A qualitative approach to developing a patient-derived intervention to increase exercise in peripheral arterial disease.
OBJECTIVE
In designing a patient-physician communication intervention, we explored patients' perceptions of the role of exercise in the treatment of peripheral arterial disease (PAD).


METHODS
We conducted qualitative interviews (5 focus groups and 13 one-on-one interviews) involving 35 patients with known PAD. We analyzed verbatim transcripts for significant dimensions of patients' explanatory models of PAD and exercise, perceptions of patient-physician communication, and other factors that would increase their participation in exercise (ie, walking). We used Atlas.ti software to facilitate data sorting and storage.


RESULTS
Based on 30 emerging codes, we identified primary themes that constitute patients' perceptions of (1) the causes and outcomes of PAD, (2) the importance of patient-physician communication, (3) the impact of PAD on their lives, and (4) the factors that would lead to their exercise participation to treat PAD. From this information, our conceptual model focuses on an intervention plan that includes addressing the known causes of PAD, the patient's behavior prior to the diagnosis of PAD, and the factors that shape a patient's overall assessment of the role of exercise for PAD. An integral aspect of our model is the impact of the physician's perception of PAD coupled with the patient's perception in order to shape the intervention-a partnership between the physician and the patient-that we posit is likely to lead to behavior change.


CONCLUSIONS
Based on qualitative data analysis, we developed a patient-derived model to influence exercise participation. This model highlights those factors most likely to influence behavior change in patients with PAD. The next step is to enact and assess an intervention based on this model, to increase physical activity in patients with PAD.
Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, and Section for Health Services Research, Baylor College of Medicine, Houston, TX, USA. tcollins@bcm.tmc.edu
Tracie C
TC
Collins
Tony L
TL
Kroll
Patricia N
PN
Krueger
Pamela
P
Willson
Carol M
CM
Ashton
Barbara F
BF
Sharf
D000368:Aged; D015331:Cohort Studies; D005006:Ethnicity; D015444:Exercise / Q000523:psychology; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D009043:Motor Activity; D010349:Patient Compliance; D016491:Peripheral Vascular Diseases / Q000523:psychology / Q000534:rehabilitation*; D010817:Physician-Patient Relations; D011788:Quality of Life; D012307:Risk Factors