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Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention

Kähkönen, Outi PhD, RN; Saaranen, Terhi PhD, RN, PHN; Kankkunen, Päivi PhD, RN; Miettinen, Heikki PhD, MD; Kyngäs, Helvi PhD, RN

doi: 10.1097/JCN.0000000000000592
ARTICLES: Adherence
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Background: Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients.

Objective: The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention.

Methods: A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model.

Results: Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it.

Conclusions: Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.

Outi Kähkönen, PhD, RN Doctor, University Teacher and Post Doctoral Researcher, Research Unit of Nursing Science and Health Management, University of Oulu, Finland.

Terhi Saaranen, PhD, RN, PHN Docent, Department of Nursing Science, University of Eastern Finland. Kuopio, Finland.

Päivi Kankkunen, PhD, RN Docent, Department of Nursing Science, University of Eastern Finland. Kuopio, Finland.

Heikki Miettinen, PhD, MD Docent, Kuopio University Hospital, Finland.

Helvi Kyngäs, PhD, RN Professor, Research Unit of Nursing Science and Health Management, University of Oulu, Finland.

Statistical supervision: Pertti Töttö, professor, Department of Social Science, University of Eastern Finland (pertti.totto@uef.fi).

Ethical approval was provided by the ethical review board of University Hospital of Kuopio (ref. 74/2012).

The authors have no funding or conflicts of interest to disclose.

Correspondence Kähkönen Outi, PhD, RN, Department of Nursing Science, University of Oulu, Aapistie 5, 90220 Oulu, Finland (outi.kahkonen@uef.fi).

Online date: July 31, 2019

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