Patient Perception, Preference and Participation Perceptions of cause of illness in acute myocardial infarction patients: A longitudinal study Orna Reges a,b, *, Noa Vilchinsky c , Morton Leibowitz a,d , Dafna Manor a , Morris Mosseri a , Jeremy D. Kark b a Meir Medical Center, Department of Cardiology, Kfar Saba, Israel b Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel c Bar-Ilan University, Department of Psychology, Ramat-Gan, Israel d N.Y.U. School of Medicine, Department of Cardiology, New York, USA 1. Introduction The current approach to the prevention of heart disease and to the rehabilitation of patients with established disease emphasizes the psychosocial factors as well as the more conventional medical aspects [1–3]. These factors include social, personal, psychological and cognitive factors [1]. The cognitive factor – i.e., the perceptions and beliefs that a person has regarding his/her illness – may play an important role in determining a person’s mode of coping with his or her illness. Therefore, this factor may have a crucial impact on patients’ recovery and wellness [3,4]. Leventhal proposed a comprehensive theoretical cognitive model for explaining patients’ behavior, incorporating perception of cause as one of its major determinants [4]. Most studies in this area have shown that psychosocial factors, especially stress, are very commonly cited causes of illness, in addition to the conventional risk factors such as smoking, hyperlipidemia, sedentary lifestyle and poor diet [1,5–8]. Studies focusing on the associations between cardiac patients’ perceptions of the possible cause of their illness and various outcome measures showed that, in most cases, the more the illness was attributed to conventional factors under the patient’s behavioral control, the more the patient was likely to perform health promoting behaviors [9,10], including participation in a cardiac prevention and rehabilitation program (CPRP) [11]. Further, patients who attribute their illness to factors such as fate, luck or stress have returned more slowly to work [12] and have had a higher recurrence of acute myocardial infarction [13]. Identification and characterization of patients who tend to attribute their illness only to psychological factors and refrain from attributing their illness to the conventional risk factors may enable health care professionals to direct recommended interventions to the vulnerable population [14]. Few studies have targeted the change in patients’ perception of cause of illness over time [1,15]. Cameron et al. [1] reported little change in attributions over a six month period in a small sample Patient Education and Counseling 85 (2011) e155–e161 A R T I C L E I N F O Article history: Received 27 May 2010 Received in revised form 31 October 2010 Accepted 31 December 2010 Keywords: Myocardial infarction Illness attribution Cardiac risk factors Socio-demographic status Cardiac rehabilitation Patient education A B S T R A C T Objective: To assess change in patient’s attributions of illness over the long term in patients with acute myocardial infarction (AMI). Methods: 178 patients were asked during the index hospitalization and 2–2.5 years after discharge whether they thought each of 13 possible factors may have contributed to their illness. Two dichotomous variables, conventional attribution (attribution to traditional risk factors, CA) and psychosocial attribution (PA), were defined and assessed for each patient. Results: General stress, cigarette smoking, and heredity were the most commonly mentioned attribution for the AMI. The proportion of individuals with positive CA increased at follow up. There was little congruence between patients’ attributions and actual self-reported risk factors, either at baseline or at follow up. Age, education, country of birth, and anxiety were found as independent predictors of illness attribution. The participation in a cardiac prevention and rehabilitation program (CPRP) did not contribute to a significant change in CA attributions. Conclusion: Substantial proportions of patients have a poor understanding of the causes of their AMI both at onset of the illness and 2–2.5 years later, notwithstanding CPRP. Practice implications: The health care system can ill afford complacency with regards patient education and understanding. ß 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Cardiology, Meir Medical Center, Kfar Saba, Israel. Tel.: +972 9 7471061; fax: +972 9 7471064. E-mail addresses: Orna.Reges@clalit.org.il, oreges@013.net.il (O. Reges). Contents lists available at ScienceDirect Patient Education and Counseling jo ur n al h o mep ag e: w ww .elsevier .co m /loc ate/p ated u co u 0738-3991/$ – see front matter ß 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2010.12.022