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重要的公共卫生问题，遵守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对急性冠脉综合征(ACS)患者复发心血管事件的二级预防。尽管健康行为的重要性是不可否认的(例如，体力活动，遵循低脂肪 饮食)在急性冠脉综合征后患者中，许多人无法遵循这些医学建议。积极的心理状态，特别是乐观，与更多地参与健康行为和更好的心血管结果有关，无论是否患有心脏病的人。一个新兴的心理干预领域一直专注于增加积极状态的频率和强度，这些“积极心理学”项目一直以来都能提高健康个体的幸福感，减轻抑郁，改善整体幸福感。然而，这些干预措施在急性冠脉综合征患者中还没有得到很好的研究，而且还没有研究它们对健康行为的影响。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治疗发展项目，利用积极的心理干预来改善特定的健康行为(体力活动，饮食， 和服药依从性)对最初住院的急性冠脉综合征患者。我们将通过半结构化访谈进行定性研究，以更好地了解这一队列中积极情绪与健康行为之间的关系，并将设计适合这一人群的积极心理干预措施。然后我们将对这一干预措施的组成部分进行试点测试，以评估初步的可行性/可接受性，并了解干预的最佳组成部分和“剂量”。最后，我们将以我们修订的治疗急性冠脉综合征患者的小型随机疗效试验结束。这笔拨款中的试验将招收至少208名患急性冠脉综合征的受试者，并将利用基于电话的干预来提高可行性和降低成本。这项研究的主要结果衡量标准将是体力活动，通过加速度计进行测量。我们之所以选择这一结果，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养生方面存在的实质性困难，以及因为积极的情绪与更多的体力活动有关。然而，考虑到干预可能会产生更广泛的影响，我们还将衡量我们的干预在遵循心脏健康饮食(通过结构化评估进行评估)和坚持药物治疗(阿司匹林，通过盖口测量)方面的影响。到授权期结束时，我们将(与PA一致)创建一种可行的基于积极心理学的干预措施，准备在更大的多点疗效试验中进行测试 这足以检测到急性冠脉综合征患者在体力活动和其他重要健康行为方面的显著改善。

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.