Patients experiencing certain social determinants of health struggled with patient behavior change and thus had lower rates of physical activity.
Interventions targeting certain social determinants of health could help drive patient motivation and healthy behavior change, according to a study published in the Journal of the American Medical Association Open Access.
The study specifically looked at how some of the social determinants of health impacted patient behavior change and uptake of a new physical activity regimen. Physical activity is a key patient behavior that supports chronic disease management. Patients with cardiovascular disease, for example, will see better outcomes when they get regular exercise, the researchers said.
“Numerous studies have demonstrated a clear and significant benefit of regular PA in high-risk secondary prevention populations,” they explained. “Patients enrolled in exercise-based cardiac rehabilitation programs have lower risk of reinfarction, reduced hospitalization rates and mortality, better exercise performance, and improved health-related quality of life compared with those not enrolled.”
But patient motivation is a lot easier said than done. Patients often struggle to make an initial change and begin increasing their physical activity. When a patient does begin new activities, adherence can often suffer. This can have an adverse impact on chronic disease management and, ultimately, healthcare spending.
An assessment of responses to the Medical Expenditure Survey from between 2006 and 2015 revealed that most women with cardiovascular disease have suboptimal physical activity levels. Suboptimal physical activity is defined as less than 30 minutes of at least moderate exercise, five days each week.
Overall, more than half of women reported suboptimal physical activity. This trend increased over the study period, with 58 percent of women having low physical activity in 2006 and 61 percent reporting the same in 2015.
What’s more, low rates of physical activity resulted in high healthcare spending. In 2006, patients with suboptimal physical activity yielded a mean cost of $13,000. By 2015, that number grew to $15,000.
The social determinants of health – primarily race, age, and socioeconomic status – impacted patient physical activity levels. Compared to non-Hispanic white women, patients who were black or Hispanic were more likely to have low physical activity.
Low-income women, women with public insurance, and women with less than a high school education also had lower rates of physical activity. Women who were older than 40 tended to have lower activity levels compared to their younger counterparts.
These findings will be essential for better targeting behavior change interventions, the researchers said. Although they did not specifically investigate why certain trends emerged, the researchers stated that healthcare professionals can still use this data to design population-level interventions to drive more behavior change.
For example, older patients may have had poorer physical activity because they had lower mobility, or post-menopausal weight gain may limit them. Using patient education techniques to inform patients that they can still get regular exercise with these limitations may be essential. Additionally, designing exercise programs that account for these limitations will be key.
Low-income patients or patients who part of ethnic minorities may have also had lower rates of physical activity because they have lower rates or referral to a cardiac rehabilitation program.
“An exercise-based cardiac rehabilitation program is not the only way to achieve PA in high-risk patients, but it is an important way to achieve PA targets after a CVD event and, hopefully, to encourage continued engagement in PA long after discharge from the program,” the research team said.
“If referral, enrollment, and participation in cardiac rehabilitation are optimized in women, particularly among these subgroups, it may improve long-term rates of favorable PA, although we could not assess this within our analyses.”
Other strategies for improving patient behavior change include improving monitoring, treating activity as a vital sign, using positive reinforcement, introducing group activities, and using exercise self-management logs.
“By identifying subgroups of women with CVD who are at the greatest risk of suboptimal PA in our study, targeted intervention strategies can be implemented to optimize PA for secondary prevention and reduction in health care costs,” the researchers concluded.
“Specific interventions targeting older women, those from lower socioeconomic status, and racial/ethnic minorities should be implemented to enable more women in these high-risk populations to fulfill the recommended PA guidelines for secondary prevention and achieve associated reduction in health care costs.”
Date: April 18, 2019