Overall, Paper I-IV showed that components, such as multidisciplinary teamwork, with focus on lifestyle rather than the disease, combining individual and group education, and using tools to increase compliance seem to have a positive outcome for the structure of the program.
The result of Paper III emerged in three different categories: How to know? – based on the individual and group sessions, and tools that strengthen self-care, Staff who know how? – Illuminates the meeting between health-care professional and participant, and the importance of competent health care professionals, and Why feedback is essential? – highlighting the views on, and effect of, the feedback between the participant and the health professional.
“How to know”-This category highlighted the participants’ experiences and views on the structured program, and health-related tools being used to strengthen self-care and improve their ability to change unhealthy lifestyle habits. The individual sessions were described as valuable, and a person-centred approach in which the health professional treated a person with an unhealthy lifestyle rather than a patient with a disease, was considered important; one participant said, “…to feel seen is important”. Participants also highlighted the importance of being included in the decision process regarding treatment goals. The participants saw the
Figure 13. Correlations between change in
program as a way of confirming what they already knew and needed to be updated on. One participant compared it to an everyday activity:
“Even if you have had a driving license for 30 years it does not mean that you would pass the theory part of the driving test, if you know what I mean.”
The participants experienced the group sessions as very positive, giving useful information and practical advice about, “What to change and how”. That the sessions were held at a cardiology unit increased their credibility according to the participants, as did the staff’s knowledge and experience in risk management and risk prevention. The health-related tools that were offered during the individual and group sessions were positively received. Participants liked the idea of having a book and an internet program for repetition between the visits. They also thought that the pedometer was a good reminder about daily physical activity. Some suggested improvements that could be made to the pedometer. It was deemed important that it should be easy to handle and access.
“Staff who know how”– the meeting with, and the importance of, competent health professionals
In this category, the participants described the importance of the health care professionals being competent and respectful. The participants expected a health care professional to be able to give individual, evidence-based advice about a healthy lifestyle. Lifestyle counselling should be based on current guidelines and transformed into practical advice. They also pointed out the importance of shared decision-making with the health professional in order to realise a personalized plan for changing their unhealthy lifestyle habits. One participant said: “She was very thorough in finding out about what I would be able to do and my current situation“
The message should be positive and be respectful. Participants also pointed out the importance of multidisciplinary team work, with all health professionals involved meeting the participant face to face; one said:
“…just to be able to put a face to the person writing the letter I received”.
One participant said that health professionals with a genuine interest in a healthy lifestyle, as well as carrying out research, are perceived as more enthusiastic and proactive due to their personal interested in the topic.
“Why feedback is essential” – the participants’ views on and effect of feedback.
In this category, the participants found value in repeated feedback about their progress. To receive data on the lifestyle changes, such as waist circumference and body-composition measurements from each visit, was appreciated, and almost all the participants found this
encouraging. They found feedback important; “like a prescription for lifestyle change”.
One participant saw feedback as “an eye opener” in the behaviour change process. The participants wanted individual feedback to be given continuously and preferably in writing. They expected the tone of the feedback to be positive, with concrete advice about how to make changes - smart choices in everyday life, described by one participant as:
“It was presented nicely and there were all the results and a little reminder about certain things I should be aware of, and pay attention to, and it felt good”
It was also important that information, both verbal and written, should be based on a person- centred approach and individualized. A few of the participants thought the time between the visits was too long and suggested an extra phone call or e-mail between the visits to increase motivation and compliance.
DISCUSSION
Cardiovascular disease is the leading cause of morbidity and all-cause mortality in the world, often caused by unhealthy lifestyle habits or lifestyle-related risk factors. Guidelines in prevention and treatment of CVD highlight the importance of preventive cardiology programs, with focus on lifestyle changes, in clinical practice. However, scientific evaluations of changing unhealthy lifestyle habits, CV risk factor management and participants’ experiences of these programs are limited.
The present thesis is an evaluation of a structured lifestyle program for individuals with high CV risk. It focusses on describing the program, participants’ experiences of the program, changes in unhealthy lifestyle habits, quality of life, CV risk over one year and associations of the effects with educational level and socioeconomic areas.