title: Do practitioners and friends support patients with coronary heart disease in lifestyle change? a qualitative study.
abstract: BACKGROUND
  Healthy lifestyles help to prevent coronary heart disease (CHD) but outcomes from secondary prevention interventions which support lifestyle change have been disappointing. This study is a novel, in-depth exploration of patient factors affecting lifestyle behaviour change within an intervention designed to improve secondary prevention for patients with CHD in primary care using personalised tailored support. We aimed to explore patients' perceptions of factors affecting lifestyle change within a trial of this intervention (the SPHERE Study), using semi-structured, one-to-one interviews, with patients in general practice.
  
  
  METHODS
  Interviews (45) were conducted in purposively selected general practices (15) which had participated in the SPHERE Study. Individuals, with CHD, were selected to include those who succeeded in improving physical activity levels and dietary fibre intake and those who did not. We explored motivations, barriers to lifestyle change and information utilised by patients. Data collection and analysis, using a thematic framework and the constant comparative method, were iterative, continuing until data saturation was achieved.
  
  
  RESULTS
  We identified novel barriers to lifestyle change: such disincentives included strong negative influences of social networks, linked to cultural norms which encouraged consumption of 'delicious' but unhealthy food and discouraged engagement in physical activity. Findings illustrated how personalised support within an ongoing trusted patient-professional relationship was valued. Previously known barriers and facilitators relating to support, beliefs and information were confirmed.
  
  
  CONCLUSIONS
  Intervention development in supporting lifestyle change in secondary prevention needs to more effectively address patients' difficulties in overcoming negative social influences and maintaining interest in living healthily.
authors.affiliation: UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Dunluce Health Centre, 1 Dunluce Avenue, Belfast BT9 7HR, Northern Ireland. jcole04@qub.ac.uk.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cole
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.forename: Nigel
authors.initials: N
authors.lastname: Hart
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Cupples
mesh_terms: D000368:Aged; D001294:Attitude to Health; D003327:Coronary Disease / Q000523:psychology / Q000628:therapy*; D004043:Dietary Fiber; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D058006:General Practice / Q000379:methods; D015438:Health Behavior; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D010817:Physician-Patient Relations; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods*; D012944:Social Support