Background. In Indonesia, coronary heart disease is the highest cause of mortality in all age following stroke, approximately around 12.9%. Treatment recommendation for coronary heart disease include medication and life style change. The medication consists of anti-clotting (blood-thinning), blood pressure, cholesterol and anti-anginal drugs. Unhealthy life style such as high junk food consumption, less or no exercise, sedentary activities, drinking alcohol and smoking can increase the chance of having the disease.  Thus, life style change is also one of important things recommended by cardiologist as it can reduce the risk of subsequent episodes of coronary heart disease. In order to follow the treatment recommendation, adherence is needed.

Adherence is defined as the extent to which a patient’s behaviors align with medical recommendation for treatment that agreed by both cardiologist and patient. Non-adherence to the medical recommendation is likely to worsen the patient condition. Yet, non-adherence is common among chronic illness patients. The symptoms of non-adherence include not taking the medicine, ignoring dietary restriction, not doing exercise, delaying meeting with the doctor, and maintaining unhealthy lifestyle. One model used to explain adherence is the Leventhal’s Self-Regulation Model (SRM). Based on this model, patient perception and belief about their disease and treatment can affect their adherence. Illness perception is a cognitive representation or belief that the patients have about their illness and medical condition. This perception can lead the patients to reduce threat from their illness or symptom by actively cope with their illness. Further, illness perception can affect patients’ emotional response and coping behavior such as adherence to medical recommendation. Thus, denoting the importance of assessing patients’ illness perception. Heart disease can also cause anxiety and depression to the patient. Heart-focused anxiety is a term used to describe the fear of stimulus and sensation connected to heart because of individual perception of negative consequences from it. Patient with anxiety maybe highly anxious about health concerns, leading to greater vigilance regarding medical recommendations. Patient with heart-focused anxiety is likely to avoid daily activities and using more unnecessary medical resource to ease the anxiety. It is possible the patient will not adhere to life style change recommendation such as exercise. Psychological distress among the patients, besides anxiety is depression. Depression is associated with impaired subsequent adherence behavior (example medication adherence, dietary restriction) in cardiac patient.

Although SRM is commonly used, there is a dearth of its use in explaining adherence in coronary heart disease in Indonesia. This recent study aims to use SRM model to explain adherence in coronary heart disease patients. Predictors to be assessed in this study are illness perception, heart-focused anxiety and depression.

Methods. This study will consist, approximately 150 adult participants, having a coronary heart disease for more than 1 year, and understand Indonesian language. The data collection will use Morisky Medication Adherence Scale (MMAS-8) and Lifestyle Adherence Measure (LAM) as measurement for Adherence. Cardiac Anxiety Questionnaire (CAQ) to measure the heart-focused anxiety. Patient Health Questionnaire (PHQ-4) for Depression screening tools and Brief Illness Perception Questionnaire (Brief-IPQ) to measure their Illness Perception.

Results. It is expected that illness perception directly affects patient adherence. Further, it is expected that illness perception will indirectly affect adherence through hearth-focused anxiety as well as depression.

Conclusions. Conclusions can be drawn upon the completion of the study

Add-on Values. The results are expected to elucidate factors affecting adherence in coronary heart disease of Indonesian patients. This will aid in planning intervention targeting adherence.

Keywords: Illness Perception, Adherence, Coronary Heart, anxiety, depression, psychology

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