Heart attack survivors face a number of behavioural and psychological difficulties that often go undetected during routine care. Chief among these are unrealistic fears about resuming normal work and recreational activities, and problems adhering to guidelines concerning physical exercise, diet, and other lifestyle changes. Clinical assessment and intervention methods developed for psychiatric populations are ill-suited to problems experienced by the vast majority of cardiac patients. A social action theory of health behaviour change suggests specific techniques for enhancing well-being and altering behavioural risk factors in persons with heart disease. Methods to measure and modify patient self-efficacy appraisals, and a conjoint approach involving members of the patient’ s family, are central features of the social action model. These methods can be applied in the course of routine medical care at clinic visits and via follow-up telephone contacts.
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