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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3079 — Process Evaluation of a Dyadic Lifestyle Change Intervention to Improve Low-Density Lipoprotein Cholesterol

Sperber NR, HSR&D/Duke University; Sandelowski M, University of North Carolina at Chapel Hill, School of Nursing; Voils CI, HSR&D/Duke University;

Adherence to cholesterol-lowering regimens is essential for improved coronary heart disease outcomes, a leading cause of death in the VHA. We evaluated a behavioral intervention that sought to improve LDL by increasing adherence to lifestyle changes via nurse-educator phone calls with patients and their spouses. In this paper, we describe how patients adhered to their goals through support of both the nurse and spouse.

A directed form of qualitative content analysis was used to code semi-structured individual interviews conducted at the end of the intervention trial with 29 patients and 24 of their spouses. Comparisons of responses were made within and across dyads. Interview responses were coded using concepts and propositions informed by Mohr’s theory of supportive accountability, which suggests that social support can increase adherence through accountability to a “legitimate” coach (characterized by trustworthiness, benevolence, expertise and reciprocity) and opportunities for self-reflection and growth.

Interviewed patients were mostly male (93%) and white (62%). The average age was 64. Patients viewed the nurse as a legitimate source of support. She garnered their trust through consistent, reliable phone contact. Patients portrayed her as being empathetic and informed, like a friend and expert who could answer questions and help solve problems. Patients also described a reciprocal relationship, in which the nurse laid out her expectations for how patients could work toward goals while also respecting individual concerns. Spouses and patients both indicated that the nurse’s involvement helped legitimize spouses’ attempts to support patient behavior change. Spouses generally provided instrumental support via meal preparation and reminders; however, some countered patient goals by providing unhealthy food or prioritizing other needs. The nurse provided patients with lessons in recovery after lapsing.

As a result of support from both the nurse and spouse, patients increased their awareness of expected behavior and capacity to commit to behavioral change. Interactions that focused on ways to reflect and self-correct helped them to stay engaged.

A nurse-delivered intervention that actively involves spouses and operationalizes tenets of supportive accountability can help patients adhere to behavior change that is critical for reducing cardiovascular risk factors.

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