Use of complementary and alternative medicine and self-tests by coronary heart disease patients

Background: Coronary heart disease patients have to learn to manage their condition to maximise quality of life and prevent recurrence or deterioration. They may develop their own informal methods of self-management in addition to the advice they receive as part of formal cardiac rehabilitation programmes. This study aimed to explore the use of complementary and alternative medicines and therapies (CAM), self-test kits and attitudes towards health of UK patients one year after referral to cardiac rehabilitation. Method: Questionnaire given to 463 patients attending an assessment clinic for 12 month follow up in four West Midlands hospitals. Results: 91.1% completed a questionnaire. 29.1% of patients used CAM and/or self-test kits for self-management but few (8.9%) used both methods. CAM was more often used for treating other illnesses than for CHD management. Self-test kit use (77.2%,) was more common than CAM (31.7%,) with BP monitors being the most prevalent (80.0%). Patients obtained self-test kits from a wide range of sources, for the most part (89.5%) purchased entirely on their own initiative. Predictors of self-management were post revascularisation status and higher scores on 'holism', 'rejection of authority' and 'individual responsibility'. Predictors of self-test kit use were higher `holism' and 'individual responsibility' scores. Conclusion: Patients are independently using new technologies to monitor their cardiovascular health, a role formerly carried out only by healthcare practitioners. Post-rehabilitation patients reported using CAM for self-management less frequently than they reported using self-test kits. Reports of CAM use were less frequent than in previous surveys of similar patient groups. Automatic assumptions cannot be made by clinicians about which CHD patients are most likely to self-manage. In order to increase trust and compliance it is important for doctors to encourage all CHD patients to disclose their self-management practices and to continue to address this in follow up consultations.

Conceptualising global strategic sustainability and corporate transformational change

Purpose – The purpose of this paper is to present the concept of global “strategic sustainability”, represented by a conceptual framework, the “spheres of strategic sustainability”. The paper examines routes, solutions and a vision for corporate strategic sustainability in the macro context of the global physical environment and the planet. This builds on previous research identifying key drivers and strategies for corporate sustainability. Design/methodology/approach – The paper is conceptual in nature and underpinned by Gaia theory, ecosystems theory and the laws of thermodynamics. These three offer specific foci for sustainability research including holism, integration and synthesis: without which, sustainability research would be difficult to achieve. Findings – The paper identifies two major domains – “corporate” and “consumer” strategic sustainability. It examines the corporate domain in which routes are identified through responses to existing globalisation, corporate strategy and corporate culture. Research limitations/implications – The paper provides insight and preliminary conceptual development towards a full theoretical model of corporate and consumer strategic sustainability. The framework will guide future conceptual and empirical investigations and broaden and deepen our understanding of how firm's can construct strategic business models that incorporate sustainability. Originality/value – The paper offers a conceptual framework that develops the concept of “corporate strategic sustainability” and provides positive, practical solutions to incorporating sustainability into business models. It also challenges the current dominant socio-economic paradigm and sets the scene for a more positive eco-paradigm that serves the present and future needs of the planet, environment, businesses and human society.