Behavioral Medicine Interventions in Secondary Prevention of Coronary Heart Disease
Gunilla Burell University Hospital-Uppsala
For people who work in the context of giving patients advice on health and lifestyle, it often comes as a surprise that patients do not do as they are told. Studies show that compliance is often discouragingly low, even to simple medical prescriptions. There is an obvious and straightforward answer to why patients do not apply the wisdom of physician advice to their daily lives -- they do not have the necessary behavioral skills. Knowing what is right does not automatically make one do the right thing. Theoretical knowledge has fairly little impact on people's daily behavior. It is a well-known fact, from studies of congruence between attitudes and behavior, that the importance of motivation may be overestimated as an influence on what people actually do. Considering that the changes required in disease prevention are often quite complex when it comes to behavior and lifestyle change, this should not come as a surprise. Disease prevention could therefore be defined as a professional activity aimed at initiating and enhancing the development of behavioral skills in patients -- skills necessary to preserve and sometimes improve health. Secondary prevention can be defined as such an activity aimed at patients with existing documented disease.
For patients with coronary heart disease (CHD), the purpose of secondary prevention is to combine medical, surgical, and behavioral strategies, methods, and techniques to slow down or stop the progression of the disease. By this means, postponement or avoidance of further manifestations of the disease is hopefully achieved. Thus, secondary prevention may prolong or improve positive effects of acute interventions. All secondary preventive interventions should be viewed as active ways to influence and treat the disease.