Barbora Silarova

It is estimated that nearly 600,000 cancer cases in the UK could have been avoided in the past five years if people had healthier lifestyles. A number of theories of behaviour change suggest that before people will change health behaviours, they must accept that a risk applies to them. This study aimed to explore the views of the public on receiving personalised cancer risk information and the potential for that information to motivate behaviour change. We conducted 27 interviews with members of the public (mean age 49 ± 23 years). Each participant completed a questionnaire to allow calculation of their risk of developing the most common cancers (10 for women, 8 for men). During the interviews we presented their risk using a web-based tool developed for the study and discussions covered their views on receiving that information. Each interview was audio-recorded and then analysed using thematic analysis. Participants generally viewed the concept of personalised cancer risk positively. The first reaction of almost all when presented with their 10-year risk of an individual cancer without any further context was that it was low and not concerning. Views on what constituted a high risk ranged widely, from 0.5 to 60%. All felt seeing the impact of changes in lifestyle was helpful. For some this led to intentions to change behaviour, but reductions in risk were not always motivating as the risks were considered low and differences small. Provision of personalised cancer risk was well received and may be a useful addition to other cancer prevention initiatives. Further work is needed in particular to develop ways to present cancer risk that reflect the general perception of what constitutes a risk high enough to motivate behaviour change and help patients contextualise a less well known health risk by providing a frame of reference.

Objective. Morbidity and mortality among Roma due to coronary heart disease (CHD) is high, but evidence on potential psychosocial pathways is lacking. This study aimed to assess the differences in the severity of anxiety symptoms and in the sense of coherence (SOC) between Roma and non-Roma CHD patients, crude and adjusted for age, sex, functional status and socio-economic status (SES). Design. We examined 607 CHD patients (mean age 58.0 ± 7.4, 28.7% female) scheduled for coronary angiography, 98 (16.1%) of whom were Roma. Anxiety symptoms were measured using the Hospital Anxiety and Depression Scale and SOC using the 13-item Orientation to Life Questionnaire. Data were analysed using hierarchical regression. Results. Roma ethnicity was associated with more severe anxiety (B = 1.89; [95% confidence interval (CI) = 0.79; 2.98]) adjusted for age, sex, functional status and SES. Roma ethnicity was also associated with lower SOC (B = −4.77; [95% CI = −7.85; −1.68]) adjusted for age, sex and functional status. The latter association lost statistical significance after adjustment for SES. Conclusion. Roma ethnicity is associated with more anxiety symptoms and lower SOC among CHD patients. Our findings indicate that Roma CHD patients have a worse position regarding psychosocial factors that increase mortality and thus require additional attention.

The aim of this study was to assess differences in health-related quality of life (HRQoL) between Roma and non-Roma coronary heart disease (CHD) patients, and whether differences in hostility contribute to this association. We examined 570 CHD patients (mean age 57.8, 28.1 % female) scheduled for coronary angiography, 88 (15.4 %) of whom were Roma. Hostility was measured using the 27-item Cook-Medley Scale and HRQoL using the Short-Form Health Survey 36, from which the mental and physical component summary (MCS, PCS) were calculated. The relationship between ethnicity, hostility and HRQoL was examined using regression analyses. Roma ethnicity was associated with poorer MCS (B = −3.44; [95 % CI = −6.76; −0.13] and poorer PCS (B = −4.16; [95 % CI = −7.55; −0.78]) when controlled for age, gender and socioeconomic status. Adding hostility to the model weakened the strength of the association between Roma ethnicity and MCS (B = −1.87; [95 % CI = −5.08; 1.35]) but not between Roma ethnicity and PCS (B = −4.07; [95 % CI = −7.50; −0.64]). Roma ethnicity is associated with poorer MCS and PCS. Hostility may mediate the association between Roma ethnicity and MCS. The poorer HRQoL of Roma CHD patients requires attention in both care and research, with special attention on the role of hostility.

A high sense of coherence (SOC) has been found to be associated with favourable health-related behaviours. However, evidence is for the most part lacking on the influence of SOC on health-related behaviours among coronary heart disease patients. The aim of this study was to explore the association between SOC at baseline and smoking status, nutrition behaviour, physical exercise and alcohol consumption of coronary heart disease patients 12–28 months after they had undergone different cardiac treatments. A total of 179 coronary heart disease patients (mean age 58.32±6.54 years, 19% female) were interviewed before coronary angiography and 12–28 months after. Self-report data about health-related behaviours were obtained via a structured interview. SOC was measured using the 13-item Orientation to Life Questionnaire. The relationship between SOC and health-related behaviours was examined using regression and cross-lagged path analyses. SOC at baseline predicted non-smoking and quitting smoking: odds ratio (OR) (95% confidence interval (CI)) per unit increase (over range 38–91) was 1.11 (1.03–1.19) and 1.09 (1.01–1.17), respectively. Moreover, baseline SOC predicted healthy nutrition behaviour among percutaneous coronary intervention patients: the OR per unit increase was 1.08 (95% CI: 1.01–1.15). Lastly, SOC at baseline predicted improvement in alcohol consumption at follow-up among coronary artery bypass grafting patients (standard score result: –0.15, p<0.05). Coronary heart disease patients with a low SOC before treatment are less likely to improve health behaviours after cardiac treatment and should thus get additional attention in health promotion.

The aim of this study was to determine whether sense of coherence (SOC) at baseline predicts health-related quality of life (HRQoL) at 12–28-month follow-up among patients with coronary heart disease when controlled for sociodemographic and medical variables. A total of 179 consecutive patients (58.28 ± 6.52 years, 16.8% women) scheduled for coronary angiography (CAG) were interviewed before CAG and 12–28 months after. SOC was measured with the 13-item Orientation to Life Questionnaire. HRQoL was measured using the Short Form Health Survey 36 (SF-36), from which the mental and physical component summaries (MCS, PCS) were calculated. The relationship between SOC and HRQoL was examined using regression analyses. SOC proved to be a significant predictor of the MCS-score (B = 0.29; 95% CI = 0.17–0.41) and PCS-score (B = 0.18; 95% CI = 0.06–0.31) when not adjusted for possible confounding sociodemographic and medical variables. After adjustment for sociodemographic and medical variables, SOC remained a predictor of the MCS-score (B = 0.26; 95% CI = 0.14–0.39). SOC also remained a predictor of the PCS-score when controlled for gender, age and family income; however, the association disappeared after adjustment for functional status (B = 0.07; 95% CI = −0.05 to 0.19). SOC is a predictor of mental and physical HRQoL at 12–28-month follow-up, crude and also after adjustment. Patients undergoing CAG with low SOC thus deserve particular attention in regard to the maintenance and improvement of their HRQoL.