Classification(s): Behavior/Lifestyle Modification; Cardiac Rehabilitation
Introduction: Non-adherence (NA) to prescribed treatment regimens has been identified as a cause of morbidity and mortality in patients with heart disease. Demographic and psychosocial variables such as age, gender, self-efficacy, and health beliefs describe patient subgroups and are associated with adherence. However identification of these variables has not provided insight regarding the mechanisms of NA. This project was designed to identify the nature of NA.
Purpose: This study explored the lived experience of patients with heart failure as they attempt to adhere to a prescribed regimen of care.
Design: A qualitative study based on hermeneutic phenomenological method: the interpretive process by which individuals derive contextual meaning of phenomena in daily life.
Methods: Fourteen patients (mean age 59, 9 male, 65% married) attending an outpatient heart failure clinic after hospital readmission for exacerbation of heart failure participated in audio taped, structured interviews with the researcher. Transcription of the interviews provided data for phenomenological analysis and interpretation.
Results: Data analysis revealed adherence to be a continuous process of marshalling resources in a new direction in order to achieve an identified goal. For some, the new direction becomes the routine way of life. External and internal factors can interfere with new actions despite having formed strong intentions to adhere. External factors that influence adherence to the new behaviors include availability of resources, support from significant others and health care professionals, and unusual circumstances. The internal factors included personal beliefs/values and temptation. Temptation is manifested as either a mental struggle that overcomes intention or a lapse that "just happens" without the individual being aware of any mental struggle.
Conclusions: Temptation was identified as a strong factor in NA in this disease management patient cohort despite having formed an intention to adhere. Action Control Theory describes the mental processes that occur between the time an individual forms an intention to act and the actual performance or non-performance of that act. Three concepts that interfere with adherence are (1) preoccupation/disengagement: mental focus on previous failures that one wishes to avoid or usual pleasant conditions that one wishes to continue; (2) persistence/volatility: distracting thoughts that prevent/disrupt activities; (3) hesitation/initiative: mental processes that prevent the initiation of an activity. Further research incorporating interventions utilizing Action Control Theory which provides a theoretical basis for adherence improvement related to temptation are needed in heart disease management programs.