The Combined Effect of Psychological and Relational Aspects on Cardiac Patient Activation
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The Combined Effect of Psychological and Relational Aspects on Cardiac Patient Activation Giada Rapelli1,2,3 · Silvia Donato1,2 · Anna Bertoni1,2 · Chiara Spatola1,3 · Ariela F. Pagani1,2 · Miriam Parise1,2 · Gianluca Castelnuovo1,3
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract The literature assumes that activating patients in the treatment is associated with positive health-related outcomes, such as clinical indicators in the normal range, high medication adherence, and low emergency department utilization. In the cardiac population, patient activation, that is the patient’s knowledge, skills, confidence, and behaviors needed for managing one’s own health and health care, has been less investigated. In addition, limited attention has been given to the role of the partner as an informal caregiver. However, the patient in the care process is rarely alone, and the partner may play a key role in this process. The goal of this dyadic study (N = 100 heterosexual couples with one partner suffering from an acute cardiac event) is to analyze how individual factors (patients’ anxiety, depression, medication adherence, pessimistic perception of illness) and the couple’s relationship functioning (e.g., different kinds of partner support and dyadic coping) are associated with patient activation. The results showed that patient activation is not a mere question of age. It is positively related to medication adherence and to the partner’s support patient activation. It is negatively correlated with the patient’s psychological distress, pessimistic perception of illness, and to the partner’s hostility. The need for a dyadic approach to both research and intervention with this population is discussed. Keywords Cardiac illness · Couple relationship · Partner support · Distress · Dyadic coping · Patient activation
Introduction A cardiac illness may be an interruption in daily life, because sometimes it imposes significant changes in people’s lives. In order to prevent the high risk of recurrence after an acute coronary event, the patients are required to take life-saving medications, follow and be adherent to the clinician’s prescriptions, get regular check-ups, assume healthy dietary attitudes, and conduct physical exercise. Despite the importance of these recommendations, non-adherence tends to be high in the cardiac population, because the changes in health * Giada Rapelli [email protected] 1
Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Largo Gemelli, 1, 20123 Milan, Italy
2
Family Studies and Research University Centre, Università Cattolica del Sacro Cuore - Milano, Largo Gemelli, 1, 20123 Milan, Italy
3
Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
behaviors that are required are demanding and could complicate the patient’s psychological situation (DiMatteo, 2004; Molloy, Perkins-Porras, Strike, & Steptoe, 2008). An important role in the patient’s health care process is played by patient activation, that
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