Objective. Cardiovascular diseases (CVD) are one of the most common causes of death. Healthy lifestyle changes are the focus of primary prevention of CVD. Naturally occurring health events that...Show moreObjective. Cardiovascular diseases (CVD) are one of the most common causes of death. Healthy lifestyle changes are the focus of primary prevention of CVD. Naturally occurring health events that spontaneously urge behavior changes have been defined as Teachable Moments (TM). However, so far TMs have been explored in urgent life events, such as experiencing an acute coronary event. The present study aimed to explore whether a less urgent event, such as being confronted with an increased risk of CVD would be a TM, which psychosocial factors are predicting this, and whether experiencing a TM in turn leads to improved health outcomes. Method. The study included 114 patients from GP practices, who were informed about their increased risk for developing CVD. They were provided with “The Stevit Box”, an at-home self-monitoring device measuring blood pressure (BP) and weight. Participants further filled out the Cardiac Lifestyle Change Intention (LCI) scale. Univariate and multivariate regression analyses were used to investigate whether risk perception, affective impact, and a changed self-concept predicted LCI and reductions in BP and body mass index (BMI) at six months, controlling for BP and BMI at baseline. Further, univariate regressions were conducted with LCI as the predictor and BP and BMI as outcome variables, while controlling for baseline measurements. Results. Of our participants, 55.3% experienced increased lifestyle change intentions. A lower risk perception ((B= -0.27; CI = -0.39 - (-0.15)) and a higher change in self-concept (B = 0.34; CI= 0.23 - 0.44) were predictors of LCI. High risk perception (B= 0.23; CI= 0.06 - 0.42) and higher changes in self-concept (B= 0.54; CI= 0.37- 0.72) predicted a lower BMI reduction at six months. A higher change in self-concept predicted a higher reduction in BP (B=-3.32; CI= -6.55- (-0.09)). Lastly, LCI predicted higher reductions in BP (-5.04; CI= -9.08- (-0.29)). Conclusion. Results suggest that less urgent cardiac events, such as a confrontation with an increased risk for CVD, can be experienced as a potential TM that urges lifestyle change intentions and affects health outcomes. TMs may offer a unique opportunity to urge lifestyle changes in primary care.Show less
Research master thesis | Psychology (research) (MSc)
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Background: Research has identified psychological factors as important predictors of highly prevelant persistent somatic symptoms (PSS). However, this research is generally not based on primary...Show moreBackground: Research has identified psychological factors as important predictors of highly prevelant persistent somatic symptoms (PSS). However, this research is generally not based on primary care data and general practitioners (GPs) experience difficulties identifying PSS in their patients. Awareness of the psychological risk factors noted in readily accessible electronic medical records (EMRs) might aid GPs with earlier discovery and treatment. Aim: The objective was to examine the predictive value of psychological registrations in primary care for PSS onset. Method: We employed a retrospective longitudinal cohort design. EMR data of Dutch primary care patients were allocated into different subsamples according to registrations of irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), fibromyalgia (FM), and a combination of these registrations (COMBI) with age and sex-matched non-PSS cohorts. Candidate predictors were registered psychological symptoms, mental health referrals, and psycho-pharmaceuticals registered prior to PSS onset. The relevance of each candidate predictor was determined via L1 regularization in a logistic Lasso regression. The resulting prediction models’ performance was assessed via area under the curve (AUC). Results: The AUC indicated a fair classification performance for IBS (AUC IBS = .77), and good classification performances for CFS, FM, and COMBI (AUC CFS = .82, AUC FM = .88, and AUC COMBI= .87). The IBS-, CFS-, FM-, and COMBI-models, retained a total of 27, 12, 22, and 15 predictors, respectively. The strongest predictor per model was registration of sexual dysfunction for IBS (OR = 4.0), concentration disorder for CFS (OR = 2.4), neurasthenia for FM (OR = 3.0), and concentration disorder for COMBI (OR = 3.8). Neither of these predictors was unique to one specific model. Each final model retained mental health referrals, psycho-pharmaceuticals, and certain psychological symptom registrations as valuable predictors. Based on shared predictors IBS and FM had the closest models while IBS and CFS models were the most dissimilar. Discussion: These findings indicate that several psychological registrations are valuable predictors for onset of IBS, CFS, and/or FM. Therefore, GPs should consider the according predictors when screening for PSS. Future research could examine the comparatively low classification performce for IBS and psychological factors outside of primary care across PSS subtypes.Show less
