Examining the ``Matthew Effect'' on the motivation and ability to make lifestyle changes in 217 heart rehabilitation patients

Abstract

Aims: Those who are socioeconomically disadvantaged and people with emotional problems have a poorer prognosis for cardiovascular disease. The authors wanted to examine: (1) what effect household income, emotional status, high-risk smoking status, and severity of heart disease had on the ability of individuals to make dietary and exercise improvements after heart disease and (2) to what extent unfavourable lifestyle outcomes among disadvantaged people were mediated by motivational problems. Methods: A two-year follow-up study of the combined cohorts of a randomized controlled trial. Level of exercise and present dietary habits were measured at inclusion and after 6 and 24 months. Different motivational factors and emotional distress were measured during rehabilitation. Results: Autonomous self-regulation was lowest among smokers (b=-0.31, p=0.02) and female participants (b=0.39, p=0.004). Participants with high scores of emotional distress predicted lower motivation for all the measures. We found no association between socioeconomic status (household income) and the ability to perform lifestyle changes. Current smoking status predicted lower ability to obtain lifestyle changes on all measures. Emotional distress was related to lower ability to increase physical activity at 6 months' but not at 24 months' follow-up. The mediating effects of motivational factors were insignificant. Conclusions: The results of this study do not support the suspicion that preventive efforts accentuate the socioeconomic differences in cardiovascular health. Health-promotive efforts after heart disease should safeguard that high-risk groups such as smokers are not discouraged from improving their lifestyle in other areas.

Keywords

Cardiac rehabilitation coronary heart disease lifestyle motivation psychosocial factors

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References

Nilsson PM , Moller L. , Ostergren PO Social class and cardiovascular disease — an update. Scand J Soc Med 1995;23:3—8.

Hellenius ML , Nilsson P. , Elofsson S. , Johansson J. , Krakau I. Reduction of high cholesterol levels associated with younger age and longer education in a primary health care programme for cardiovascular prevention. Scand J Prim Health Care 2005;23:75—81.

Kiecolt-Glaser JK , McGuire L. , Robles TF , Glaser R. Emotions, morbidity, and mortality: New perspectives from psychoneuroimmunology. Annu Rev Psychol 2002;53: 83—107.

Becker MH The tyranny of health promotion. Public Health Rev 1986;14:15—23.

Hart JT Coronary heart disease prevention in primary care: Seven lessons from three decades. Fam Pract 1990;7:288— 94.

Hart JT The inverse care law. Lancet 1971;1:405—12.

Langham S. , Basnett I. , McCartney P. , Normand C. , Pickering J. , Sheers D. , et al. Addressing the inverse care law in cardiac services. J Public Health Med 2003;25:202—7.

Adams J. , White M.

Is the inverse care law no longer operating?

J Epidemiol Community Health 2004;58:802.

Joseph K. , KS. The Matthew effect in health development. Br Med J 1989;298:1497—8.

10.

Gabhainn SN , Kelleher CC , Naughton AM , Carter F. , Flanagan M. , McGrath MJ Socio-demographic variations in perspectives on cardiovascular disease and associated risk factors . Health Educ Res 1999;14:619—28.

11.

Schuster PM , Waldron J. Gender differences in cardiac rehabilitation patients. Rehabil Nurs 1991;16:248—53.

12.

Bandura A. Social foundations of thought and action: A social cognitive theory . Englewood Cliffs, NJ: Prentice-Hall ; 1986.

13.

Bandura A. Self-efficacy: The exercise of control. New York : Freeman; 1997.

14.

King TK , Marcus BH , Pinto BM , Emmons KM , Abrams DB Cognitive-behavioral mediators of changing multiple behaviors: Smoking and a sedentary lifestyle. Prev Med 1996;25:684—91.

15.

Deci EL , Ryan RM Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.

16.

Williams GC , Grow VM , Freedman ZR , Ryan RM , Deci EL Motivational predictors of weight loss and weight-loss maintenance. J Pers Soc Psychol 1996;70:115—26.

17.

Leganger A. , Kraft P. , Roysamb E. Perceived self-efficacy in health behaviour research: Conceptualisation, measurement and correlates . Psychol Health 2000;15:51—69.

18.

Ryan RM , Connell JP Perceived locus of causality and internalization: examining reasons for acting in two domains. J Pers Soc Psychol 1989;57:749—61.

19.

Havik OE , Maeland JG Patterns of emotional reactions after a myocardial infarction. J Psychosom Res 1990;34: 271—85.

20.

Meland E. , Maeland JG , Laerum E.

The importance of self-efficacy in cardiovascular risk factor change. Scand

J Public Health 1999;27:11—17.

21.

Jacobsen BK , Knutsen SF , Knutsen R. The Tromso Heart Study: Comparison of information from a short food frequency questionnaire with a dietary history survey. Scand J Soc Med 1987 ;15:41—7.

22.

Maere A. , Bjorndal A. , Holmen J. , Midthjell K. , Kjaersgaard P. [Physical activity habits among adults in Nord-Trondelag]. Tidsskr Nor Laegeforen 1991;111:3695—9.

23.

Naess O. , Claussen B. , Thelle DS , Smith GD Four indicators of socioeconomic position: Relative ranking across causes of death. Scand J Public Health 2005 ;33:215—21.

24.

Iversen A. , Anette Christine. Social differences in health behaviour: The motivational role of perceived control and coping. Anette Christine Iversen.

25.

Haukkala A. , Uutela A. , Vartiainen E. , McAlister A. , Knekt P. Depression and smoking cessation: The role of motivation and self-efficacy. Addict Behav 2000;25:311—16.

26.

Hitsman B. , Borrelli B. , McChargue DE , Spring B. , Niaura R. History of depression and smoking cessation outcome: A meta-analysis. J Consult Clin Psychol 2003;71:657—63.

27.

Boniface DR , Cottee MJ , Neal D. , Skinner A. Social and demographic factors predictive of change over seven years in CHD-related behaviours in men aged 18—49 years. Public Health 2001;115:246—52.

28.

Mulder M. , Ranchor A. , Sanderman R. , Bouma J. , van den Heuvel W. The stability of lifestyle behaviour. Int J Epidemiol 1998 ;27:199—207.

29.

Weinehall L. , Hellsten G. , Boman K. , Hallmans G. , Asplund K. , Wall S. Can a sustainable community intervention reduce the health gap?—10-year evaluation of a Swedish community intervention program for the prevention of cardiovascular disease. Scand J Public Health 2001; 56(Suppl):59—68.