Adherence in CABG Patients: An Empirical Test of a Health Behavior Model


To benefit from a Coronary Artery Bypass Graft Surgery (CABG), patients must adhere to their therapeutic regimen. To test the extent of which the Information-Motivation-Behavioral Skills (IMB) model constructs explain the variability in adherence behaviors in CABG patients, and also to examine the relationship between the IMB model constructs, CABG patients (N = 152) were randomly assigned to either an intervention group, or a standard care control group. They completed pretest measures, and were reassessed later. Although perfect replication of the IMB model’s predicted pathways was not achieved in this study, support for several of these pathways was demonstrated. The estimated model for adherence-demonstrated good fit of the data. Motivation was a significant predictor of adherence behavior in CABG patients. These findings suggest that IMB model-based intervention that improves motivation can enhance adherence. Therefore, CABG patients’ education programs should mainly target motivation in order to affect adherence behavior.

Share and Cite:

Zarani, F. , Sarami, G. and Sadeghian, S. (2014) Adherence in CABG Patients: An Empirical Test of a Health Behavior Model. International Journal of Clinical Medicine, 5, 225-233. doi: 10.4236/ijcm.2014.55036.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Charlson, M.E. and Isom, O.W. (2003) Clinical Practice: Care after Coronary-Artery Bypass Surgery. The New England Journal of Medicine, 348, 1456-1463.
[2] Karthik, S., Tahir, N., Thakur, B. and Nair, U. (2006) Risk Factor Awareness and Secondary Prevention of Coronary Artery Disease: Are We Doing Enough? Interactive Cardiovascular and Thoracic Surgery, 5, 268-271.
[3] Mc Call, L.A. and Martin Ginis, K.A. (2004) The Effects of Message Framing on Exercise Adherence and Health Beliefs among Patients in a Cardiac Rehabilitation Program. Journal of Applied Biobehavioral Research, 9, 22-135.
[4] Ben-Zur, H., Rappaport, B., Ammar, R. and Uretzkky, G. (2000) Coping Strategies, Life Style Changes, and Pessimism after Open-Heart Surgery. Health & Social Work, 25, 201-209.
[5] Leong, J., Molassiotis, A. and Marsh, H. (2004) Adherence to Health Recommendation after a Cardiac Rehabilitation Program in Post-Myocardial Infarction Patients: The Role of Health Beliefs, Locus of Control and Psychological Status. Clinical Effectiveness Nursing, 8, 26-38.
[6] Lynam, I., Catl, D., Goggin, K., Rabinowits, J.L., Gerkovich, M.M., Williams, K. and Wright, J. (2009) Autonomous Regulation and Locus of Control as Predictors of Antiretroviral Medication Adherence. Journal of Humanistic Psychology, 14, 578-586.
[7] J. Woodgate and Brawley, L.R. (2008) Self-Efficacy for Exercise in Cardiac Rehabilitation: Review and Recommendations. Journal of Health Psychology, 13, 366-387.
[8] Alm-Roije, C., Stagmo, M., Udén, G. and Erhardt, L. (2004) Better Knowledge Improves Adherence to Lifestyle Changes and Medication in Patients with Coronary Heart Disease. European Journal of Cardiovascular Nursing, 3, 321-330.
[9] Fonarow, G.C., Gawlinski, A., Moughrabi, S. and Tillisch, J.H. (2001) Improved Treatment of Coronary Heart Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). American Journal of Cardiology, 87, 819-822.
[10] Fonarow, G.C. and Ballantyne, C.M. (2001) In-Hospital Initiation of Lipid Lowering Therapy for Patients with Coronary Heart Disease: The Time Is Now. Circulation, 103, 2768-2770.
[11] Bandura, A. (1997) Self-Efficacy: The Exercise of Control. W. H. Freeman and Company, New York, 25-30.
[12] Hardeman, W., Kinmonth, A.L., Michie, S. and Sutton, S. (2011) Theory of Planned Behaviour Cognitions Do Not Predict Self-Reported or Objective Physical Activity Levels or Change in the ProActive Trial. British Journal of Health Psychology, 16, 135-150.
[13] Mihalko, S.L., Brenes, G.A., Farmer, D.F., Katula, J.A., Balkrishnan, R. and Bowen, D.J. (2004) Challenges and Innovations in Enhancing Adherence. Controlled Clinical Trials, 33, 775-790.
[14] Fisher, J.D. and Fisher, W.A. (2002) The Information-Motivation Behavioral Skills Model. In: Diclemente, R.J., Crosby, R.A. and Kegler, M.C., Eds., Emerging Theories in Health Promotion Practice and Research: Strategies for Improving Public Health, Jossey-Bass, Inc., Indianapolis.
[15] Fisher, J.D. and Fisher, W.A. (2000) Theoretical Approaches to Individual-Level-Change in HIV Risk Behavior. In: Peterson, J.I. and DiClemente, R.J., Eds., Handbook of HIV Prevention, Klumer Academic/Plenum Publishers, New York, 3-55.
[16] Fishe, W.A., Fisher, J.D. and Harman, J.J. (2003) The Information-Motivation-Behavioral Skills Model: A General Social Psychological Approach to Understanding and Promoting Health Behavior. In: Suls, J. and Wallston, K., Eds., Social Psychological Foundations of Health and Illness, Blackwell, Malden, 82-106.
[17] Fisher, J.D. and Fisher, W.A. (1992) Changing AIDS-Risk Behavior. Psychological Bulletin, 111, 455-474.
[18] Zarani, F., Besharat, M.A., Sadeghian, S. and Sarami, G. (2010) The Effectiveness of the Information-Motivation-Behavioral Skills Model in Promoting Adherence in CABG Patients. Journal of Health Psychology, 15, 828-837.
[19] Zarani, F., Besharat, M.A., Sarami, G. and Sadeghian, S. (2012) An Information-Motivation-Behavioral Skills (IMB) Model-Based Intervention for CABG Patients. International Journal of Behavioral Medicine, 19, 543-549.
[20] Starace, F., Massa, A., Amico, K.R. and Fisher, J.D. (2006) Adherence to Antiretroviral Therapy: An Imperical Test of the Information-Motivation-Behavioral Skills Model. Health Psychology, 25, 153-162.
[21] Fisher, J.D., Fisher, W.A., Amico, K.R. and Harman, J.J. (2004) An Information-Motivation-Behavioral Skill Model of Adherence to Antiretroviral Therapy. Health Psychology, 25, 462-475.
[22] Hays, R.D., Kravitz, R.L., Mazel, R.M., Sherbourne, C.D., Dimatteo, M.R., Rogers, W.H. and Greenfield, S. (1994) The Impact of Patient Adherence on Health Outcomes for Patients with Chronic Disease in the Medical Outcome Study. Journal of Behavioral Medicine, 17, 347-360.
[23] Brown, M.W. and Cudeck, R.I. (1993) Alternative Ways of Assessing Model Fit. In: Bollen, K. and Long, K., Eds., Testing Structural Equation Models, Sage, Newbury Park, 136-162.
[24] Ridgon, E. (1996) CFI versus RMSEA: Comparison of Two Fit Indexes for Structural Equation Modeling. Structural Equation Modeling, 3, 369-379.
[25] French, D.P., Sutton, S., Hennings, S.J., Mitchell, J., Wareham, N.J., Griffin, S. and Kinmonth, A.L. (2005) The Importance of Affective Beliefs and Attitudes in the Theory of Planned Behavior: Predicting Intentions to Increase Physical Activity. Journal of Applied Social Psychology, 35, 1824-1848.
[26] Karvinen, K.H., Courneya, K.S., Campbell, K.L., Hennings, S.J., Mitchell, J., Wareham, N.J., Griffin, S. and Kinmonth, A.L. (2007) Correlates of Exercise Motivation and Behavior in a Population-Based Sample of Endometrial Cancer Survivors: An Application of the Theory of Planned Behavior. International Journal of Behavioral Nutrition and Physical Activity, 4, 21-25.
[27] Rhodes, R.E., Blanchard, C.M., Hunt Matheson, D. and Coble, J. (2006) Disentangling Motivation, Intention, and Planning in the Physical Activity Domain. Psychology of Sport and Exercise, 7, 15-27.
[28] Beswick, A.D., Rees, K., West, R.R., Taylor, F.C. and Burke, M. (2005) Improving Uptake and Adherence in Cardiac Rehabilitation: Literature Review. Advanced Nursing, 49, 538-555.
[29] Kiviniemi, M.T., Voss-Hunke, A.M. and Seifert, A.L. (2007) How Do I Feel about the Behavior? The Interplay of Affective Associations with Behaviors and Cognitive Beliefs as Influences on Physical Activity Behavior. Health Psychology, 26, 152-158.
[30] Kalichman, S.C., Rompa, D., DiFonzo, K., Simpson, D., Austin, J. and Jacobson, L.P. (2001) HIV Treatment Adherence in Women Living with HIV/AIDS: Research Based on the Information-Motivation-Behavioral Skills Model of Health Behavior. Journal of the Association of Nurses in AIDS Care, 12, 58-67.
[31] Osborn, C.Y. and Fisher, J.D. (2008) Diabetes Education: Integrating Theory, Cultural Considerations, and Individually Tailored Content. Clinical Diabetes, 26, 148-150.
[32] Osborn, C.Y., Rivet Amico, K. and Fisher, W.A. (2010) An Information-Motivation-Behavioral Skills Analysis of Diet and Exercise Behavior in Puerto Ricans with Diabetes. Journal of Health Psychology, 15, 1201-1213.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.