A group cardiac rehabilitation program tailored for women

The intervention will use a group, mutual aid model to improve knowledge regarding secondary prevention and empowerment of self-management strategies in women. The group will use a mutual aid framework, whereby the leader facilitates group members to help each other. This framework recognises the alliance of individuals to work on mutual issues (Beckie et al 2008). The intervention will occur in a 4-week, nurse-coordinated program in which a group of 8-12 women will meet weekly for a 2-hour session in an outpatient setting. Each week, a research nurse, trained in the intervention, will facilitate sessions promoting education and awareness, social support, and strategies for behaviour change. A topic schedule will guide the content of each week’s sessions, although formats will remain flexible to allow for emerging issues within groups. Each session is comprised of: a 35-minute educational lecture, 35 minutes of group discussion, 30 minutes of small group activities, and a 20-minute meditation exercise. The facilitator will keep track of intervention adherence by taking attendance at each session. Participants will be reminded to attend the following week's session at the end of weekly sessions. If a participant was not able to attend a session, they received a phone call reminder in advance of the next session. Sessions are based upon empowerment through knowledge and development of an individualized, behavioural change strategy. Key components of the intervention include information about heart disease, changing social roles, the impact of emotions on cardiovascular health, coping with stress, communication, and strategies to promote self-management. Information about heart disease: The program will commence with providing information about women and heart disease, discussing the signs and symptoms of an acute cardiac event, and the particular risks and problems that they are facing in coping and adjusting to their diagnosis. Psychosocial aspects: Issues related to coping with changing and multiple roles such as being a caregiver, engaging in home duties, and being a person with a heart condition will be addressed. Self-efficacy: Belief in one's own capacity to cope with heart disease will be discussed and used as a tool for enhancing self-management of particular target behaviours. Participants will be taught how to self-regulate by selecting specific behaviours they wish to target (e.g. diet, exercise, medication, stress management). Pedometers and diaries will be used to promote self-efficacy for physical activity. Throughout these sessions, the nurse leading the group will provide encouragement to participants in order to maximise participants' self-efficacy, affirming their ability to effectively manage their heart condition. Anxiety and depression: Cognitive-behavioural therapy (CBT) and mindfulness techniques such as changing self-talk, relaxation, meditation, and time management skills will be included in the program. Instrumental support: In order to enhance role integration, the program will provide referrals to HomeCare services when applicable (e.g. cooking, cleaning, and washing) to reduce the stress related to women's role of homemaker. Physical activity: Aspects such as combining a physical activity program in participants' daily schedule will also be addressed according to the guidelines of the National Heart Foundation (Briffa et al 2006). Prompts and reminders, such as pedometers, fridge magnets and diaries will be provided to participants in addition to handouts summarising class discussions (Du et al 2009). References: Beckie T, Fletcher G, Beckstead JW. SD, Evans M. Adverse baseline physiological and psychological profiles of women enrolled in a cardiac rehabilitation clinical trial. Journal of Cardiopulmonary Rehabilitation and Prevention. 2008; 28: 52-61. Briffa T, Maiorana A, Sheerin N, et al. Physical activity for people with cardiovascular disease: Recommendations of the National Heart Foundation of Australia. Med J Aust. 2006; 184: 71-75. Du H, Newton PJ, Salamonson Y, Carrieri-Kohlman VL, Davidson PM. A review of the six-minute walk test: Its implication as a self-administered assessment tool. Eur J Cardiovasc Nurs. 2009; 8: 2-8.Schulman LTE. The Skills of Helping Individuals, Families and Groups 1992.