Motivational communication skills to improve motivation and adherence in cardiovascular disease prevention: A narrative review.

Lifestyle optimization is one of the most essential components of cardiovascular disease prevention. Motivational counseling provided by health care professionals could promote lifestyle modification. The purpose of the review is to identify possible evidence-based psychological principles that may be applicable to motivational counseling in the prevention of cardiovascular disease. These motivational communication skills promote behavioral change, improved motivation and adherence to cardiovascular disease prevention. A personal collection of the relevant publications. The review identified and summarized the previous evidence of implementation intentions, mental contrasting, placebo effect and nocebo effects and identity-based regulations in behavior change interventions and proposed their potential application in cardiovascular disease prevention. However, it is challenging to provide real support in sustainable CVD-risk reduction and encourage patients to implement lifestyle changes, while avoiding being unnecessarily judgmental, disrespectful of autonomy, or engaging patients in burdensome efforts that have little or no effect on the long run. Motivational communication skills have a great potential for effectuating sustainable lifestyle changes that reduce CVD-related risks, but it is also surrounded by ethical issues that should be appropriately addressed in practice. It is key to realize that motivational communication is nothing like an algorithm that is likely to bring about sustainable lifestyle change, but a battery of interventions that requires specific expertise and long term joint efforts of patients and their team of caregivers.

Psychometric properties of the Flemish version of the MacNew heart disease health-related quality of life questionnaire.

BACKGROUND: Assessment of health-related quality of life, increasingly being used as an outcome measure in cardiovascular disease research studies and clinical practice, requires questionnaires with sound psychometric properties. The aim of this study was to evaluate the psychometric properties of the Flemish version of the MacNew Heart Disease Health-related Quality of Life questionnaire in Flemish-speaking Belgian patients. METHOD: Between 2002 and 2008, as part of the international HeartQol Project, 344 Belgian patients with a diagnosis of angina, ischaemic heart failure or myocardial infarction completed the Flemish versions of the MacNew, the Short-Form 36 and the Hospital Anxiety and Depression Scale. Ceiling and floor effects of the MacNew were analysed. Internal consistency was assessed by Cronbach's a and reproducibility (intra-class correlation coefficients) was assessed in a subsample of patients over a 2-3 week period with repeated tests. Convergent validity (Pearson's correlation between MacNew and Short-Form 36 constructs) and discriminant validity ('known-group' approach) were tested. RESULTS: The Flemish version of the MacNew appears to be a reliable instrument with a high internal consistency, demonstrating strong discriminative validity and satisfactory construct validity. The results of factor analysis are similar to the factor structure of the original MacNew explaining 59.8% of the total variance. CONCLUSION: The Flemish version of the MacNew demonstrates good psychometric properties. It can be recommended as a specific instrument for assessing and evaluating health-related quality of life in Flemish-speaking patients in each of the three major ischaemic heart disease diagnoses: angina, ischaemic heart failure and myocardial infarction. However, responsiveness to change could not be tested in this cross-sectional study and should be further investigated in a larger sample of patients following an intervention likely to induce a change in health-related quality of life.

Comparison of two motion sensors for use in cardiac telerehabilitation.

We compared the activity estimated by a pedometer and an accelerometer in coronary artery disease patients included in a phase III cardiac rehabilitation programme. Nine patients were divided into two groups and wore the pedometer for four weeks, and then subsequently the accelerometer for four weeks, or vice versa. The recorded daily exercise level (total daily steps and calories burned) was measured for each patient and compared with oxygen uptake and ventilatory threshold measured by ergospirometry at the end of the study. There was a significant correlation between the calories measured by the accelerometer and the ventilatory threshold (i.e. the sub-maximal capacity), r = 0.75 (P = 0.05). There was a significant correlation between the measured steps on the accelerometer and the ventilatory threshold, r = 0.72 (P = 0.07). There were no significant correlations for the pedometer. A questionnaire concerning ease of use of the sensors indicated that the cardiac patients favoured the pedometer.