Illness beliefs shape prevention program adherence

By Joene Hendry

NEW YORK (Reuters Health) - Individual beliefs about heart disease, including its symptoms, controllability, likely duration, and consequences influence adherence to secondary prevention regimens designed to reduce risk, researchers report.

"We need to be sure patients understand how potentially serious heart disease can be," Dr. Lesley Stafford, at the University of Melbourne in Australia, told Reuters Health.

Stafford and colleagues found that patients generally understand that genetics, aging, stress, diet, and smoking all contribute to heart disease, they report in the journal Psychosomatic Medicine.

However, their findings also revealed that a person's need to be socially accepted was "the most important determinant of their reported adherence to a treatment regimen," Stafford said.

The researchers collected illness belief questionnaires and self-reports of adherence to secondary prevention regimens from 193 patients (64 years old on average, 81 percent male) hospitalized for heart attack, coronary artery bypass surgery, or surgical unclogging of coronary arteries.

Most of the patients (66 percent) cited heredity as a major contributor to their heart disease. As noted, most also listed aging (64 percent), stress (58 percent), and diet (55 percent) as contributing to heart disease, while 33 percent mentioned smoking as causal.

Patients who smoked, drank to excess, had a history of depression, or a family history of heart disease appeared more likely to recognize these factors as contributory. Importantly, patients who perceived more severe consequences were more likely to adhere to secondary prevention regimens.

Still, Stafford noted, "people portray themselves in a way that is thought to be socially approved." This may lead to their underreporting of adherence to prevention regimens.

Taken together, and if confirmed in larger groups of men and women of various ages, these findings indicate that interventions to modify and correct faulty beliefs might be useful aspects of secondary prevention regimens.

SOURCE: Psychosomatic Medicine, October 2008