813432.2020.1794414

Cited by 18 publications

(14 citation statements)

References 30 publications

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“…Patients who dropped out of the lifestyle programme could have had different experiences or viewpoints from those interviewed for this study. The rationale for this is that this study is a part of an evaluation of the one-year lifestyle programme [16,17,21], and we therefore chose to interview patients who attended all five counselling sessions. Second, the interviews took place three years after the patients participated in the programme, which may have imposed a recall bias, although the elapsed time may have provided a better perspective on the lifestyle programme.…”

Section: Discussionmentioning

confidence: 99%

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Lifestyle counselling – a long-term commitment based on partnership

2022

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Background Lifestyle habits are important factors in the development of non-communicable diseases. Different ways of providing counselling in primary care to promote healthier lifestyle habits have been launched and evaluated in recent years. It is important to provide an insight into what makes lifestyle counselling useful for patients and healthcare providers. Objective The overall aim of this study was to explore patients´ and community health nurses´(CHNs) experiences of lifestyle counselling in primary care to support healthier lifestyle habits. Methods Patients and CHNs were interviewed, face to face. Sixteen patients (eight men, eight women, aged 51–75 years) diagnosed with hypertension or type 2 diabetes mellitus and three CHNs participated. Data material was analysed with qualitative content analysis to explore the participants experiences of lifestyle counselling. Results The theme demonstrates that lifestyle counselling is a long-term commitment based on partnership between patients and CHNs. Five categories describe this partnership: respect and mutual interest, understanding of illness, measurements and goal setting, long-term support, and a structure to support counselling within the primary care unit. Conclusion The results from this study are consistent with and add to previous understanding of how lifestyle counselling can be performed successfully in the context of primary health care. The results emphasize that lifestyle counselling should encompass a partnership based on mutual respect, recognition of the patient as the expert on his/her current life situation, and the need for both parties to engage in the process of lifestyle change. Practice implications A structured lifestyle program with five counselling sessions within primary care was experienced as helpful for enhanced lifestyle habits and considered to be feasible by both patients and CHNs.

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Section: Discussionmentioning

confidence: 99%

“…Nine patients had hypertension, six patients had T2DM, and one patient had impaired glucose tolerance. A more detailed description has been presented earlier [21].…”

Section: Participants and Recruitmentmentioning

confidence: 99%

Lifestyle counselling – a long-term commitment based on partnership

2022

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“…Increased stroke risk in acute phases of pre-eclampsia is well known and is a risk factor for later stroke [ 31 ]. The need of careful and long-term follow-up regarding all risk factors have been pointed out in a recent review [ 8 ], as well as of primary care preventive actions.…”

Section: Discussionmentioning

confidence: 99%

Forty-four-year longitudinal study of stroke incidence and risk factors – the Prospective Population Study of Women in Gothenburg

Blomstrand

Hakeberg

et al. 2022

Scandinavian Journal of Primary Health Care

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Objective To assess stroke incidence over 44 years and association with risk factors. To study total stroke incidence at 60–82 years of age and risk factors. Design Prospective population study. Setting Gothenburg, Sweden, with ∼450,000 inhabitants. Subjects A representative sample of a general population of women (1462 in total) in 5 age strata aged 38–60 years in 1968–1969 (the Population Study of Women in Gothenburg, PSWG) were followed up to the ages of 82–104 years in 2012. Further, analysis was also performed for the age interval 60–82 years. Main outcome measures Incidence of total stroke (TS), ischaemic (IS), haemorrhagic (HS), non-specified (NS) and fatal (FS) strokes and association with baseline classic risk factors (such as hypertension, atrial fibrillation, low physical activity, diabetes, high waist-hip-ratio, hyperlipidaemia, smoking), low education, mental stress, pre-eclampsia and oral health as expressed by loss of teeth and bone score. Blood pressure in levels 1–3 according to modern guidelines. Associations with atrial fibrillation, diabetes and myocardial infarction shown in survival analyses. The five cohorts contributed to risk time data concerning associations with TS in the 60–82 age interval from the examination performed when they were 60. Results Three hundred and thirty-seven (23%) women had a first-ever stroke, 64 (19%) fatal. TS was associated with physical inactivity, high triglycerides and low education in multivariable analysis. The main sub-type IS was associated with systolic blood pressure, physical inactivity and low education. Pre-eclampsia showed association with IS only in the univariable analysis. FS was associated with systolic blood pressure and smoking. During 60–82 years of age, having <20 teeth (HR 1.74, CI 1.25–2.42), diabetes (HR 2.28 CI 1.09–4.76), WHR (HR 1.29 per 0.1 units CI 1.01–1.63), systolic blood pressure (HR 1.11 per 10 units CI 1.04–1.18) and smoking (HR 1.57, CI 1.14–2.16), were associated with TS in the combined five cohorts. Conclusions Several classic risk factors showed independent associations with stroke. Vulnerability factors as low education and oral health, reflected by loss of teeth, also showed association with stroke. All these factors are possible to target in primary care preventive interventions. Key Points Stroke is a common disease and the risk of stroke is a key issue demanding preventive strategies in primary health care. The present prospective population study of women shows Out of 1460 women, almost a quarter got a stroke. The stroke incidence 60–82 years of age was rather stable between the first four age cohorts but somewhat lower in the latest cohort, born 1930. Hypertension, low physical activity, low education and high triglyceride levels but not...

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“…This finding is in line with another study using coronary calcium scoring to demonstrate subclinical atherosclerosis [ 16 ]. When patients with a high risk of CVD were interviewed about their experience of lifestyle change after participating in a lifestyle program, increased knowledge was an important factor for change [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Increased knowledge makes a difference! – general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial

Bengtsson

Lindvall

Norberg

et al. 2021

Scandinavian Journal of Primary Health Care

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Objectives To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors. Design, setting and subjects Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis. Results Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result – A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action. Conclusion and implications Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures. Trial registration https://clinicaltrials.gov/ct2/show/NCT01849575 . KEY POINTS Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention: •Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measures •GPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-making •GPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis

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“It’s up to me”: the experience of patients at high risk of cardiovascular disease of lifestyle change

Cited by 18 publications

References 30 publications

Lifestyle counselling – a long-term commitment based on partnership

Lifestyle counselling – a long-term commitment based on partnership

Forty-four-year longitudinal study of stroke incidence and risk factors – the Prospective Population Study of Women in Gothenburg

Increased knowledge makes a difference! – general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial

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