Cardiovascular disease (CVD) is a leading cause of death worldwide . In Israel, heart disease is the second most common cause of death among the general population, and the main cause among people aged 75 or older .
In order to prevent recurrence after an acute coronary event, patients are advised to change lifestyle habits that are major risk factors for CVD. Specifically, there are compelling recommendations to adopt an active lifestyle [3, 4]. Despite this, there continue to be large segments of the patient population that do not exercise on their own volition nor avail themselves of organized rehabilitation services. There is also an increasing awareness that ethnic minorities figure prominently among those population groups that do not adhere to these recommendations [5, 6].
Participation in Cardiac Prevention and Rehabilitation programs (CPRP) is probably the most effective way to promote engagement in an active life routine. Indeed, CPRP is recommended by the major international guidelines following an acute coronary event [7, 8]. Despite these recommendations, once again minorities are known to participate less in CPRP worldwide [9–11]. We have shown substantial differences between the Jewish majority and the Arab minority in Israel with regards to participation in CPRP, 61.1% and 17.2%, respectively .
An examination of patient-related barriers is essential to promote adoption of an active lifestyle either independently or through CPRP participation. Theories of health behavior emphasize that the way people perceive the situation they encounter is a crucial determinant of health-promoting behavior . It is therefore plausible to assume that the challenge of equalizing services in minority ethnic groups also depends on understanding patients’ health and illness cognitions, i.e. attitudes and perceptions of their illness and the ways to cope with it. This report, theoretically based on the Health Belief Model (HBM) and the Common Sense Model (CSM), focuses on the individual’s illness cognitions as contributing to adoption of an active lifestyle and participation in CPRP among Jewish and Arab patients following acute coronary syndrome (ACS).
The Health Belief Model (HBM) , which has been extensively applied to explore the association between individuals’ cognitive beliefs and health behavior, is considered an effective tool for preventive health interventional planning .
The original model includes the following dimensions: perceived susceptibility (subject’s perception of the risk of contracting a condition); perceived severity (the medical, clinical and social consequences of the illness); perceived benefits (the subject’s estimate of the effectiveness of a given intervention); and perceived barriers (an estimate of possible negative consequences of a given behavior/intervention).
Aside from focusing on the illness situation per se, a substantial body of literature in the psychology arena has also focused on variables which characterize the patient. One important variable that has been shown to be associated with participation in CPRP is belief that the illness could be controlled . This variable is particularly relevant to the current study since it focuses on the illness cognitions of two different ethnic groups, which may differ in their perceptions regarding control over the disease . The current study followed Levental’s well-known common sense model (CSM) and focused specifically on the contribution of both personal control and treatment control to self-adaptive physical activity or participation in CPRP after ACS [18, 19]. Personal control evaluates one’s subjective assessment of his/her ability to deal with the illness whereas treatment control taps one’s intuitive understanding of the efficacy of one’s treatment.
Although many studies have demonstrated the important contribution of illness cognition (IC) to the adoption of an active lifestyle as well as participation in CPRP [16, 20–25], exploration of these associations in minority populations has been limited [26–28].
Therefore, the current longitudinal prospective study examined the contribution of illness cognition (the four HBM components together with the two CSM aspects of perceived control) to the adoption of an active lifestyle and participation in CPRP among Jewish (majority) and Arab (minority) patients hospitalized with acute coronary syndrome in an Israeli community hospital.