Background
Despite the decline in mortality from cardiovascular diseases in recent decades, they remain a leading cause of death worldwide.1–3 Furthermore, they are responsible for an increasing number of deaths among people under 75 years of age.1 High morbidity also persists; approximately one-fifth of all non-healthy life years in Europe are due to cardiovascular disease, with half of these specifically due to ischaemic heart disease.4 5 In Portugal, there has been a notable increase in premature deaths among people under 70. Here, cardiovascular diseases account for 30% of all causes of mortality, with 21% of these being due to ischaemic heart disease.6
Despite the progress achieved in the treatment of ischaemic heart diseases, recovery from myocardial infarction remains problematic, as the causes of symptoms reported by the person are related to many aspects of health not only physical conditions.7 8 People with myocardial infarction might experience an identity shift, characterised by both losses and gains, and leading to a need to adapt regular activities in line with their ‘ill heart’ condition.9–11 A successful and sustainable recovery requires the acknowledgement of personal, psychological and social factors. This entails understanding the evolving nature of being, knowing and transforming as a person, a process that occurs both at the clinical and personal level.9 12 As such, the recovery process involves a personal dimension that allows the person to continue living with greater connection and renewed purpose (ie, gains).9
Evidence suggests a discrepancy between care delivered in a clinical setting and the needs and preferences of patients.13 Therefore, a person-centred approach to care becomes essential for recovery. This approach allows for a greater understanding of an patients’ perceptions and their role in the overall recovery process.10 14 15 Person-centred practice is committed to a person’s self-determination, beliefs and values, which are foundational for shared decision-making and encourage continuous development.12 Every person has a unique life story that lends meaning to what they value and influences their decisions towards the adoption of healthy behaviours. Thus, understanding a person’s life story can offer invaluable insight to foster recovery and reach psychosocial and physical well-being.12 To fully and comprehensively understand a person’s life story, including their inherent values, needs and resources, it is essential to be present in the moment and to intentionally recognise the patient as a person and an active partner in care.16 17
Underpinned on the person-centred practice framework by McCormack & McCance,17 the University of Gothenburg Center for Person-Centred Care (GPCC) developed an ethical model that is grounded on the best evidence, experience and practice and aims to support the implementation of person-centred care (PCC) interventions.18 The GPCC model establishes three routines in daily practice that support the establishment of PCC: (1) initiating the partnership by listening to the person’s narrative; (2) implementing the partnership through shared decision-making; and (3) safeguarding the partnership by documenting the narrative (figure 1).19 20
The three routines are integrated and together create person-centred care.20
Listening to a person’s narrative is the first step in establishing a partnership. It provides insight into their expectations, values and beliefs, feelings and fears, as well as their experience of myocardial infarction symptoms. Improved listening and communication by healthcare professionals may bolster a person’s self-efficacy and improve their ability to manage his/her cardiac condition.17 20 True cardiac recovery can be attained only when both the physical and psychological needs of the person are met. This can be best accomplished through a co-creation approach (implementing the partnership) where goals are set within a healthcare plan that incorporates patients’ capabilities, resources, and family and social support. These goals go beyond objective measures of clinical success and include subjective measures, such as the results reported by person and/or process-oriented results.18 In conventional care, health plans often comprise behavioural changes devised solely by health professionals. However, when people identify their own goals and resources, with the help of healthcare professionals, these goals often emphasise maintaining social relationships and being able to return to important activities of daily living. The partnership is documented (safeguarding) in the form of a health plan that combines the person’s own knowledge and the expertise and resources of the healthcare professional.20
Setting goals together makes people more aware of their own resources and ability to manage the consequences of a cardiac event.12 20 Their beliefs about how they can carry out these actions21 play a crucial role in shaping their self-efficacy and determining whether a given behaviour will be performed, the amount of effort that will be expended, and its sustainability over time in the presence of obstacles and/or adverse experiences.22 People with higher self-efficacy have better self-management and adherence to healthy lifestyles post-myocardial infarction. This, in turn, leads to an improvement in quality of life.23–27
Recent studies have shown that person-centred practices can modify and/or reinforce self-efficacy after a myocardial infarction. The early establishment of a partnership within the hospital stay28 can improve self-efficacy, which, in turn, is linked to better control of symptoms and functional maintenance after the cardiac event.8 23 28 29 A co-creation approach to goal setting allows the person’s perspective to come closer to that of healthcare professionals, which then reflects healthier behaviours.17 28 30
Starting from an evidence-based PCC intervention that was originally developed and evaluated for patients with acute coronary syndrome in Sweden, we purpose to culturally adapt it to be available to delivered to patients with myocardial infarction into the Portuguese healthcare context.
To ensure success, it is imperative to understand both the user’s and provider’s perspectives. This necessitates a co-creation approach, involving both the target beneficiaries of the intervention and those who will implement it.31 32 The insights of these stakeholders, who are familiar with the characteristics of the context, are vital in the adaptation of existing complex interventions into new environments.32
The research will aim to address the following key question: How should the content and delivery of an evidence-based PCC intervention to promote self-efficacy after a myocardial infarction be culturally adapted to align with the needs and characteristics of the Portuguese healthcare system?
This post was originally published on https://bmjopen.bmj.com