Background and Aims: Cardiovascular disease is the single greatest cause of death in Canada. Positive, healthy lifestyle change is the cornerstone of treatment. In the cardiac rehabilitation setting, a theoretical basis is often used to understand health behavior and develop interventions that promote uptake of positive lifestyle change. Despite advancements in the application of health behavior theories, long-term maintenance of healthy lifestyle change remains elusive for many individuals. The purpose of this study was to explore how the adult learning theory of transformative learning can inform health education and behavior change strategies.

Methods and Materials: Using a mixed methods approach, 13 individuals, who were one year post participation in a cardiac rehabilitation program, were recruited. Quantitative parameters were used to classify participants into 2 groups: those who had maintained healthy lifestyle change and those who had not. Qualitative semi-structured interviews, informed by the constructs of transformative learning theory, generated the data.

Results: Data analysis highlighted the main difference between both groups as being an engagement in trustful and collaborative reflective discourse. Participants who were able to maintain healthy changes described empowering interactions with both health care professionals and others that enabled them to clarify the meaning of their experience and enact positive and lasting changes. Participants who failed to maintain healthy lifestyle changes described anxious and disempowering interactions that impeded their ability to understand and engage in the management of their overall health.

Conclusion: Results from this study suggest that providing opportunities for reflective discourse within the cardiac rehabilitation setting would allow patients to develop new perspectives on healthy lifestyle change based on a truer understanding of their own health and self-management ability. Reflective discourse describes the process of engaging in interactive dialogue where ideas and questions can be exchanged in an environment considered respectful and safe by participants. This type of dialogue allows individuals to solve problems, deal with adversity, and maintain a sense of mastery and control over life. It is well documented to be a critical component of adult learning and even considered to be a key determinant of heath by the Public Health Agency of Canada. The results of this study highlight the need to create intervention strategies that include this vital component of adult learning.