Abstract
Objective Despite knowledge of the effect of lifestyle changes in preventing cardiovascular disease, a large proportion of people have unhealthy lifestyle habits. The aim of our study is a) to explore the experiences of participants at high risk of CVD of lifestyle change after participation in a one-year structured lifestyle counselling programme and b) to link the techniques and strategies used by the participants to the processes of the transtheoretical model of behaviour change (TTM). Design A qualitative explorative design was used to collect data on participants’ experiences. An abductive content analysis was conducted using the processes within TTM for the deductive analysis. Setting Patients that participated in a one-year lifestyle counselling programme in Swedish primary care, were interviewed. Subjects Eight men and eight women, aged 51–75 years, diagnosed with hypertension or type 2 diabetes mellitus. Main outcome measures Experiences of lifestyle change in patients at high cardiovascular risk. Results The analysis yielded four dimensions that assisted lifestyle change: ‘The value of knowledge’, ‘Taking control’, ‘Gaining trust in oneself’ and ‘Living with a chronic condition’. The theme ‘It’s up to me’ illustrated that lifestyle change was a personal matter and responsibility. Conclusion Enhanced knowledge, self-efficacy, support from others and the individual’s insight that it was his/her own decisions and actions that mattered were core factors to adopt healthier lifestyle habits. Practice Implications: Although lifestyle change is a personal matter, the support provided by primary healthcare professionals and significant others is essential to increase self-efficacy and motivate lifestyle change. Key Points A large proportion of people persist to have unhealthy lifestyle habits also after receiving a diagnosis of hypertension or diabetes mellitus, type 2. This study contributes to enhanced knowledge of how patients experience lifestyle change after counselling in primary care. Both experiential and behavioural processes as defined by the transtheoretical model of behaviour change were used to make lifestyle changes by the patients in this study.
Highlights
There have been substantial improvements in cardiovascular disease (CVD) outcomes, non-communicable diseases—including ischemic heart disease, type 2 diabetes mellitus (T2DM), stroke and chronic obstructive pulmonary disease—still account for the majority of deaths and disability-adjusted life-years (DALYs) worldwide [1]
The aim of our study is a) to explore the experiences of participants at high risk of CVD of lifestyle change after participation in a one-year structured lifestyle counselling programme and b) to link the techniques and strategies used by the participants to the processes of change in the transtheoretical model of behaviour change (TTM)
Our results indicate that involvement of others in lifestyle changes can be both encouraging and aggravating when a person is living with a chronic condition
Summary
There have been substantial improvements in cardiovascular disease (CVD) outcomes, non-communicable diseases—including ischemic heart disease, type 2 diabetes mellitus (T2DM), stroke and chronic obstructive pulmonary disease—still account for the majority of deaths and disability-adjusted life-years (DALYs) worldwide [1]. Despite the guidelines and the knowledge of the effect of lifestyle changes in preventing future CVD through practices such as improved diet, increased physical activity (PA) and smoking cessation, a large proportion of individuals at high risk of CVD do not comply [5,6,7]. Scientific evaluations of lifestyle programmes in primary care are scarce, and structured lifestyle counselling is still not integrated into everyday clinical practice [4,8,9]. To improve the care of individuals at high risk of CVD, a structured lifestyle programme was launched at a primary care unit in V€asterås, Sweden. To improve the effectiveness of lifestyle interventions, it is important to investigate how patients with chronic illness manage lifestyle changes after diagnoses of conditions such as T2DM or hypertension, and thereby prevent future CVD
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