Symptoms as a moderator of the relationship between beliefs and behaviors among patients undergoing coronary artery bypass surgery

There is growing evidence suggesting health behaviors (e.g., physical activity, medications) significantly improve health outcomes and quality of life following coronary artery bypass graft (CABG) surgery. Despite the clear benefits of these behaviors, adherence is poor and interventions designed to promote them have yielded mixed results. This dissertation, guided by Leventhal's Commonsense Model of Self-Regulation (CSM) and Bandura's Social Cognitive Theory (SCT), was a descriptive study designed to identify beliefs that might predict adherence and serve as intervention targets. Participants were 89 CABG (M age = 65.4, 73% male, 79.8% white) surgery patients who spoke English and were free of any neurological, cognitive, or medical condition that might influence their ability to complete the study. They were interviewed prior to surgery about their CSM and SCT beliefs and their health behaviors (i.e., physical activity, medication adherence) using structured interviews. All measures exhibited factor structures that fit with a priori expectations and had acceptable reliability (αs between .67 and .91). Demographic information was gathered during the structured interviews. Medical information was gathered from medical records and aggregated to create a single cardiac risk factor index. Results suggested that personal control and emotional cause beliefs were positively associated with physical activity, whereas medical cause beliefs were inversely associated with physical activity. In addition, the relationship between symptoms and physical activity appeared to be statistically mediated by emotional cause beliefs. With regard to SCT beliefs, negative medication outcome expectancies (NMOE) was inversely associated with medication adherence, and the relationship between medication adherence self-efficacy and medication adherence was statistically mediated by NMOE. Examination of the possible moderating influence of symptoms on beliefs suggested that both self-efficacy and bed rest outcome expectancies were associated with physical activity if an individual was symptomatic but they were not associated with physical activity if an individual was asymptomatic. Overall, results suggest that integrating the CSM with SCT provides a useful conceptual framework for understanding medication adherence and physical activity. Future research is required to evaluate the prospective, predictive utility of this framework. In addition, interventions that are tailored to patients' symptom status seem worth pursuing.Ph.D.Includes bibliographical references (p. 58-62)