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EMPIRICAL STUDIES

The effect of education and telephone follow-up intervention based on the Roy Adaptation Model after myocardial infarction: randomised controlled trial

Selma Turan Kavradim PhD, RN (Assistant Professor) and Zeynep Canli €Ozer PhD, RN (Professor) Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey

Scand J Caring Sci; 2020; 34: 247–260

The effect of education and telephone follow-up

intervention based on the Roy Adaptation Model

after myocardial infarction: randomised controlled

trial

Background: Patients’ lifestyle changes after myocardial

infarction reduce the risk of infarction. Nursing interven-

tions are important for the initiation and maintenance of

lifestyle adaptation.

Aim: The aim of this study was to evaluate the effect of

education and telephone follow-up intervention based on

the Roy Adaptation Model for improving myocardial

infarction patients’ self-efficacy, quality of life and life-

style adaptation.

Method: In this parallel, randomised controlled trial,

patients were randomly allocated to a control group or

an intervention group (n = 33/group). The control group

received routine care, while the intervention group

received routine care plus a telephone follow-up inter-

vention, which consisted of a predischarge education pro-

gramme and three telephone follow-up sessions. Data

were collected before discharge, in the 12th week after

discharge between April 2016 and August 2017. All

outcomes were assessed at baseline and at 12 weeks, and

included quality of life, coping adaptation process, self-ef-

ficacy and lifestyle changes. The CONSORT checklist was

used in the study.

Results: In the 12th week after discharge, patients in the

intervention group had significant improvements in self-

efficacy, quality of life and coping adaptation process

compared with the control group. The intervention group

also had more adaptation lifestyle changes concerning

patients nutrition and physical activity in the 12-week

follow-up.

Conclusion: This study demonstrated that education and

telephone follow-up intervention based on Roy Adap-

tation Model was had positive and significant results

after 12 weeks compared with usual care. The findings

of this study are important for supporting nursing

practice and health professionals who care for individ-

uals with myocardial infarction to develop nursing

care.

Keywords: lifestyle change, myocardial infarction, nurs-

ing, telephone follow-up, Roy Adaptation Model, self-

efficacy.

Submitted 28 May 2019, Accepted 17 October 2019

Introduction

According to the European Society of Cardiology Guide-

line (2018), cardiovascular disease is the leading cause of

deaths; it was responsible for 17.5 million deaths with

46% of these deaths, an estimated 7.4 million, due to

ischaemic heart disease (1). Myocardial infarction (MI)

has an important place in ischaemic heart diseases. It

commonly appears during productive age, together with

acute postrhythm problems, heart failure, angina and

recurrence of MI (2,3). The social, psychological and

physical problems that occur after MI affect the quality of

life and self-efficacy (4) and make it difficult to adapt to

lifestyle change (3,5).

Lifestyle interventions for secondary prevention are

strongly emphasised by the guidelines of the European

Society of Cardiology and the American Heart Associa-

tion (1,6). Key lifestyle interventions include cessation of

smoking, diet advice, weight control and encouraging

physical activity (1). During the hospitalisation after MI,

the time for implementing secondary prevention is lim-

ited and nursing interventions are important for the initi-

ation and maintenance of lifestyle interventions (1,7).

Studies show that patients’ lifestyle changes after MI

Correspondence to:

Selma Turan Kavradim, Department of Internal Medicine Nursing,

Faculty of Nursing, Akdeniz University, Antalya, Turkey

E-mail: [email protected]

Name of trial registry of Clinical Trials: The Effect of Education and

Telephone Follow-up Intervention Based on the Roy Adaptation

Model, Identifier: NCT03771937

doi: 10.1111/scs.12793

https://orcid.org/0000-0002-2302-6823

https://orcid.org/0000-0001-8405-1208

mailto:

reduce the risk of infarction (1,6), but patients have diffi-

culty in making the changes. Because lifelong habits are

not easily changed, these changes take a long time (1,7).

Many techniques are used to improve adaptation to

lifestyle changes, such as home visits, telephone follow-

ups, self-management enhancement, patient education

and counselling (8,9). Among these interventions, it has

been stated that education is an effective method for risk

factor control and adherence to lifestyle change in that it

increases awareness and responsibility and also that fol-

low-up of these changes is important (1). Telephone fol-

low-up is an effective method of increasing quality of life

and self-efficacy, reducing stress and avoiding recurrent

hospitalisations (7,10,11). Recent meta-analyses of RCTs

have reported that telephone follow-up interventions are

associated with improvements in adaptation and lifestyle

changes (12–14). To reduce the rate of repeated cardio-

vascular events and improve adaptation, single methods

are commonly used in the literature, but it is thought

that the use of theoretical intervention applications in

combination with other methods based on evidence to

improve adaptation may be more effective. It is known

that the theory-based interventions contribute to an

increase in the effectiveness of nursing interventions

(15,16). Although some studies have been found in the

literature on improving quality of life, self-efficacy and

adaptation for patients with MI (7,10,11), no studies

have been reported on the education and telephone fol-

low-up intervention of patients with MI based on Roy

Adaptation Model (RAM).

RAM is an adaptation theory and interaction model,

which focuses on interaction between humans and the

environment as the basis of a conceptual model of nurs-

ing. It was developed in the 1960s by Sister Callista Roy

(16,17). The model is the most widely used and is being

continuously tested and developed in the field of nursing

research, practice and education (17). Physiological pro-

cesses (regulator subsystem) and cognitive and emotional

processes (cognator subsystem) holistically interact to

maintain personal integrity and foster adaptation and

personal growth. Because the regulator and cognator

subsystems are internal processes and cannot be directly

observed, these subsystems have been defined as adap-

tive modes (physiological mode, self-concept mode, role

function mode and interdependence mode) (16,18).

According to the model, the main concept of which is

adaptation, the purpose of nursing is to create effective

adaptive behaviours in these adaptive modes by using

the regulator subsystem and cognator subsystem of indi-

viduals against stimuli (focal, contextual and residual)

and to take the individual to an excellent level of adapta-

tion (16,18). The reason for preferring the RAM in this

study is its potential to be continuously used, tested and

improved in different patient groups. It strengthens adap-

tation by affecting the areas of physiology, self-concept,

role function and interdependence of individuals with

MI. According to the RAM, ‘person’ is the individual

who has undergone MI; ‘environment’ according to Roy

is the environment of the individual who has undergone

MI and consists of focus stimuli, affecting stimuli and

potential stimuli. ‘Health’ is the passing of the person

who has undergone MI from a state of unbalance to a

state of balance. ‘Nurse’ is the person who supports the

patient in the four adaptive fields by means of the nurs-

ing care given, who evaluates factors affecting behaviours

and adaptation skills, and who contributes to the health

and quality of life of the patient by increasing environ-

mental interaction. After MI, patients can show negative

coping behaviours such as denial of the disease and emo-

tional exhaustion, feelings of shame and guilt, insecurity,

and depressive and disease-centred behaviours (19). An

increase in adaptation enables patients to return to an

active life after MI, to pursue their lives in a healthy way

and to continue life under the best physical, mental and

social conditions (9,20).

Aims

The specific aim of this study was to evaluate the effect

of education and telephone follow-up intervention based

on RAM for improving MI patients’ self-efficacy, quality

of life and lifestyle adaptation. We hypothesised that edu-

cation and telephone follow-up intervention based on

RAM would (a) increase quality of life, (b) improve the

coping and adaptation process, (c) increase self-efficacy

and (d) enhance adaptation to lifestyle changes.

Methods

Study design

This study had a prospective, parallel, RCT research

design. Patients were randomly allocated who were

being treated for myocardial infarction in the hospital

and who met the inclusion criteria of the control group

or the intervention group. This study is based on rec-

ommendations from CONSORT Statement (See

Appendix S1) (21).

Participants and setting

This study was conducted at the Clinic and Polyclinic of

the Department of Cardiology of University Hospital in

Antalya, Turkey, between April 2016 and August 2017.

Inclusion criteria of the study were as follows: (a) partici-

pants were adults aged ≥ 30 years and had been admitted to the hospital with a diagnosis of MI (which must be

supported by ECG and an increase in biomarkers), (b)

were clinically stable, (c) willing to participate, (d) able

to understand and write Turkish, (e) able to receive

248 S. Turan Kavradim, Z. Canli €Ozer

telephone calls or fill in questionnaires, and (f) able to

come to the hospital for checkups. Patients were

excluded from the study if according to medical file

records they had chronic renal failure, cancer, heart fail-

ure, and severe aortic stenosis, if they were planned for

surgical treatment or had chronic cognitive and psychi-

atric disease, if they had problems with hearing and

speaking on the phone, or if they had mobility

restriction.

Randomisation

The simple randomisation method was chosen as the

randomisation method to provide an equal number of

samples in the intervention and control group. During

the study period, patients were recruited from the cardi-

ology clinic according to the inclusion criteria and ran-

domly assigned to either the intervention group

(n = 33) or the control group (n = 33) before pretest

data were collected. In order to randomise patients

according to the date of admission to the hospital, the

next envelope of those that had been prepared was

opened, and this determined whether the patient was

assigned to the intervention or the control group. Once

group allocation was decided, each subject was informed

in writing what his or her participation in the study

involved. The allocation was kept in sequentially num-

bered opaque envelopes by researcher. Single blinding

was provided that included inclusion criteria and agree-

ment to participate in the study. Patients did not know

whether they were included in the intervention group

or the control group. The patients were told that this

was a study with two parallel monitored groups. How-

ever, they were not told about the interventions applied

to the other group.

Data collection

The aims of the study and the research process were

explained to the patients who were being treated and fol-

lowed up at the cardiology clinic because of MI, who had

had an acute period of illness and who fitted the inclu-

sion criteria, after which their informed voluntary con-

sent was obtained with an Approval Form prepared in

line with the Helsinki Declaration. Collection of research

data was performed by the researcher by face-to-face

interview. Baseline data on quality of life, self-efficacy

and the coping adaptation process and adaptation to life-

style changes were collected at the hospital after ran-

domisation. Baseline data of the study were collected by

providing a quiet environment in the patient’s room in

the cardiology clinic between 9.00 and 12.00 hours, out-

side visiting time. Demographic and clinical data were

collected by self-report and from medical records during

hospital stays. The data collection period lasted

approximately 30 minutes for each participant. After this,

patients in the intervention groups were given education

by the researcher, with the help of an education booklet.

After the patients in the intervention group were dis-

charged from hospital, they were followed up and given

counselling by telephone by the same researcher. Post-

test data were collected by the researcher in the 12th

week after discharge when the patients arrived at the

polyclinic for checkup.

Preliminary application

To examine the feasibility of the research and the inter-

vention, research processes were applied as preliminary

applications to three patients with MI and patients inter-

viewed were not included in the study sample. Following

the preliminary application, a number of changes were

made to the study. Two sessions were originally planned,

but because patients were discharged from hospital in a

short time, this was reduced to one.

The intervention

The intervention group received face-to-face education

with an education booklet during the hospital, and after

discharge, three structured telephone call follow-up

interventions were conducted.

The education booklet was prepared by the researcher

according to the needs of the patients to know their risk

factors, to help the patients to establish an attitudinal

and knowledge foundation and adapt to the postdisease

lifestyle changes of patients with MI, based on evidence-

based treatment guidelines and RAM (1,6,18,22). In

accordance with the Discern Guide (23), ten expert opin-

ions were obtained. In addition, the booklet and the edu-

cation plan were translated into English and sent to

Sister Callista Roy via e-mail. We received positive feed-

back from Roy regarding the suitability of the booklet,

the CTE diagram and the education plan. The education

booklet had 33 pages and covered a range of topics

including cardiovascular risk factors, lifestyle change and

psychosocial support, the use of drugs, healthy nutrition,

active life and exercise, sexual life, smoking and alcohol

use, emotions and coping, and tests used in cardiology.

This education booklet was supported by visuals and

tables.

Education with the booklet. Education was delivered by

the research assistant, who had previous experience and

training in cardiology nursing and interviewing. Each

education session was conducted for 30-45 minutes and

in line with the goals set out in the education plan. Dur-

ing the education session, patient participation and ques-

tioning was encouraged and supported. In order to make

it easy to remember important points, marking was done

Education and telephone follow-up intervention 249

with the patient in the booklet, and the booklet was

given to the patients to recall and read again.

Telephone follow-up. Three structured phone calls were

conducted in the first, third and eighth weeks following

discharge from the hospital and each call was limited to

15—20 minutes. During these phone calls, the researcher

engaged the patient in sharing potential barriers to

adherence or other factors that might contribute to poor

disease control, discussed the patient’s readiness to mod-

ify behaviours and worked with the patient to agree on a

shared plan of strategies to improve adherence and dis-

ease control. For telephone calls, a form was prepared

including telephone follow-up and interview steps by the

researcher. The form consisted of appropriate lifestyle

measures and adaptation to follow, and covered patient

assessment, identification of problems, experience of

physical and emotional problems, adherence the lifestyle

change and reminders on issues patients deemed neces-

sary, health checks, identification of common goals, and

encouragement and enhancement of self-efficacy, finish-

ing and planning. Individually tailored telephone consul-

tation was also conducted by the researcher. In the

telephone calls, the researcher was available and coun-

selling was provided to patients any time it was needed.

Counselling was conducted under a protocol. In this pro-

tocol, patients were directed to the emergency clinic if

they had chest pain that lasted more than 15 minutes, a

pain which spread to the neck, lower jaw or left arm, a

pain which did not respond to nitroglycerin, palpitations,

severe breathlessness, symptomatic hypotension, uncon-

sciousness or syncope, and they were directed to the

polyclinic if they had side effects of medicines.

The process of using a conceptual model to guide

research requires the construction of a conceptual–theo-

retical–empirical (CTE) structure and communication of

that structure in a diagram and a narrative (15). The CTE

structure for this study is given in Fig. 1. This CTE struc-

ture provided a systematic framework to guide the evalu-

ation of patient data through a holistic approach,

planning and analysis of applications.

Control group. All patients in the control group received

usual care. Usual nursing care at the hospital consisted of

giving drug prescriptions, giving diet recommendations to

patients with a high cholesterol level and giving the

times to come for checkup at the time of discharge. Ethi-

cally, the patients in the control group were trained by

the researcher with the education booklet when they

completed the study.

Outcome measures

The primary outcomes were patients’quality of life, cop-

ing adaptation process and self-efficacy from baseline (in

hospital) to 12 week after randomisation. The secondary

outcomes were the change from baseline to 12 week

after randomisation of fasting triglyceride, high-density

Complications, Drugs

life activities

(Diet, exercise, ...)

Psychosocial

changes

Changing roles

and functions

Social

support

needs

MIDAS

Morisy Scale

CAPS

MIDAS

CAPS

General Self-

Efficacy Scale

CAPS MIDAS

CAPS

Coping mechanisms

Physiological processes after disease

Dealing with the problem after disease

Coping and Adaptation Process Scale

General Self-Efficacy Scale

Stumuli

Focal Contextual Residual

Biyo-Psycho-Social response modes

Physiological Self-concept Role-function Inter-

dependence

Subsystems

Regulator Cognator

Age, gender, genetics,

education level,

knowledge about the

disease and treatment,

economic conditions

Lifestyle (nutrition-

exercise-stress,

alcohol, smoking),

obesity

Beliefs about the

disease, cope with

the unknown factor

that will affect

Myocardial

infarction

Conceptual

Theory

Empirical

Hospital

records

Data collection form based on RAM

Research design Randomised

Controlled Trial

Samples MI patients

Self-efficiency Adaptation level in health

behavior

Quality of life

Intervention Nursing Care Based on RAM

Education and telephone follow-up

Neural,

chemicals,

endocrine

Perceptual, informational, learning,

decision making, emotional

Ineffective Responses Adaptive

responses

Figure 1 Conceptual–theoretical–experimental structure to myocardial infarction

250 S. Turan Kavradim, Z. Canli €Ozer

lipoprotein cholesterol (HDL) and LDL, body mass index,

dietary behaviour, smoking behaviour and walking for

exercise.

All participants completed a Personal Information

Form which contained 50 items that included demo-

graphic and disease-related information and cardiac

physiological risk parameters. This form was created by

the researcher and was piloted by nursing professionals

(15–18). The self-efficacy levels of the patients were

measured by the General Self-Efficacy Scale (GSES). The

GSES contains 10 items, and each item score ranges

from 0 to 5 (24). Cronbach’s a of the GSES was 0.83. The highest and lowest possible score is between 10 and

40. High score indicates that the individual perceives

high self-efficacy (25). To evaluate the coping and adap-

tation processes, the Coping and Adaptation (CAPS)

scale was used. The CAPS was developed by Callista Roy

(22). The Turkish validity and reliability study of the

scale was conducted by C�atal and Dicle (2015) (26), and the Cronbach alpha value was 0.82 for the total scale.

The highest and lowest possible score is between 47 and

188. Higher scores indicate better use of effective coping

methods (26).

To evaluate the quality of life after the disease, the

Myocardial Infarction Dimensional Assessment Scale

(MIDAS) was used. This was developed by Thompson

et al. in 2002. The Cronbach alpha values of the scale

were found in seven dimensions, and ranged from 0.74

to 0.95, showing it to be a useful and highly reliable tool

(27). The validity and reliability study of the scale was

made by Yilmaz et al. Cronbach alpha values ranged

from 0.79 to 0.90. The highest and lowest possible score

is between 0 and 100, with 0 indicating the best health

condition and 100 indicating the worst health condition

(28). Also, the Morisky Adherence Scale was used to

measure medication adherence. The scale was validated

by Morisky, Green and Levine in 1986. The Cronbach

alpha value was found to be 0.61 (29). The validity and

reliability study of the scale was conducted by Bahar

et al., and it was found to be a valid and reliable instru-

ment (30). Because of the participation in the research of

patients who did not have continuous medication, this

scale did not apply in baseline.

Data analysis

The sample size calculation was based on the conven-

tional method of power analysis by using a medium

effect size of 0.5, a power of 0.85 and a significance level

of 0.05. All statistical analyses were conducted with the

SAS 9.4 package. The test of conformity of the data used

primarily to normal distribution was performed with the

Shapiro–Wilk test. The results of the test indicated that

the data showed normal distribution, and parametric tests

were used. In two-way comparison between two-

category variables, t-test was applied for independent

groups, and in order to find the differences between vari-

ables with three or more categories, ANOVA analysis was

applied. As a test of the time of two different measure-

ments obtained from the same individuals, the paired

sample t-test was used. Repeated measures variance anal-

ysis was used to examine whether there were differences

over time and between groups in mean scale scores, and

chi-square or the Fisher’s exact chi-square test was used

to see whether there was a difference in categoric vari-

ables between the experimental and control groups. In

the whole of the study, the significance level was taken

as 0.05.

Results

Characteristics of study participants

During the application phase of the study, 141

patients with a diagnosis of MI were evaluated, and

of these, 66 consented to participate in this study.

However, four patients were lost to follow-up: contact

was lost with two patients, and two patients did not

come for checkups in the hospital (Fig. 2). The demo-

graphic and clinical characteristics of the patients are

shown in Table 1. No differences among the control

and the intervention group were noted in terms of

according to sociodemographic characteristics. The

majority of participants were male (51/66, 82.26%)

with a mean age of 57.79 years (SD = 11.17), 53.23%

were not working, and 66.13% had a family history

of heart disease.

Quality of life, self-efficacy and coping and adaptation

In a comparison of quality of life data with MIDAS, phys-

ical activity (F = 2.86, p = 0.0049), insecurity (F = 2.73,

p = 0.0072), emotional reaction (F = 2.72, p = 0.0074)

and side effects (F = 3.50, p = 0.0006) revealed a signifi-

cant difference between the two groups from the baseline

to the 12th week (Fig. 3). However, other domains of

MIDAS no statistically significant differences were

observed (Table 2; Fig. 3). As shown in Table 2, there

were also significant improvements in self-efficacy (F=

�4.22, p = 0.0001) in the intervention group. Addition- ally, comparison of the coping and adaptation process

with CAPS between groups revealed a significant differ-

ence (F= �4.54, p = 0.0001) at 12 weeks (Fig. 3). There were no statistical differences between the groups for

medication adherence. It was determined that 96.77% of

the intervention group and 93.55% of the control group

continued medication use. Also, both groups were found

to show high adherence to regular use of the medication

(83.87% in the intervention group and 77.42% in the

control group).

Education and telephone follow-up intervention 251

Changes in lifestyle habits between the two groups during the

12-week study period

There was a higher adherence level in the intervention

group than in the control group on active lifestyle and

physical activity (p < 0.001). Also, a meaningful difference

was found in dietary behaviour between the two study

groups, with better results among patients who received

intervention (p = 0.023). The intervention was not effec-

tive on smoking cessation (p = 0.608) or symptoms experi-

enced (p = 0.194) (Table 3). The effect of the intervention

on physical parameters, serum high-density lipoprotein

(p = 0.045) and waist circumference (p = 0.011) was

confirmed and there was a significant difference between

the groups. However, no significant differences were

observed in other outcomes (p> 0.05) (Table 4).

Discussion

This study reported conducting a holistic intervention

related clinically important topic and aimed at improving

self-efficacy, quality of life and coping adaptation process

to lifestyle changes post-MI. The innovative aspect of this

study was that a nursing model was integrated into edu-

cation and telephone follow-up intervention on adapta-

tion for MI patients. To our knowledge, this study is the

first RCT to evaluate the effectiveness of education and

telephone follow-up intervention based on the RAM for

improving MI patients’ self-efficacy, quality of life and

lifestyle adaptation. This study demonstrated that educa-

tion and telephone follow-up intervention based on the

RAM was effective and applicable to increasing self-effi-

cacy, the coping and adaptation process and quality of

life, and to potentially enhancing exercise and diet

adherence in MI patients.

Quality of life, self-efficacy and coping and adaptation process

In this study results show that there was an increase in

the quality of life during the follow-up in the interven-

tion group, but that the control group showed a decrease

in quality of life during the follow-up period (Fig. 3).

Among the reasons why the intervention was effective, it

is thought that the MIDAS quality of life scale is related

to four bio-psycho-social response modes. There are simi-

larities between the physiological field and the quality of

Figure 2 Flow diagram of the study

252 S. Turan Kavradim, Z. Canli €Ozer

Table 1 Characteristics of participants

Characteristics of participants

Intervention

group

(N = 31)

Control

group

(N = 31)

Total

(N = 62)

v2 P valuen % n % n %

Gender Female 5 16.13 6 19.35 11 17.74 0.111 0.740*

Male 26 83.87 25 80.65 51 82.26

Age (years) Mean �x � SS 56.23 � 10.16 59.35 � 12.05 57.79 � 11.17 t = 1.105 0.273

Educational status Primary school 16 51.61 19 61.29 35 56.45 1.477 0.478

High school 6 19.35 7 22.58 13 20.97

College/university 9 29.03 5 16.13 14 22.58

Marital status Single 6 19.35 6 19.35 12 19.35 0.000 1.000*

Married 25 80.65 25 80.65 50 80.65

Working status Working 16 51.61 13 41.94 29 46.77 0.583 0.445*

Not working 15 48.39 18 58.06 33 53.23

Living situation Alone 1 3.23 2 6.45 3 4.84 0.350 0.554*

With family 30 96.77 29 93.55 59 95.16

Income and expenditure situation Income less than Expenditure 4 12.90 11 35.48 15 24.19 4.543 0.103*

Income and Expenditure Balanced 23 74.19 18 58.06 41 66.13

Income more than Expenditure 4 12.90 2 6.45 6 9.68

Occupation Worker 11 35.48 7 22.58 18 29.03 2.346 0.504*

Office worker 3 9.68 2 6.45 5 8.06

Homemaker 1 3.23 3 9.68 4 6.45

Retired 16 51.61 19 61.29 35 56.45

Family history of heart disease Yes 22 70.97 19 61.29 41 66.13

No 9 29.03 12 38.71 21 33.87

Additional disease Yes 15 48.39 19 61.29 34 54.84 7.143 0.129*

Hypertension 3 9.68 11 35.48 14 22.58

Diabetes 1 3.23 2 6.45 3 4.84

Hypertension and diabetes 10 32.26 5 16.13 15 24.19

Other* 1 3.23 1 3.23 2 3.23

Explanation of cause of disease Smoking 6 19.35 6 19.35 12 19.35 2.730 0.742*

Nutrition 5 16.13 2 6.45 7 11.29

Obesity 1 3.23 0 0 1 1.61

Stress 16 51.61 20 64.52 36 58.06

Genetic 2 6.45 2 6.45 4 6.45

Destiny 1 3.23 1 3.23 2 3.23

Plan to change disease process Nothing to do 3 9.68 3 9.68 6 9.68 3.667 0.722*

Active life 1 3.23 2 6.45 3 4.84

Smoking cessation-reduction 7 22.58 8 25.81 15 24.19

Nutrition regulation 8 25.81 7 22.58 15 24.19

Obesity reduction 1 3.23 0 0 1 1.61

Stress reduction-coping 11 35.48 9 29.03 20 32.26

Praying 0 0 2 6.45 2 3.23

Sharing the disease process Yes 28 90.32 29 93.55 57 91.94 0.218 0.641*

No 3 9.68 2 6.45 5 8.06

Social support perception Yes 22 70.97 22 70.97 44 70.97 1.000 0.607*

Partly 7 22.58 5 16.13 12 19.35

No 2 6.45 4 12.90 6 9.68

Going to health control When ill 6 19.35 9 29.03 15 24.19 2.325 0.508*

Every few months 6 19.35 8 25.81 14 22.58

Once a year 5 16.13 2 6.45 7 11.29

I never went 14 45.16 12 38.71 26 41.94

*p> 0.05

Education and telephone follow-up intervention 253

life subscale in the model. In addition to this, it is

thought that the detection of change in compliance areas,

stimuli and coping mechanisms of data collection form

based on the RAM and use of model-based intervention

is effective in increasing the quality of life. In the litera-

ture, there was no study evaluating the efficacy of educa-

tion or telephone follow-up on quality of life in coronary

diseases based on the RAM. However, studies in different

patient populations based on the RAM seem to show an

increase in the quality of life of patients (31,32). In addi-

tion, the results of our study show similar results to other

studies using education and telephone follow-up inter-

vention (33,34). When different studies of telephone fol-

low-up interventions were examined in patients with

cardiovascular disease, it was found that these interven-

tions had positive effects on patient satisfaction and par-

ticipation in cardiac rehabilitation, decreased stress and

hospital admissions (7,10,11). Also, training and tele-

phone follow-up interventions have significantly

improved the quality of life in cardiovascular disease

patients (33,34).

The self-efficacy of patients in the intervention group

was found to be significantly increased (Fig. 3). In this

regard, it is seen that the research hypothesis is con-

firmed. Among the reasons for the effectiveness of the

intervention are thought to be face-to-face predischarge

education and implementation of strengthening-encour-

agement strategies with structured telephone follow-up

interventions based on the RAM. Self-efficacy includes

four basic processes: cognitive, motivational, emotional

and selection (35). The cognitive and selection processes

of the patients were supported in this study by the edu-

cation, and motivational and emotional processes were

supported by telephone follow-up intervention. Further-

more, an aim of the study was to strengthen the coping

mechanisms of patients in order to establish effective

adaptation behaviours according to the RAM. There are

similarities between the coping mechanisms in the model

b. Change in the mean of the patients' self-efficacy scale scores over time

Control Intervention

Baseline 12th week

a. Change in the mean of the patients' quality of life subscale scores over time

Control Intervention

c. Change in the mean of the patients' coping and adaptation process scale scores over time

Control Intervention

Baseline 12th week Baseline 12th week

Physical activity

Diet

Insecurity Dependency

Medication Side effects

Emotional reaction

Baseline 12th week Baseline 12th week

Figure 3 (a) Change in the mean of the patients’ subscale scores over time. (b) Change in the patients’ self-efficacy scores over time. (c) Change

of mean score of patients’ coping and adjustment process scale over time

254 S. Turan Kavradim, Z. Canli €Ozer

T a b le

2 T re a tm

e n t e ff e ct s fr o m

b a se lin e to

1 2 th

w e e k fo r q u a lit y o f lif e , se lf -e ffi ca cy

a n d co p in g a n d a d a p ta ti o n o f th e in te rv e n ti o n a n d co n tr o l g ro u p

V a ri a b le s

In te rv e n ti o n g ro u p

C o n tr o l g ro u p

F* *

p va lu e

E ff e ct

si ze

(c o h e n -d )* * *

B a se lin e

A ft e r 1 2 w e e k s

t* P va lu e

B a se lin e

A ft e r 1 2 w e e k s

t* p

M ID A S d o m a in s

n M e a n �

S D

n M e a n �

S D

n M e a n �

S D

n M e a n �

S D

P h ys ic a l a ct iv it y

3 3

4 3 .5 5 �

2 1 .8 3

3 1

1 6 .3 3 �

1 6 .3 4

7 .0 2

0 .0 0 0 1

3 3

4 2 .8 1 �

1 9 .3 0

3 1

4 0 .1 2 �

2 3 .2 2

0 .6 6

0 .5 1 6 3

2 .8 6

0 .0 0 4 9 *

1 .1 8

In se cu ri ty

3 3

3 0 .7 3 �

2 0 .4 9

3 1

1 4 .6 1 �

1 7 .5 7

6 .3 5

0 .0 0 0 1

3 3

2 7 .3 3 �

1 9 .4 6

3 1

3 8 .0 8 �

1 9 .9 3

�2 .9 0

0 .0 0 7 0

2 .7 3

0 .0 0 7 2 *

1 .2 5

E m o ti o n a l re a ct io n

3 3

4 2 .1 4 �

2 5 .1 0

3 1

1 6 .9 4 �

1 8 .5 5

6 .4 4

0 .0 0 0 1

3 3

3 5 .0 8 �

2 0 .8 3

3 1

4 7 .7 8 �

2 4 .1 8

�3 .8 2

0 .0 0 0 6

2 .7 2

0 .0 0 7 4 *

1 .4 3

D e p e n d e n cy

3 3

5 5 .1 1 �

2 3 .2 4

3 1

2 7 .9 6 �

1 7 .2 9

5 .4 7

0 .0 0 0 1

3 3

4 1 .4 0 �

1 7 .8 1

3 1

4 5 .4 3 �

2 4 .9 9

�1 .0 9

0 .2 8 5 0

0 .4 5

0 .6 5 0 9

0 .8 1

D ie t co n ce rn s

3 3

4 7 .5 8 �

3 0 .6 7

3 1

1 2 .1 0 �

1 5 .0 4

6 .9 0

0 .0 0 0 1

3 3

3 1 .4 5 �

2 3 .1 5

3 1

3 1 .1 8 �

2 3 .8 6

0 .0 5

0 .9 5 6 6

0 .3 1

0 .7 5 9 3

0 .9 5

M e d ic a ti o n

3 3

6 3 .3 1 �

3 2 .5 9

3 1

2 2 .1 8 �

2 2 .5 3

5 .8 1

0 .0 0 0 1

3 3

4 2 .3 4 �

3 3 .1 8

3 1

4 7 .9 8 �

3 2 .6 1

�0 .9 2

0 .3 6 4 5

0 .4 0

0 .6 9 0 2

0 .9 2

S id e e ff e ct s

3 3

3 3 .8 7 �

3 4 .7 9

3 1

1 2 .9 0 �

1 7 .5 2

3 .1 2

0 .0 0 4 0

3 3

4 4 .7 6 �

3 2 .0 8

3 1

4 2 .3 4 �

3 7 .4 6

�0 .9 2

0 .3 6 4 5

3 .5 0

0 .0 0 0 6 *

1 .0 0

G e n e ra l se lf -e ffi ca cy

sc a le

3 3

2 7 .7 1 �

5 .4 0

3 1

3 4 .4 5 �

3 .7 0

�6 .2 1

0 .0 0 0 1

3 3

2 7 .8 7 �

4 .9 8

3 1

2 5 .5 2 �

6 .4 7

2 .8 8

0 .0 0 7 2

�4 .2 2

0 .0 0 0 1 *

1 .6 9

C o p in g a n d A d a p ta ti o n S ca le

3 3

1 1 6 .1 0 �

1 5 .2 5

3 1

1 4 8 .9 0 �

1 3 .8 7

�8 .9 8

0 .0 0 0 1

3 3

1 2 1 .7 1 �

1 3 .3 3

3 1

1 1 1 .5 8 �

1 8 .0 3

0 .3 7

0 .7 1 4 2

�4 .5 4

0 .0 0 0 1 *

2 .3 2

M ID A S : M yo ca rd ia l In fa rc ti o n D im

e n si o n a l A ss e ss m e n t S ca le .

* D if fe re n ce s b e tw

e e n b a se lin e a n d a ft e r 1 2 w e e k in

e a ch

g ro u p .

* * D if fe re n ce s b e tw

e e n e xp e ri m e n ta l a n d co n tr o l g ro u p (p

< 0 .0 5 ).

* * * E ff e ct

si ze

w a s e va lu a te d b y ca lc u la to r fo r S tu d e n t’ s t- te st . (h tt p s: // w w w .d a n ie ls o p e r. co m /s ta tc a lc /c a lc u la to r. a sp x? xm

l: id = 4 8 ).

Education and telephone follow-up intervention 255

https://www.danielsoper.com/statcalc/calculator.aspx?xml:id=48

and the concept of self-efficacy. To our knowledge, there

is no study evaluating the efficiency of the RAM on self-

efficacy in coronary diseases, but it has been shown that

the application of this model with a care plan in elderly

individuals had positive effects on improving self-efficacy

(36). It is known that increasing self-efficacy in disease

management influences behavioural choices and has pos-

itive effects on lifestyle change (5,37,38).

In the present study, the coping and adaptation process

score increased in the intervention group of the study,

whereas it decreased significantly in the control group

(Fig. 3). It is thought that the telephone follow-up was

an important intervention that contributed to the coping

and adaptation processes in terms of early detection and

control of symptoms, the provision of fast, useful and

effective solutions, information exchange and improve-

ment in the quality of the health education of the

patients. It has been observed in studies that RAM con-

tributed to the coping and adaptation process of patients

(39,40).

Changes in lifestyle habits during the study period

In Turkey generally, there is no systematic cardiac reha-

bilitation programme at most centres after MI, and thus,

no routine monitoring system is applied to follow-up

changes in the lifestyle of patients. It is stated that the

period in which patients with cardiovascular disease are

most likely to discontinue their medication is one to

three months after discharge (41,42). In this study, medi-

cation adherence was high in both groups and there was

no statistically significant difference in drug adherence in

the groups. Although some studies were conducted by

telephone follow-up intervention, medication adherence

was significantly increased compared with the control

group (43,44). In contrast to these studies, other studies

determined that education and counselling interventions

were not effective (45,46). And also when studies of

RCTs were examined, it was shown that education and

telephone follow-up interventions had positive effects on

nutrition and physical activity (46–49).

Table 3 Treatment effects from baseline to 12th week for lifestyle habits

Variables

Baseline 12 weeks after discharge

v2 P value

Intervention

group

Control

group

Intervention

group

Control

group

n % n % n % n %

Symptoms experienced None 13 41.94 15 48.39 22 70.97 14 45.16 4.71 0.194

Fatigue and weakness 8 25.81 10 32.26 2 6.45 6 19.35

Shortness of breath 1 3.23 3 9.68 0 0 0 0

Chest pain 8 25.81 3 9.68 6 19.35 9 29.03

Other 1 3.23 0 0 1 3.23 2 6.45

Health status perception Good 16 51.61 11 35.48 23 74.19 10 32.26 11.08 0.004

Middle 13 41.94 18 58.06 7 22.58 17 54.84

Bad 2 6.45 2 6.45 1 3.23 4 12.90

Smoking habits Yes 16 51.61 14 45.16 9 29.03 10 32.26 0.99 0.608

Not smoking 7 22.58 11 35.48 15 48.39 17 54.84

Stopped smoking 8 25.81 6 19.35 7 22.58 4 12.90

Alcohol habits Yes 3 9.68 1 3.23 0 0 0 0

No 25 80.65 28 90.32 31 100 31 100 - -

Quit 3 9.68 2 6.45 0 0 0 0

Physical activity Yes 4 12.90 4 12.90 27 87.10 8 25.81 23.68 0.000

No 27 87.10 27 87.10 4 12.90 23 74.19

Active lifestyle Yes 16 51.61 12 38.71 20 64.52 10 32.26 23.60 0.000

Partly 7 22.58 9 29.03 11 35.48 4 12.90

No 8 25.81 10 32.26 0 0 17 54.84

Rest during the day Yes 18 58.06 22 70.97 28 90.32 23 74.19 3.49 0.175

Partly 9 29.03 5 16.13 3 9.68 6 19.35

No 4 12.90 4 12.90 0 0 2 6.45

Dietary behaviour I know what I need to eat 11 35.48 7 22.58 31 100 14 45.16 23.42 0.000

I do not know what to eat 20 64.52 24 77.42 0 0 17 54.84

I pay attention 10 32.26 11 35.48 29 93.55 19 61.29 9.53 0.023

I do not pay attention 2 6.45 1 3.23 0 0 2 6.45

I do not pay much attention 11 35.48 12 38.71 2 6.45 9 29.03

I never pay attention 8 25.81 7 22.58 0 0 1 3.23

256 S. Turan Kavradim, Z. Canli €Ozer

Psychosocial adaptation fields

MI makes adaptation difficult by affecting an individual’s

physiological, self-concept, role function and interdepen-

dence fields. The aims of a nurse in this process were to

change ineffective adaptation behaviours into effective

ones and to maintain or develop existing effective adap-

tation behaviours. In research in the physiological field

relating to the fields of psychosocial adaptation, signifi-

cant results have been obtained on the topic of nutrition,

exercise and an active life. Examination of randomised

controlled studies in the literature in which education

and monitoring by telephone were used has shown that

they have beneficial effects on nutrition and physical

activity (46–49). Psychosocial problems such as feeling

bad about oneself, uncertainty about the future, hope-

lessness and feelings of guilt are related to the field of

concept of self. When the state of perception of health

was considered in the study, it was seen that the state of

feeling good was better in the intervention group than in

the control group.

No randomised controlled studies with cardiovascular

diseases were found in the literature based on the Roy

Adaptation Model. In studies with other patient popula-

tions using the RAM, the levels of effect of education on

adaptation fields were investigated. In two studies inves-

tigating the effectiveness on psychosocial adaptation

fields of theory-based patient education based on the

RAM in increasing adaptation in haemodialysis patients,

it was shown that patients’ adaptation in the physiologi-

cal and self fields increased in the intervention group

compared with the control group, providing physical,

psychological and social adaptation (4,50). In a ran-

domised controlled study examining the effects on physi-

cal and psychosocial adaptation of patient education

given based on the RAM to patients with chronic

obstructive pulmonary disease, it was found that the edu-

cation given to the intervention group increased adapta-

tion to the illness in three modes – psychological, self-

concept and role function modes. In addition to this, no

significant increase was observed in the interdependence

mode of the RAM (51). In another randomised controlled

study examining adaptation in individuals with heart fail-

ure to education based on the RAM, increases in

patients’ quality of life, functional capacities and receipt

of social support were seen compared with the control

group (31).

Limitations

While the study did have some strengths (single-blind,

concealed random assignment, clear inclusion/exclusion

criteria, the use of reliable and valid outcome measures,

obtaining some preliminary feedback on the intervention

and the assessment of range of potentially relevantT a b le

4 C h a n g e s in

p h ys ic a l p a ra m e te rs

re la te d to

lif e st yl e b e tw

e e n th e in te rv e n ti o n a n d co n tr o l g ro u p d u ri n g fo llo w -u p

V a ri a b le s

In te rv e n ti o n g ro u p

C o n tr o l g ro u p

F* *

P va lu e

B a se lin e

A ft e r 1 2 w e e k s

t* P va lu e

B a se lin e

A ft e r 1 2 w e e k s

t* P va lu e

n M e a n �

S D

n M e a n �

S D

n M e a n �

S D

n M e a n �

S D

H D L

3 1

4 7 .6 5 �

4 6 .4 1

2 6

4 0 .9 2 �

1 1 .2 2

0 .9 0

0 .3 7 6 5

3 1

3 3 .2 6 �

8 .7 7

1 8

3 6 .0 0 �

5 .7 4

�2 .3 0

0 .0 3 4 1

�2 .0 2

0 .0 4 5 8 *

LD L

3 1

1 2 5 .4 5 �

3 8 .3 0

2 6

8 7 .1 9 �

4 7 .0 4

5 .3 6

0 .0 0 0 1

3 1

1 1 2 .1 9 �

3 5 .2 9

1 8

8 2 .5 0 �

2 6 .3 8

4 .5 7

0 .0 0 0 3

�0 .8 3

0 .4 0 8 3

T ri g

3 1

1 9 9 .7 1 �

1 2 9 .9 5

2 3

1 7 9 .7 4 �

1 1 9 .3 1

0 .3 2

0 .7 4 9 5

3 1

2 3 0 .3 9 �

1 9 3 .4 7

1 7

1 7 2 .5 3 �

6 7 .3 6

1 .2 0

0 .2 4 7 4

0 .6 6

0 .5 1 2 7

G lu co se

3 1

1 2 8 .2 9 �

6 2 .1 0

2 1

1 0 2 .7 6 �

3 9 .6 8

1 .7 8

0 .0 8 9 9

3 1

1 3 8 .0 6 �

5 7 .2 3

1 8

1 2 1 .1 1 �

4 9 .6 7

1 .0 7

0 .2 9 7 9

1 .2 7

0 .2 0 8 2

H b A 1 C

3 1

6 .4 6 �

1 .3 9

2 0

6 .2 4 �

0 .9 3

0 .3 6 4 3

3 1

6 .4 6 �

1 .5 4

1 3

6 .7 9 �

1 .4 6

0 .8 3

0 .4 2 2 6

0 .6 7

0 .5 0 7 6

W C

3 1

1 0 2 .4 8 �

1 2 .8 5

3 1

1 0 0 .1 0 �

1 1 .5 0

3 .4 6

0 .0 0 1 7

3 1

1 0 7 .0 3 �

1 1 .5 5

3 1

1 0 6 .6 8 �

1 2 .5 3

0 .4 6

0 .6 4 9 9

2 .5 7

0 .0 1 1 4 *

B M I

3 1

2 7 .5 7 �

4 .4 5

3 1

2 7 .1 5 �

4 .2 6

2 .9 1

0 .0 0 6 7

3 1

2 8 .5 4 �

3 .8 7

3 1

2 8 .4 2 �

3 .8 6

0 .9 7

0 .3 3 8 9

1 .5 2

0 .1 3 1 2

B M I: b o d y m a ss

in d e x (k g /m

2 ); H b A 1 C , h a e m o g lo b in

A 1 C

(m m o l/ L) ); H D L,

h ig h -d e n si ty

lip o p ro te in

(m g /d L) ; LD

L, lo w -d e n si ty

lip o p ro te in

(m g /d L) ; T ri g , tr ig ly ce ri d e s (m

g /d L) ; g lu co se , m g /d L;

W C , w a is t

ci rc u m fe re n ce

(c m ).

* D if fe re n ce s b e tw

e e n b a se lin e a n d a ft e r 1 2 w e e k s in

e a ch

g ro u p .

* * D if fe re n ce s b e tw

e e n e xp e ri m e n ta l a n d co n tr o l g ro u p .

Education and telephone follow-up intervention 257

outcome measures), the study did have some limitations.

The limitations of this trial were 1) the self-reported mea-

sure of physical activity and nutrition behaviour, 2) due

to the nature of the intervention it was impossible to

blind the researcher so patients provided data to a single

interventionist, 3) the study is limited to the patients

who had MI in University Hospital Cardiology Clinic

between April 2016 and August 2017, 4) the study had a

small sample and was performed at a single centre and 5)

the population was limited about primarily male, pre-

sumably of Turkish descent and related to only including

those patients with sufficient reading and writing skills,

as well as mobility and transportation access. Thus, the

results cannot be generalised to all patients.

Conclusion

In conclusion, it has been established that nursing care

given based on education based on the RAM and tele-

phone follow-up can be applied to individuals who have

undergone MI. The results from this study indicate that

education and telephone follow-up intervention based on

the RAM had positive and significant results after

12 weeks on quality of life, self-efficacy and coping and

adaptation process, and on enhancing exercise and diet

adherence compared to the control group. The findings

of this study are important for health professionals who

care for individuals with MI to develop nursing care.

Based on the research process and the results obtained, it

is recommended that education based on the RAM and

telephone follow-up should be performed, that an educa-

tion booklet should be used in education in the clinic

before the patient is discharged and that the education

booklet should be given to the patient, and that a post-

discharge tele-monitoring system should be formed for

management of the postillness process. Due to the small

number of participants in the study, further research is

recommended to conduct with larger sample. It is also

recommended that studies of education based on the

RAM and telephone follow-up studies should be carried

out in which the follow-up period is longer to obtain sig-

nificant positive results on smoking habits, physical

parameters and managing symptoms.

Acknowledgements

The authors want to thank the cardiology clinic team at

University Hospital for their support and advice and MI

patients for participating.

Conflict of interest

No conflict of interest has been declared by the authors.

Funding

This research did not receive any specific grant from

funding agencies in the public, commercial, or not-for-

profit sectors.

Ethical approval

Before starting the research, permission was obtained from

University Hospital. In addition, ethics committee approval

(Approval No: 2012-KAEK-20) was obtained from the

Ethics Committee for Clinical Investigations of University.

This study was conducted in accordance with the princi-

ples of the Helsinki Declaration. Written informed consent

also was obtained from each participant.

Author contribution

Selma Turan Kavradım and Zeynep €Ozer made substan-

tial contributions to conception and design. Selma Turan

Kavradım collected the data and a statistic expert anal-

ysed the data. Each author is responsible for the theoreti-

cal approaches. Zeynep €OZER supervised and reviewed

the drafting of the manuscript.

References

1 Ibanez B, James S, Agewall S,

Antunes MJ, Bucciarelli-Ducci C,

Bueno H, Caforio ALP, Crea F,

Goudevenos JA, Halvorsen S, Hin-

dricks G, Kastrati A, Lenzen MJ,

Prescott E, Roffi M, Valgimigli M,

Varenhorst C, Vranckx P, Widimsk�y

P. 2017 ESC Guidelines for the man-

agement of acute myocardial infarc-

tion in patients presenting with ST-

segment elevationThe Task Force for

the management of acute

myocardial infarction in patients

presenting with ST-segment eleva-

tion of the European Society of Car-

diology (ESC). Eur Heart J 2018; 39:

119–77.

2 Cepeda-Valery B, Cheong AP, Lee A,

Yan BP. Measuring health related

quality of life in coronary heart dis-

ease: The importance of feeling well.

Int J Cardiol 2011; 149: 4–9.

3 Ran�ci�c NK, Petrovi�c BD, Apostolovi�c

SR, Koci�c BN, Ili�c MV. Health-related

quality of life in patients after the

acute myocardial infarction. Central

European Journal of Medicine. 2013; 8:

266–72.

4 Afrasiabifar A, Karimi Z, Hassani P.

Roy’s adaptation model-based patient

education for promoting the adapta-

tion of hemodialysis patients. Iran

Red Crescent Med J 2013; 15: 566–72.

5 Hannah K, Holly M. The role of self-ef-

ficacy in cardiovascular disease self-man-

agement: A review of effective programs.

2010.

6 Amsterdam EA, Wenger NK, Brindis

RG, Casey DE, Ganiats TG, Holmes

DR, Jaffe AS, Jneid H, Kelly RF,

258 S. Turan Kavradim, Z. Canli €Ozer

Kontos MC, Levine GN, Liebson PR,

Mukherjee D, Peterson ED, Sabatine

MS, Smalling RW, Zieman SJ. AHA/

ACC Guideline for the Management

of Patients With Non–ST-Elevation

Acute Coronary Syndromes: A

Report of the American College of

Cardiology/American Heart Associa-

tion Task Force on Practice Guideli-

nes. J Am Coll Cardiol 2014; 64:

e139–e228.

7 Eshah NF, Bond AE. Cardiac rehabil-

itation programme for coronary heart

disease patients: an integrative litera-

ture review. Int J Nurs Pract 2009;

15: 131–9.

8 Beswick AD, Rees K, West RR, Tay-

lor FC, Burke M, Griebsch I, Taylor

RS, Victory J, Brown J, Ebrahim S.

Improving uptake and adherence in

cardiac rehabilitation: literature

review. J Adv Nurs 2005; 49: 538–55.

9 Karmali KN, Davies P, Taylor F, Bes-

wick A, Martin N, Ebrahim S. Pro-

moting patient uptake and adherence

in cardiac rehabilitation. Cochrane

Database Syst Rev 2014; 25:

Cd007131.

10 Harkness K, Smith KM, Taraba L,

Mackenzie CL, Gunn E, Arthur HM.

Effect of a postoperative telephone

intervention on attendance at intake

for cardiac rehabilitation after coro-

nary artery bypass graft surgery.

Heart Lung 2005; 34: 179–86.

11 Hawkes AL, Patrao TA, Atherton J,

Ware RS, Taylor CB, O’Neil A, Fore-

man R, Oldenburg BF. Effect of a tele-

phone-delivered coronary heart

disease secondary prevention program

(proactive heart) on quality of life and

health behaviours: primary outcomes

of a randomised controlled trial. Int J

Behav Med 2013; 20: 413–24.

12 Coorey GM, Neubeck L, Mulley J,

Redfern J. Effectiveness, acceptability

and usefulness of mobile applications

for cardiovascular disease self-man-

agement: Systematic review with

meta-synthesis of quantitative and

qualitative data. Eur J Prev Cardiol

2018; 25: 505–21.

13 Gandhi S, Chen S, Hong L, Sun K,

Gong E, Li C, Yan LL, Schwalm JD.

Effect of mobile health interventions

on the secondary prevention of car-

diovascular disease: systematic

review and meta-analysis. Can J Car-

diol 2017; 33: 219–31.

14 Pfaeffli Dale L, Dobson R, Whittaker

R, Maddison R. The effectiveness of

mobile-health behaviour change

interventions for cardiovascular dis-

ease self-management: A systematic

review. Eur J Prev Cardiol 2016; 23:

801–17.

15 Fawcett J. Using the Roy adaptation

model to guide research and/or

practice: construction of conceptual-

theoretical-empirical systems of

knowledge. Aquich�an 2009; 9: 297–

306.

16 Whittemore R, Sister Callista R.

Adapting to diabetes mellitus: a the-

ory synthesis. Nursing Sci Q 2002; 15:

311–7.

17 J. Fawcett SD-M. Contemporary

Nursing Knowledge: Analysis and

Evaluation of Nursing Models and

Theories. 2013.

18 Roy SC. The Roy adaptation model,

3rd. edn. 2008, Pearson Education,

1–576.

19 Salminen-Tuomaala M, Astedt-Kurki

P, Rekiaro M, Paavilainen E. Coping

experiences: a pathway towards dif-

ferent coping orientations four and

twelve months after myocardial

infarction-a grounded theory appro-

ach. Nurs Res Pract 2012; 2012:

674783.

20 Ahyana S, Kritpracha C, Thaniwat-

tananon P. Cardiac Rehabilitation

Enhancing Programs in Patients with

Myocardial Infarction: A literature

Review. 2013.

21 Boutron I, Altman DG, Moher D,

Schulz KF, Ravaud P. CONSORT

Statement for Randomized Trials of

Nonpharmacologic Treatments: A

2017 Update and a CONSORT Exten-

sion for Nonpharmacologic Trial

Abstracts. Ann Intern Med 2017; 4:

40–47.

22 Roy SC. Research based on the Roy

adaptation model: last 25 years.

Nursing Sci Q 2011; 24: 312–20.

23 Charnock D. DDISCERN Handbook

Quality Criteria for Consumer Health

Information on Treatment Choices,

1998, Radcliffe Medical Press, Oxon.

24 Schwarzer R, Jerusalem M. Gener-

alized self-efficacy scale. In Measures

in Health Psychology: A User’s Portfo-

lio. Causal and Control Beliefs, (Wein-

man J, Wright S, Johnston M eds),

1995, NFER-NELSON, Windsor, UK,

35–37.

25 Aypay A. The Adaptation Study of

General Self-Efficacy (GSE) Scale to

Turkish. Inonu University Journal of

the Faculty of Education 2010; 11:

113–31.

26 C�atal E, AD. A validity and reliability study of the coping and adaptation

processing scale in Turkey. Euro

Heart J Acute Cardiovas Care Abst Suppl

2015; 1: 44.

27 Thompson DR, Jenkinson C, Roe-

buck A, Lewin RJ, Boyle RM, Chan-

dola T. Development and validation

of a short measure of health status

for individuals with acute myocardial

infarction: the myocardial infarction

dimensional assessment scale

(MIDAS). Qual Life Res 2002; 11:

535–43.

28 Yilmaz E, Eser E, Sekuri C, Kultursay

H. The psychometric properties of

the Turkish version of Myocardial

Infarction Dimensional Assessment

Scale (MIDAS). Anatol J Cardiol

2011; 11: 386–401.

29 Morisky DE, Green LW, Levine DM.

Concurrent and predictive validity of

a self-reported measure of medica-

tion adherence. Med Care 1986; 24:

67–74.

30 Bahar G, Savas� HA, €Unal A, Savas� E, Kaya H, Morisky Bahar A. Tedavi

Uyum €Olc�e�ginin iki uc�lu duygudu- rum bozuklu�gu ic�in gec�erlilik ve g€uvenilirlik c�alıs�ması. Anatol J Psy- chiat 2014; 15: 141–9.

31 Bakan G, Akyol AD. Theory-guided

interventions for adaptation to heart

failure. J Adv Nurs 2008; 61: 596–

608.

32 Lefaiver CA, Keough V, Letizia M,

Lanuza DM. Using the Roy Adapta-

tion Model to explore the dynamics

of quality of life and the relationship

between lung transplant candidates

and their caregivers. ANS Adv Nurs

Sci 2007; 30: 266–74.

33 Chan DS, Chau JP, Chang AM. Acute

coronary syndromes: cardiac rehabili-

tation programmes and quality of life.

J Adv Nurs 2005; 49: 591–9.

34 Kurc�er MA, €Ozbay A. Koroner arter hastalarında uygulanan yas�am tarzı e�gitim ve danıs�manlı�gının yas�am kalitesine etkisi. Anatol J Cardiol

2011; 11: 107–14.

35 Bandura A. Self-efficacy. Encyclopedia

of human Behavior. New York, Aca-

demic Press, 1994.

Education and telephone follow-up intervention 259

36 Maghsoudi E, Maslak M, Zareie F,

Pour Rashid S, Sofiyani A.The Effect

of Care Plan Application Based On Roy

Adaptation Model on the Self-Efficacy in

Elderly People in Urmia Nursing Homes.

2015.

37 Marks R, Allegrante JP, Lorig K. A

review and synthesis of research evi-

dence for self-efficacy-enhancing

interventions for reducing chronic

disability: implications for health

education practice (part I). Health

Promot Pract 2005; 6: 37–43.

38 Sarkar U, Ali S, Whooley MA. Self-

efficacy and health status in patients

with coronary heart disease: findings

from the heart and soul study. Psy-

chosom Med 2007; 69: 306–12.

39 Fl�orez-Torres IE, Herrera-Alarc�on E,

Carpio-Jim�enez E, Veccino-Amador

MA, Zambrano-Barrios D, Reyes-

Narv�aez Y, Torres-Contreras S.

Afrontamiento y adaptaci�on en

pacientes egresados de unidades de

cuidado intensivo. Aquich�an 2011;

11: 23–39.

40 Kroemeke A. Changes in well-being

after myocardial infarction: Does

coping matter? Qual Life Res 2016; 1:

2593–601.

41 Ho PM, Spertus JA, Masoudi FA, Reid

KJ, Peterson ED, Magid DJ, Krumholz

HM, Rumsfeld JS. Impact of medica-

tion therapy discontinuation on mor-

tality after myocardial infarction. Arch

Intern Med 2006; 25: 1842–7.

42 Lee HY, Cooke CE, Robertson TA.

Use of secondary prevention drug

therapy in patients with acute coro-

nary syndrome after hospital dis-

charge. J Manag Care Pharm 2008;

14: 271–80.

43 Al-Ganmi AH, Perry L, Gholizadeh

L, Alotaibi AM. Cardiovascular medi-

cation adherence among patients

with cardiac disease: a systematic

review. J Adv Nurs 2016; 72: 3001–

14.

44 Rinfret S, Rodes-Cabau J, Bagur R,

Dery JP, Dorais M, Larose E, Bar-

beau G, Gleeton O, Nguyen CM,

Noel B, Proulx G, Roy L, Taillon I,

Larochelliere R, Bertrand OF. Tele-

phone contact to improve adherence

to dual antiplatelet therapy after

drug-eluting stent implantation.

Heart2013; 99: 562–9.

45 Amado Guirado E. Pujol Ribera E,

Pacheco Huergo V, Borras JM.

Knowledge and adherence to antihy-

pertensive therapy in primary care:

results of a randomized trial. Gac

Sanit 2011; 25: 62–67.

46 Jiang X, Sit JW, Wong TK. A nurse-

led cardiac rehabilitation programme

improves health behaviours and car-

diac physiological risk parameters:

evidence from Chengdu, China. J

Clin Nurs 2007; 16: 1886–97.

47 Craigie AM, Barton KL, Macleod M,

Williams B, van Teijlingen E, Belch JJ,

Anderson AS. A feasibility study of a

personalised lifestyle programme

(HealthForce) for individuals who

have participated in cardiovascular risk

screening. Prev Med 2011; 52: 387–9.

48 Maddison R, Pfaeffli L, Whittaker R,

Stewart R, Kerr A, Jiang Y, Kira G,

Leung W, Dalleck L, Carter K, Raw-

storn J. A mobile phone intervention

increases physical activity in people

with cardiovascular disease: Results

from the HEART randomized con-

trolled trial. Eur J Prev Cardiol 2015;

22: 701–9.

49 Mok VK, Sit JW, Tsang AS, Chair

SY, Cheng TL, Chiang CS. A con-

trolled trial of a nurse follow-up

dietary intervention on maintaining

a heart-healthy dietary pattern

among patients after myocardial

infarction. The. J Cardiovasc Nurs

2013; 28: 256–66.

50 Kacaroglu Vicdan A, Gulseven

Karabacak B. Effect of treatment

education based on the Roy Adapta-

tion Model on adjustment of

hemodialysis patients. Clin Nurse Spec

2016; 30: 1–13.

51 Akyil RC, Erguney S. Roy’s adapta-

tion model-guided education for

adaptation to chronic obstructive

pulmonary disease. J Adv Nurs 2013;

69: 1063–75.

Supporting Information

Additional Supporting Information

may be found in the online version

of this article:

Appendix S1. 2017 CONSORT

checklist of information to include

when reporting a randomized trial

assessing nonpharmacologic treat-

ments (NPTs).

260 S. Turan Kavradim, Z. Canli €Ozer

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