title: Understanding the influence of urban- or rural-living on cardiac patients' decisions about diet and physical activity: descriptive decision modeling.
abstract: BACKGROUND
  It is challenging to assist people to attend to risk factors for coronary artery disease (CAD). There is potential for cultural elements associated with place of residence (i.e., urban- or rural-living) to have an effect on peoples' decision-making about managing CAD risk.
  
  
  OBJECTIVE
  To better understand patient's decision-making processes regarding having a heart-healthy diet and engaging in regular physical activity (major CAD risk factors), and the potential influence of urban- or rural-living.
  
  
  METHODS
  Based on a previous series of qualitative interviews with 42 cardiac patients (21 urban-living, 21 rural-living), hierarchical decision-models regarding eating a heart-healthy diet and engaging in regular physical activity were developed, and a survey based on the decision-models generated. The models were then tested for 'fit' with another group of 42 cardiac patients, and were revised to make them more parsimonious. The final models were tested with a novel group of 647 CAD patients from Alberta, Canada (327 urban-living, 320 rural-living). The primary analysis was focused on determining the extent to which patients completing the survey fell in the correct behavioral group. Thereafter individual nodes were examined to determine decision-making constructs that were different between urban- and rural-living patients.
  
  
  RESULTS
  When tested, the models had overall accuracy of 93.5% for diet and 97.5% for physical activity. The most salient model nodes that led to differing behavioral outcomes reflected these constructs: perception of control over health; time, effort, or competing priorities; receipt of appropriate information; and appeal of the activity.
  
  
  CONCLUSIONS
  This information is potentially useful to assist healthcare providers to: (1) understand patients' decisions regarding their cardiac risk factor modification behavior, and (2) better direct conversations about risk factor modification and educational activities.
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada. Electronic address: kingk@ucalgary.ca.
authors.forename: K M
authors.initials: KM
authors.lastname: King-Shier
authors.forename: C
authors.initials: C
authors.lastname: Mather
authors.forename: P
authors.initials: P
authors.lastname: LeBlanc
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000523:psychology*; D003657:Decision Making; D003661:Decision Support Techniques; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012424:Rural Population; D014505:Urban Population
keywords: Coronary artery disease; Decision-making; Diet; Exercise; Rural-living; Urban-living