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Supporting Lifestyle Change in Patients With CHD

Supporting Lifestyle Change in Patients With CHD


Ethical approval for this study was granted by the Office for Research Ethics Committees (Northern Ireland), ref 10/NIR03/11 (April 2010), and the Irish College of General Practitioners Research Ethics Committee (May 2010).

We invited 23 practices, purposively selected to include different sizes and locations, from the original 48 practices which took part in SPHERE (8 in Northern Ireland (NI); 15 in Republic of Ireland (RoI)). Within these practices we selected participants, based on their responses to validated questionnaires at baseline and 18 month follow-up, and invited them to participate in semi-structured interviews. A maximum variation sampling strategy identified individuals with varying baseline values and levels of change in physical activity (PA) (Godin questionnaire) and in dietary fibre (Dietary Instrument for Nutrition Education (DINE)). The DINE questionnaire provides an objective measure of both dietary fibre and fat however we focused on fibre. Participants were asked about both fat and fibre intake during the semi structured interviews.

Maximum variation sampling strategy also identified individuals with different genders, ages, areas of residence, diagnoses (angina/myocardial infarction) and time since diagnosis, in both intervention and control groups. We included control group patients in order to determine if their views differed from those of patients who received the intervention. The opportunity for exclusion was provided for individuals with significant mental health or physical illness, whose general practitioner considered contact may cause distress, or who would be unable to participate in an interview.

Interviews lasting 20–60 minutes were conducted by the researcher (JC) (December 2010 to September 2011) in participants' own homes or their local general practice premises. A semi-structured interview schedule was designed (Table 2). The primary questions related to what participants thought of the SPHERE Study, the information booklet they had received, their health-related beliefs, their motivations for living a healthy lifestyle and barriers to lifestyle change.

Interviews were transcribed and then analysed using a thematic framework and the constant comparative method, facilitated by using NVivo. Data collection and analysis were iterative and continued until data saturation was achieved. For validation purposes and to pursue discovered evidence, themes emerging in earlier interviews were explored further in later interviews. We followed the Consolidated criteria for Reporting Qualitative research (COREQ) principles, a detailed outline of which is presented in Additional file 1 and includes consideration of the research team, methods, study setting, results and analyses.

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