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See detailReversing social gradient: Impact of patients’ communication with their practitioners on adherence to preventive behaviours
Baumann, Michèle UL; Bucki, Barbara; Tchicaya, Anastase et al

in "Health Psychology across the Lifespan: Uniting Research, Practice and Policy” (2018)

Good communication with a physician has positive effects on the patients’ adopting preventive behaviours. Knowing social inequalities in health, we aimed at analysing in what extent financial situation ... [more ▼]

Good communication with a physician has positive effects on the patients’ adopting preventive behaviours. Knowing social inequalities in health, we aimed at analysing in what extent financial situation influences the associations between quality of communication and improved secondary preventive behaviours and limited risk factors - in cardiovascular diseases: hypertension, overweight, obesity, hypercholesterolemia, diabetes. Methods: 1,289 patients who underwent a coronary angiography in Luxembourg completed a self-administered questionnaire in 2008/09 and 2013/14. The association between improving each preventive eating behaviour (decrease of salt, sugar, fat consumption; increase of fruits/vegetables) and the quality of physician-patient communication (5-items scale) was evaluated using logistic regression models. Perceived financial situation (difficult, easy, and very easy) was introduced in interaction with the communication score. Findings: Patients declared in a difficult or easy financial situation had a higher probability of decreasing their salt intake when physician-patient communication quality was higher (OR [95% CI] respectively: 1.139 [1.045; 1.240], 1.105 [1.032; 1.182]). The pattern was similar for increased consumption of fruits/vegetables in patients with hypertension, diabetes, overweight and hypercholesterolemia. Reduced sugar consumption was associated with communication quality in hypercholesterolemia patients in financial difficulty (OR [95% CI]: 1.095 [1.009; 1.189]). Discussion: The quality of communication has a higher impact on adopting healthy behaviours in patients declaring themselves in financial difficulty. These findings raise awareness on the importance, in patients with perceived financial difficulties, of physician-patient quality to improve adherence to the secondary preventive recommendations. Across the lifespan, it highlights the role of physicians in reversing their patients’ social gradient. [less ▲]

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See detailLife Satisfaction and longitudinal changes in physical activity, diabetes and obesity among patients with cardiovascular diseases.
Baumann, Michèle UL; Tchicaya, Anastase; Lorentz, Nathalie et al

in BMC Public Health (2017), (17), 925

Patients with cardiovascular disease who underwent coronary angiography at the National Institute of Cardiac Surgery and Cardiological Intervention (INCCI) in Luxembourg were surveyed for cardiovascular ... [more ▼]

Patients with cardiovascular disease who underwent coronary angiography at the National Institute of Cardiac Surgery and Cardiological Intervention (INCCI) in Luxembourg were surveyed for cardiovascular risk factors (CVRF) (hypertension, hypercholesterolemia, diabetes, obesity, physical inactivity, tobacco consumption). In 2013/14, their life satisfaction (LS) was also assessed. Our aim was to analyse the relationships between LS on one hand and <br />longitudinal changes in CVRF between 2008/09 and 2013/14 and socioeconomic factors on the other. <br />Methods: 1289 patients completed a self-administered questionnaire. Life Satisfaction, originally recorded on a 1 to 10 scale of complete satisfaction was dichotomized into two groups: ≤ 7 and. >7. We then performed logistic multiple regressions. The event on which the probability was modelled, was LS > 7. Data were adjusted on age, sex and income. Longitudinal changes in CVRF were assessed by their presence or absence in 2008/09 and 2013/ 14 (categories: ‘no-no’; ‘no-yes’; ‘yes-no’; ‘yes-yes’). <br />Results: Physical activity in 2008/09 and 2013/14 was associated with a lower LS (OR = 0.469). The same pattern was observed for obesity and physical inactivity: lower LS was related to the presence of these risks (yes-yes; no-yes) in 2013/14 (mean OR for obesity and physical inactivity in 2013/14: 0.587 and 0.485 respectively), whereas their presence or absence in 2008/09 was not related to LS. Finally, patients who suffered from diabetes in 2008 <br />were more likely to experience a decline in LS, particularly if their diabetes was less severe in 2013/14 (OR = 0.462). <br />Conclusions: The lowest LS was observed when obesity or physical inactivity was present in 2013/14, newly or otherwise. The same trend was seen in diabetes among patients who had it in 2008/9, but were less severely affected in 2013/14. In secondary prevention, CVD-related upheavals could be minimised if professionals and patients ecame ‘Partners in Healthcare’ to better adhere to healthy lifestyles, as well as to reduce CVRF, and thereby enhance LS. [less ▲]

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See detailLe statut matrimonial et la qualité des liens sociaux des personnes souffrant de maladies cardiovasculaires influent-ils sur les inégalités liées aux changements des comportements à risque?
Tchicaya, Anastase; Baumann, Michèle UL

in Sociétés en mouvement - Sociologie en changement (2016)

Les maladies cardiovasculaires constituent l’une des principales causes de morbidité et de mortalité dans les pays développés. Liées aux modes de vie et aux choix alimentaires, elles représentent un ... [more ▼]

Les maladies cardiovasculaires constituent l’une des principales causes de morbidité et de mortalité dans les pays développés. Liées aux modes de vie et aux choix alimentaires, elles représentent un problème sociétal et de santé publique majeur. Dans une étude de suivi des patients ayant passé un examen des coronaires 5 ans plus tôt au Luxembourg (n=1289), notre communication tentera de mettre en évidence l’impact du statut matrimonial et des liens sociaux sur la prise de conscience des facteurs de risque de maladies cardiovasculaires dans un monde globalisé dans lequel des mutations sociales inéluctables sont à l’œuvre (famille recomposée, individualisme, identification à de nouvelles communautés à travers les réseaux sociaux, internet, etc.). La cellule familiale actuelle peut-elle rester une ressource centrale dans l’adoption de comportements sains ? Quelle est la place de la qualité des liens sociaux dans le processus de la réflexivité individuelle face à cette prévention secondaire ? Dans ce processus, les savoirs des patients s’enrichissent continuellement en mobilisant plusieurs ressources, à savoir les professionnels de santé, les médias, les réseaux sociaux, la famille et les amis. Ainsi, la modification du comportement (ou son absence) serait-elle la résultante d’un choix délibéré des patients au regard des représentations et des croyances que ceux-ci se feraient des risques qu’entraîneraient leur maladie à la fois pour eux-mêmes et pour leur entourage proche. [less ▲]

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See detailImpact of Patients’ Communication with the Medical Practitioners, on Their Adherence Declared to Preventive Behaviours, Five Years after a Coronary Angiography, in Luxembourg
Baumann, Michèle UL; Tchicaya, Anastase; Lorentz, Nathalie et al

in PLoS ONE (2016), 11(6), 0157321

Patients of the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg who underwent coronary angiography were surveyed for hypertension, hypercholesterolemia, diabetes and ... [more ▼]

Patients of the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg who underwent coronary angiography were surveyed for hypertension, hypercholesterolemia, diabetes and overweight/obesity between 2008/9 and 2013/4. For each cardiovascular risk factor (CVRFs), we analysed the associations between the quality of the patients' communication with the medical practitioner and their adherence declared to preventive behaviours. Methods 1,289 completed a self-administered questionnaire on communication with the medical practitioner (P’Com-5 items scale; Cronbach 0.87). 61.8%stopped smoking, 57.9% reduced or stopped their consumption of salt, 71.9% of fat, and 62.8%of sugar, and whereas 65% increased their consumption of fruit and vegetables and 19.8% increased their physical activity. Around 37% reported having made changes following their doctor's advice. 90% were followed by a cardiologist and 95.9% by an attending physician. Results No link was observed between declaration of physical activity, smoking, fats, and quality of communication. Significant associations: for increased consumption of fruit and vegetables was linked with the quality of doctor-patient communication when patients were overweight (OR = 1.081), obese (OR = 1.130), hypercholesterolemic (OR = 1.102), hypertensive (OR = 1.084) or diabetic (OR = 1.103). Reduction in salt intake was linked only to patients with hypertension (OR = 1.102), whereas reduction or cessation of sugar consumption was linked to overweight (OR = 1.093), and more so obese, (OR = 1.106), hypercholesterolemics (OR = 1.103) and diabetics (OR = 1.173). Conclusions Good doctor-patient communication was related to nutrition, particularly increased consumption of fresh fruits and vegetables. Accurate perception of CVRFs by both patients and medical practitioners is essential for CV protection. The aim of instructing patients is to encourage them to make informed decisions about how to change their lifestyle. In routinely, P’Com-5 scale can collect data to assess the improvement of the professional skills. It can be used in medical training to enhance the quality of the therapeutic communication, especially for nutritional coaching, and to evaluate its efficacy in reducing CVRFs. [less ▲]

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See detailDoctor-patient communication about nutrition on related secondary preventive behaviours, especially for hypertension
Baumann, Michèle UL; Tchicaya, Anastase

in Hypertension (2016)

Inadequate consumption of fruit and vegetables and salt intake are two major factors that can play a role in increased to secondary prevention behaviours. Doctor-patient relationship intervenes on the ... [more ▼]

Inadequate consumption of fruit and vegetables and salt intake are two major factors that can play a role in increased to secondary prevention behaviours. Doctor-patient relationship intervenes on the adherence of these advices. For hypertension, hypercholesterolemia, diabetes, overweight and obesity, our study’s aim was to analyse the associations between the quality of the doctor-patient communication, evaluated in 2013, and patients’ adherence to their general practitioner (GP)’s nutritional advices, between 2008 and 2013. Methods Performed by the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg, 4391 patients were contacted. Five years after a coronary angiography, 1289 completed a self-rating questionnaire assessing the GP’Com-5 items scale (Cronbach 0.87). The variables were analysed with a multiple logistic regression model. Results Patients declared that 57.9% reduced or stopped their consumption of salt intake, whereas 65% increased their consumption of fresh fruits and vegetables. Around 37% of the patients reported having made changes following the advice of their doctor. An increased consumption of fresh fruits and vegetables was linked with the quality of doctor-patient communication when patients were hypertension (odd ratio (OR) = 1.084, IC 95%, [1.017-1.157]), overweight (1.081 [1.013-1.155]), obesity (OR = 1.130 [1.056-1.209]), hypercholesterolemia (OR = 1.102 [1.033–1.175]) and diabetes (OR = 1.103 [1.029-1.181]). The decreased of salt intake consumption was associated with the quality of physician-patient communication when the patient was hypertension (OR = 1.102 [1.034 – 1.176]). Conclusion Doctor-patient communication is a relevant determinant in obtaining a favourable behavioural outcome, especially on nutrition. The rehabilitation program must promote more exchange and telephone assistance to develop a mutual engagement. [less ▲]

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See detailWeight Loss Aassociated With Socioeconomic Status in Patients With Angina Pectoris, 5 Yeras After and Angiography
Tchicaya, Anastase; Baumann, Michèle UL

in Cardiology (2015), (132 (104)), 60

The aim of the study is to assess the association between weight loss and socioeconomic status (SES) in patients with cardiovascular disease (CVD) such as angina pectoris. Method: In 2013-2014, 1,873 ... [more ▼]

The aim of the study is to assess the association between weight loss and socioeconomic status (SES) in patients with cardiovascular disease (CVD) such as angina pectoris. Method: In 2013-2014, 1,873 patients out of 4,391 that had undergone an angiography in 2008- 2009 participated in a follow-up study. Among these patients, 457 suffered from angina pectoris and were obese or overweight at baseline. A self-administered questionnaire was completed. Moderate weight loss was defined as the loss of 5%-10%, severe weigh loss as more than 10% of baseline weight. Household-income was used as proxy for SES. Logistic regression was applied to assess the association between weight loss and SES. Results: During the reference period, 28% of the participants lost weight. A moderate weight loss was higher in patients with a household income between 3000€ and 4500€ per month (OR: 2.3; CI 95%: 1.0-5.2) and higher than 4500€ per month (OR: 3.0; CI 95%: 1.3-7.2) compared to the lowest income group (less than 3000€ per month). A severe weight loss was not associated with income. However, a severe weight loss was higher for retired patients (OR: 4.3; CI 95%: 1.1- 17.0) compared to non-retired. Conclusion: The potential reduction of health inequality by an elimination of social inequalities in weight loss among patients with angina pectoris might be substantial. Moderate weight loss in overweight patients with angina pectoris at baseline could be associated with household income. Intervention strategies in secondary prevention should address these social inequalities in order to support equity in health. [less ▲]

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See detailDoctor-patient communication on nutrition and the related secondary preventive behaviours
Baumann, Michèle UL; Le Bihan, Etienne UL; Lorentz, Nathalie et al

in Cardiology (2015), 132

Doctor-patient relationship impacts on the compliance. For hypercholesterolemia, diabetes, overweight and obesity, our study’s aim was to analyse the associations between the quality of communication ... [more ▼]

Doctor-patient relationship impacts on the compliance. For hypercholesterolemia, diabetes, overweight and obesity, our study’s aim was to analyse the associations between the quality of communication, evaluated in 2013, and patients’ adherence to their general practitioner (GP)’s nutritional advice, between 2008 and 2013. Methods. Five years after a coronary angiography performed by the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg, 4391 patients were contacted. 1289 completed a self-rating questionnaire assessing the GP’Com-5 items scale (Cronbach 0.87). The variables were analysed with a multiple logistic regression model. Results. Patients declared that they reduced or stopped their consumption 71.9% of fat, 62.8% of sugar and 65% increased their consumption of fruits and vegetables. Around 37% of the patients reported having made changes to their risk behaviours following the advice of their doctor. An increased consumption of fruits and vegetables was linked with the quality of doctor-patient communication when patients were overweight (odd ratio = 1.081, IC 95%, [1.013-1.155]), obesity (OR = 1.130 [1.056-1.209]), hypercholesterolemia (OR = 1.102 [1.033–1.175]) and diabetes (OR = 1.103 [1.029-1.181]). The reduction or cessation of sugar consumption was associated with the quality of physician-patient communication when the patient was overweight (OR = 1.093 [1.020-1.170]), and more so obese (OR = 1.106 [1.031-1.187]). The same held true for patients with hypercholesterolemia (OR = 1.103 [1.031-1.180]) or diabetes (OR = 1.173 [1.088-1.265]). Conclusion. In prevention of secondary CVDs, doctor-patient communication is a relevant determinant in obtaining a favourable behavioural outcome, especially with the consumption of fresh fruit and vegetables. [less ▲]

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See detailLife satisfaction, cardiovascular risk factors, unhealthy behaviours and socioeconomic inequality, 5 years after coronary angiography.
Baumann, Michèle UL; Tchicaya, Anastase; Vanderpool, kyle et al

in BMC Public Health (2015), (15), 668-678

Five years after coronary angiography, life satisfaction (LS) among patients may be related to incidents of cardiovascular diseases, risk factors and unhealthy behaviours and socioeconomic conditions, but ... [more ▼]

Five years after coronary angiography, life satisfaction (LS) among patients may be related to incidents of cardiovascular diseases, risk factors and unhealthy behaviours and socioeconomic conditions, but their respective influence remains unclear. Our aim is to analyze LS and its relationships with those factors. Methods. Among the 4,391 patients initially contacted, 547 deaths were reported and 209 had an invalid address. In 2013-2014, 3,635 patients who underwent coronary angiography in 2008-2009 at the National Institute of Cardiac Surgery and Cardiological Intervention in Luxembourg were asked to complete a self-administered questionnaire assessing LS [1-10] and other variables. Data were analysed via multiple regression models adjusted initially on age, sex and income, and for a second time with the addition of all CVRF. Results. LS of 1,289 volunteers (69.2 years) was 7.3/10. Most were men, Luxembourgish, employees and manual workers, had secondary education and an income of 36,000 euros or more per year. LS was lowest in female patients, and those with a low to middle income. Patients who lived in a couple had the best LS. Patients with a history in the previous 5 years of physical inactivity (regression coefficient: -0.903), angina pectoris (rc -0.843), obesity (rc -0.512), diabetes, or hypercholesterolemia, were more likely to have lower LS. The previous associations were mostly maintained on the second analysis, with the exceptions of diabetes and obesity. In addition, patients who stopped smoking because of peer pressure (rc -0.011) had a lower LS. Conclusions. The finding that LS was lowest among female patients calls for further research on symptoms, and potential risk factors. Also, certain patient profiles are linked with low LS: ‘inclined abstainers’ who intended to modify their behaviours, but could not do so, and ‘disinclined abstainers’ who had no intention of changing and were insufficiently concerned to do so. Patients who stopped smoking and perceived it as unpleasant also had low LS. ‘Disinclined actors’ were those patients who had to adjust their lifestyles, but were ambivalent about their intentions and the behaviour, which they continued. Health promotion programs would benefit from targeting factors that moderate the unfavourable intention-behaviour relationship and can help enhance LS. [less ▲]

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See detailLife satisfaction, five-years after a coronary angiography, between physical exercise and socio-economic inequalities.
Baumann, Michèle UL; Le Bihan, Etienne UL; Lorentz, Nathalie et al

in Pracana, Clara (Ed.) Health Psychology (2015)

Five-years after undergoing a coronary angiography, socioeconomic status and health related behaviours are known to affect life satisfaction (LS), but their respective influence remains unclear. Our aim ... [more ▼]

Five-years after undergoing a coronary angiography, socioeconomic status and health related behaviours are known to affect life satisfaction (LS), but their respective influence remains unclear. Our aim was to analyze patients’ LS and its relationships with cardiovascular diseases, risk factors and preventive behaviours developed in the last 5 years and socioeconomic conditions. Methods: Based on records from the National Institute of Cardiac Surgery and Cardiological Intervention in Luxembourg, 3632 survivors who underwent coronary angiography between 2008 and 2009 were contacted in 2013 by letter to complete a self-questionnaire assessing LS [1-10] and other cofounder factors. Data were analysed via multiple regression models. Results. Life satisfaction of 1289 volunteers (69.2 years) was 7.3/10. Majority were men, Luxembourgish, secondary education level, employees and manual workers, and those with an income of 36000 euros or more per year. Being a woman, not living in couple and having a low middle income were negatively associated with the LS level. Patients who suffered in the last 5 years from angina pectoris, diabetes, hypercholesterolemia, obesity, or who stopped smoking because of the disease were more likely to have lower LS, in contrast to those who participate in regular physical activity or exercise. Conclusions: Patients’ LS indicator was lower than the national life satisfaction in Luxembourg (7.8/10) which was higher than that from the European (7.0 for EU-27). Coaching patients with interventions that foster healthy attitudes can help sustain rehabilitation and enhance life satisfaction, adding beyond a reduction of socioeconomic inequalities. [less ▲]

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See detailWeight loss associated with socioeconomic status in patients with angina pectoris, 5 years after an angiography
Tchicaya, Anastase; Baumann, Michèle UL

in Cardiology (2015), (132 (suppl 1)), 60

The aim of the study is to assess the association between weight loss and socioeconomic status (SES) in patients with cardiovascular disease (CVD) such as angina pectoris. Method:In 2013-2014, 1,873 ... [more ▼]

The aim of the study is to assess the association between weight loss and socioeconomic status (SES) in patients with cardiovascular disease (CVD) such as angina pectoris. Method:In 2013-2014, 1,873 patients out of 4,391 that had undergone an angiography in 2008 -2009 participated in a follow-up study. Among these patients, 457 suffered from angina pectoris and were obese or overweight at baseline. A self-administered questionnaire was completed. Moderate weight loss was defined as the loss of 5%-10%, severe weigh loss as more than 10 % of baseline weight. Household-income was used as proxy for SES. Logistic regression was applied to assess the association between weight loss and SES. Results:During the reference period, 28% of the participants lost weight. A moderate weight loss was higher in patients with a household income between 3000€ and 4500€ per month (OR: 2.3; CI 95%: 1.0-5.2) and higher than 4500€ per month (OR: 3.0; CI 95%: 1.3-7.2) compared to the lowest income group (less than 3000€ per month). A severe weight loss was not associated with income. However, a severe weight loss was higher for retired patients (OR: 4.3; CI 95%: 1.1-17.0) compared to non-retired.Conclusion: The potential reduction of health inequality by an elimination of social inequalities in weight loss among patients with angina pectoris might be substantial. Moderate weight loss in overweight patients with angina pectoris at baseline could be associated with household income. Intervention strategies in secondary prevention should address these social inequalities in order to support equity in health. [less ▲]

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See detailWhy medication or tobacco consumption enhance the life satisfaction of cardiovascular patients?
Bucki, Barbara UL; Tchicaya, Anastase; Baumann, Michèle UL

in European Health Psychologist (The) (2015), special

While life satisfaction (LS) promotes the health of cardiovascular patients, LS may be affected by a range of primary and secondary determinants. We analysed LS and its relationships with cardiovascular ... [more ▼]

While life satisfaction (LS) promotes the health of cardiovascular patients, LS may be affected by a range of primary and secondary determinants. We analysed LS and its relationships with cardiovascular risk factors and unhealthy behaviours. Methods. In 2013, 3,632 survivors who underwent coronary angiography in 2008-2009 at the Luxembourgish National Institute of Cardiac Surgery and Cardiological Intervention (INCCI), living at home were asked to estimate, five years after, their LS [1-10] and other health-related variables. Data were analysed via multiple regression models including interaction effects. Findings. LS of the 1,289 participants (age: 69.2±11.1) was 7.3/10. Most were men, employees or manual workers, had secondary education and a 36,000€ or more/year income. The interactions between hypercholesterolemia and hypertension (regression coefficient= 0.628) and with smoking (rc= 0.941) were positively related with LS, but physical inactivity was negatively associated (rc= -0.630). Discussion. Taking medications or maintaining tobacco consumption produces better LS than being ambivalent towards physical activity. Further research is needed to evaluate the efficacy of health interventions eliciting and promoting the behaviour change wheel based on capabilities, opportunities, and motivations. [less ▲]

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See detailPatients with cardiovascular risk factors were more likely to have lower life satisfaction.
Baumann, Michèle UL; Tchicaya, Anastase

in Circulation (2015), 132

Five years after coronary angiography, life satisfaction (LS) among patients may be related to incidents of cardiovascular diseases, risk factors and unhealthy behaviours and socioeconomic conditions but ... [more ▼]

Five years after coronary angiography, life satisfaction (LS) among patients may be related to incidents of cardiovascular diseases, risk factors and unhealthy behaviours and socioeconomic conditions but their respective influence remains unclear. Our aim is to analyze LS and its relationships with those factors. Methods. Among the 4,391 patients initially contacted, 547 deaths were reported and 209 had an invalid address. 3,635 patients who underwent coronary angiography in 2008-2009 at the National Institute of Cardiac Surgery and Cardiological Intervention (INCCI) in Luxembourg completed a self-questionnaire assessing LS [1-10] and other covariates. Data were analysed via multiple regression models adjusted initially on age, sex and income, and for a second time with the addition of all CVRF. Results. LS of 1,289 volunteers (69.2 years) was 7.3/10. Most were men, Luxembourgish, employees and manual workers, had secondary education and an income of 36,000 euros or more per year. LS was lowest in female patients, those with a low to middle income. Patients who live in couple had the best LS. Patients with a history in the previous 5 years of physical inactivity (regression coefficient: – 0.903), angina pectoris (rc -0.843), obesity (rc -0.512), diabetes, or hypercholesterolemia, were more likely to have lower LS. The previous associations were mostly maintained on the second analysis, with the exceptions of diabetes and obesity. In addition, patients who stopped smoking because of peer pressure (rc -0.011) had a lower LS. Conclusions. Profiles of patients are linked with least LS: ‘inclined abstainers’ who intended to modify their behaviours, but could not do it, and ‘disinclined abstainers’ who had no intention of changing and were insufficiently concerned to do so. Patients who stopped smoking and perceived it as unpleasant also had the lowest LS. ‘Declined actors’ were those patients who had to adjust their lifestyles, but were ambivalent about their intentions and the behaviour, which they continued. Health promotion programs would benefit from targeting factors that moderate the unfavourable intention-behaviour relationship and can help enhance LS. [less ▲]

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