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Table of Contents
ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 1  |  Page : 49-54

Effectiveness of a self instructional module on lifestyle changes to prevent heart diseases


Assoc Professor, Lowry Memorial College Campus, Bangalore, India

Date of Web Publication11-Jun-2020

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Source of Support: None, Conflict of Interest: None


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  Abstract 


Cardio Vascular Diseases (CVDs) are the number one cause of death globally: more people die annually from CVDs than from any other causes. The purpose of this study was to evaluate the effectiveness of Self Instructional Module (SIM) on knowledge regarding lifestyle changes to prevent heart diseases. A quantitative, pre experimental, one group pretest posttest design was selected for the study. The participants were 70 Information Technology (IT) professionals from selected IT companies in Bangalore. A non-probability convenience sampling technique was used to select the samples for the study. A structured knowledge questionnaire was used to collect data from the participants. The data obtained was analyzed using both descriptive and inferential statistics. In the pretest 17.1% of the respondents had inadequate knowledge, 54.3% had moderately adequate knowledge and 28.6% had adequate knowledge. In the post test all subjects (100%) had adequate knowledge. The ‘t’ test value was 16.31 which was found to be significant (p<.05). SIM was found to be effective in imparting knowledge regarding lifestyle changes to prevent heart diseases.

Keywords: lifestyle, self-instructional module, knowledge, heart diseases, IT professionals, IT companies


How to cite this article:
Das GL. Effectiveness of a self instructional module on lifestyle changes to prevent heart diseases. Indian J Cont Nsg Edn 2018;19:49-54

How to cite this URL:
Das GL. Effectiveness of a self instructional module on lifestyle changes to prevent heart diseases. Indian J Cont Nsg Edn [serial online] 2018 [cited 2021 May 8];19:49-54. Available from: https://www.ijcne.org/text.asp?2018/19/1/49/286495






  Introduction Top


CVD’s and cancer are at present the leading cause of death in developing countries (Roth et al., 2015). Primordial prevention aimed at identification of risk factors and health promotion activities are being increasingly applied in the control of chronic diseases. CVD’s comprise of a group of diseases of the heart and the vascular system. The major conditions are coronary artery disease, ischemic heart disease, rheumatic heart disease, and valvular diseases that continues to be an important health problem in many developing countries.

The most important behavioral risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Behavioural risk factors are responsible for about 80% of coronary heart disease and cerebrovascular disease (World Health Organization [WHO], 2017).

The goals of nursing are to promote, preserve, and restore health when it is impaired and to minimize suffering and disease. Many diseases can be prevented by changing life style through intensive education. Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular physical activity, and avoiding excessive use of alcohol have been shown to reduce the risk of cardiovascular disease (Combes, 2015). Common modifiable risk factors namely physical inactivity, unhealthy diet, harmful effects of tobacco and alcohol and other habit forming substances have been identified. Controlling the common modifiable risk factors will help in prevention and control of cardiovascular diseases (WHO, 2015).


  Background Top


CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause. An estimated 17.3 million people died from CVDs in 2008, representing 30% of all global deaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke. Over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women. The number of people, who die from CVDs, mainly from heart disease and stroke, will increase to reach 23.3 million by 2030. CVDs are projected to remain the single leading cause of death, 9.4 million deaths each year, or 16.5% of all deaths can be attributed to high blood pressure. This includes 51% of deaths due to strokes and 45% of deaths due to coronary heart disease (European Society of Preventive Medicine, 2016).

Ischaemic heart disease and stroke are the two most common causes of death worldwide. Over 80 % of deaths and 85 % of disability from CVD occur in low- and middle- income countries (Benjamin, 2017). The Indian subcontinent (including India, Pakistan, Bangladesh, Sri Lanka, and Nepal) is home to 20 per cent of the world’s population and may be one of the regions with the highest burden of CVD in the world (Goyal & Yusuf, 2006).

A study conducted to investigate the influence of irregular and poor quality sleep on cardiac autonomic activity using the spectral analysis of Heart Rate Variability (HRV) on Business Process Outsourcing (BPO) employees in Bangalore revealed that sleepiness was significantly higher among night shift workers (p<.001) and the researcher concluded that night shift working increased the heart rate and shifted the sympatho-vagal balance towards sympathetic dominance and decreased vagal parameters of HRV (Kunikullaya, Kirthi, Venkatesh, & Goturu, 2010) . This is an indicator of unfavorable change in the myocardial system, and thus shows increased risk of CVD among the night shift employees.

Chaturvedi, Singh, Boolchandani, and Chandra (2012) compared the knowledge, attitudes and practices for coronary heart disease (CHD) risk between healthy adults and patients with CHD in Jaipur city. The results revealed that there was a relationship between knowledge and attitudes of subjects for diet and life style-related risk factors for CHD at p > 0.05. Smoking practice was found to have a correlation with knowledge for Group A and with attitudes for Group B.

Another study assessed the risk factors and knowledge on modification of lifestyle among patients who have experienced acute myocardial infarction in Taif. The results revealed that the mean knowledge score of patients recruited in this study was either low (51%) or medium (29%)(Ahmed, Youssif, & Ayasreh, 2013).

In another study from Nepal conducted by Vaidya, Aryal and Krettek (2013) the findings revealed that 60% of respondents did not know any heart attack symptoms compared with 20% who knew two to four symptoms. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge.

Based on the literature reviewed the researcher concluded that there exists a vast gap in knowledge regarding cardiovascular health among persons with and without a diagnosis of cardiovascular disease. A year-long study carried out by the diabetes unit at a tertiary hospital and on-site healthcare providers ‘Just for Hearts’ in India have found that 61% IT of professionals had more than three risk factors for diabetes and CVD’s (Isalkar, 2014). IT professionals who spend most of the time in front of the computers are common victims for heart diseases. However, most of the CVD’s can be prevented by lifestyle changes. So the researcher found it relevant to evaluate the effectiveness of SIM on knowledge regarding lifestyle changes to prevent heart diseases among IT professionals in selected companies, Bangalore.

The objectives of this study were to

  • assess knowledge on lifestyle changes to prevent heart diseases among IT professionals
  • evaluate the effectiveness of SIM on lifestyle changes to prevent heart diseases by comparing mean pre test and post test knowledge scores
  • determine association between pretest knowledge scores on lifestyle changes to prevent heart diseases among IT professionals with their selected socio demographic variables



  Methods Top


A quantitative, evaluative approach with a pre experimental one group pretest posttest design was used.



O1- Pretest assessment of knowledge of IT Professionals regarding lifestyle changes to prevent heart diseases before the implementation of the SIM.

X- Distribution of SIM regarding lifestyle changes to prevent heart diseases.

O2- Posttest assessment of knowledge of IT Professionals regarding lifestyle changes to prevent heart diseases after the implementation of the SIM

The study was conducted in four IT companies namely, Ways2save, Mphasis, Capita, and Target corporations India, Bangalore, Karnataka. About 70 IT professionals working in four IT Companies who consented to participate and fulfilled the inclusion criteria were selected for the study using a non- probability convenience sampling technique. IT professionals who had not attended any awareness program regarding lifestyle changes to prevent heart diseases within last 6 months were included.

Instruments

Part I: Socio - Demographic Proforma

This section consisted of 14 items such age, gender, religion, type of family, educational qualification, working hours, smoking habit, alcohol consumption, family history of heart diseases, consumption of beverages and fast food, exercise pattern, leisure activities, and prior information regarding lifestyle changes to prevent heart diseases.

Part-II: Structured Knowledge Questionnaire

A structured knowledge questionnaire was prepared by the investigator, based on the review of the literature and in consultation with experts to assess the knowledge regarding lifestyle changes to prevent heart diseases. The major content areas covered in this SIM were anatomy and physiology of heart, risk factors, causes and clinical manifestations, diagnostic evaluation and complications and lifestyle changes to prevent heart diseases.The tool was divided into 4 sections. Section A consisted of 5 items related to anatomy and physiology of the heart. Section B consisted of 7 items related to risk factors, causes, and clinical manifestations of heart diseases. Section C consisted of 5 items related to diagnostic evaluation and complications of heart diseases. Section D consisted of15 items related to lifestyle changes to prevent heart diseases.

The questions in the knowledge questionnaire were phrased in a multiple choice form with 4 options, three distracters and one correct response. The correct response was given a score of one and incorrect response as zero score. The maximum possible score was 32. The resulting knowledge score was graded as above 75 % - Adequate Knowledge, 50-75% - Moderately Adequate and less than 50% as Inadequate knowledge.


  Data Collection Top


Formal permission was obtained from the concerned authorities to conduct the study. Samples were selected according to the inclusion criteria. Seventy subjects were selected from four IT companies. Prior to the study, consent was obtained from each subject. In the pretest, a structured knowledge questionnaire prepared by the investigator was administered on day one followed by distribution of SIM on the same day. The post test was conducted on day eight in which the same structured knowledge questionnaire was administered. The participants were given seven days to complete the SIM.


  Results Top


The collected data was organized, tabulated and analyzed based on the objectives of the study by using descriptive statistics i.e., percentage, mean, standard deviation and inferential statistics such as chi square and ‘t’ test. A paired ‘t’ test was used to find out the difference in knowledge between pre and post test and a Chi square test was used to test the association between demographic variables with pre test knowledge score.

The findings indicate that majority (54.2%) of IT professionals were in the age group of24-29 and 30 - 34 years (32.9%). Majority of the professionals (74.3%) were males. Regarding educational qualification, it was observed that majority of the subjects (68.6%) held Bachelors degree, 24.3% held Masters degree while 7.1% were Diploma holders. With regards to the working hours, majority (71.4%) of the participants worked for more than 8 hours/day, 25.7% worked for 6-8 hours/day while only 2.9% worked less than 6 hours/day. A greater proportion of subjects (65.7%) were Hindus, 24.3% were Christians, 7.1% were Muslims and 2.9% belonged to other religions. Majority of the subjects (60%) belonged to a nuclear family. With regards to history of smoking 32.9% respondents smoked and 67.1 % respondents did not smoke. In regard to alcohol consumption, 44.3% of the respondents consumed alcohol on a regular basis, while 55.7% of them did not drink alcohol.

Among the participants one half (50%) of the respondents did not practice any exercise while the other half (50%) of the respondents performed some form of exercise regularly. With regards to consumption of fast food, it was observed that a great number of the respondents (90%) consumed fast food. Beverages like tea and coffee were consumed regularly by 88.6% of the respondents.

In their leisure time, majority (60%) of the respondents engaged themselves in watching television, playing video games or using the computer, while 11.4%, 11.4% , 5.7% and 11.4% of them engaged in self-scheduled exercise programs, outdoor games, gymnasium, and other leisure activities respectively. Majority (68.6%) of the participants had not received prior information regarding lifestyle changes to prevent heart diseases, while 31.4% of them had received some information regarding lifestyle changes to prevent heart diseases. Among them 11.4% acquired information from the Internet, while 5.7%, 2.9% ,and 11.4% received information from books and magazines, health professionals like (Doctors, Nurses, Paramedics, etc.,) and other sources respectively.

Majority of the subjects 54.3% subjects had moderately adequate knowledge regarding lifestyle changes to prevent heart diseases (see [Figure 1]). Participants had the highest knowledge score of 73.67% with regard to the aspect of risk factors, causes and clinical manifestations of heart diseases and they had the least knowledge score of 57.71% in the aspect of anatomy and physiology of human heart.
Figure 1: Knowledge level of the subjects in pretest

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In the post test all subjects (100%) had adequate knowledge on lifestyle changes to prevent heart diseases. When a paired ‘t’ test was done the obtained ‘t’ value was 16.31 at p< 0.05 level of significance from which it can be inferred that the SIM was effective in enhancing the knowledge of IT Professionals (see [Table 1]).
Table 1: Overall Pretest and Post Test Knowledge Scores of IT Professionals regarding Lifestyle Changes to Prevent Heart Diseases

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In the present study, association was sought between the mean pretest knowledge and their selected socio demographic variables such as age (χ2=26.458), gender (χ2=18.066), religion (χ2=51.022), educational qualification (χ2=29.250), working hours (χ2=25.711), type of family (χ2=36.303), smoking (χ2=16.653), alcohol consumption (χ2=20.505), family history of heart diseases (χ2=12.039), exercise (χ2=19.224), consumption of fast food (χ consumption of beverages (24.803), leisure activities (χ2=84.556) prior information (χ2=34.162) and source of information (χ2=12.478) regarding lifestyle changes to prevent heart diseases. Among these, all the variables showed significant association with pretest knowledge at p<.05.


  Discussion Top


The study revealed that the knowledge regarding life style changes for preventing CVD was moderately adequate or adequate even before the teaching intervention. This is not surprising considering the educational qualifications of the subjects in the study and the findings that many had received information regarding the same through various modes. However SIM was instrumental in improving the knowledge to an optimal level with a mean posttest knowledge score of 91.6%. All the subjects had adequate knowledge in the post test. SIM has been found to be effective in another study with IT professionals where there was a significant improvement in knowledge regarding hypertension (Divya, 2013). It may be concluded that a SIM can be a valuable tool to impart health related information to educated individuals.

Optimal knowledge rather than some knowledge on life style changes for prevention of chronic illness like CVDs can improve quality of life in individuals with and without the illness. Therefore it is mandatory for nurses to reinforce teaching on healthy life style through structured/ self- instructional teaching programmes.

In the present study, the comparison of overall pretest and post test mean knowledge scores of IT Professionals regarding lifestyle changes to prevent heart diseases showed a mean enhancement from 8.37 to 26.16 (p<.05). From this it can be inferred that the SIM was effective in enhancing the knowledge of IT Professionals.

In the present study all socio-demographic variables showed significant association with the pretest knowledge. In other studies significant association were found between knowledge of CVDs and age and education age, gender, education and family history of heart disease (Francis, Jose, Sunny, Juvairiya, & Varghese, 2014; Pandey & Khadka, 2012).

Limitations

This study had sampling constraints. A convenience sampling technique was used to select the sample; hence generalizability of inferential statistics should be done with caution. A true experimental study would have been ideal.


  Conclusion Top


CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause. We can prevent many diseases by changing life style through intensive education. Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. The cardiovascular risk can also be reduced by preventing or treating hypertension, diabetes, and raised blood lipids. Therefore, health care professionals should take initiative to educate the general public regarding prevention of cardiovascular diseases through simple lifestyle changes. SIM can be used an effective educational tool for professionals.

Conflicts of Interest: The author has declared no conflicts of interest.





 
  References Top

1.
Ahmed, E., Youssif, M., & Ayasreh, I. (2013). Assess the risk factors and knowledge on modification of lifestyle among patients who have experienced acute myocardial infarction in Taif. International Journal of Medical Science and Public Health, 2, 354-359.  Back to cited text no. 1
    
2.
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., … & Jiménez, M. C. (2017). Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, /55(10), e146-e603.  Back to cited text no. 2
    
3.
Chaturvedi, R., Singh, N., Boolchandani, R., & Chandra, R. (2012). Knowledge, attitudes and practices on CHD in businessmen and patients. Nutrition & Food Science, 42(3), 148-155.  Back to cited text no. 3
    
4.
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5.
Divya, K. A. (2013) A study to assess the impact of self- instructional module (SIM) on knowledge regarding the prevention of hypertension among IT (information technology) employees at selected company in Bangalore (Masters Thesis). Rajiv Gandhi University of Health Sciences, Bangalore.  Back to cited text no. 5
    
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European Society of Preventive Medicine. (2016). Cardiovascular diseases: Preventing and predicting diseases. Personalized and Participatory Medicine. Retrieved from http://www.esprevmed.org /esprevmed/about/  Back to cited text no. 6
    
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Francis, J., Jose, J., Sunny, J. K., Juvairiya, U. S., & Varghese, S. (2014). Knowledge regarding cardiovascular risk factors among people in South India: A community based study. Nitte University Journal of Health Science, 4(1).  Back to cited text no. 7
    
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Goyal, A., & Yusuf, S. (2006). The burden of cardiovascular disease in the Indian subcontinent. Indian Journal of Medical Research, 124(3), 235.  Back to cited text no. 8
    
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Kunikullaya, K. U., Kirthi, S. K., Venkatesh, D., & Goturu, J. (2010). Heart rate variability changes in business process outsourcing employees working in shifts. Indian Pacing and Electrophysiology Journal, 10(10), 439.  Back to cited text no. 10
    
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