Pre-exercise screening and health coaching in CHD secondary prevention: A qualitative study of the patient experience
Shaw, R and Gillies, M and Barber, J and Macintyre, K and Harkins, C and Findlay, IN and McCloy, K and Gillie, A and Scoular, A and MacIntyre, PD, Pre-exercise screening and health coaching in CHD secondary prevention: A qualitative study of the patient experience, Health Education Research: Theory and Practice, 27, (3) pp. 424-436. ISSN 0268-1153 (2012) [Refereed Article]
Secondary prevention programmes can be effective in reducing morbidity and mortality from coronary heart disease (CHD). In particular, UK guidelines, including those from the Department of Health, emphasize physical activity. However, the effects of secondary prevention programmes with an exercise component are moderate and uptake is highly variable. In order to explore patients' experiences of a pre-exercise screening and health coaching programme (involving one-to-one consultations to support exercise behaviour change), semi-structured telephone interviews were undertaken with 84 CHD patients recruited from primary care. The interviews focused on patients' experiences of the intervention including referral and any recommendations for improvement. A thematic analysis of transcribed interviews showed that the majority of patients were positive about referral. However, patients also identified a number of barriers to attending and completing the programme, including a belief they were sufficiently active already, the existence of other health problems, feeling unsupported in community-based exercise classes and competing demands. Our findings highlight important issues around the choice of an appropriate point of intervention for programmes of this kind as well as the importance of appropriate patient selection, suggesting that the effectiveness of health coaching may be under-reported as a result of including patients who are not yet ready to change their behaviours.