Understanding the influence of urban- or rural-living on cardiac patients’ decisions about diet and physical activity: Descriptive decision modeling

• Published in: International journal of nursing studies Vol. 50; no. 11; pp. 1513 - 1523
• Main Authors: King-Shier, K.M., Mather, C., LeBlanc, P.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-11-2013; Elsevier Limited
• Subjects: Aged; Cardiovascular disease; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - psychology; Coronary artery disease; Decision Making; Decision Support Techniques; Diet; Exercise; Female; Humans; Male; Middle Aged; Motor Activity; Nursing; Physical fitness; Rural areas; Rural Population; Rural-living; Urban areas; Urban Population; Urban-living; Alberta Canada; Canada; Decision-making; Exercise; Diet; Rural-living; Coronary artery disease; Urban-living
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2013.03.003

It is challenging to assist people to attend to risk factors for coronary artery disease (CAD). There is potential for cultural elements associated with place of residence (i.e., urban- or rural-living) to have an effect on peoples’ decision-making about managing CAD risk.
To better understand patient's decision-making processes regarding having a heart-healthy diet and engaging in regular physical activity (major CAD risk factors), and the potential influence of urban- or rural-living.
Based on a previous series of qualitative interviews with 42 cardiac patients (21 urban-living, 21 rural-living), hierarchical decision-models regarding eating a heart-healthy diet and engaging in regular physical activity were developed, and a survey based on the decision-models generated. The models were then tested for ‘fit’ with another group of 42 cardiac patients, and were revised to make them more parsimonious. The final models were tested with a novel group of 647 CAD patients from Alberta, Canada (327 urban-living, 320 rural-living). The primary analysis was focused on determining the extent to which patients completing the survey fell in the correct behavioral group. Thereafter individual nodes were examined to determine decision-making constructs that were different between urban- and rural-living patients.
When tested, the models had overall accuracy of 93.5% for diet and 97.5% for physical activity. The most salient model nodes that led to differing behavioral outcomes reflected these constructs: perception of control over health; time, effort, or competing priorities; receipt of appropriate information; and appeal of the activity.
This information is potentially useful to assist healthcare providers to: (1) understand patients’ decisions regarding their cardiac risk factor modification behavior, and (2) better direct conversations about risk factor modification and educational activities.