Is patient attachment an important consideration when examining support and efficacy dynamics in exercise-based cardiac rehabilitation?


Engaging in exercise-based cardiac rehabilitation (CR) consistently reduces post-event cardiac risk and improves quality of life. Promoting patients' exercise self-efficacy is key as low self-efficacy inhibits self-care, prolonging symptoms and elevating risk. Support from a partner (spouse or caregiver) is seen as an important predictor of successful rehabilitation outcomes. Partner's perceptions of a patient's capabilities, known as other-efficacy, may also be important, as they may relate to the support partners provide. The current study explored whether partner's other-efficacy was related to how they supported the patient and in turn how this predicted patient's self-efficacy. Further, this project extended work in this area by drawing from attachment theory to examine whether the patient's attachment style may moderate the relationship between support and self-efficacy. CR patient and partner dyads (N=68) were recruited from a 10-week CR program, completing measures of self-efficacy, other efficacy, support, and attachment styles. The overall model was tested using an SPSS macro called PROCESS. Overall mediation was not found; however, other-efficacy was negatively associated with overprotective support (b=-.01, p=.03), and overprotective support was negatively associated with patient self-efficacy (b=-5.03, p=.02). A significant interaction was found between overprotective support and attachment anxiety when predicting patient's self-efficacy (b=4.47, p=.005), indicating that the self-efficacy of patients lower in attachment anxiety was more strongly negatively associated with overprotective support offered by the partner. The findings of this study provide insight into the dynamics between efficacy perceptions, support and attachment, which may help to inform tailoring of education and assistance in partner-based CR.

Acknowledgments: SSHRC Small Institutions Grant