The relationship between specific aspects of cognition and adherence is examined in a group of individuals participating in the Dr. Dean Ornish Program for Reversing Heart Disease, an intensive lifestyle modification program. This research was guided by a hypothesis of supply and demand the information-processing skills in highest demand for adherence may be in short supply due to how the cardiovascular disease process impacts the brain. This hypothesis was evaluated by using results of neuropsychological testing administered to participants before they began the Ornish program to predict specific learning and adherence outcomes. Hierarchical regression was used to evaluate the contribution made by neuropsychological and non-neuropsychological variables (disease, demography, amount of Ornish lifestyle knowledge at the time of program entry and self-reported emotional status, psychosocial adjustment, and quality of life) to the prediction of adherence and program-specific learning. Nine outcomes were examined including behavioral adherence (diet, exercise, group support, and stress management), in-program learning (knowledge acquisition and procedural learning), staff perceptions of participant learning, and the level of program intensity required at the end of twelve weeks (Phase II Stratification). Neuropsychological variables made the most significant and unique contributions to the majority of predictive models. Measures of working memory and executive control were strongly represented in the adherence models. Explicit verbal memory and working memory were, respectively, significant facilitators of in-program knowledge acquisition and improvements in the accuracy of food diaries. Also, working memory was an important predictor of the level of program intensity participants needed at the end of twelve weeks. In summary, most aspects of the neuropsychological supply information-processing demand (NIP) model were supported. By carefully selecting neuropsychological measures that capture vulnerable areas of cognitive processing in individuals with cardiovascular disease, the importance of cognitive information-processing capacity to adherence and adherence-based learning is demonstrated. Moreover, the research validates previous studies showing that critical cognitive moderators of adherence and learning cannot be discerned by health care professionals delivering clinical care, even when this contact involves intensive educational interventions. Only through the administration of a broad-based neuropsychological assessment battery are these essential cognitive facilitators of learning and adherence identified.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-06152005-192755 |
| Date | 20 June 2005 |
| Creators | Kelly, Mary Ann |
| Contributors | Nancy S. Elman, Ph.D., Roger D. Klein, Ph.D., Christopher M. Ryan, Ph.D., Louis A. Pingel, Ph.D. |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-06152005-192755/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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