Patients' understanding of heart disease : relationships with decisions to seek help with acute symptoms, and with adherence to treatment
Pre-hospital delay in seeking help for acute chest pain in patients with coronary heart disease is a major impediment to prompt thrombolysis. Failure to adhere to medication, attend cardiac rehabilitation where appropriate, and change lifestyle, all impair secondary prevention. This thesis examined psychological factors related to these problems, and the psychological models of illness held by patients diagnosed with acute coronary syndromes (ACS). Two main issues were investigated firstly, what factors were associated with shorter pre-hospital delays following symptom onset and secondly, whether cognitive models of illness predicted adherence to advice, psychological and emotional adjustment, and quality of life at 3 months and 13 months post-discharge. Data were collected from 269 patients diagnosed with ACS within five days of hospital admission. Analyses were focussed on the total time between symptom onset and admission to hospital (pre-hospital delay). This interval was divided into two phases time between symptom onset and decision to call for medical help (patient decision time), and time from call for help to admission (home to hospital delay). Patients were followed up 3 and 13 months later. Adherence to medical advice (lifestyle changes, adherence to medication, attendance at cardiac rehabilitation programmes), psychological distress and quality of life were measured by telephone interview and questionnaire. A number of sociodemographic, social, clinical and psychological factors were associated with pre-hospital delay. Beliefs about the causes of heart disease made an important contribution. Cognitive representations of heart disease measured during hospital admission did not predict adherence to treatment regimens after discharge, but significantly predicted later psychological and emotional adjustment, and quality of life. Theses findings have implications for understanding the contribution of psychological factors to the experience of acute heart disease, and point to methods of more effective patient care and management.