HEALTH BEHAVIOR BELIEFS AND PHYSICAL HEALTH
RISK FACTORS FOR CARDIOVASCULAR DISEASE IN
AN OUTPATIENT SAMPLE OF CONSUMERS WITH A
SEVERE MENTAL ILLNESS: A CROSS-SECTIONAL
SURVEY
ARTICLE WRITTEN BY: SCOTT BRUNERO & SCOTT LAMONT
PRESENTED BY: LASHONDA MARTIN
INTRODUCTION
 Schizophrenia: A brain disorder that causes patients to be
unable to distinguish reality from imagination.
 Affects about 3 million Americans
 Peak incidence of onset is 15-25 years of age in men & 25-35 in
women.
 Symptoms: delusions, hallucinations, disorganized thinking, speech
and behavior, flat affect, social withdrawal or discomfort
 Medications: Haldol, Seroquel, Risperdal, Clozaril
INTRODUCTION (CONT’D)
 Known: Many factors contribute to an increased risk of
developing health related diseases in those with a mental illness.
 Unknown: The beliefs of these patients toward their health
 Purpose: To understand the correlation between physical health
risk factors and health behavior beliefs in schizophrenia patients.
 Understanding their perspective → better delivery of care.
EVIDENCE FOR CARE
 Nursing care problem:
 There is little understanding the beliefs of schizophrenia patients
towards their physical health.
 Health behavior beliefs are key in allowing patients to engage in
treatment for physical health issues
NURSING THEORY
 Health Belief Model
 Theory of Reasoned Action
 Cognitive Theory Based Model
 Faye Abdellah’s Patient-Centered
Approaches to Nursing
HEALTH BELIEF MODEL
STUDY METHODS AND RESULTS
 Participants: 163 schizophrenia patients
 Methods:
 BP, waist circumference, BMI, smoking hx, exercise levels, demographics, family
hx of diabetes and cardiovascular disease
 European Health and Behavior Survey (EHBS)
 Results:
 Mean waist circumference and BMI > normal population
 Consumers beliefs toward their health were positive.
 Physical health risks > than the general population norms.
EVALUATION OF THE EVIDENCE ??
 Critique:

Cross-sectional

Ethically approved by the South Eastern Sydney Illawarra Area Health Service Ethics
Committee

No conflicts of interest

2 authors

Scholarly, peer-reviewed article
 Limitations:

Participants on Clozapine, an antipsychotic with a known side effect of weight gain and lipid
abnormality.

No matched control group

Prior exposure to health education programs or promotion?
PATIENT CARE DESIGN
 Place patient, their beliefs, and their needs at the center of care
 Address both physical and mental health risk factors
 Shared/collaborative approach between mental health care givers and general
physicians
NURSING CARE PLAN
Nursing Diagnosis
Interventions
Rationales
Goals
Readiness for
enhanced power:
expresses willingness
to enhance
participation in choice
for daily living and
health and enhance
knowledge for
participation in
change
1. Encourage pt to
continue to verbalize
true feelings
2.Allow pt to make
choices in ADL’s and
their health
3. Give patient
learning/educational
opportunities such as
programs
1. Promotes a trusting
relationship between
RN and pt
2. Instills confidence
to help develop
decision-making skills
and allows them to
have a voice in their
care
3. Helps to build pt’s
knowledge
1. Pt will develop trust
in at least one staff
member within one
weeks
2. Pt will be able to
comfortably make
small decision on
their own in ADL’s
and care within two
weeks.
Ineffective health
maintenance R/T lack
of resources
Provide pt with
healthy/educational
nutritional programs
and exercise activities
Improving pt health
will decrease risk of
developing a physical
health problem.
Pt will participate in 3
health promotion
activities each week.
NURSING PRACTICE

Many factors including health beliefs influence health behavior

Develop individualized treatment programs in addition to a physiological and/or
pharmacological approach
Understand
the “whole”
patient
Individualized,
accessible
treatment
programs
Prevent
physical health
disease
ADVOCATE ROLE
 Patient advocate
 Empathy:

Build trust and rapport

Effective, therapeutic communication

Comfortable, healing environment

Best patient outcomes
SUMMARY
 Although patients with a mental illness have an increased risk for serious physical
health problems, they have a positive attitude toward their physical healthcare.

Health professionals must do more to improve the physical health of these
patients by providing them with access to adequate treatment and services.
REFERENCES
 Brunero, S., & Lamont, S. (2010) Health behavior beliefs and physical
health risk factors for cardiovascular disease in an outpatient
sample of consumers with a severe mental illness: A cross-sectional
survey. International Journal of Nursing Studies, 47, 753-760. doi:
10.1016/j.ijnurstu.2009.11.004
 Health behavior and health education: Theory, research, and practice.
(2014). Retrieved from http://www.med.upenn.edu/hbhe4/part2ch3-main-constructs.shtml
 Videbeck, S.L. (2014) Psychiatric-mental health nursing (6th ed.).
Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.