BACKGROUND: Patients with chronic diseases create their own subjective beliefs about their conditions based on their illness perceptions. In the common-sense model, illness perceptions constitute personal beliefs about illness with regard to five components: identity, timeline, cause, control/cure, and consequences. Patients' illness perceptions affect both their management of their disease and their adherence to treatment. Since patients with peripheral arterial disease need life-long treatment for secondary prevention, generating knowledge about illness perceptions in patients with peripheral arterial disease is essential.

OBJECTIVES: To systematically review and synthesise the literature on illness perceptions in patients with peripheral arterial disease.

DESIGN: A systematic review DATA SOURCES: PubMed, CINAHL, and PsycINFO.

REVIEW METHODS: A systematic search strategy was conducted in December 2017, with an update in July 2019. Two team members independently screened all titles and abstracts. A relevance and quality appraisal of the studies was performed. The references from the included studies were evaluated for additional studies. The data from 14 studies were extracted and synthesised using a "best-fit" approach to framework analysis. A deductive analysis was conducted using the common-sense model. The data not suitable for the framework were analysed separately using inductive conventional content analysis, yielding an additional component representing the retrospective consequences of peripheral arterial disease.

FINDINGS: The findings showed diversity in illness perceptions in each of the five components of the framework as well as in the additional component. The findings showed participants' lack of understanding of the chronic nature of the disease, i.e., about the timeline, the identity of the symptoms and the cause of the disease. The patients' beliefs about control and cures varied from having high motivation to engage in physical activity to thinking that walking could make their situations worse. There was fear about the future, as patients perceived disease progression and decreasing control to be consequences of their illness. Living with the disease, the emphasis in the additional component, was a process for regaining control and adapting to their situations.

CONCLUSIONS: Patients with peripheral arterial disease shape their own understandings of their conditions. These beliefs may influence their management of their disease and adherence to treatment. Therefore, the current study suggests that illness perceptions should be addressed when planning secondary prevention for patients with peripheral arterial disease.

Background: Intermittent claudication requires treatment with secondary prevention to reduce disease progression and the risk of cardiovascular events and to improve quality of life. Health literacy and self-efficacy are important preconditions for the health behaviour changes necessary for adhering to secondary prevention.

Aim: Evaluate health literacy in patients with intermittent claudication regarding clinical characteristics, demographics, self-efficacy and quality of life.

Methods: A cross-sectional study evaluating health literacy, self-efficacy and quality of life using questionnaires. Patients with intermittent claudication from vascular units in the south of Sweden were included.

Results: In total, 158 patients were included, of which, 52.5% reported “inadequate” (0-8 points) or “problematic” (9-12 points) health literacy with no differences between men and women. A significant higher proportion of patients living alone reported “inadequate” or “problematic” health literacy than “sufficient” (13-16 points) health literacy. Patients with “sufficient” health literacy reported significantly higher self-efficacy and quality of life and were more physically active than patients with “inadequate” or “problematic” health literacy. Also, patients with a university degree reported a significantly higher ability to “access” (seek, find and obtain) and “understand” (comprehend the accessed) information relevant to health.

Conclusion: The majority of patients with intermittent claudication have “inadequate” or “problematic” health literacy. Also, an “inadequate” or “problematic” health literacy level is more common among patients living alone, and education level appears to be more important when “accessing” and “understanding” information relevant to health. This illuminates the importance of not only the patients’ health literacy but also demographics when planning for secondary prevention.

Background: Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication.

Aim: to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication.

Methods: A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life.

Results: In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy.

Conclusion: Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

Background: Patients with intermittent claudication (IC) need lifelong treatmen twith secondary prevention, including smoking cessation, walking exercise, and best medical treatment. The deficiency in existing support indicates a need for new strategies to improve self-management of the disease. However, knowledgeof electronic health (e-health) as support for these patients is lacking. The primary aim was to evaluate the usability of a web-based application and its effect on secondary prevention outcomes for patients with IC. The secondary aim was to describe the patients’ experiences of using a web-based application.

Patients and methods: Patients with IC (n=34) were recruited from a vascular outpatient clinic to a randomized controlled pilot trial. For three months, the intervention group (n=18) reported information through/via the application about physical activity, smoking, medication therapy, blood pressure, pain afteractivity, and quality of life (QoL). Primary outcome was walking distance, and the secondary outcome included ankle brachial index (ABI), blood pressure measurements, lifestyle factors, health education, and QoL. After completing the study, the intervention group was interviewed in focus groups.

Results: The reporting adherence was high (86–93 %). ABI and QoL were improved in the intervention group, and the level of insight into their condition increased in both groups. There was a trend for longer walking distance in the intervention group. The interviews show an overall positive experience of using the application. Some patients experienced that the application increased their motivation to adhere to lifestyle recommendations.

Conclusions: High reporting adherence, a positive trend in walking distance, improved ABI, and QoL, together with the participants experiences, indicate that using e-health may support adherence to secondary prevention in patients with IC but needs to be further studied in a full-scale randomized controlled trial.