Self-management of vascular risk factors

Abstract

Summary The aim of this thesis was to provide insight into the potential of a self-management approach in treatment of vascular risk factors and to develop a self-management intervention. Furthermore to examine if this intervention, based on self-efficacy promoting theory, is effective in reducing vascular risk factors in patients with established vascular diseases. Patients with different manifestations of vascular diseases appeared to have high levels of self-efficacy concerning the self-management tasks necessary for adequate vascular risk reduction. When those patients had diabetes, overweight (BMI > 30 kg/m2) or were actually smoking, their self-efficacy was significantly lower. In a randomized controlled study measuring self-efficacy at the start and after one year, we found self-efficacy levels concerning healthy food choices and exercise increased, while other self-efficacy scores were not influenced by the intervention. Changes in self-efficacy between baseline and follow up were not associated to changes in vascular risk factors during the study. Because of the small differences between the intervention and control group in the randomized controlled trial concerning self-efficacy score at follow up, we hypothesized that the intervention needs more strongly theory based. Therefore we further developed a self-management intervention, based on Bandura’s social cognitive approach of behavioral change and Wagner’s cooperative problem definition. In evaluating this intervention we saw that cholesterol and blood pressure reduced more in the self-management group compared to the usual care group. Quality of life improved more in the self-management group. To better understand the underlying process we also analyzed the association between self-efficacy and health behavior according to guidelines for vascular risk reduction. Again we found changes in self-efficacy, especially concerning healthy food and exercise between baseline and follow up. The self-efficacy changes were associated to changes in behavior concerning food choices and to exercise behavior. Baseline level of self-efficacy was not associated to any behavioral change. But developing or continuing healthy behavior was associated to higher levels follow up self-efficacy. Self-efficacy and self-management are influenced by social support. Social support is known to be influential in morbidity and mortality of cardiovascular diseases. We measured social support in our vascular population to clarify the influence in vascular risk management. We found associations between social support from having a partner and reduction of BMI and some association between social support and blood glucose. No other associations between social support and vascular risk management were found. Although the changes in risk factors achieved with the self-management intervention were in the right direction, the absolute effect was relatively small. Optimal self-management of vascular risk factors might be too difficult with too little short-term health benefit to compensate for patients’ effort. The achieved behavioural changes are worthwhile in reducing cardiovascular risk on the long term.