Effectiveness of a tailored communication intervention to improve physical activity in hypertensive patients: a twelve-month randomized controlled trial.

BACKGROUND: Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally. Arterial hypertension is one of the main cardiovascular risk factors. Despite this, individuals with hypertension often fail to follow medical advice to counteract cardiovascular risks. A physically active lifestyle is one of the most challenging behaviors to adopt. This study aimed to preliminarily investigate the effectiveness of a tailored print message intervention to increase physical activity in patients with arterial hypertension. METHODS: A sample of 188 patients with hypertension (mean age = 63 years; SD = 10.9; 50% men) participated in a theory-based tailored health communication intervention. Participants were randomly assigned to three parallel groups: (1) the tailored group, which received tailored health brochures; (2) the non-tailored group, which received non-tailored health brochures; or (3) the usual care group, which received no informative print materials. The longitudinal physical activity trajectories (baseline, 6- and 12-month follow-ups) were examined using repeated measures ANOVA and growth curve models. RESULTS: At the baseline, 38.8% of patients achieved the target physical activity. This percentage rose to 43.0% at 6-month follow-up and 46.0% at 12-month follow-up. The descriptive statistics divided in function of the experimental group suggested differences in the longitudinal trend of the mean physical activity depending on the experimental group. However, statistical significance using repeated measures ANOVA did not support this observation. The analysis of the growth curves suggested that the tailored group showed a progressive increase in physical activity over twelve months (the model that best described the longitudinal trajectory was a linear growth model). The non-tailored group showed an increase in physical activity six months after the beginning of the intervention, followed by a decrease (free time score model). The usual care group did not change over time (no-growth model). CONCLUSIONS: Findings suggest the effectiveness of the tailored intervention proposed. However, further investigations and empirical confirmations are required. TRIAL REGISTRATION: ISRCTN13415993 ( https://doi.org/10.1186/ISRCTN13415993 ). Registration date: 08/04/2019.

The TTCYB Study Protocol: A Tailored Print Message Intervention to Improve Cardiovascular Patients' Lifestyles.

This article describes the development of the "Time to Change Your Behavior" (TTCYB) study protocol, a theory-based, tailored print message intervention to improve compliance with the self-care regimen in patients with cardiovascular diseases. A design with a baseline measurement and two follow-ups at six and 12 months will be applied. At baseline and the six-month follow-up, patients will complete self-report questionnaires evaluating lifestyle habits and socio-demographic and psychological variables; at the 12-month follow-up, patients will answer a telephone interview assessing lifestyle habits. After the baseline measurement, patients will be randomized into one of three groups: (1) the tailored group, which will receive tailored health brochures; (2) the "non-tailored" group, which will receive non-tailored health brochures; or (3) the usual care group, which will receive no print information materials. The effectiveness of the intervention will be assessed through patients' judgments of the brochures and changes in lifestyle. The role of socio-demographic and psychological variables as potential moderators of the materials' effectiveness will be explored. If the TTCYB is efficacious, it will have implications for the design and implementation of tailored communication programs. Concepts from this study can be potentially extended to primary prevention among high-risk groups.

What hypertensive patients want to know [and from whom] about their disease: a two-year longitudinal study.

BACKGROUND: This study explored both the evolution of the information needs and the perceived relevance of different health information sources in patients with essential hypertension. It also investigated the relationships between information needs and the perceived relevance of information sources with socio-demographic and clinical variables. METHODS: Two hundred and two patients with essential arterial hypertension were enrolled in the study and evaluated at baseline and during three follow-ups at 6, 12 and 24 months after baseline. Patients had a mean age of 54.3 years [range 21-78; SD = 10.4], and 43% were women. Repeated measures ANOVA, Bonferroni post hoc tests, and Cochran's Q Test were performed to test differences in variables of interest over time. RESULTS: It was observed a significant reduction in all the domains of information needs related to disease management except for pharmacological treatment and risks and complications. At baseline, patients reported receiving health information primarily from specialists, general practitioners, relatives, and television, but the use of these sources decreased over time, even if the decrease was significant only for relatives. Multiple patterns of relationships were found between information needs and the perceived relevance of sources of information and socio-demographics and clinical variables, both at baseline and over time. CONCLUSIONS: The findings showed a general decrease in both the desire for information and the perceived relevance of different information sources. Hypertensive patients appeared to show little interest in health communication topics as their disease progressed. Understanding patients' information needs and the perceived relevance of different information sources is the first step in implementing tailored communication strategies that can promote patients' self-management skills and optimal clinical outcomes.

A longitudinal inquiry into directionality of effects between coping and information needs in hypertensive patients.

PURPOSE: It is well recognized that effective health communication is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. However, there is limited knowledge about the variables on which to tailor health messages. This study examined whether coping strategies were related to information needs over time in a sample of patients with hypertension. PATIENTS AND METHODS: A three-wave longitudinal design was used to examine the potential reciprocal relationships among variables. The sample included 271 patients (43.5% women) affected by essential arterial hypertension with a mean age of 54.66 years (SD =10.74 years; range 30-78 years). Data on patients' demographic characteristics, coping strategies, and information needs were collected three times over 12 months. To test the directionality of the relationships linking coping to information needs, cross-lagged path analyses were applied in a structural equation modeling approach. RESULTS: Active coping was related to a greater need for information regarding behavioral habits; avoidance coping was negatively associated with the need for information regarding daily life activities, while passive coping showed a positive relationship with this need. Moreover, results sustained the hypothesis that the relationship between coping and information needs was bi-directional. In fact, greater need for information about the disease and its pharmacological treatment was related to greater adoption of active coping strategies. The need for information about risk and complications was associated with the coping strategy related to alcohol use. CONCLUSION: These results provide important suggestions for implementing more effective intervention programs aimed at fostering patients' self-care abilities. As it was possible to modify coping strategies, health care providers may consider measuring patients' strategies before the medical examination so they have time to refine the information they give to patients.

A longitudinal study on the information needs and preferences of patients after an acute coronary syndrome.

BACKGROUND: Research has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome. METHODS: Two hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35-75; SD = 7.98). Patients' needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran's Q Test were performed to test differences in variables of interest over time. RESULTS: Results showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time. CONCLUSION: The present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients' information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care.

Basic needs, stress and the effects of tailored health communication in vulnerable populations.

This study examined whether unmet basic needs (food, housing, personal and neighborhood safety, money for necessities) and perceived stress affect recall of and response to a tailored print intervention one month later. Participants (N = 372) were adults who had called 2-1-1 Missouri between June 2010 and June 2012. A series of path analyses using Mplus were conducted to explore the relationships among basic needs, perceived stress, number of health referrals received in a tailored intervention, recalling the intervention and contacting a health referral. Participants were mainly women (85%) and African-American (59%) with a mean age of 42.2 years (SD = 13.3; range 19-86); 41% had annual household income <$10 000. Unmet basic needs were positively associated with increased levels of perceived stress, which, in turn, were negatively associated with recalling the intervention and calling any of the health referrals provided. Tailored printed interventions may be less effective in populations with acute unmet basic needs. More broadly, the effectiveness of minimal contact behavioral interventions might be enhanced by simultaneous efforts to address unmet basic needs.

Cardiovascular Management Self-efficacy: Psychometric Properties of a New Scale and Its Usefulness in a Rehabilitation Context.

BACKGROUND: Self-efficacy beliefs have been shown to affect various effective health-promoting behaviors in patients. Unfortunately, availability of reliable and valid measures of self-efficacy in cardiovascular diseases (CVDs) is still very limited. PURPOSE: The aims of this study were to present a new scale measuring self-efficacy beliefs in managing CVD and to examine its psychometric properties. METHODS: The study involved 172 patients (mean age = 66.4 years; SD = 9.99 years; 76.2% men) undergoing cardiovascular rehabilitation. Various psychological factors and CVD severity indicators were collected. RESULTS: An Exploratory Structural Equation Model showed that the Cardiovascular Management Self-efficacy Scale has three factors: Cardiac Risk Factors, Adherence to Therapy, and Recognition of Symptoms. They all showed high internal consistency, and good convergent, discriminant, and predictive validity. Furthermore, these factors showed significant relations with CVD severity indicators. CONCLUSIONS: The Cardiovascular Management Self-efficacy Scale could be a helpful instrument to monitor differences during interventions to improve good disease management.

The Situational Version of the Brief COPE: Dimensionality and Relationships With Goal-Related Variables.

This study is aimed at investigating the dimensionality of the situational version of the Brief COPE, a questionnaire that is frequently used to assess a broad range of coping responses to specific difficulties, by comparing five different factor models highlighted in previous studies. It also aimed at exploring the relationships among coping responses, personal goal commitment and progress. The study involved 606 adults (male = 289) ranging in age from 19 to 71. Using confirmatory factor analysis, we compared five models and assessed relationships of coping responses with goal commitment and progress. The results confirmed the theoretical factor structure of the situational Brief COPE. All the 14 dimensions showed acceptable reliability and relationships with goal commitment and progress, attesting the reliability and usefulness of this measure to evaluate coping responses to specific events.

Smoking behavior: a cross-sectional study to assess the dimensionality of the brief Wisconsin inventory of smoking dependence motives and identify different typologies among young daily smokers.

INTRODUCTION: The present study aims to investigate the dimensionality of the brief version of the Wisconsin Inventory of Smoking Dependence Motives (B-WISDM) and identify different smoking motivational profiles among young daily smokers (N = 375). METHODS: We tested 3 measurement models of the B-WISDM using confirmatory factor analysis, whereas cluster analysis was used to identify the smokers' motivational profiles. Furthermore, we compared clusters toward dependence level and the number of cigarettes smoked per day using analysis of variance tests. RESULTS: The results confirmed that the B-WISDM measures 11 first-order intercorrelated factors. The second-order model, originally proposed for the longer version of the questionnaire, showed adequate fit indices but fitted the data significantly worse than the first-order model. Five motivational clusters were identified and differed in terms of tobacco addiction and the number of cigarettes smoked per day. Although each cluster had specific features, 2 main smoker groups were distinguished: Group A (composed of 3 clusters), which was mainly characterized by high levels of secondary dependence motives, and Group B (composed of 2 clusters), in which the primary and secondary dependence motives reached similar levels. In general, the clusters of Group B were more addicted to cigarettes than Group A clusters. CONCLUSIONS: Using the B-WISDM to identify different smoking motivational profiles has important practical implications because they might help characterize addiction, which represents the first step to help an individual quit smoking.