Knowing but not doing: how psychological factors influence adherence in cardiovascular patients

Cardiovascular diseases remain the leading cause of death worldwide, and to a large extent they can be prevented through a healthy lifestyle. When disease strikes, adherence is essential – patient involvement in treatment, correct use of medication, a healthy diet, physical activity, and health monitoring.

Studies have shown that lifestyle and health behaviour changes significantly improve patient outcomes, but it is often difficult to implement such changes. Therefore, to better understand how to promote adherence, a deeper understanding of the role of psychological factors in patient behaviour is needed.

In her doctoral thesis, Acting Asst. Mg. psych. Gunita Skaldere-Darmudasa, PhD student at the RSU Department of Health Psychology and Pedagogy and a clinical and health psychologist, explores how psychological factors determine patient compliance with treatment and care for heart health.

She identifies several key factors:

• Illness perception –how patients understand and evaluate their diagnosis and its consequences; better understanding correlates with higher treatment compliance;
• Self-efficacy – ''belief in one’s ability to influence one’s health; patients with high self-efficacy are more likely to follow recommendations regarding diet, physical activity, and medication use;
• Emotion regulation skills – the ability to manage stress and negative emotions; help to maintain healthy behaviour in stressful situations;
• Health locus of control –determines whether individuals perceive themselves as responsible for events in their lives and their health (internal locus) or shift this responsibility onto others, such as doctors or fate (external locus). An internal locus correlates with higher compliance and active involvement in maintaining health.

The aim of the study is to investigate the relationship between adherence and its psychological and demographic factors in people with cardiovascular diseases. Initial data from the study show that only one third of patients believe they know enough about the use of prescribed medications, 70% would like additional information, and 81% would like individual consultations on how to maintain their health, taking into account their diagnosis. Similarly, patients with a pronounced internal locus of control are more likely to follow their doctor’s recommendations and demonstrate a higher level of treatment control, while patients with poor disease awareness are less likely to engage in maintaining their health. These aspects emphasise the role of knowledge in health behaviour, as well as the importance of being aware of one’s responsibility and control over one’s health.

Individual approach to promotion of adherence

The researcher emphasises that an individual approach to patient education – both regarding the use of medication and overall health maintenance – would be effective in promoting adherence, because as long as the issue is addressed in general terms, it does not seem as important. Only after being diagnosed and leaving the doctor’s office with the first prescription do patients start asking questions: What should I do? What kind of medication should I take? Why? Will I be able to stop taking medication? When will I feel better? Can I fully recover? What else can I do to stop the disease from progressing?

Good cardiovascular health is clearly not self-evident – in most cases it requires purposeful effort in self-care, mindfulness, and a good understanding of our bodies and bodily reactions when the body is signalling that something is wrong. Are we able to notice symptoms in a timely manner? Can we recognise them?

Our everyday behaviour is something we can control – what we eat, how much we move, how close our relationship with our bodies is and how we feel. Behaviour is also something we can change, if we put in purposeful effort for the sake of our heart health. Therefore, I urge everyone to think about habits they could change in their health behaviour by being more adherent and responsible for their own heart health.

Gunita Skaldere-Darmudasa

From study to practical recommendations to support patients

The study is being conducted in close collaboration with general practitioners throughout Latvia and cardiologists at major cardiology centres, ensuring that data is collected in a real clinical setting. This approach allows the study results to be based on practical experience and the everyday needs of patients.

Over the course of the study, evidence-based recommendations will be developed to promote adherence, paying particular attention to the role of psychological factors in health behaviour. These recommendations are intended for both patient education and the work of healthcare professionals, so that support for patients is more targeted, individually tailored, and effective in the long term.