Background
European guidelines advocate that secondary prevention for coronary heart disease (CHD) should include adopting a healthier diet and increasing physical activity (PA). Those with responsibility for healthcare should support people in their efforts to change their lifestyle behaviours. Interventions designed to improve secondary prevention improve life expectancy, processes of care and clinical outcomes. However, EUROASPIRE surveys show persisting unhealthy lifestyle trends and inadequate adoption of prevention measures within clinical practice.
Murray et al. stated that there was a lack of clarity about the main barriers and facilitators to lifestyle change among high risk patients. In their review incorporating 33 qualitative studies they presented five main themes – emotions, beliefs, information and communication, friends and family support, and cost/transport – as major influences of behaviour change. They concluded that further investigation was needed to determine which barriers and facilitators affected participation in behaviour change programmes.
A new framework, the 'behaviour change wheel', was designed in order to address the limitations of existing behaviour change frameworks, upon which many lifestyle interventions are based. This highlights a need to consider conditions internal to individuals, in addition to those within their social and physical environment, which need to exist before behaviour change can occur.There remains a gap in knowledge regarding the best approach to helping patients make and maintain lifestyle change.
Previously an intervention designed to support patients with CHD in lifestyle change and take into account known barriers to change was developed in the SPHERE Study (Table 1) and evaluated in a randomised controlled trial. Participants were invited to regular four-monthly consultations, during which motivational interviewing techniques were employed to address barriers to change and targets and goals were set and reviewed. Outcome data, collected in 2008, 18 months after the start of the intervention in each general practice (July 2005 to July 2007) showed that, whilst hospital admissions were reduced, no other benefits or effects on lifestyle behaviours were found.
The current study aimed to expand current knowledge of what helps and hinders patients with CHD to make and maintain lifestyle changes, by using a mixed methods approach: qualitative methods were used to explore the experiences of those who participated in the tailored intervention of the SPHERE Study and to help explain measurement data derived from validated questionnaires.