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The Combined Effect of Psychological and Relational Aspects on Cardiac Patient Activation

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Abstract

The literature assumes that activating patients in the treatment is associated with positive health-related outcomes, such as clinical indicators in the normal range, high medication adherence, and low emergency department utilization. In the cardiac population, patient activation, that is the patient’s knowledge, skills, confidence, and behaviors needed for managing one’s own health and health care, has been less investigated. In addition, limited attention has been given to the role of the partner as an informal caregiver. However, the patient in the care process is rarely alone, and the partner may play a key role in this process. The goal of this dyadic study (N = 100 heterosexual couples with one partner suffering from an acute cardiac event) is to analyze how individual factors (patients’ anxiety, depression, medication adherence, pessimistic perception of illness) and the couple’s relationship functioning (e.g., different kinds of partner support and dyadic coping) are associated with patient activation. The results showed that patient activation is not a mere question of age. It is positively related to medication adherence and to the partner’s support patient activation. It is negatively correlated with the patient’s psychological distress, pessimistic perception of illness, and to the partner’s hostility. The need for a dyadic approach to both research and intervention with this population is discussed.

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References

  • Acitelli, L. K., & Badr, H. J. (2005). 2F—My illness or our illness—Attending to the relationship when one partner is ill. In T. A. Revenson, K. Kayser, & G. Bodenmann (Eds.), Couples coping with stress: Emerging perspectives on dyadic coping (pp. 121–136). Washington, DC: American Psychological Association. https://doi.org/10.1037/11031-006.

    Chapter  Google Scholar 

  • Barello, S., Graffigna, G., Vegni, E., Savarese, M., Lombardi, F., & Bosio, A. C. (2015). “Engage me in taking care of my heart”: A grounded theory study on patient-cardiologist relationship in the hospital management of heart failure. British Medical Journal Open, 5, e005582. https://doi.org/10.1136/bmjopen-2014-005582.

    Article  Google Scholar 

  • Baroletti, S., & Dell’Orfano, H. (2010). Medication adherence in cardiovascular disease. Circulation, 121, 1455–1458. https://doi.org/10.1161/CIRCULATIONAHA.109.904003.

    Article  PubMed  Google Scholar 

  • Bauer, L. K., Caro, M. A., Beach, S. R., Mastromauro, C. A., Lenihan, E., Januzzi, J. L., & Huffman, J. C. (2012). Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients. The American Journal of Cardiology, 109, 1266–1271. https://doi.org/10.1016/j.amjcard.2011.12.017.

    Article  PubMed  Google Scholar 

  • Bertoni, A., & Bodenmann, G. (2010). Satisfied and dissatisfied couples: Positive and negative dimensions, conflict styles, and relationships with family of origin. European Psychologist, 15, 175–184. https://doi.org/10.1027/1016-9040/a000015.

    Article  Google Scholar 

  • Bertoni, A., Donato, S., Acquati, C., & Rapelli, G. (2017). La coppia di fronte alla malattia cardiaca: il ruolo della relazione nel processo di cura. In C. Acquati & E. Saita (Eds.), Affrontare insieme la malattia (pp. 163–177). Roma: Carocci Faber.

    Google Scholar 

  • Bertoni, A., Donato, S., Graffigna, G., Barello, S., & Parise, M. (2015). Engaged patients, engaged partnerships: Singles and partners dealing with an acute cardiac event. Psychology, Health & Medicine, 8506, 1–13. https://doi.org/10.1080/13548506.2014.969746.

    Article  Google Scholar 

  • Bertoni, A., Donato, S., & Molgora, S. (2018). When “we” are stressed: A dyadic approach to coping with stressful events. Hauppauge, NY: Nova Science Publisher.

    Google Scholar 

  • Bodenmann, G. (1997). Dyadic coping-a systematic-transactional view of stress and coping among couples: Theory and empirical findings. European Review of Applied Psychology, 47, 137–140.

    Google Scholar 

  • Bodenmann, G. (2005). Dyadic coping and its significance for marital functioning. In T. A. Revenson, K. Kayser, & G. Bodenmann (Eds.), Couples coping with stress: Emerging perspectives on dyadic coping (pp. 33–50). Washington: American Psychological Association. https://doi.org/10.1037/11031-002.

    Chapter  Google Scholar 

  • Bodenmann, G., Arista, L. J., Walsh, K. J., & Randall, A. K. (2018). Dyadic coping inventory. In J. Lebow, A. Chambers, & D. Breunlin (Eds.), Encyclopedia of couple and family therapy (pp. 1–5). Cham: Springer. https://doi.org/10.1007/978-3-319-15877-8_678-1.

    Chapter  Google Scholar 

  • Bodenmann, G., Meuwly, N., & Kayser, K. (2011). Two conceptualizations of dyadic coping and their potential for predicting relationship quality and individual well-being: A comparison. European Psychologist, 16, 255–266. https://doi.org/10.1027/1016-9040/a000068.

    Article  Google Scholar 

  • Brummett, B. H., Barefoot, J. C., Feaganes, J. R., Yen, S., Bosworth, H. B., Williams, R. B., & Siegler, I. C. (2000). Hostility in marital dyads: Associations with depressive symptoms. Journal of Behavioral Medicine, 23, 95–105. https://doi.org/10.1023/A:1005424405056.

    Article  CAS  PubMed  Google Scholar 

  • Burns, J. W., Peterson, K. M., Smith, D. A., Keefe, F. J., Porter, L. S., Schuster, E., & Kinner, E. (2013). Temporal associations between spouse criticism/hostility and pain among patients with chronic pain: A within-couple daily diary study. Pain, 154, 2715–2721. https://doi.org/10.1016/j.pain.2013.07.053.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burns, J. W., Post, K. M., Smith, D. A., Porter, L. S., Buvanendran, A., Fras, A. M., & Keefe, F. J. (2018). Spouse criticism and hostility during marital interaction: Effects on pain intensity and behaviors among individuals with chronic low back pain. Pain, 159, 25–32. https://doi.org/10.1097/j.pain.0000000000001037.

    Article  PubMed  Google Scholar 

  • Cano, A., & Tankha, H. (2018). Spousal criticism and hostility in response to pain: What is the alternative? Pain, 159, 1–2. https://doi.org/10.1097/j.pain.0000000000001045.

    Article  PubMed  PubMed Central  Google Scholar 

  • Castelnuovo, G., Pietrabissa, G., Manzoni, G., Cappella, E. A., Baruffi, M., Malfatto, G., … Molinari, E. (2014). The need of psychological motivational support for improving lifestyle change in cardiac rehabilitation. Experimental and Clinical Cardiology, 20, 4856–4861.

    Google Scholar 

  • Chauvet-Gelinier, J.-C., & Bonin, B. (2017). Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilitation. Annals of Physical and Rehabilitation Medicine, 60, 6–12. https://doi.org/10.1016/j.rehab.2016.09.002.

    Article  PubMed  Google Scholar 

  • Conway, B. (2015). Understanding illness perception as a barrier to cardiac rehabilitation uptake. British Journal of Cardiac Nursing, 10, 21–25. https://doi.org/10.12968/bjca.2015.10.1.21.

    Article  Google Scholar 

  • Coyne, J. C., & Smith, D. A. (1991). Couples coping with a myocardial infarction: A contextual perspective on wives’ distress. Journal of Personality and Social Psychology, 61, 404–412.

    Article  CAS  PubMed  Google Scholar 

  • Coyne, J. C., & Smith, D. A. F. (1994). Couples coping with a myocardial infarction: Contextual perspective on patient self-efficacy. Journal of Family Psychology, 8, 43–54. https://doi.org/10.1037/0893-3200.8.1.43.

    Article  Google Scholar 

  • Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19, 1–15.

    Article  CAS  PubMed  Google Scholar 

  • DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: a meta-analysis. Health Psychology, 23, 207–218. https://doi.org/10.1037/0278-6133.23.2.207.

    Article  PubMed  Google Scholar 

  • DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.

    Article  CAS  PubMed  Google Scholar 

  • Donato, S., & Bertoni, A. (2018). A relational perspective on patient engagement: Suggestions from couple-based research and intervention. Health care delivery and clinical science: Concepts, methodologies, tools, and applications (pp. 1–24). IGI Global: Hershey, PA.

    Google Scholar 

  • Donato, S., Iafrate, R., Barni, D., Bertoni, A., Bodenmann, G., & Gagliardi, S. (2009). Measuring dyadic coping: The factorial structure of Bodenmann’s “Dyadic Coping Questionnaire” in an Italian sample. TPM—Testing Psychometrics Methodology, 16, 25–47.

    Google Scholar 

  • Donato, S., Pagani, A. F., Parise, M., Bertoni, A., & Iafrate, R. (2014). The capitalization process in stable couple relationships: Intrapersonal and interpersonal benefits. Procedia-Social and Behavioral Sciences, 140, 207–211. https://doi.org/10.1016/j.sbspro.2014.04.411.

    Article  Google Scholar 

  • Donato, S., Parise, M., Iafrate, R., Bertoni, A., Finkenauer, C., & Bodenmann, G. (2015). Dyadic coping responses and partners’ perceptions for couple satisfaction: An actor-partner interdependence analysis. Journal of Social and Personal Relationships, 32, 580–600. https://doi.org/10.1177/0265407514541071.

    Article  Google Scholar 

  • Fiske, V., Coyne, J. C., & Smith, D. A. (1991). Couples coping with myocardial infarction: An empirical reconsideration of the role of overprotectiveness. Journal of Family Psychology, 5, 4–20.

    Article  Google Scholar 

  • French, D. P., Cooper, A., & Weinman, J. (2006). Illness perceptions predict attendance at cardiac rehabilitation following acute myocardial infarction: A systematic review with meta-analysis. Journal of Psychosomatic Research, 61, 757–767.

    Article  PubMed  Google Scholar 

  • Goldstein, C. M., Gathright, E. C., & Garcia, S. (2017). Relationship between depression and medication adherence in cardiovascular disease: The perfect challenge for the integrated care team. Patient Preference and Adherence, 11, 547–559. https://doi.org/10.2147/PPA.S127277.

    Article  PubMed  PubMed Central  Google Scholar 

  • Graffigna, G., Barello, S., Bonanomi, A., Lozza, E., & Hibbard, J. (2015). Measuring patient activation in Italy: Translation, adaptation and validation of the Italian version of the patient activation measure 13 (PAM13-I). BMC Medical Informatics and Decision Making, 15, 109. https://doi.org/10.1186/s12911-015-0232-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Graffigna, G., Barello, S., Riva, G., Savarese, M., Menichetti, J., Castelnuovo, G., … Bosio, A.C. (2017). Fertilizing a Patient Engagement Ecosystem to Innovate Healthcare : Toward the First Italian Consensus Conference on Patient Engagement. Frontiers in psychology. https://doi.org/10.3389/fpsyg.2017.00812

  • Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation result in improved self-management behaviors? Health Services Research, 42, 1443–1467. https://doi.org/10.1111/j.1475-6773.2006.00669.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39, 1005–1026. https://doi.org/10.1111/j.1475-6773.2004.00269.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hilpert, P., Randall, A. K., Sorokowski, P., Atkins, D. C., Sorokowska, A., Ahmadi, K., … Bettache, K. (2016). The associations of dyadic coping and relationship satisfaction vary between and within nations: A 35-nation study. Frontiers in Psychology, 7, article n. 1106. https://doi.org/10.3389/fpsyg.2016.0110

  • Le Grande, M. R., Jackson, A. C., Murphy, B. M., & Thomason, N. (2016). Relationship between sleep disturbance, depression and anxiety in the 12 months following a cardiac event. Psychology, Health & Medicine, 21, 52–59. https://doi.org/10.1080/13548506.2015.1040032.

    Article  Google Scholar 

  • Leifheit-Limson, E. C., Kasl, S. V., Lin, H., Buchanan, D. M., Peterson, P. N., Spertus, J. A., & Lichtman, J. H. (2012). Adherence to risk factor management instructions after acute myocardial infarction: The role of emotional support and depressive symptoms. Annals of Behavioral Medicine, 43, 198–207. https://doi.org/10.1007/s12160-011-9311-z.

    Article  PubMed  Google Scholar 

  • Leuchtmann, L., & Bodenmann, G. (2018). New perspectives on dynamics of dyadic coping. In A. Bertoni, S. Donato, & S. Molgora (Eds.), When “we” are stressed: A dyadic approach to coping with stressful events (pp. 3–14). Hauppauge, NY: Nova Publisher.

    Google Scholar 

  • Leventhal, H., & Cameron, L. (1987). Behavioral theories and the problem of compliance. Patient Education and Counseling, 10, 117–138.

    Article  Google Scholar 

  • Maeda, U., Shen, B. J., Schwarz, E. R., Farrell, K. A., & Mallon, S. (2013). Self-efficacy mediates the associations of social support and depression with treatment adherence in heart failure patients. International Journal of Behavioral Medicine, 20, 88–96. https://doi.org/10.1007/s12529-011-9215-0.

    Article  PubMed  Google Scholar 

  • Mattsson, N. B., Williams, H. V., Rickels, K., Lipman, R. S., & Uhlenhuth, E. H. (1969). Dimensions of symptom distress in anxious neurotic outpatients. Psychopharmacology Bulletin, 5, 19–32.

    CAS  PubMed  Google Scholar 

  • McGrady, A., McGinnis, R., Badenhop, D., Bentle, M., & Rajput, M. (2009). Effects of depression and anxiety on adherence to cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, 29, 358–364. https://doi.org/10.1097/HCR.0b013e3181be7a8f.

    Article  PubMed  Google Scholar 

  • Molloy, G. J., Perkins-Porras, L., Strike, P. C., & Steptoe, A. (2008). Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 27, 52–58. https://doi.org/10.1037/0278-6133.27.1.52.

    Article  Google Scholar 

  • Mosen, D. M., Schmittdiel, J., Hibbard, J., Sobel, D., Remmers, C., & Bellows, J. (2007). Is patient activation associated with outcomes of care for adults with chronic conditions? The Journal of Ambulatory Care Management, 30, 21–29. https://doi.org/10.1097/00004479-200701000-00005.

    Article  PubMed  Google Scholar 

  • Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., & Buick, D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology and Health, 17, 1–16. https://doi.org/10.1080/08870440290001494.

    Article  Google Scholar 

  • Norton, R. (1983). Measuring marital quality: A critical look at the dependent variable. Journal of Marriage and the Family, 45, 141–151. https://doi.org/10.2307/351302.

    Article  Google Scholar 

  • Nunnally, J. C. (1978). Psychometric Theory (2nd ed.). New York: McGraw-Hill.

    Google Scholar 

  • Pagani, A. F., Donato, S., Parise, M., Bertoni, A., Iafrate, R., & Schoebi, D. (2019a). Explicit stress communication facilitates perceived responsiveness in dyadic coping. Frontiers in Psychology, 10, 401. https://doi.org/10.3389/fpsyg.2019.00401.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pagani, A. F., Donato, S., Parise, M., Iafrate, R., Bertoni, A., & Schoebi, D. (2015). When good things happen: Explicit capitalization attempts of positive events promote intimate partners’ daily well-being. Family Science, 6, 119–128. https://doi.org/10.1080/19424620.2015.1082013.

    Article  Google Scholar 

  • Pagani, A. F., Parise, M., Donato, S., Gable, S., & Schoebi, D. (2019b). If you shared my happiness, you are part of me: Capitalization and the experience of couple identity. Personality and Social Psychology Bulletin. https://doi.org/10.1177/0146167219854449. advance online publication.

    Article  PubMed  Google Scholar 

  • Parise, M., Donato, S., Pagani, A. F., Ribeiro, M. T., & Manzi, C. (2015). Couple identity processes in young adulthood: An experimental study on the role of intrusive parenting for romantic partners’ other-serving bias. In A. M. Columbus (Ed.), Advances in psychology research (Vol. 111, pp. 123–138). Hauppauge, NY: Nova Publisher.

    Google Scholar 

  • Parise, M., Donato, S., Pagani, A. F., & Schoebi, D. (2017a). Keeping calm when riding the rapids: Optimism and perceived partner withdrawal. Personal Relationships, 24, 131–145. https://doi.org/10.1111/pere.12172.

    Article  Google Scholar 

  • Parise, M., Manzi, C., Donato, S., & Iafrate, R. (2017b). Free to love? The role of intrusive parenting for young adult children’s romantic relationship quality. Journal of Prevention & Intervention in the Community, 45, 187–201. https://doi.org/10.1080/10852352.2016.1198127.

    Article  Google Scholar 

  • Parise, M., Pagani, A. F., Donato, S., & Sedikides, C. (2019). Self-concept clarity and relationship satisfaction at the dyadic level. Personal Relationships, 26, 54–72. https://doi.org/10.1111/pere.12265.

    Article  Google Scholar 

  • Rajpura, J., & Nayak, R. (2014). Medication adherence in a sample of elderly suffering from hypertension: Evaluating the influence of illness perceptions, treatment beliefs, and illness burden. Journal of Managed Care Pharmacy, 20, 58–65.

    Article  PubMed  Google Scholar 

  • Saunders, M. (2008). Factors associated with caregiver burden in heart failure family caregivers. Western Journal of Nursing Research, 30, 943–959. https://doi.org/10.1177/0193945908319990.

    Article  PubMed  Google Scholar 

  • Scheier, M. F., Carver, C. S., & Bridges, M. W. (2001). Optimism, pessimism, and psychological well-being. In E. C. Chang (Ed.), Optimism & pessimism: Implications for theory, research, and practice (pp. 189–216). Washington, DC: American Psychological Association. https://doi.org/10.1037/10385-009.

    Chapter  Google Scholar 

  • Schoebi, D., Pagani, A. F., Luginbuehl, T., & Bradbury, T. N. (2015). Committed to maintain: A brief measure of maintenance-oriented relationship commitment (MORC). Family Science, 6, 160–169. https://doi.org/10.1080/19424620.2015.1082046.

    Article  Google Scholar 

  • Thompson, K., Kulkarni, J., & Sergejew, A. A. (2000). Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research, 42, 241–247. https://doi.org/10.1016/S0920-9964(99)00130-9.

    Article  CAS  PubMed  Google Scholar 

  • Uchino, B. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29, 377–387. https://doi.org/10.1007/s10865-006-9056-5.

    Article  PubMed  Google Scholar 

  • Vellone, E., Chung, M. L., Cocchieri, A., Rocco, G., Alvaro, R., & Riegel, B. (2014). Effects of self-care on quality of life in adults with heart failure and their spousal caregivers: Testing dyadic dynamics using the actor–partner interdependence model. Journal of Family Nursing, 20, 120–141. https://doi.org/10.1177/1074840713510205.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Largo Gemelli, 1, 20123, Milan, Italy

    Giada Rapelli, Silvia Donato, Anna Bertoni, Chiara Spatola, Ariela F. Pagani, Miriam Parise & Gianluca Castelnuovo

  2. Family Studies and Research University Centre, Università Cattolica del Sacro Cuore - Milano, Largo Gemelli, 1, 20123, Milan, Italy

    Giada Rapelli, Silvia Donato, Anna Bertoni, Ariela F. Pagani & Miriam Parise

  3. Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy

    Giada Rapelli, Chiara Spatola & Gianluca Castelnuovo

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  2. Silvia Donato
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Giada Rapelli, Donato Silvia, Bertoni Anna, Chiara Spatola, Ariela F. Pagani, Miriam Parise, and Castelnuovo Gianluca declare that they have no conflict of interest.

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Rapelli, G., Donato, S., Bertoni, A. et al. The Combined Effect of Psychological and Relational Aspects on Cardiac Patient Activation. J Clin Psychol Med Settings 27, 783–794 (2020). https://doi.org/10.1007/s10880-019-09670-y

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