A Novel Approach to Cardiovascular Health by Optimizing Risk Management: An Intensive Behavioural Intervention Study

Participants will all receive a global risk factor assessment prior to intervention and at the end of the intervention phase (roughly 7 months later). Participants recruited from a previous study that did not show change will be asked to enroll in the current study. The previous study (A Novel Approach to Cardiovascular Health By Optimizing Risk Management: ANCHOR) recruited adults from two family practice offices in Nova Scotia. Each individual received one-on-one behaviour change counselling by a health care provider aimed at reducing cardiac risk. Cardiac risk was assessed utilizing a global risk factor assessment that computed a Framingham score and risk category. The Framingham score was percent measure of 10 year risk of experiencing a cardiac event. Thus, those that were not able to reduce their 10 year risk, will be approached to enrol in the current study. Additionally, new participants will be recruited from the same health centre. Once an initial assessment is complete, previous participants will be matched to new participants based on several risk indicators and randomly assigned as a dyad. Each participant will be randomized to one of four group based intervention conditions: 1) Motivation ONLY 2) Awareness building and coping strategy training 3)Combination of above 4) Neither. New participants that are not matched will receive one-to-one behavioural counseling from a nurse trained in behaviour change counseling. The group interventions are described below: Motivational Enhancement The use of motivational enhancement as an intervention strategy will differ from the ANCHOR Study primarily in format and duration. In the current study, this intervention will be delivered in a small group setting. Each group will be comprised of 5-8 members depending on participant availability. Participants will attend a one hour session, every month, for 6 months. In these small groups, participants will explore the components of motivation as it relates to engaging in and changing health behaviours. Participants will be encouraged to evaluate the behaviours in need of change based on the individualized Heart Risk Assessment feedback given during the initial assessment. Concepts such as stages of change, readiness for change, decisional balance, SMART goals, and relapse prevention will be presented and discussed. Participants will be guided through creating a change plan and will be encouraged to find reinforcers for positive health behaviours. The facilitator will present concepts, guide discussion, and encourage participation utilizing concepts of motivational interviewing and motivational enhancement. The overall goal is to support participants in increasing motivation to engage in positive health behaviours. Awareness Building and Coping Strategy Training Participants assigned to this intervention will be presented with material to increase awareness of risks and rewards of health behaviours. The facilitator will guide discussion around increasing awareness of detrimental health behaviours. A problem solving and stress management approach will be utilized to encourage the participants to explore new adaptive coping strategies while reducing the use of maladaptive strategies. The overall goal is to increase distress regarding health behaviours while supporting the participants in problem solving and coping activities that can lead to increasing positive health behaviours.