Developing a positive psychology intervention to improve cardiac health behaviors

描述（由申请人提供）：预防医疗事件是一个关键的公共卫生问题，坚持推荐的健康行为可以在这种预防中发挥重要作用。健康行为重要性的一个关键例子是急性冠状动脉综合征（ACS）患者复发性心血管事件的二级预防。尽管健康行为的重要性不可否认（例如，身体活动，低脂肪 在ACS后患者中，许多人无法遵循这些医疗建议。 积极的心理状态，特别是乐观，与健康行为的更多参与以及患有和不患有心脏病的人的上级心血管结局有关。一个新兴的心理干预领域专注于增加积极状态的频率和强度，这些“积极心理学”计划一直导致幸福感的改善，抑郁症的减少，以及健康个体整体幸福感的改善。然而，这种干预措施尚未在ACS患者中得到充分研究，其对健康行为的影响尚未得到检验。 与PA-11-063（将基本行为和社会科学发现转化为改善健康相关行为的干预措施）一致，我们提出了一个多步骤的治疗开发项目，利用积极的心理干预措施来改善特定的健康行为（身体活动，饮食， 和药物依从性）。我们将通过半结构化访谈进行定性研究，以更好地了解这一人群的积极情绪和健康行为之间的关系，并设计适合这一人群的积极心理干预。然后，我们将对该干预措施的组成部分进行试点测试，以评估初始可行性/可接受性，并了解干预措施的最佳组成部分和“剂量”。最后，我们将结束一个小的随机疗效试验，我们的修订治疗ACS患者。本研究资助的试验将招募至少208名ACS患者，并将利用基于电话的干预措施来提高可行性并降低成本。 该补助金中研究的主要成果指标将是通过加速度计测量的身体活动。我们选择这个结果是因为这种健康行为的重要性，以及许多ACS患者在开始和维持体力活动方案方面的巨大困难，因为积极的情绪与更多的体力活动有关。然而，鉴于干预可能具有更广泛的影响，我们还将测量我们的干预对遵循心脏健康饮食（通过结构化评估进行评估）和坚持药物治疗（阿司匹林，通过瓶盖开口测量）的影响。到资助期结束时，我们将（与PA一致）创建一个可行的基于积极心理学的干预，将准备在更大的多地点功效试验中进行测试 这是足够的权力，以检测ACS患者的身体活动和其他重要的健康行为的显着改善。

DESCRIPTION (provided by applicant): Preventing medical events is a critical public health concern, and adherence to recommended health behaviors can play a major role in such prevention. A key example of the importance of health behavior is in the secondary prevention of recurrent cardiovascular events in patients suffering an acute coronary syndrome (ACS). Despite the undeniable importance of health behaviors (e.g., physical activity, following a low-fat diet) in post-ACS patients, many are unable to follow these medical recommendations. Positive psychological states, especially optimism, have been linked to greater participation in healthy behaviors and superior cardiovascular outcomes in persons with and without heart disease. An emerging field of psychological interventions has focused on increasing the frequency and intensity of positive states, and these 'positive psychology' programs have consistently led to improvements in happiness, reductions in depression, and improvements in overall well-being in healthy individuals. However, such interventions have not been well-studied in ACS patients, and their effect on health behaviors has not been examined. Consistent with PA-11-063 (Translating Basic Behavioral and Social Science Discoveries into Interventions to Improve Health-Related Behaviors), we propose a multi-step treatment development project to utilize positive psychological interventions to improve specific health behaviors (physical activity, diet, and medication adherence) in patients initially hospitalized with ACS. We will perform qualitative research via semi-structured interviews to better understand the relationship between positive emotions and health behaviors in this cohort, and will design a positive psychological intervention that is suited to this population. We will then pilot test components of this intervention to assess initial feasibility/acceptability and understand the optimal components and 'dosing' of the intervention. Finally, we will end with a small randomized efficacy trial of our revised treatment in ACS patients. The trials in this grant will enroll a minimum of 208 subjects admitted with ACS, and will utilize a phone-based intervention to improve feasibility and reduce cost. The primary outcome measure for studies in this grant will be physical activity, as measured via an accelerometer. We selected this outcome because of the importance of this health behavior and the substantial difficulty that many ACS patients have in initiating and maintaining a physical activity regimen, and because positive emotions have been linked to greater physical activity. Given that the intervention may have broader effects, however, we will also measure the impact of our intervention on following a heart-healthy diet (evaluated via structured assessment) and adhering to medication (aspirin, as measured by cap openings). By the end of the grant period, we will have (in concordance with the PA) created a viable positive psychology- based intervention that will be ready for testing in a larger, multisite efficacy trial that is adequately powered to detect significant improvements in physical activity and other important health behaviors in ACS patients.