HEALTH RISK BEHAVIOR-CHANGE AND ADAPTATION IN CARDIAC PATIENTS

Integrating much from the health belief model, the precaution-adoption model, self-efficacy theory, expectancy theory, and the transtheoreti cal model of behaviour change, a cognitive-behavioural model for asses sment and intervention in cardiac patients is presented in which healt h risk appraisal is seen as the central construct. Specifically, we hy pothesize that people's beliefs regarding the seriousness of their hea lth risk, the modifiability of their health risk, and their confidence in the risk-reduction methods and in their ability to employ these me thods, will influence their adoption of and adherence to health risk-r eduction behaviours as well as influencing their psychological adjustm ent. Furthermore, attentional processes such as ruminative states or a voidance are seen to play a pivotal role in facilitating or impeding c ognitive appraisal processes and behaviour change. Dispositional expec tancy styles (e.g. optimism versus pessimism) are seen to shape belief s regarding the modifiability of health risk via their effects on appr aisals of self-efficacy and appraisals of the effectiveness of risk-re duction methods. Finally, clinical scenarios are presented to illustra te the utility of the model in guiding assessment and intervention in patients with medical problems. (C) 1998 John Wiley & Sons, Ltd.