John, Catherine Holly (2011)
Ph.D. thesis, University of Birmingham.
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and patients require appropriate information and education. Cardiovascular disease (CVD) accounts for 50% of its mortality, due to both clustering of traditional risk factors and the novel role of systemic inflammation. However, there are no educational materials about CVD designed specifically for people with RA; existing generic resources are likely to be inadequate as their advice is not set in the context of the physical and psychosocial constraints of RA. Using a recommended framework for the design of complex interventions, qualitative stakeholder research was undertaken which informed the design of an eight week cognitive-behavioural education programme, underpinned by social cognition models and stages of change theory. An appropriate outcome questionnaire was developed and psychometrically validated. A randomised controlled trial of this programme showed that, compared to controls, patients achieved significant improvements in knowledge, which translated into changing their psychological views, particularly intentions, to make behaviour change and, in turn, an improvement in diastolic blood pressure was observed. The implications of this study are that patient education has a significant role to play in CVD risk factor modification for patients with RA and furthermore a theoretically-driven process of developing patient education materials is the approach most likely to yield dividends.
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