Self-management of coronary heart disease in angina patients after elective percutaneous coronary intervention:A mixed methods study
Introduction and aim:
An estimated 100,000 people in the United Kingdom have percutaneous coronary intervention (PCI) each year to help alleviate angina symptoms. Thereafter, they are expected to modify their coronary heart disease (CHD) risk factors, adhere to medication and effectively manage any recurring angina symptoms. The rate of ‘redo-revascularisation’ in PCI patients seems disproportionately high (75%) when compared to patients who have their angina symptoms managed with coronary artery bypass surgery (<20%). PCI patients’ self-management may be ineffective, however, existing research on this subject is limited by design (e.g. single methods of data collection), methodology (e.g. samples with patients of mixed diagnoses) and lack of theoretical underpinning. Few theories had been used to help explain self-management in a PCI patient group. Researchers have used Leventhal’s Self-Regulation Model to understand how people manage other chronic illnesses but not CHD after elective PCI. Bandura’s Social Cognitive Theory was found to be the basis of self-management but had not been used to explain PCI patients’ CHD self-management. Consequently these two theories were tested to determine their ability to explain self-management in this PCI patient group.
The research questions used for this study were: How do patients self-manage their CHD after they have undergone elective PCI? What factors influence patients’ self-management of CHD after elective PCI? To what extent do Bandura’s Social Cognitive Theory and Leventhal’s Self-Regulatory Model help explain self-management of CHD in patients after elective PCI?
Design and method:
This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected in Phase 1 by means of a self-administered survey and were subject to univariate and bivariate analysis. Path analysis was also used to identify factors that influenced CHD self-management. Phase 1 findings informed the purposive sampling for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualitative data were analysed using thematic analysis.
After PCI, 74% of participants managed their angina symptoms inappropriately and one in five stated that they would consider using emergency care services for any recurrence of angina symptoms. Few patients adopted a healthier lifestyle after PCI: 75% were physically inactive, 65% were obese, and 27% made no lifestyle changes at all. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. More educated, self-efficacious participants with fewer co-morbidities and less threatening perceptions of their illness had a greater likelihood of adopting healthier behaviours. Qualitative analysis revealed that intentional non-adherence to some medicines, particularly statins, was found to be an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management and seemed socially isolated. Others reported strong emotional responses to CHD such as fear, shock and disappointment. This had a detrimental effect on their self-management. Neither the Self-Regulation Model nor the Social Cognitive Theory fully explained CHD self-management after PCI. The emotional perceptions participants had of their CHD influenced their cognition and that affected how they coped with their condition. That finding did not align with the Self-Regulation Model. Aspects of the Social Cognitive Theory helped to explain participants’ likelihood of adopting more healthy behaviours but the other components of CHD self-management(manage angina symptoms and adhere to medication)were not explained using this theory.
This is the first study to report that patients experienced poor social and healthcare support after elective PCI. Patients had difficulty regulating strong emotions such as fear, shock and disappointment after PCI. This had a detrimental effect on their self-management and neither the Social Cognitive Theory nor the Self-Regulation Model could fully explain CHD self-management after elective PCI.
Recommendations for practice / research:
Patients after PCI wanted (and should be given) more support to help them manage their CHD yet few accessed or were able to access the traditional means of support: cardiac rehabilitation. Emotional support should be included in such programmes. This is in addition to providing more traditional interventions that focus on: practical support to assist patients in adopting and maintaining healthier behaviours, guidance on angina symptom management and the need for adherence to medication after PCI. Research could be conducted to investigate other means of supporting CHD patients after elective PCI. For example, the effectiveness of telehealth programmes in optimising CHD self-management. An intervention study could be conducted to determine which telehealth programmes are beneficial in optimising CHD self-management. A cohort study could also be considered to explore the effect telehealth has on PCI patients’ revascularisation rates, morbidity and mortality.
Dawkes, S. Self-management of coronary heart disease in angina patients after elective percutaneous coronary intervention:A mixed methods study. (Thesis). Edinburgh Napier University. Retrieved from http://researchrepository.napier.ac.uk/id/eprint/9172
|Deposit Date||Oct 19, 2015|
|Peer Reviewed||Not Peer Reviewed|
|Keywords||Coronary heart disease; self-management; angina; elective percutaneous coronary intervention;|
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