Developing feasible CBT-based interventions to manage cardiac misconceptions that are predictive of poor outcomes in people with coronary heart disease in cardiac rehabilitation

  • Helen L. Fletcher

    Student thesis: Master's ThesisMaster of Science by Research


    Background: Misconceptions about coronary heart disease (CHD) are correlated with poorer physical functioning and psychological status. Research suggests that cognitive behavioural methods of changing misconceptions are most promising, however, despite guidelines advising cardiac rehabilitation clinicians to dispel cardiac misconceptions, there is a lack of advice regarding how best to go about this.

    Purpose of the study and setting: To develop interventions to dispel cardiac misconceptions that are acceptable to people with CHD who are attending a Stage 4 cardiac rehabilitation centre.

    Intervention design: Using Medical Research Council guidelines for developing complex interventions as a guide, an initial design phase identified Leventhal’s Common-Sense Model of illness behaviour as a theoretical basis. An individual and group intervention were drafted, and a booklet, with input from an expert panel.

    Study design and methods: A pragmatic qualitative study using semi-structured interviews and a focus group was used. A convenience sample of people with CHD was recruited from two different Stage 4 cardiac rehabilitation centres. Six people (4 men, 2 women), mean age 61 years, received the individual intervention and completed a semi-structured interview. Eight participants from the second cardiac rehabilitation centre received the group intervention and 5 people (4 men, 1 woman), mean age 54 years, took part in a focus group. One staff member took part in a semi-structured interview about the group intervention.

    Data analysis: data were analysed thematically using Framework Analysis.

    Findings: Generally, the study found that both interventions were acceptable and regarded as being of benefit to people with CHD. The process of tailoring the individual intervention was acceptable, however, the findings identified that some people may feel anxious and need reassurance that they are not being ‘tested’. The individual intervention was valued for its personal focus and viewed as helpful for enhancing people’s understanding of CHD. The group intervention was viewed as useful and well-received by the member of staff and participants valued being with others who had experienced a heart event. The booklet was viewed as being helpful as an intervention in itself and could be received by patients and/or their family members soon after a heart event. Challenges to the group intervention included some people’s experience of poor concentration and memory which should be taken into account when delivering a future intervention. Overall, participants thought the intervention and booklet would be best received soon after a heart event as this is when people would be more motivated and have more time to engage with an intervention to understand their illness.

    Conclusion: The findings of the study were used to further refine the interventions; changes included making the content of the booklet more acceptable to people with disabilities. While the study found that the interventions were acceptable, it is unknown if the interventions would be experienced differently by people who are not already attending cardiac rehabilitation, therefore, the interventions would benefit from further pilot testing with people who are less motivated to attend or make health behaviour changes. The study did not explore if changing misconceptions led to changes in behaviour, however, focusing on the ‘patient’s perspective’ has enabled interventions to be produced that are more fully developed and acceptable to the people intended to receive them and optimally developed interventions are more likely to be efficacious. A future trial can explore how effective the interventions are at changing behaviour which will also help identify how important a determinant of behaviour change cardiac misconceptions are.
    Date of Award2014
    Original languageEnglish
    Awarding Institution
    • Coventry University
    SupervisorGill Furze (Supervisor) & Andy Turner (Supervisor)


    • Cognitive therapy
    • Coronary heart disease

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