The Feasibility of an Intervention Targeting Sources of Meaning in Cardiac Rehabilitation

Being diagnosed with heart disease can be a life-changing experience, often sparking existential questions and concerns about meaning in life. A lack of meaning in life has been found associated with increased emotional distress and decreased quality of life. Health professionals recognize that issues related to personal meaning in life are relevant but rarely address these aspects systematically in cardiac rehabilitation. This may be due to a lack of necessary tools.

The project evaluates a novel, brief and structured intervention that aims to strengthen the experience of meaningfulness and reduce or prevent emotional distress by addressing personal sources of meaning in life among patients attending cardiac rehabilitation and their relatives in Denmark. The intervention is based on the Sources of Meaning Card Method, a method developed by Peter la Cour and Tatjana Schnell to map and explore personal sources of meaning (www.somecam.org). For the current project, the method has been adapted for a cardiac rehabilitation context.

Three intervention formats are examined in a feasibility study in a municipal rehabilitation setting: 1) an individual format for patients in cardiac rehabilitation, 2) a dyadic format including a patient together with a relative, and 3) a group format for patients. Approximately 60 patients and 20 relatives are expected to participate. The study explores (a) participants' experience with and acceptability of the intervention formats; (b) changes in meaningfulness and emotional distress in a pre-post design; (c) recruitment and adherence rate, and (d) acceptability and practicality of the three formats among rehabilitation professionals.

Study Overview

• Status: Enrolling by invitation
• Conditions: Rehabilitation; Heart Disease; Mental Health Outcomes
• Intervention / Treatment: Other: Conversation on Sources of Meaning in life with heart disease; Other: Dyadic Conversation on Sources of Meaning in Life with heart disease; Other: Group based session on Sources of Meaning in life with heart disease

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Region Syddanmark
    • Odense, Region Syddanmark, Denmark, 5000
      • Center for Sundhed og Forebyggelse
    • Vejle, Region Syddanmark, Denmark, 7100
      • Sundhedskurser, Sundhedshus Vejle

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

A.

Inclusion criteria, individual and group-based intervention formats:

• ≥18 years of age
• attending municipal cardiac rehabilitation
• proficiency in Danish

Exclusion criteria, individual and group-based intervention formats:

• severe psychiatric disorder
• severe cognitive impairment

B. Inclusion criteria, patients in dyadic intervention format

• as in A
• and having a relative who would like to participate

Inclusion criteria, relative in dyadic intervention format:

• ≥18 years of age
• relative to a patient attending municipal cardiac rehabilitation
• proficiency in Danish

Exclusion criteria, patient and relative dyadic intervention format

- as in A

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: a) Individual intervention format; 1:1 conversation between a professional and a patient in rehabilitation.	Other: Conversation on Sources of Meaning in life with heart disease; The intervention uses the brief and structured Sources of Meaning Card Method (SoMeCaM; www.somecam.org), which has been adapted for use in cardiac rehabilitation. It explores personal sources of meaning in a conversation with one patient in a 1-hour session. It comprises 26 cards each including statements on a particular source of meaning. The patient prioritizes the cards, reflects on them, and identifies possibilities for change. The conversation is facilitated by a professional (trained master students in psychology) and followed up with a phone call approximately 4 weeks after the conversation.
Experimental: b) Dyadic (patient-relative) intervention format; The patient participates together with a relative and a professional.	Other: Dyadic Conversation on Sources of Meaning in Life with heart disease; The intervention is based on the brief and structured Sources of Meaning Card Method (SoMeCaM; www.somecam.org), which has been adapted for use in dyads in a cardiac rehabilitation context. The method uses 26 cards, each representing a specific source of meaning. The dyadic format considers both the patient's and the relative's individual and shared sources of meaning in 1 session, which may enhance understanding for each other's sources of meaning and facilitate their joint daily life. They both prioritize the cards individually, reflect on them and identify possibilities for change through a talk-and-listen approach. The conversation is facilitated by a professional (trained master students in psychology) and followed up with a phone call approximately 4 weeks after the conversation.
Experimental: c) Group based intervention format; A group-based approach, where approximately 6-10 patients in rehabilitation meet for a group session.	Other: Group based session on Sources of Meaning in life with heart disease; The intervention is based on the brief and structured Sources of Meaning Card Method (SoMeCaM; www.somecam.org), which has been adapted for use in groups in a cardiac rehabilitation context. The method uses 26 cards, each representing a specific source of meaning. Approximately 6-10 participants are guided through a process of individually prioritizing the cards, reflecting on them and identifying potential areas for change or development in smaller groups. The group-based format enables mutual sharing and support in reflection and change processes among patients. The workshop is facilitated by a professional (trained master students in psychology) and followed up with individual phone calls with all participants approximately 4 weeks after the conversation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment rate	Recruitment rate is defined as the proportion of participants who consented to participate in the study, reported as a percentage over the recruitment period.	From study start until recruitment ends (approximately 1 year)
Intervention adherence	The proportion of participants who completed the full intervention, defined as participation in the one-session Sources of Meaning conversation (individual, patient-relative, or group-based) and the follow-up phone call. Data will be recorded by the research team.	Through study completion, approximately 1 year
Practicality of the intervention formats among rehabilitation professionals	Defined as the rehabilitation professionals' evaluation of whether the intervention can be successfully used in practice (municipal cardiac rehabilitation). Including factors such as time, resources, and workflow compatibility. Explored via focus group with professionals in the municipal cardiac rehabilitation.	After study enrollment (approximately 1 year from study start)
Participants' experiences with the three intervention formats	Defined as the participants' experiences with their participation in one of the three intervention formats. Explored via focus groups and semi structured interviews.	Approximately 1 month post intervention
Theoretical Framework of Acceptability (TFA) Questionnaire	Participants' acceptability of the intervention will be quantitatively assessed using the Theoretical Framework of Acceptability (TFA) Questionnaire. This scale evaluates the following seven constructs: affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy, and intervention coherence. Each item is rated on a 5-point Likert scale ranging from 1 to 5. Higher scores indicate greater acceptability of the intervention across the measured domains.	1 month post intervention
Acceptability of the three intervention formats among participants	Acceptability will be explored qualitatively via focus groups and semi-structured interviews with participants enrolled in one of the three intervention formats	Approximately 1 month post intervention
Changes in symptoms of depression	The Patient Health Questionnaire 9-item depression scale (PHQ-9) will be used to assess symptoms of depression in the past two weeks. Each item is scored 0 to 3. The severity score can range from 0 to 27, with higher scores indicating more severe symptoms.	Baseline, 1 month post intervention and 3 months post intervention
Changes in symptoms of anxiety	The 7-item General Anxiety Disorder Scale (GAD-7) will be used to measure symptoms of anxiety in the past two weeks. Each item is scored 0 to 3, providing a 0 to 21 severity score, with higher scores indicating more severe symptoms.	Baseline, 1 month post intervention and 3 months post intervention
Changes related to meaning in life	Changes in participants' self-reported experience of meaning in life will be assessed using two validated subscales from the Sources of Meaning and Meaning in Life Questionnaire: the Meaningfulness and Crisis of Meaning subscales. Each subscale consists of 5 items, scored on a Likert scale from 0 (Strongly disagree) to 5 (Strongly agree). For the Meaningfulness subscale, higher scores indicate a stronger sense of meaning in life. For the Crisis of Meaning subscale, higher scores indicate a stronger experience of life as empty, pointless and lacking of meaning.	Baseline, 1 month post intervention and 3 months post intervention
Study attrition (dropout rate)	The proportion of participants who drop out from the study before completing all parts of the intervention, the 3 surveys and focus group and/or individual interview. Dropout will be assessed via administrative data.	Through study completion (approximately 15 months from study start)
Acceptability among rehabilitation professionals	Acceptability of the three intervention formats will be explored via focus groups with rehabilitation professionals involved in cardiac rehabilitation. The focus groups will address professionals' views on the interventions and perceived usefulness of the intervention in the municipal cardiac rehabilitation setting.	After study enrollment (approximately 1 year from study start)
Intervention facilitators' experience with delivering the intervention	Intervention facilitators will document their experience using semi-structured worksheets with field notes completed after each intervention session. These will capture reflections on feasibility, participant responsiveness, and challenges encountered in each step of the intervention.	Through study completion (approximately 1 year from study start)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intervention costs	To calculate intervention costs, information on time spent by intervention facilitators and other staff as well as material costs will be collected.	Through study completion (approximately 1 year post study start)
Changes in health-related quality of life	Explores changes in participants' self-reported health-related quality of life measured by EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L). The EQ-5D-5L consists of 2 scales: the descriptive system (EQ-5D) and the EQ visual analogue scale (EQ VAS). EQ-5D measures the five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each with 5 levels from 'no problems', 'slight problems', 'moderate problems', 'severe problems' to 'extreme problems'. EQ VAS captures the participant's self-rated health on a vertical visual scale from 0-100 where 100 means: 'The best health you can imagine' and 0 means 'The worst health you can imagine'. Higher scores indicate better self-reported health-related quality of life.	Baseline, 1 month post intervention and 3 months post intervention
Changes in awareness on sources of meaning in everyday life.	Changes in awareness on sources of meaning in everyday life will be explored using a purpose-designed self-report measure with 2 items covering awareness rated on a Likert scale ranging from 0 (Strongly disagree) to 5 (Strongly agree). Higher scores indicate greater awareness on sources of meaning in everyday life.	Baseline, 1 month post intervention and 3 months post intervention
Changes in engagement in sources of meaning in everyday life	Changes in engagement in sources of meaning in everyday life will be explored using purpose-designed self-report measure with 3 items covering engagement rated on a Likert scale ranging from 0 (Strongly disagree) to 5 (Strongly agree). Higher scores indicate greater engagement on sources of meaning	Baseline, 1 month post intervention and 3 months post intervention
Changes in mutual understanding (dyadic intervention arm)	Mutual understanding between patients and relatives in the dyadic intervention format will be assessed using the Understanding Subscale of the Perceived Partner Responsiveness Scale (PPRS) (Reis & Carmichael, 2006). The subscale consists of 5 items rated on a 9-point Likert scale ranging from 1 (Not at all true) to 9 (Very true). Higher scores indicate higher mutual understanding in the relationship to the other person.	Baseline, 1 month post intervention and 3 months post intervention
Changes in relationship quality (dyadic intervention arm)	Relationship quality will be assessed using the Relationship Ladder, a single-item visual analogue scale in which participants rate their perceived relationship quality on a scale from 0 (Very poor) to 10 (Excellent). Higher scores indicate better perceived relationship quality.	Baseline, 1 month post intervention and 3 months post intervention
Reasons for dropout	Reasons for participant dropout will be collected using a voluntary purpose-designed 3-item questionnaire at the time of dropout.	At time of dropout (Up to 4 months post intervention)
Engagement in intervention	Participant's engagement in the intervention is assessed through 2 purpose-designed questions: (1) 'Thought about the conversation at home' and (2) 'Used the reflection booklet at home'. Each question has an option to elaborate the answer qualitatively.	1 month post intervention

Collaborators and Investigators

• Sponsor: University of Southern Denmark
• Collaborators: Danish Heart Foundation; Odense Municipality, Denmark

Publications and helpful links

Helpful Links

• Link to Website of the Sources of Meaning Card Method.

Study record dates

Study Major Dates

• Study Start (Actual): November 20, 2025
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): February 1, 2027

Study Registration Dates

• First Submitted: September 24, 2025
• First Submitted That Met QC Criteria: November 21, 2025
• First Posted (Estimated): December 3, 2025

Study Record Updates

• Last Update Posted (Actual): January 13, 2026
• Last Update Submitted That Met QC Criteria: January 9, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Intervention; Heart disease; Group intervention; Feasibility study; cardiac rehabilitation; Dyadic intervention; Acceptability of interventions; Sources of Meaning Card Method; Individual intervention; Sources of Meaning; Pre-post design; Intervention adherence; Recruitment rate; Staff perspectives on acceptability and practicality; Patients and relatives
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Behavior; Treatment Adherence and Compliance; Health Behavior; Patient Compliance; Patient Acceptance of Health Care; Medication Adherence; Heart Diseases; Adherence Interventions
• Other Study ID Numbers: REC610; Grant no. 2023-12404 (Other Grant/Funding Number: The Danish Heart Foundation)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No