Health Psychology - Theses

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Browsing Health Psychology - Theses by Supervisor "Meena Hariharan"
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    Form and frequency of congnitive intervention : Impact on adherence and management of primary hypertension
    (University of Hyderabad, 2018-07) Asher Andrew ; Meena Hariharan
    The exponential rise in the prevalence of hypertension and the resultant surge in cardiac emergencies highlight the urgent need for management of primary hypertension. Hypertension, being a chronic illness mandates high clinical adherence for effective management resulting in good prognosis. Optimizing adherence behaviour is possible through Cognitive Intervention. The purpose of Cognitive Intervention is to enhance knowledge and form a cognitive base about the seriousness of the disease and significance of its management. This in turn is expected to create a conviction and affect state that culminates in enhancing adherence behaviour. The research study examined the differential impact of the Cognitive Intervention modules varying in form and frequency on adherence and management of primary hypertension. Using a pretest-posttest control group quasi experimental design, five groups of patients were compared. Group 1 called ‗Direct Interaction Single Exposure Group‘ (DIS) received Cognitive Intervention through Direct Interaction (DI) mode, where a qualified doctor through a session exposed them to the functional knowledge on primary hypertension. Group 2 called as ‗Direct Interaction Double Exposure (DID)‘ received the same DI form of Cognitive Intervention twice with a gap of 15 days. Group 3 is referred to as ‗Audio Visual Single Exposure Group‘ (AVS) which received the Cognitive Intervention through Audio-visual recorded form (AV) without the physical presence of the doctor while group 4, referred to as ‗Audio Visual Double Exposure Group‘ (AVD) was given the same AV form twice with a gap of 15 days between them. All these four intervention groups were compared with group 5, called as Control Group (C) that was given mere standard medical care. A sample of 450 participants was sequentially assigned to the five groups in the order of DIS, DID, AVS, AVD and Control. The participants were assessed before and after intervention usingHypertension Knowledge Test, Hypertension Compliance Scale, Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support and Hypertension Self Efficacy Scale. To assess hypertension management, Blood pressure readings were recorded thrice before and thrice after the intervention with a gap of one week between the recordings. In a three month follow up the groups were compared on adherence and management before and after the intervention. ANCOVA results showed that cognitive intervention was successful in impacting the adherence and management of hypertension. Particularly the Direct interaction form when repeated had the highest impact on the adherence and management. The audio visual form when repeated proved counterproductive on management of hypertension. In addition, the Cognitive Intervention through direct interaction when repeated reduced the levels of depression compared to the control group. Cognitive Intervention also enhanced the levels of perceived social support land Hypertension specific self-efficacy. Further the study attempted to trace the pathway between the intervention and the management of hypertension. By means of pathway modeling using multiple regression analyses, pathways evolved for both the direct interaction modules (DIS and DID). The knowledge enhancements by the exposure to these modules enhanced self-efficacy. This in turn enhanced hypertension management through enhanced clinical adherence. Thus indispensability of integrating Cognitive Intervention into the hypertension care alongside standard medical treatment is the key conclusion. Implications, strengths and limitations of the study are also discussed.
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    Health communication between doctors and patients \b impact on patient adherence and disease prognosis
    (University of Hyderabad, 2013-08-01) Sunayana Swain ; Meena Hariharan
    Health Communication is the crucial link that keeps the health care system running and delivering effective service. Doctor-patient communication is one form of health communication which has a direct impact on treatment and prognosis, particularly in Non-Communicable Diseases (NCDs) like Hypertension, Diabetes, Arthritis, etc. The present study investigates into the impact of Quality of Communication between doctors and patients diagnosed with primary hypertension on their adherence to treatment and prognosis of the disease. The objective is to determine if doctor-patient communication has an effect on the treatment adherence and prognosis of the patients with primary hypertension and the impact of adherence on prognosis. For this a mixed approach of correlational design, between-subjects and Simple Mixed factorial design was adopted. A sample of 30 doctors and 300 hypertensive patients forming 30 nests, each with one doctor and 10 patients was studied. Quality of communication was measured with a unique method using similarity index that took into account the transaction between the doctor and the patient as a whole. Adherence was measured through self report while prognosis was measured by pre and post Blood Pressure readings as well as doctors‟ ratings. Results revealed that quality of communication plays a significant role in adherence to treatment and prognosis. Results also revealed that adherence plays an important role in deciding the prognosis. Further, the impact of quality of communication on prognosis suggested a definite pathway through adherence. The implications discussed included the need for scientific approach to study the quality of doctor-patient communication, and the analysis of cost- effectiveness of training the doctors in effective communication to address the disease burden of Hypertension.
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    Impact of Psychological intervention on adherence and prognosis in patients undergoing coronary artery bypass grafting
    (University of Hyderabad, 2016-03-01) Thomas, Marlyn ; Meena Hariharan
    Coronary Artery Bypass Grafting (CABG) is an invasive surgical procedure for patients with Coronary Artery Disease. Given the intensity of pain, dependency and medical protocols during the period of CABG, patients tend to experience psychological distress which may lower their adherence and prognosis after surgery. This research study examined the impact of psychosocial intervention, facilitated in conjunction with standard hospital treatment, on adherence and prognosis in patients undergoing CABG. Using a pretest-posttest non-equivalent control groups design, three groups of patients were compared. The first group received the Programme for Affective and Cognitive Education (PACE) intervention, the second was given the Relaxation intervention, and the third formed the Control group with standard hospital treatment only. The participants were assessed using Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Locus of Control checklist for CABG, Adherence Scale for Cardiac Patients, and Biopsychosocial Prognosis Scale for CABG. A sample of 300 participants was sequentially assigned to the three groups (100 in each) in the order of PACE, Relaxation, and Control. The interventions were administered twice to the participants. They were also given the intervention CD or DVD, to be used for reinforcement after discharge. A day before CABG, the pre-surgery assessment was carried out to measure psychological distress, perceived social support and health locus of control. Following this on the same day, the PACE and Relaxation groups received their respective intervention. CABG was performed the next day as per schedule. A day before discharge from hospital (pre- discharge phase), the PACE and Relaxation groups received the second part of their respective intervention. All participants were followed up for six weeks afterdischarge. Psychological distress was assessed during participants’ first and second medical reviews, while adherence and prognosis were measured at the second medical review. A sub-sample of 100 participants was followed up five months after discharge as part of the assessment of prognosis. Semi-structured interviews were individually conducted with a sub-sample of 15 participants to gain deeper insight into their feelings, experiences, and opinions. Results showed that the PACE group had the highest adherence and prognosis as well as the highest reduction in psychological distress from pre-surgery to second review assessments. The Control group had the lowest adherence and prognosis as well as the lowest reduction in psychological distress from pre-surgery to second review assessments. Further, the study attempted to trace the pathway between interventions, adherence and prognosis. By means of pathway modelling using multiple linear regression analyses, adherence was found to be independently and positively predicted by the PACE intervention, the Relaxation intervention and perceived social support, and negatively predicted by psychological distress at second review. The PACE intervention was the only positive independent predictor of prognosis, while psychological distress before surgery, psychological distress at second review and female gender were negative independent predictors. Thematic analysis of qualitative data indicated three themes in participants’ experiences: relief through psychosocial intervention, differential impact of psychosocial interventions, and finding solace in interaction and assessment. The results consistently indicated that psychosocial intervention, namely PACE, was effective in optimising adherence and prognosis after CABG, primarily by reducing psychological distress prior to surgery and during convalescence. The indispensability of integrating psychosocial care into CABG alongside biomedical treatment is the key conclusion. Implications, strengths, and limitations of the study are also discussed
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    Psychosocial care in intensive care units : impact on trauma and wellbeing
    (University of Hyderabad, 2013-08-01) Venkata Usha, Chivukula ; Meena Hariharan
    Intensive Care Units (ICUs) are isolated areas of hospitals meant for providing focused care to patients critically ill or convalescing from surgery. Patients here need close monitoring and intervention. Such isolation, while necessary to protect the patients from infection and complications may create distress and trauma. This can be minimized with biopsychosocial approach in ICU treatment. The present study investigates the impact of Psychosocial Care on ICU Trauma and Wellbeing of patients convalescing in ICU after Coronary Artery Bypass Graft. The study involved a combination of a correlation design and a between subject design with unrelated samples. A multistage sampling method was used. The sample consisted of hospitals and 250 post-operative CABG patients. The study measured the ICU Quality, Psychosocial Care received by the patients, their Trauma and Hospital Wellbeing. The results indicated that Psychosocial Care was a major predictor of ICU Trauma and Hospital Wellbeing. The results revealed significant differences among hospitals in Quality of ICU and Psychosocial Care. The findings indicated that patients treated in High ICU Quality, received higher Psychosocial Care experienced lower levels of ICU Trauma and higher Wellbeing, than patients treated in a Low ICU Quality. The study suggests a biopsychosocial approach in treatment and care of ICU patients. The implications and limitations of the study are disc