Exploring the psychological and behavioural responses to cardiovascular screening interventions
Date of Award
Edith Cowan University
Doctor of Philosophy
School of Medical and Health Sciences
Screening for asymptomatic cardiovascular disease (CVD) by non-invasive imaging can detect CVD risk, often decades before a clinical event. Early detection of CVD can improve health outcomes by allowing for earlier intervention and treatment. Psychological and behavioural responses to screening can influence health outcomes. However, the impact of screening for asymptomatic CVD from a psychological and behavioural perspective is not well understood. Furthermore, little is known about how to best support individuals in coping with screening-related psychological and behavioural responses, and more research is needed to identify effective interventions to promote healthy responses and behaviours. This thesis aims to provide insight into the psychological and behavioural responses to cardiovascular screening as a beginning step in the development of effective interventions.
The thesis is comprised of 7 chapters including literature reviews, a meta-analysis and a mixed method process evaluation of a randomised controlled trial (RCT). The first chapter of the thesis includes a comprehensive introduction to CVD and rationale for the thesis. This is followed by the second chapter, a description of key concepts/constructs and theories that feature prominently in behaviour change literature. The systematic narrative review presented in chapter 3 synthesised evidence on the impact of cardiovascular screening interventions on perceived threat, efficacy beliefs and behavioural intentions. The findings showed largely encouraging effects of screening interventions on increased self-efficacy beliefs, behavioural intentions and individual perceptions of CVD risk. Evidence of the impact of cardiovascular screening interventions on perceived threat, efficacy beliefs and behavioural intentions was limited.
Chapter 4 mapped the evidence related to health-related quality of life and the potential psychological harms of communicating screening findings. The scoping review showed some mixed evidence related to health-related quality of life, and psychological distress following provision of screening results. Evidence on psychological distress following vascular screening is limited by the use of measures with poor psychometric properties and the paucity of high-quality studies.
In Chapter 5, the effects of the provision of vascular imaging results on medication adherence are examined. Findings showed that the detection of asymptomatic coronary and carotid atherosclerosis assessed by carotid ultrasound and coronary computed tomography significantly increases the likelihood of CVD medication adherence.
The delivery of the Modification Of Diet, Exercise, and Lifestyle (MODEL) RCT is evaluated in chapter 6 together with the mechanisms underlying behaviour change after screening. The results revealed several psycho-social barriers and enablers for modification of lifestyle including weather, social relationships, and behavioural intentions. Participants also encountered some challenges related to completing questionnaires, and interpreting screening results. Participants requested for more clarity about screening results and support to perform recommended behaviours.
To conclude, Chapter 7 provides an overall discussion of all the studies included in the thesis, conclusions, and future directions for research. It underscores the benefits of screening for asymptomatic CVD in terms of the potential impact on behavioural modification and CVD management. Strategies to improve CVD risk communication and support individuals to make lasting changes to their lifestyles are also discussed.
Access to this thesis has been embargoed until 19th May 2025.
Anokye, R. (2023). Exploring the psychological and behavioural responses to cardiovascular screening interventions. Edith Cowan University. http://dx.doi.org/10.25958/v2sa-hm08