Johnson Jennie E, Gulanick Meg, Penckofer Sue, Kouba Joanne
Jennie E. Johnson PhD, RN-BC Lifestyle Counselor, Owner, Living For A Healthy Heart, LLC, Post Falls, Idaho. Meg Gulanick, PhD, APRN, FAAN Professor Emeritus, Niehoff School of Nursing, Loyola University, Chicago, Illinois. Sue Penckofer, PhD, RN, FAAN Professor and Loyola Faculty Scholar, Niehoff School of Nursing, Loyola University, Chicago, Illinois. Joanne Kouba, PhD, RD, LDN Director, Dietetics Programs, Niehoff School of Nursing, Loyola University, Chicago, Illinois.
J Cardiovasc Nurs. 2015 Jan-Feb;30(1):15-25. doi: 10.1097/JCN.0000000000000103.
Evidence indicates that a healthy lifestyle can reduce cardiovascular disease risk, yet many people engage in unhealthy behaviors. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Knowledge of an abnormal finding could provide the "teachable moment" to enhance motivation for change.
The aim of this study was to examine how knowledge of CAC score affects risk perception, likelihood of taking action, and health-promoting behavior change in persons at high risk for cardiovascular disease.
This study used a descriptive prospective design with 174 high-risk adults (≥3 major risk factors) recruited at a radiology center offering CAC scans. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Benefits and Barriers Scale, the Quality of Life Index, and the Health-Promoting Lifestyle Profile II were completed immediately after a screening CAC scan but before results were known. Follow-up occurred 3 months later using mailed packets.
Participants' mean age was 58 years; 62% were men, 89% were white, and most were well educated. There was no significant change in risk perception scores over time or between groups, except for a positive interaction in the moderate-risk group (CAC scores of 101-400) (P = .004). Quality of life remained unchanged. Health-promoting behavior changes increased in all groups over time (P < .001). McNemar χ² analysis indicated that risk reduction medication use increased in all groups, with a significant increase in statin (P < .001) and aspirin (P < .001) intake. Predictors of behavior change were perceived barriers (β = -.41; P < .001) and quality of life (β = .44; P < .001).
Knowledge of CAC score does impact risk perception for some at-risk groups. This knowledge does enhance motivation for behavior change. Knowledge of CAC score does not impact quality of life. It is hoped that through improved understanding of the effect of CAC scoring on behavior change, nurses can better assist patients to modify behaviors during teachable moments.
有证据表明，健康的生活方式可降低心血管疾病风险，但仍有许多人存在不健康行为。冠状动脉钙化（CAC）筛查等新技术能够在临床疾病出现之前检测出动脉粥样硬化。知晓异常检查结果可能会提供“可教育时机”，以增强改变行为的动力。
本研究旨在探讨CAC评分信息如何影响心血管疾病高危人群的风险认知、采取行动的可能性以及促进健康的行为改变。
本研究采用描述性前瞻性设计，在一家提供CAC扫描的放射科中心招募了174名高危成年人（≥3个主要风险因素）。在进行CAC筛查扫描后但结果知晓前，立即使用心脏病风险感知量表、益处与障碍量表、生活质量指数和促进健康生活方式概况II完成基线自我报告调查。3个月后通过邮寄问卷进行随访。
参与者的平均年龄为58岁；62%为男性，89%为白人，且大多数受教育程度较高。除中度风险组（CAC评分为101 - 400）存在正向交互作用外（P = 0.004），风险感知得分随时间推移或在不同组间均无显著变化。生活质量保持不变。随着时间推移，所有组的促进健康行为改变均有所增加（P < 0.001）。McNemar χ²分析表明，所有组中降低风险药物的使用均有所增加，他汀类药物（P < 0.001）和阿司匹林（P < 0.001）的摄入量显著增加。行为改变的预测因素为感知到的障碍（β = -0.41；P < 0.001）和生活质量（β = 0.44；P < 0.001）。
CAC评分信息确实会影响部分高危人群的风险认知。这一信息确实能增强行为改变的动力。CAC评分信息不会影响生活质量。希望通过更好地理解CAC评分对行为改变的影响，护士能够在可教育时机更好地协助患者改变行为。
