Faculty of Education - Research Publications
Permanent URI for this collection
Search Results
1 - 10 of 29
-
ItemThe cardiac distress inventory: A new measure of psychosocial distress associated with an acute cardiac event(BMC, 2022-11-03)BACKGROUND: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as 'cardiac distress'. It spans multiple psychosocial domains incorporating patients' responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. METHOD: An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. RESULTS: Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. CONCLUSION: The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted.
-
ItemPsychosocial impacts of spontaneous coronary artery dissection: A qualitative study(PUBLIC LIBRARY SCIENCE, 2022-09-06)Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute myocardial infarction, particularly in younger women without classic cardiac risk factors. While recent quantitative studies have noted high anxiety and depression in SCAD survivors, the full range and extent of psychosocial impacts of SCAD is unknown. The present study used a qualitative approach to investigate the psychosocial impacts of SCAD in Australian SCAD survivors. Focus group participants were recruited as part of a larger study of SCAD survivors currently being undertaken by the Victor Chang Cardiac Research Institute. Thirty SCAD survivors participated in one of seven online focus groups, conducted using a semi-structured format. Focus group duration was 1.5 hours. Each was digitally recorded and transcribed. Data were analyzed thematically according to recommended guidelines. One over-arching theme, five main themes and 26 sub-themes were identified. The over-arching theme related to lack of information, while the five main themes related to emotional impacts, issues with self-management, issues with family, impacts on work life, and the need for psychosocial support. The 'emotional impacts' theme comprised 11 sub-themes, namely shock and disbelief, confusion and uncertainty, unfairness, fear and anxiety, loss and grief, isolation and loneliness, guilt, invalidation and embarrassment, depression, vulnerability, and frustration. Findings are discussed in light of relevant psychological theories. This qualitative study extends previous quantitative investigations of SCAD survivors by providing an in-depth understanding of the complex, inter-related and highly distressing impacts of SCAD. The findings point to the urgent need for a coherent approach to information provision, the development and delivery of SCAD-specific cardiac rehabilitation programs, and the provision of psychosocial support programs for SCAD survivors.
-
ItemNo Preview AvailableImpact of rumination on severity and persistence of anxiety and depression in cardiac patients(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2021-01-01)
-
ItemNo Preview Available
-
ItemNo Preview AvailableAdjustment to a New Heart: Concept Analysis Using a Hybrid Model(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2021)BACKGROUND: Although the phenomenon of adjustment to a new heart in transplant recipients is very complex, very few studies have been conducted on this important issue. Therefore, no careful and clear definition exists for this concept. MATERIALS AND METHODS: This concept analysis was conducted in Iran in 2018 on 13 patients undergoing heart transplantation. In the theoretical phase, a conceptual framework was created according to the existing data in the literature about the phenomenon. In this study, 13 participants were selected using purposive sampling with maximum diversity.-Ž In the fieldwork phase, 20 deep and semistructured interviews were conducted with patients undergoing heart transplantation over 4 months. After data saturation, interviews were analyzed using the qualitative content analysis method proposed by Granheim and Lundman (2009). At the final analytical phase, the results of the two previous phases were integrated using a hybrid model. RESULTS: Adjustment to a new heart is a unique multiphase process in patients undergoing heart transplantation. The antecedents include the transplantation time, physical conditions, social and family support, relationship with congeners, and spiritual beliefs. The desirable consequences of adjustment to a new heart may include a new life, inner peace, and spiritual excellence, and the undesirable consequences may include psychological abuse and emotional stagnation. CONCLUSIONS: According to the results, the health-care team should consider the patient as a unique client and initiate discussions before and following heart transplantation that address patients' adjustment to a new heart in all their physical, sexual, and emotional aspects.
-
ItemGetting "Back on Track" After a Cardiac Event: Protocol for a Randomized Controlled Trial of a Web-Based Self-management Program(JMIR PUBLICATIONS, INC, 2021-12)BACKGROUND: After a cardiac event, a large majority of patients with cardiac conditions do not achieve recommended behavior change targets for secondary prevention. Mental health issues can also impact the ability to engage in health behavior change. There is a need for innovative, flexible, and theory-driven eHealth programs, which include evidence-based strategies to assist patients with cardiac conditions with their recovery, especially in behavioral and emotional self-management. OBJECTIVE: The aim of this study is to determine the short- and longer-term behavioral and emotional well-being outcomes of the Back on Track web-based self-management program. In addition, this study will test whether there is enhanced benefit of providing one-on-one telephone support from a trained lifestyle counselor, over and above benefit obtained through completing the web-based program alone. METHODS: People who have experienced a cardiac event in the previous 12 months and have access to the internet will be eligible for this study (N=120). Participants will be randomly assigned to one of the two study conditions: either "self-directed" completion of the Back on Track program (without assistance) or "supported" completion of the Back on Track program (additional 2 telephone sessions with a lifestyle counselor). All participants will have access to the web-based Back on Track program for 2 months. Telephone sessions with the supported arm participants will occur at approximately 2 and 6 weeks post enrollment. Measures will be assessed at baseline, and then 2 and 6 months later. Outcome measures assessed at all 3 timepoints include dietary intake, physical activity and sitting time, smoking status, anxiety and depression, stage of change, and self-efficacy in relation to behavioral and emotional self-management, quality of life, and self-rated health and well-being. A demographic questionnaire will be included at baseline only and program acceptability at 2 months only. RESULTS: Recruitment began in May 2020 and concluded in August 2021. Data collection for the 6-month follow-up will be completed by February 2022, and data analysis and publication of results will be completed by June 2022. A total of 122 participants were enrolled in this study. CONCLUSIONS: The Back on Track trial will enable us to quantify the behavioral and emotional improvements obtained and maintained for patients with cardiac conditions and, in particular, to compare two modes of delivery: (1) fully self-directed delivery and (2) supported by a lifestyle counselor. We anticipate that the web-based Back on Track program will assist patients in their recovery and self-management after an acute event, and represents an effective, flexible, and easily accessible adjunct to center-based rehabilitation programs. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000102976; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378920&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34534.
-
ItemComparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery: Randomized Clinical Trial(JMIR PUBLICATIONS, INC, 2021-12-10)BACKGROUND: Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. OBJECTIVE: This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. METHODS: This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient's smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. RESULTS: One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. CONCLUSIONS: Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507.
-
ItemUnraveling the Complexity of Cardiac Distress: A Study of Prevalence and Severity(FRONTIERS MEDIA SA, 2022-03-31)INTRODUCTION: While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. METHOD: A sample of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. RESULTS: Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were "being physically restricted" (66%), "lacking energy" (60%), "being short of breath" (60%), "thinking I will never be the same again" (57%), and "not sleeping well" (51%). While less prevalent, "not having access to the health care I need," "being concerned about my capacity for sexual activity," and "being unsupported by family and friends" were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. CONCLUSION AND IMPLICATIONS: Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery.
-
ItemThe of effect of partnership-based education on adherence to the treatment plans in open heart surgery(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2021)BACKGROUND: Adherence to the treatment plans is one of the most effective conducts to prevent and reduce postoperative side effects. Partnership-based education is one of the most efficient ways to shape health behaviors. The aim of the present study was to determine the effect of partnership-based education on adherence to the treatment plans in open heart surgery. MATERIALS AND METHODS: This quasi-experimental study was conducted in 2019-2020 on the patients undergoing open heart surgery in Tehran (Capital of Iran). Sampling was done in one educational hospital. A total of 86 patients and their caregivers participated in the study. Sampling was done nonrandomly by tossing a coin, and patients were allocated into the odd week in the intervention group and the even week in the control group (n = 43 in each group), and data were collected before and after intervention using the Treatment Adherence Questionnaire concerning dietary, physical activity, and medication aspects. The educational intervention was carried out after the pretest analysis in five 20-45 min sessions (two individual and three group educations). Data were analyzed with Chi-square, independent t-test, and paired t-test using SPSS 19 at a significance level of P < 0.05. RESULTS: Patients and caregivers in both groups did not have a significant difference in terms of demographic variables (P > 0. 05). In addition, there was no significant difference in the mean of dietary, physical activity, and medication plans before the intervention in both groups; however, after the intervention, the mean of the three aspects in the intervention group was significantly higher than that of control (P < 0.001). CONCLUSION: Implementing partnership-based education with participation of patients and caregivers is influential in improving patients' adherence to the treatment plans and it is recommended as a clinical dynamic educational strategy.
-
ItemThe Intergenerational Transmission of At-Risk/Problem Gambling: The Moderating Role of Parenting Practices(WILEY, 2017-10)BACKGROUND AND OBJECTIVES: Although parenting practices are articulated as underlying mechanisms or protective factors in several theoretical models, their role in the intergenerational transmission of gambling problems has received limited research attention. This study therefore examined the degree to which parenting practices (positive parenting, parental involvement, and inconsistent discipline) moderated the intergenerational transmission of paternal and maternal problem gambling. METHODS: Students aged 12-18 years (N = 612) recruited from 17 Australian secondary schools completed a survey measuring parental problem gambling, problem gambling severity, and parenting practices. RESULTS: Participants endorsing paternal problem gambling (23.3%) were 4.3 times more likely to be classified as at-risk/problem gamblers than their peers (5.4%). Participants endorsing maternal problem gambling (6.9%) were no more likely than their peers (4.0%) to be classified as at-risk/problem gamblers. Paternal problem gambling was a significant predictor of offspring at-risk/problem gambling after controlling for maternal problem gambling and participant demographic characteristics. The relationship between maternal problem gambling and offspring at-risk/problem gambling was buffered by parental involvement. DISCUSSION AND CONCLUSIONS: Paternal problem gambling may be important in the development of adolescent at-risk/problem gambling behaviours and higher levels of parental involvement buffers the influence of maternal problem gambling in the development of offspring gambling problems. Further research is therefore required to identify factors that attenuate the seemingly greater risk of transmission associated with paternal gambling problems. SCIENTIFIC SIGNIFICANCE: Parental involvement is a potential candidate for prevention and intervention efforts designed to reduce the intergenerational transmission of gambling problems. (Am J Addict 2017;26:707-712).