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Identifying the health and mental health information needs of people with coronary heart disease, with and without depression

Ciaran Pier, Kerrie A Shandley, Julie L Fisher, Frada Burstein, Mark R Nelson and Leon Piterman
Med J Aust 2008; 188 (12): S142. || doi: 10.5694/j.1326-5377.2008.tb01879.x
Published online: 16 June 2008

Abstract

Objective: To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression.

Design and setting: A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients.

Participants: 14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing).

Results: Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect.

Conclusion: This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.

Heart and vascular diseases remain a leading cause of death and disability in Australia, contributing to about 38% of all deaths in 2002.1 In people with established coronary heart disease (CHD), the absolute risk of subsequent adverse cardiovascular events is exceptionally high. There is a continuous relationship between risk factor levels and risk of further illness,2 indicating that reducing modifiable risk factors through secondary prevention is imperative.

While CHD on its own causes significant impairment, comorbid depression seriously impedes prognosis and increases the risk of death.3,4 Clinical depression and non-clinical depressive symptoms are also strongly associated with reduced quality of life and increased physical limitation and symptom burden.5,6 The prevalence of depression in patients with established CHD is disproportionately high.6 One study found 45% of patients had major depression within 10 days after myocardial infarction, with no remission 4 months later for 33%.7

Secondary prevention of CHD is largely managed by general practitioners and may involve medication use and behavioural counselling to encourage modification of high-risk behaviour.2 Behavioural counselling typically involves providing advice, motivational interviewing, and establishing and assessing goals. A key component is health education to increase awareness of the contribution of the patient’s social and physical environment and behaviour on his or her health. Effective health education also promotes self-efficacy, which is essential for self-directed behaviour change.8

“Health literacy” is the capacity to access, comprehend and use information in ways that promote and maintain good health.9 By extension, “mental health literacy” refers to an individual’s ability to recognise mental disorders, knowledge of risk factors and causes, and understanding of how to seek mental health information and services.10 Physical and mental health is diminished among those with inadequate health literacy, which is related to relatively poor use of preventive health services,11-13 delayed diagnoses,14 decreased knowledge of medical conditions,15,16 reduced adherence to medical advice17 and poor self-management.18

We conducted exploratory qualitative research to identify the types of health information that patients with CHD endorse as beneficial in assisting them to manage their physiological and psychosocial health. Due to the high prevalence of depression in people with established CHD, people both with and without depression were included.

Methods
Results

Complete data were collected for 12 men (mean age, 67 years) and two women (mean age, 81 years) with CHD. Demographic and health characteristics of the participants are shown in the Box. Eight participants had a current diagnosis or prior history of major depression, as assessed by the MINI.19

All participants endorsed the view that further provision of health information would be useful in helping them manage their CHD or psychosocial wellbeing. Four common themes of information topics emerged from the data, categorised as: psychosocial; physical activity; medical; and information for family.

Psychosocial
Medical

Nine patients reported a need for medical information, particularly to assist in alleviating anxiety levels. The suggested information could be grouped into the two areas of symptoms and prognosis, and surgery.

Discussion

This small sample of primary care patients with CHD in metropolitan Melbourne endorsed the need for health and mental health information to help them self-manage their physical and psychosocial health.

It is notable that most patients expressed the view that information about how to manage risk-related physical symptoms would alleviate their health anxiety. This finding suggests that improvements in subjective psychosocial wellbeing may result if this information is readily available to patients. The provision of such information may enhance patients’ perceived control over their medical condition.

Secondary prevention of CHD, including behavioural counselling, is primarily managed by GPs. However, time limitations and other constraints on GPs often preclude systematic provision of secondary prevention.20 This, combined with relatively low rates of attendance at cardiac rehabilitation programs,2 limits the opportunity for people with CHD to gain access to health and mental health information resources.

GPs need to be assisted to improve the health and mental health literacy of patients with CHD, which may in turn enhance patients’ self-management of their chronic illness. For example, affording GPs direct access to a range of health and mental health resources for patients may be useful. Such resources may provide patients with guidance on the self-management of various health concerns. The provision of health information tailored to the specific needs of individual patients is likely to be the most effective strategy. Therefore, innovative approaches, such as the use of technology for information delivery, may be required.

  • Ciaran Pier1
  • Kerrie A Shandley2
  • Julie L Fisher3
  • Frada Burstein3
  • Mark R Nelson4
  • Leon Piterman5

  • 1 School of Psychology, Deakin University, Melbourne, VIC.
  • 2 Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, VIC.
  • 3 Faculty of Information Technology, Monash University, Melbourne, VIC.
  • 4 Menzies Research Institute, University of Tasmania, Hobart, TAS.
  • 5 School of Primary Health Care, Monash University, Melbourne, VIC.


Correspondence: ciaran.pier@deakin.edu.au

Competing interests:

None identified.

  • 1. Australian Institute of Health and Welfare. Heart, stroke and vascular diseases, Australian facts 2004. Canberra: AIHW and National Heart Foundation of Australia, 2004. (AIHW Cat. No. CVD 27.)
  • 2. Australian Institute of Health and Welfare. Secondary prevention and rehabilitation after coronary events or stroke: a review of monitoring issues. Canberra: AIHW, 2003. (AIHW Cat. No. CVD 25.)
  • 3. Bunker SJ, Colquhoun DM, Esler MD, et al. “Stress” and coronary heart disease: psychosocial risk factors. National Heart Foundation of Australia position statement update. Med J Aust 2003; 178: 272-276. <MJA full text>
  • 4. Araquistain JM, Montesanti R. [Depressive syndrome and ischemic cardiopathy] [Italian]. Clin Ter 2003; 154: 251-254.
  • 5. Ruo B, Rumsfeld JS, Hlatky MA, et al. Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA 2003; 290: 215-221.
  • 6. Leon FG, Ashton AK, D’Mello DA, et al. Depression and comorbid mental illness: therapeutic and diagnostic challenges. J Fam Pract 2003; 55: 1-21.
  • 7. Schleifer SJ, Macari-Hinson MM, Coyle DA, et al. The nature and course of depression following myocardial infarction. Arch Intern Med 1989; 149: 1785-1789.
  • 8. Twinn S. The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge. J Adv Nurs 2001; 34: 230-237.
  • 9. Nutbeam D, Wise M, Bauman A, et al. Goals and targets for Australia’s health in the year 2000 and beyond. Canberra: AGPS, 1993.
  • 10. Jorm AF, Korten AE, Jacomb PA, et al. “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 1997; 166: 182-186. <MJA full text>
  • 11. Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med 2005; 165: 1946-1952.
  • 12. Feldman JJ, Makuc DM, Kleinman JC, Cornoni-Huntley J. National trends in educational differentials in mortality. Am J Epidemiol 1989; 129: 919-933.
  • 13. Yen IH, Moss N. Unbundling education: a critical discussion of what education confers and how it lowers risk for disease and death. Ann N Y Acad Sci 1999; 896: 350-351.
  • 14. Bennett CL, Ferreira MR, Davis TC, et al. Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. J Clin Oncol 1998; 16: 3101-3104.
  • 15. Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns 2003; 51: 267-275.
  • 16. Wolf MS, Davis TC, Cross JT, et al. Health literacy and patient knowledge in a Southern US HIV clinic. Int J STD AIDS 2004; 15: 747-752.
  • 17. Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med 1999; 14: 267-273.
  • 18. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA 2002; 288: 475-482.
  • 19. Sheehan D, Janavs J, Baker R, et al. Mini International Neuropsychiatric Interview. English Version 5.0.0. Tampa, Fla: Sheehan DV and Lecrubier Y, 2000.
  • 20. SPHERE: a national depression project. Med J Aust 2001; 175 (2 Suppl): S1-S56.

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