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Prediction of Changes in Adherence to Secondary Prevention Among Patients With Coronary Artery Disease
Minmin Lu1, Marilyn Hravnak, Jianying Ma
1Minmin Lu, MSN, RN, is Lecturer, School of Nursing, Fudan University, Shanghai, P.R. China. Marilyn Hravnak, PhD, RN, ACNP-BC, CCNS, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Jianying Ma, MD, is Associate Chief Physician, Zhongshan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Ying Lin, RN, is Supervisor Nurse, Zhongshan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Xian Zhang, RN, is Supervisor Nurse, Zhongshan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Yunzhi Shen, RN, is Associate Chief Nurse, Huashan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Haiou Xia, PhD, RN, is Professor, School of Nursing, Fudan University, Shanghai, P.R. China.
Background:
Healthcare providers are concerned about adherence to provider recommendations in coronary artery disease management. Seeking patient-related factors influencing changes in adherence over time is necessary for formulating suitable intervention measures-especially among diverse populations.
Objective:
To explore whether health literacy, self-efficacy, and disease knowledge predict changes in adherence over time (between baseline and 3 months) to secondary prevention recommendations for Chinese coronary artery disease patients.
Methods:
A longitudinal study was performed for 662 patients following percutaneous coronary intervention in China. Self-reported data were collected at baseline during hospitalization and at a 3-month telephone follow-up. Variables included demographics, health literacy, self-efficacy, disease knowledge, and adherence to secondary prevention recommendations for medication taking and a heart-healthy lifestyle. Multinomial logistic regression identified predictors of adherence changes over time.
Results:
Patients were categorized into three groups: sustained/declined to nonadherence between baseline and 3 months, improved to adherence, and sustained adherence. The number of patients in sustained/declined to nonadherence group was small. Absence of stents predicted sustained/declined to nonadherence to medication and lifestyle over time. Health literacy was not associated with adherence changes over time. Higher self-efficacy scores were associated with lower likelihood of sustained/declined to nonadherence to a healthy lifestyle over time, whereas higher disease knowledge scores were associated with higher sustained/declined to nonadherence to medication.
Conclusions:
Adherence to secondary prevention 3 months after discharge was relatively good in Chinese patients with coronary artery disease who received percutaneous coronary intervention. Absence of stents and lower self-efficacy can predict the poor adherence changes, which should be considered in formulating follow-up care.
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