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Tamara H. Bisbee, PsyD, is a 2012 graduate of the PsyD Program in Clinical Psychology at Antioch University New England.

Dissertation Committee

  • Susan Hawes, PhD (Committee Chair)
  • Victor Pantesco, EdD (Committee Member)
  • Thomas Stearns, PhD (Committee Member)

Keywords

cardiac rehabilitation, lifestyle behavior change, adherence, Transtheoretical Model of Change

Document Type

Dissertation

Publication Date

2012

Abstract

This dissertation describes a tele-health follow-up program designed to attend to the problem of noncompliance in the process of health-behavior change after formal Cardiac Rehabilitation treatment at a southern New Hampshire community hospital. Cardiac Rehabilitation treatment encompassing lifestyle behavior change is associated with a significant reduction in morbidity and mortality in individuals with Coronary Heart Disease. However, evidence that adherence to lifestyle behavior change recommendations diminishes significantly within six months of treatment suggests that noncompliance is a significant barrier to the secondary prevention of a disease with prodigious consequences. Accumulating evidence that Cardiac Rehabilitation treatment encompassing extended duration of contact with the treatment team is associated with long-term health-risk behavior change as well as significantly fewer clinical events provides rationale for development of this program. Consistent with the identified outpatient treatment program, the proposed aftercare program aims to achieve significant and sustained changes in risk-factor related lifestyle behavior areas. Based on the conceptualization that behavior change is an ongoing dynamic process that encompasses repeated cycles of relapse, the program provides ongoing telephone sessions over the first year after discharge from the outpatient program. The Transtheoretical Model of Change as it interacts with the principles of Motivational Interviewing provide the foundation for planning and facilitating interventions that are relevant to the patient during each contact. The RE-AIM Model guided the development and formative evaluation of the program. The proposed plan for summative program evaluation is based on guidelines provided by the American Association of Cardiovascular and Pulmonary Rehabilitation, and assesses outcomes in Health, Clinical, Behavioral and Service Domains. Barriers to implementation of the proposed program include financial issues as they interact with the necessity for provider training and the current economic environment that impedes the implementation of adjunct programs within the health-care system.

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