Predictors of health and health behaviours in people with heart related health problems

An extensive amount of research has been conducted on mortality and morbidity in patients who have experienced an acute cardiac event. The literature includes findings regarding predictors of attendance and adherence to Cardiac Rehabilitation (CR) Programmes and factors which are related to the development of Coronary Heart Disease (CHD). This literature discusses the factors that predict health behaviours and perceptions of general health; socio-demographic variables, depression, social support and coping. Specifically, lower socioeconomic status is related to higher levels of stress hormones, greater likelihood of smoking, less likelihood of eating breakfast, and less diverse social networks. Depression and CHD appear to be independent risk factors for the development of each other. Being in an intimate relationship is associated with less mortality after an acute cardiac event, while active coping styles are associated with positive well-being at later time points after heart attack. Despite the extensive research in this area, the mechanisms underlying the relationships between these factors remain unclear. Also, a large amount of variance in health and health behaviour accounted for by psycho-social and demographic variables overlap. Hence little is known about the unique variance accounted for by these factors. Coronary heart disease (CHD) is the leading cause of death in Australia. An extensive body of research has been conducted into factors related to positive health outcomes and health behaviour in people with CHD. This research indicates that psycho-social and demographic factors play an important role in determining adjustment in patients after an acute cardiac event, but also in the development of CHD. Despite the extensive research on this topic, many questions remain regarding the underlying mechanisms behind the relationships between psychosocial and demographic variables and general health and health behaviour. The present study aims to build on the understanding of these relationships. Specifically, the study looks at the unique variance in patients' perceived overall general health and health behaviour accounted for by education, depression, Body Mass Index (BMI) social support and coping. The participants were 57 people who had either been diagnosed with CHD or had been advised to make changes to their lifestyle for their heart health because of high risk for developing CHD. They were recruited through the UTAS School of Psychology on-line study web page, a General Practitioner, and an allied-health professional at the Royal Hobart Hospital. Participants completed a one-off assessment booklet either on-line or via a mail out survey. Three separate hierarchical multiple regressions were employed to investigate the aims of the study. The first used level of educational attainment, depression, social support (satisfaction and size of social network) and coping effort to predict unique variance in perceived overall general health. The second used BMI, social support (satisfaction and size of social network) and coping to predict unique variance in intention to exercise. The third regression used social support (satisfaction and size of social network) and coping effort to predict unique variance in intention to eat a healthy diet. Consistent with the hypotheses, higher levels of educational attainment predicted better overall perceived general health. Also as predicted, lower levels of depression were related to high levels of perceived overall general health. Contrary to predictions, social support (satisfaction and size of social network) and coping effort were not found to be related to health. The hypothesis that a greater BMI would be predict lower intention to exercise was supported, as was the hypothesis that a larger social network would be associated with intention to exercise. Satisfaction with social support and coping effort were not found to be related to intention to exercise. The hypothesis that a larger social network would be associated with a greater intention to eat a healthy diet was supported by the findings, however, satisfaction with social support and coping effort were not found to be related to intention to eat a healthy diet. It was concluded that depression and level of educational attainment are of great importance when considering factors associated with positive general health outcomes in people with CHD and heart health concerns. This has implications for health care professionals, with regards to primary and secondary prevention of CHD in people with low levels of educational attainment and also the importance of screening for depression in people after a diagnosis of CHD.