Development of a health-related lifestyle self-management intervention for patients with coronary heart disease Ritin Santiago Fernandez, PhD, MN, RN, a,b Patricia Davidson, PhD, RN, c Rhonda Griffiths, DrPH, RN, a,b,e Craig Juergens, FACC, FRACP, MBBS, d and Yenna Salamonson, PhD, RN e Risk-factor modification after an acute coronary event is imperative, and intervention strategies are continuously being developed to assist patients with behavioral change and, consequently, decreasing the risk of further coronary episodes. This article describes the development of the health-related lifestyle self-management (HeLM) intervention, which is a brief structured intervention embedded within the transtheoretical model of behavioral change. The HeLM intervention was developed by undertaking three discrete yet interrelated studies and consisted of the following components: goal-setting, the HeLM booklet, feedback regarding personal risk, team-building and communication with the patient’s family physician, three supportive telephone calls, trained interviewers, a refrigerator magnet, and a health diary for self-monitoring. The HeLM intervention has been successfully implemented in 50 patients with acute coronary syndrome after discharge from hospital and has been demonstrated to be feasible and practical and could easily be delivered by health care professionals. (Heart Lung® 2009;38:491– 498.) C oronary heart disease (CHD) remains the leading cardiovascular cause of mortality and morbidity globally. 1 The associated costs re- sulting from physical and psychosocial disabilities places a significant burden on the patients and the community. 2 Failure to modify risk factors contrib- uting to CHD, such as low physical activity levels, 3 hypertension, 3 dyslipidaemia, 3 smoking, 3,4 hypergly- cemia, 3 and obesity, 3 are associated with CHD pro- gression and an increased incidence of mortality and morbidity. Therefore, it is essential for patients with known CHD to adopt recommended lifestyle and behavioral changes to ameliorate modifiable risk factors and minimize CHD progression. 5 Cardiac rehabilitation remains the “gold stan- dard” for all patients with CHD because it enables return to an active and satisfying life, decreases mortality by 35%, and prevents recurrent cardiac events. 6 Despite these benefits, participation and adherence to cardiac rehabilitation programs re- mains low. 7,8 Barriers to participation in these pro- grams included limited availability and accessibil- ity, program length (ranging from 4 weeks to 1 year), distance from home or work, time conflicts, lack of physician and family support, and transportation and scheduling of classes. 7,9 Various strategies to increase participation rates and promote adherence to cardiac rehabilitation programs, including the introduction of evening classes, provision of trans- port, and home-based cardiac rehabilitation, 9 have been implemented with limited success. Poor atten- dance at cardiac rehabilitation programs clearly in- dicates that alternate strategies for delivering infor- mation relating to cardiac risk factors and support for these patients is essential. New intervention strategies, such as individual- ized coaching 10 and modular approaches 11 for car- diovascular risk-factor modification, are continuously being developed. Trialling models of interventions that have been demonstrated to be effective in other clinical settings is one way of addressing this problem. A brief intervention (BI) 2,12,13 is another method that has been used to motivate people to adopt healthy behaviors. A BI is a simple and effective tool con- From a South Western Sydney Centre for Applied Nursing Re- search, NSW; b New South Wales Centre for Evidence-Based Health, University of Western Sydney; c Family and Community Health College of Health and Science, Curtin University of Tech- nology, NSW; d Interventional Cardiology, Liverpool Health Ser- vice, Sydney; e University of Western Sydney Australia, Australia. Corresponding author: Ritin Santiago Fernandez, Senior Lecturer University of Western Sydney, Campbelltown, Australia. 0147-9563/$ – see front matter © 2009 Published by Mosby, Inc. doi:10.1016/j.hrtlng.2009.01.008 HEART & LUNG VOL. 38, NO. 6 www.heartandlung.org 491