Lynn Caldwell


Nonadherence to therapeutic regimens which necessitate major lifestyle change is recognized as one of the most serious problems in medical practice today. Attempts to prevent and control chronic disease, including the development and progression of cardiovascular disease, are only effective when recommendations to the patient are carried out. Few studies have systematically studied the relationship of psychosocial and behavioral factors to adherence outside the theoretical framework of a specific behavioral model; no study has done so with a carefully measured diet as the outcome variable in a controlled prospective clinical trial with patients suffering from cardiovascular disease.

This study, as part of a larger controlled clinical intervention trial attempted to address this deficiency in adherence research, the aim of the larger trial is to assess the effects of a comprehensive lifestyle intervention program on ischemic heart disease in 49 male veterans, the object of this study was to analyze the psychosocial and behavioral characteristics of these patients and their relationship to dietary After collection of baseline data on diet, psychosocial and behavioral variables, the patients were then randomized into either a adherence. control (usual care) or intervention group. An intensive eight week nutrition education program was then instituted for the patients in the intervention group, while the control group continued to receive the regular VA clinical care which does not include a lifestyle modification program. During this time, the intervention patients were asked to attend weekly classes with a coparticipant regarding diet aimed at cardiovascular risk reduction. In addition to the classes, I saw these patients in clinic several times for individual nutrition counselling. At the end of the eight week period, questionnaires were again administered regarding the same variables collected at baseline. All data collected was then analyzed in order to answer the questions presented by this study on the relationship of patients' psychosocial and behavioral characteristics to dietary changes.

The major findings of this research are summarized as follows: (a) the tools used for measuring variables under study were found generally reliable, and the two methods of dietary analysis correlated highly with one another for most nutrients? (b) the nutrition intervention program was considered successful in changing patients* eating behavior to meet or exceed most of the goals established; (c) the multidimensional Health Locus of Control (MHLC) demonstrated the greatest potential in predicting subsequent dietary changes, with high internal and low external (other) making the greatest improvements? (d) the larger the number of members in a patient*s family, the less improvement the patient made in his diet, although rating of members as more stable or supportive was positively associated with greater weight loss and (e) increased class participation was generally positively correlated with improvements in diet.

Effectiveness in influencing health behavior aimed at curbing the epidemic of cardiovascular disease, as well as other chronic diseases. can in part be based on identification of the psychosocial and behavioral variables which may influence adherence. Reliable and valid tools for measuring these variables, especially multidimensional ones such as diet. are essential for designing the appropriate educational interventions as well as accurately collecting data to by analyzed for research. Nutritionists, cardiac rehabilitation specialists and health educators alike can incorporate the major findings in this study in planning lifestyle and nutrition programs resulting in optimum patient adherence.


School of Public Health

First Advisor

Joyce Hopp

Second Advisor

Ruth White

Third Advisor

Gary E. Fraser

Fourth Advisor

Jerry W. Lee

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Coronary Disease -- therapy; Diet Therapy; Patient Education



Page Count

xiii; 203

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website


Loma Linda University. Del E. Webb Memorial Library. University Archives