Perspectives of older people engaging in nurse-led cardiovascular prevention programmes: a qualitative study in primary care in the Netherlands

Abstract

BackgroundCardiovascular prevention programmes are increasingly being offered to older people. To achieve the proposed benefits, adherence is crucial. Understanding the reasons for adherence and non-adherence can improve preventive care.AimTo gain insight into what motivates older people living in the community to partake in a cardiovascular prevention programme, and reasons for subsequent continuation or withdrawal.Design and settingQualitative study of current and former participants of the ongoing ≥6 year PreDIVA (prevention of dementia by intensive vascular care) trial in primary care practices in suburban areas in the Netherlands.MethodSemi-structured interviews were conducted with a purposive sample of 15 participants (aged 76–82 years). Interviews were audiorecorded and analysed by two independent researchers using a thematic approach. Participants were asked about their motivation for participating in the programme, along with the facilitators and barriers to continue doing so.ResultsResponders reported that regular check-ups offered a feeling of safety, control, or being looked after, and were an important motivator for participation. For successful continuation, a personal relationship with the nurse and a coaching approach were both essential; the lack of these, along with frequent changes of nursing staff, were considered to be barriers. Participants considered general preventive advice unnecessary or patronising, but practical support was appreciated.ConclusionTo successfully engage older people in long-term, preventive consultations, the approach of the healthcare provider is crucial. Key elements are to offer regular check-ups, use a coaching approach and to build a personal relationship with the patient.

Investigating Community Perspectives on Falls Prevention Information Seeking and Delivery: Older Person Perceptions Regarding Preferences for Falls Prevention Education Using a World Cafe Approach

“…Specifically, older adults felt supported and did not feel threatened in such an informal and welcoming space. This is in keeping with other similar research showing that talking down to older people creates a barrier to adopting healthier lifestyle practices (Ligthart et al, 2015;Ryan, Hummert, & Boich, 1995;Woolhead, Calnan, Dieppe, & Tadd, 2004).…”

“…Specifically, engaging older adults in an informal and welcoming manner to discuss ideas in a supportive and non-threatening manner is appealing to this age range. This is in keeping with other research around engaging older adults in health and lifestyle discussions whereby 'talking down' to older persons created a barrier to encouraging them to adopt healthier lifestyle practices (Ligthart et al, 2015;Ryan, Hummert, & Boich, 1995;Woolhead, Calnan, Dieppe, & Tadd, 2004).…”

Determinants of Dropout and Nonadherence in a Dementia Prevention Randomized Controlled Trial: The Prevention of Dementia by Intensive Vascular Care Trial

“…It may be the personal attention from the intervention nurse was responsible for these differential findings. Findings from qualitative research in preDIVA completers and dropouts that showed that the personal approach of the nurse was an important motivator to keep participating corroborated this . The greater risk of dropout in people with greater disability in the intervention group may indicate that even this low‐intensity intervention became too demanding for more physically impaired participants.…”

GPs’ perspectives on secondary cardiovascular prevention in older age: a focus group study in the Netherlands

“…26 Recently Ligthart et al reported that regular check-ups, a coaching approach, and a personal relationship with the patient facilitated engagement of older people in long-term preventive consultations. 27 Congruent with the present finding that quality of life is the ultimate aim of secondary cardiovascular preventive care in older age, Drewes and Frank also describe a shift in treatment goals in older patients away from prolonging life to controlling symptoms, or maximising function, and individualised patient-centred goal setting. 28,29 Implications for research and practice To facilitate implementation, the present authors recommend development of specific (attenuated) targets and specific charts showing benefits and risks for older people, and to incorporate these into current guidelines for secondary cardiovascular prevention.…”