Anticipated Impact on Veterans' Healthcare: The proposed pilot project will establish the feasibility of a telehealth nursing intervention for veterans with coronary heart disease (CHD) who are recovering from myocardial infarction (MI) and other acute coronary syndromes (ACS). The intervention targets the modification of misconceptions in veterans' common sense models-or cognitive representations-of CHD, with the goal of facilitating health behavior change (e.g., smoking cessation, medication adherence, diet management, and physical activity), improving quality of life (QoL), and reducing CHD-related morbidity and mortality. Project Background/Rationale: Our past research found that post-MI patients often failed to incorporate personally relevant behavioral risk factors into their CHD representations; such beliefs predicted subsequent non-adherence to diet, exercise, and smoking cessation recommendations. These findings suggested that efforts to motivate post-MI/ACS behavior change often fail because patients hold misconceptions regarding their illness and its associations with behavior and health outcomes. We used these findings as the basis for developing the preliminary framework for a nursing intervention designed to promote adaptive conceptual change in patients' representations about CHD etiology and self-management. We currently are collecting longitudinal descriptive data regarding CHD representations and their implications for health outcomes in a multi-site sample of African American and Caucasian veterans with MI/ACS. These data will allow us to incorporate content into the intervention that is tailored to veterans' unique characteristics and experiences. However, before testing the intervention's efficacy in a large, multi-site randomized controlled trial (RCT), we need to refine and finalize the intervention materials and protocol and evaluate its feasibility in a small sample of veterans with MI/ACS. Project Objectives:
The aims of the proposed project are to: (1) refine the intervention materials and protocols to incorporate veteran-centric content; (2) develop an organizational-level assessment process to identify the optimal strategies for implementing the Vet-HART intervention within the VAMC setting; and (3) evaluate the feasibility of the Vet-HART intervention in a pilot sample of 24 post-MI/ACS veterans recruited from the Iowa City VAMC. Results will provide the basis for a subsequent full-scale proposal to evaluate the intervention's efficacy in a multi-site RCT. Project Methods: Intervention protocols will be modified to incorporate veteran-centric content and a setting-level organizational and operations assessment will be undertaken to optimize implementation of the intervention in the Iowa City VAMC. The intervention will be pilot-tested in a small sample of post-MI/ACS veterans. Participants' representations of CHD will be assessed by telephone at 1-week post-hospital discharge and medical record data will be collected regarding health status and CHD risk factors. Participants then will be randomized to the intervention vs. standard care control groups. The intervention itself will delivered via telephone and is designed to reinforce participants' accurate beliefs about CHD, while creating conditions conducive to the modification of CHD misconceptions. Outcome measures will be collected at 1- and 3- months and will include self-report measures of representational change, QoL, health behaviors, perceptions of and receptivity to the intervention.
Coronary heart disease (CHD) is the most common cause of morbidity/mortality among veterans using VHA services. The proposed study will refine an intervention designed to facilitate adaptive conceptual change in veterans'beliefs about CHD causes and self-management in order to (1) reduce morbidity/mortality following heart attacks and other acute coronary syndromes and (2) improve veterans'quality of life. The study will contribute to the VHA HSR&D research priorities emphasizing the care of complex, chronic conditions and implementation research in three ways: (1) by refining the intervention to incorporate veteran-centric content; (2) developing an organizational assessment process to identify the optimal strategies for implementing the intervention within the VA;and (3) evaluating the feasibility of the intervention. The proposed study is an essential next step in the development of an intervention that targets CHD representations as a tool in improving risk factor modification and improving health outcomes among veterans with CHD.
