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Kärner Köhler, A., Nilsson, S., Jaarsma, T. & Tingström, P. (2017). Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model. Scandinavian Journal of Caring Sciences, 31(2), 332-341
Open this publication in new window or tab >>Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model
2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 2, p. 332-341Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Spousal concordance on risk factors and lifestyle habits exists and can partly be explained by patients' and spouses' health beliefs and underuse of cardiac rehabilitation. However, there have been very few qualitative comparisons of health beliefs between patients and spouses after a cardiac event.

AIM:

To examine and qualitatively compare the health beliefs of patients with coronary heart disease and their spouses about lifestyle habits, 1 year after the cardiac event.

DESIGN:

Explorative and descriptive.

METHOD:

Semi-structured focus group interviews were conducted with patients (n = 14) 1 year after a cardiac event, as well as individual interviews with spouses (n = 8). The transcriptions underwent a deductive qualitative content analysis, within the framework of the Health Belief Model.

FINDINGS:

Patients' and spouses' health beliefs about lifestyle habits qualitatively differed in most predetermined main analytical categories of the Health Belief Model. The patients relied more on their own capacity and the healthcare system than on collaboration with their spouses who instead emphasised the importance of mutual activities to establish lifestyle habits. The spouses therefore experienced problems with different family preferences compared to the patients' wishes. Moreover, only patients believed supervised exercise was beneficial for risk reduction of coronary heart disease and they related barriers for medication to a self-healing body and a meaningless life without relatives and old habits. Patients and spouses agreed that despite the severity of illness, life was captured and that normalisation to a life as usual was possible.

CONCLUSION:

The patients' and spouses' qualitatively different health beliefs regarding health-related behaviours imply a new approach. Nurses and associated professionals need to follow-up patients' and spouses' in primary health care to support them in a tailored way, for example in problem-based sessions. Recognition and understanding of their different views and otherness could lead to compromises and goals to work with.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Coronary Heart Disease, Primary Care, Health Psychology, Qualitative content analysis.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-130771 (URN)10.1111/scs.12351 (DOI)000404644100014 ()27439667 (PubMedID)
Projects
The COR-PRIM study
Funder
Region Östergötland, Lio-433801
Note

Funding agencies: Swedish Heart and Lung Association [E103/13, E090/14]; Region Ostergotland, Sweden [LIO-433801]

Available from: 2016-08-23 Created: 2016-08-23 Last updated: 2019-06-27
Lundgren, J. G., Dahlström, Ö., Andersson, G., Jaarsma, T., Kärner Köhler, A. & Johansson, P. (2016). The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial.. Journal of Medical Internet Research, 18(8), 1-13, Article ID e194.
Open this publication in new window or tab >>The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial.
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2016 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 18, no 8, p. 1-13, article id e194Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Depressive symptoms, and the associated coexistence of symptoms of anxiety and decreased quality of life (QoL), are common in patients with heart failure (HF). However, treatment strategies for depressive symptoms in patients with HF still remain to be established. Internet-based cognitive behavioral therapy (ICBT), as guided self-help CBT programs, has shown good effects in the treatment of depression. Until now, ICBT has not been evaluated in patients with HF with depressive symptoms.

OBJECTIVE: The aims of this study were to (1) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF; (2) investigate the effect of the ICBT program on cardiac anxiety and QoL; and (3) assess factors associated with the change in depressive symptoms.

METHODS: Fifty participants were randomized into 2 treatment arms: ICBT or a Web-based moderated discussion forum (DF). The Patient Health Questionnaire-9 was used to measure depressive symptoms, the Cardiac Anxiety Questionnaire (CAQ) was used to measure cardiac-related anxiety, and the Minnesota Living with Heart Failure questionnaire was used to measure QoL. Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean.

RESULTS: No significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients.

CONCLUSIONS: Guided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected.

CLINICALTRIAL: Clinicaltrials.gov NCT01681771; https://clinicaltrials.gov/ct2/show/NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN).

Keywords
Internet; Internet-based cognitive behavioral therapy; cognitive behavioral therapy; depression; eHealth; heart failure
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-130548 (URN)10.2196/jmir.5556 (DOI)000382314400001 ()27489077 (PubMedID)
Note

Funding agencies: Swedish Heart and Lung Association [E087/13, E08/14]; Medical Research Council of Southeast Sweden [FORSS-374721, FORSS-470121]; Region Ostergotland [LIO-355611, LIO-374831, LIO-443711, LIO-470271]

Available from: 2016-08-15 Created: 2016-08-15 Last updated: 2019-06-27Bibliographically approved
Lundgren, J., Dahlström, Ö., Andersson, G., Jaarsma, T., Kärner Köhler, A. & Johansson, P. (2016). The effect of guided web-based cognitive behavioral therapy on patients with depressive symptoms and heart failure-: A randomized controlled trial.. In: : . Paper presented at 18:e Svenska Kardiovaskulära vårmötet, Göteborg, 27-29 april 2016. , Article ID Poster 123.
Open this publication in new window or tab >>The effect of guided web-based cognitive behavioral therapy on patients with depressive symptoms and heart failure-: A randomized controlled trial.
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2016 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: The aims of this study were to: (I) evaluate the effect of a nine-week guided Internet-based Cognitive Behavioral Therapy (ICBT) program on depressive symptoms (DS) in patients with HF; (II) to assess factors associated with the change in DS; and (III) to investigate the effect of the ICBT program on cardiac anxiety and QoL.

Methods: Fifty participants were included and randomized into two treatment arms: ICBT or an online moderated discussion forum (DF). Data were collected at baseline and at the nine-week follow-up; the Patient Health Questionnaire- nine, (DS); the Cardiac Anxiety Questionnaire, (cardiac-related anxiety); the Minnesota Living with Heart Failure questionnaire, (QoL). Intention to treat analysis was used. Between group differences were determined by analysis of covariance.

Results: In the ICBT-group (n=25), DS improved significantly (P=.02). Also cardiac anxiety in the subscale of fear decreased significantly (P=.04) between baseline and the follow up in the ICBT-group. QoL improved in the ICBT-group by 6 points in the total score and 2.4 points in the physical factor, but this was not significant (P=.09 and P=.12). In the DF-group (n=25) no significant change in the level of DS was found (P=.36). There were no significant differences in the change in DS between the DF- and the ICBT-group (P=.21), nor in cardiac related anxiety (P=.22) or in QoL (total score P=.09, physical factor P=.07). In the ICBT-group, the number of logins to the web-portal correlated significantly with improvement in DS (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in DS.

Conclusions: Guided ICBT adapted for persons with HF and DS can potentially reduce DS, cardiac anxiety and increase QoL, but is not statistically superior to participation in an online DF.

Keywords
heart failure, depressive symptoms, internet based cognitive behavioural therapy, eHealth, telehealth
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-130819 (URN)
External cooperation:
Conference
18:e Svenska Kardiovaskulära vårmötet, Göteborg, 27-29 april 2016
Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2019-06-27Bibliographically approved
Lundgren, J., Andersson, G., Dahlström, Ö., Jaarsma, T., Kärner Köhler, A. & Johansson, P. (2015). Internet-based cognitive behavior therapy for patients with heart failure and depressive symptoms: A proof of concept study. Patient Education and Counseling, 98(8), 935-942
Open this publication in new window or tab >>Internet-based cognitive behavior therapy for patients with heart failure and depressive symptoms: A proof of concept study
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2015 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 98, no 8, p. 935-942Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was (1) to describe the development of a guided internet-based CBT (ICBT) program adapted to patients with heart failure (HF) and (2) to evaluate the feasibility of the ICBT program in regard to depressive symptoms, the time used by health care providers to give feedback, and participants perceptions of the ICBT program. Method: A multi-professional team developed the program and seven HF patients with depressive symptoms were recruited to the study. The Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Asberg Depression Rating-Self-rating scale (MADRS-S) were used to measure depression, and patients were interviewed about their perceptions of the program. Results: Based on research in HF and CBT, a nine-week program was developed. The median depression score decreased from baseline to the end of the study (PHQ-9: 11-8.5; MADRS-S: 25.5-16.5) and none of the depression scores worsened. Feedback from health care providers required approximately 3 h per patient. Facilitating perceptions.(e.g. freedom of time) and demanding perceptions (e.g. part of the program demanded a lot of work) were described by the patients. Conclusion: The program appears feasible and time-efficient. However, the program needs to be evaluated in a larger randomized study.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Internet; Cognitive behavior therapy; Heart failure; Depression
National Category
Sociology Basic Medicine
Identifiers
urn:nbn:se:liu:diva-120266 (URN)10.1016/j.pec.2015.04.013 (DOI)000357246000003 ()25990216 (PubMedID)
Available from: 2015-07-24 Created: 2015-07-24 Last updated: 2019-06-27
Grönlund, V., Rudenas, A., Appel, M., Ednarsson, T., Nilsson, S., Tingström, P., . . . Kärner Köhler, A. (2014). Problem-based learning after Coronary artery disease - how do patients experience it?. In: : . Paper presented at EuroHeartCare 2014, 4-5 April 2014, Stavanger, Norway. Sage Publications
Open this publication in new window or tab >>Problem-based learning after Coronary artery disease - how do patients experience it?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
Place, publisher, year, edition, pages
Sage Publications, 2014
Series
European Journal of Cardiovascular Nursing, ISSN 1474-5151 ; 2014:13, Suppl.1
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107998 (URN)10.1177/1474515114521363 (DOI)
Conference
EuroHeartCare 2014, 4-5 April 2014, Stavanger, Norway
Note

The DOI links to a summary of all Moderated Posters. Se page S41 in PDF file for the publication (P 103).

Available from: 2014-06-25 Created: 2014-06-24 Last updated: 2019-06-27Bibliographically approved
Hjelmfors, L., Abrandt Dahlgren, M., Kärner, A. & Tingström, P. (2014). Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles. Studies in Continuing Education, 36(2), 218-232
Open this publication in new window or tab >>Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles
2014 (English)In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 36, no 2, p. 218-232Article in journal (Refereed) Published
Abstract [en]

Several studies show that how patients have difficulties in changing lifestyle even though such changes are essential because they are suffering from a life-threatening disease. Coronary artery disease (CAD) patients met 13 times during a year and used problem-based learning (PBL) to improve their empowerment and self-efficacy in making lifestyle changes. District nurses functioned as tutors, helping patients to formulate issues and to state self-care goals. To identify and describe the enactment of PBL, an ethnographic approach was used, including, for example, participant observations and interviews, all derived from six sessions of the education programme. Five different enactments were found, metaphorically expressed as: ‘The study circle’, ‘The classroom’, ‘The expert consultation’, ‘The therapy session’ and ‘The coffee party’. The education programme did not always function as it was supposed to according to the model, but perhaps this should not be seen as a failure of the pedagogical intervention since these enactments as a whole seem to be a way for the patients to be able to make healthy lifestyle changes. The metaphors can broaden the understanding of what can happen when implementing problem-based learning in health care practice.

Place, publisher, year, edition, pages
Routledge, 2014
Keywords
problem-based learning, patient education, ethnography, lifestyle change, empowerment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107493 (URN)10.1080/0158037X.2014.904779 (DOI)000337964500008 ()
Projects
COR-PRIM
Available from: 2014-06-13 Created: 2014-06-13 Last updated: 2017-12-05Bibliographically approved
Jaarsma, T., Strömberg, A., Franzén Årestedt, K., Broström, A., Kärner, A., Mårtensson, J., . . . Thompson, D. R. (2013). A good manuscript review for the European Journal of Cardiovascular Nursing. European Journal of Cardiovascular Nursing, 12(2), 102-103
Open this publication in new window or tab >>A good manuscript review for the European Journal of Cardiovascular Nursing
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2013 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 102-103Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Sage Publications, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-93261 (URN)10.1177/1474515113476605 (DOI)000317855800001 ()23463617 (PubMedID)
Available from: 2013-05-28 Created: 2013-05-28 Last updated: 2019-06-27Bibliographically approved
Grönlund, V., Carlsson, A., Tingström, P., Nilsson, S., Jaarsma, T. & Kärner, A. (2013). The desire for a good life - patients beliefs of self-care after a coronary event. In: : . Paper presented at EuroHeartCare 2013, 22-23 March 2013, Glasgow, United Kingdom. Sage Publications
Open this publication in new window or tab >>The desire for a good life - patients beliefs of self-care after a coronary event
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2013 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

     

Introduction: After a first coronary event there is an increased risk for a recurrent event. Despite that risk, 1/5 of the patients continue to smoke, 1/3 is obese and more than half of the patients have elevated blood pressure and total cholesterol. Secondary preventive self-care activities are needed to improve outcomes and the belief of patients plays a vital role in changing behavior.                         

Aim: To examine patients’ beliefs of self-care 6-12 months after a coronary event.                         

Method: The study design was qualitative. Twenty-five patients, including 10 women, mean age 65 years with stable coronary artery disease participated in four focus group interviews. Data were taped, transcribed and analyzed according to the conventional content analysis.                         

Findings: Patients’ belief of self-care is influenced by their desire of a good life even though life seems fragile. Patients try to live up to the standard of health care prescription and advices. However, these achievements require behavior change and conscious boundaries, which are challenged by various obstacles such as fear of, overstrain and stress. Physical activity is considered as both a source to well-being and a necessity, but patients are uncertain and afraid for overstraining. A healthy diet is seen as important but the advices given are sometimes contradictory and create confusion. Medication is found important but not at the cost of all the side-effects. Patients also report that in order to believe in their ability and to be responsible for self-care, support from health care providers is expected. But at the same time the invaluable support and information is often not provided, creating uncertainty.                         

Discussion: The study highlights the patients’ perspective of self-care and what they view as important in self-care after an event of coronary artery disease. The patients’ expectations on health services comprise information, support and continuous follow-up. This is necessary to facilitate the patient’s responsibility for their own care.                         

Conclusion: Patients’ beliefs about the concept of self-care after an event of coronary artery disease are multifaceted and voluminous compared to the health care definition. The findings of the study challenge health care policies approach to self-care. There is a need to reconsider and assess what and how secondary preventive patient education should be performed after an event of coronary artery disease.  

                    

Place, publisher, year, edition, pages
Sage Publications, 2013
Series
European Journal of Cardiovascular Nursing, ISSN 1474-5151 ; 2013:12, Suppl 1
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107992 (URN)10.1177/1474515113477019 (DOI)
Conference
EuroHeartCare 2013, 22-23 March 2013, Glasgow, United Kingdom
Note

The DOI links to a summary of all oral sessions. Se page S37 in PDF file for the publication (P 98).

Available from: 2014-06-25 Created: 2014-06-24 Last updated: 2019-06-27Bibliographically approved
Ranheim, A., Kärner, A. & Berterö, C. (2012). Caring Theory and Practice - Entering a Simultaneous Concept Analysis. Nursing Forum, 47(2), 78-90
Open this publication in new window or tab >>Caring Theory and Practice - Entering a Simultaneous Concept Analysis
2012 (English)In: Nursing Forum, ISSN 0029-6473, Vol. 47, no 2, p. 78-90Article in journal (Refereed) Published
Abstract [en]

PROBLEM.  To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the caring theory of Watson with the empirical findings from the three studies performed to reveal nurses' caring intentions and their lived experience of reflecting caring theory in practice.

METHOD.  Through a simultaneous concept analysis of nine concepts, caring science theory was consolidated with the findings of the three empirical studies to reveal the dynamics of caring theory and caring practice.

FINDINGS AND CONCLUSION.  These nine concepts were found to be interrelated with the advanced concept of mediating care, which emphasizes that mediating care calls for an authenticity of being and ability—an ability to be present to self and others in the dynamism of openness and frames of thought.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
Caring;concept analysis;theory and practice
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-78736 (URN)10.1111/j.1744-6198.2012.00263.x (DOI)
Available from: 2012-06-19 Created: 2012-06-19 Last updated: 2016-12-12Bibliographically approved
Kärner, A., Nilsson, S., Jaarsma, T., Andersson, A., Wiréhn, A.-B., Wodlin, P., . . . Tingström, P. (2012). The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study. BMC Family Practice, 13(110)
Open this publication in new window or tab >>The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study
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2012 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, no 110Article in journal (Refereed) Published
Abstract [en]

Background

Even though there is convincing evidence that self-care, such as regular exercise         and/or stopping smoking, alters the outcomes after an event of coronary heart disease         (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention         programmes are structurally and pedagogically applied using adult learning principles         e.g. problem-based learning (PBL). Until now, most education programs for patients         with CHD have not been based on such principles. The basic aim is to discover whether         PBL provided in primary health care (PHC) has long-term effects on empowerment and         self-care after an event of CHD.     

Methods/Design

A randomised controlled study is planned for patients with CHD. The primary outcome         is empowerment to reach self-care goals. Data collection will be performed at baseline         at hospital and after one, three and five years in PHC using quantitative and qualitative         methodologies involving questionnaires, medical assessments, interviews, diaries and         observations. Randomisation of 165 patients will take place when they are stable in         their cardiac condition and have optimised cardiac medication that has not substantially         changed during the last month. All patients will receive conventional care from their         general practitioner and other care providers. The intervention consists of a patient         education program in PHC by trained district nurses (tutors) who will apply PBL to         groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients         in the control group will not attend a PBL group but will receive home-sent patient         information on 11 occasions during the year.     

Discussion

We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy         and empowerment to achieve self-care goals significantly more than one year of standardised         home-sent patient information. The assumption is that PBL will reduce cardiovascular         events in the long-term and will also be cost-effective compared to controls. Further,         the knowledge obtained from this study may contribute to improving patients’ ability         to handle self-care, and furthermore, may reduce the number of patients having subsequent         CHD events in Sweden.

Place, publisher, year, edition, pages
BioMed Central, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86741 (URN)10.1186/1471-2296-13-110 (DOI)000312733600001 ()
Projects
COR-PRIM study
Available from: 2013-01-14 Created: 2013-01-02 Last updated: 2019-06-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2646-8715

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