|Year : 2019 | Volume
| Issue : 3 | Page : 241-246
Awareness about behavioral risk factors of noncommunicable diseases and practices related to healthy lifestyle among class IV female employees in a tertiary care hospital of Eastern India
Saswatika Beura, Lipilekha Patnaik, Sumitra Pattanaik, Trilochan Sahu
Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
|Date of Submission||16-Jun-2019|
|Date of Decision||26-Jul-2019|
|Date of Acceptance||15-Aug-2019|
|Date of Web Publication||2-May-2020|
Dr. Lipilekha Patnaik
Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha eOf Anusandhan Deemed to be University, Sector-8,Kalinga Nagar, Ghatikia, Bhubaneswar - 751 003, Odisha
Source of Support: None, Conflict of Interest: None
Background: Noncommunicable diseases (NCDs) represent the biggest threat to women's health in developing countries in their most productive years. Working women have to manage both work and their family which may increase the risk of NCDs. Objective: The objectives of this study were (1) to assess the awareness about behavioral risk factors of NCDs and (2) to know the practices related to healthy lifestyle. Subjects and Methods: This was a cross-sectional study conducted among Class IV female employees of a tertiary care hospital between September and October 2018. A total of 102 female employees were included in the study. Data were collected using predesigned and pretested interview schedule. Descriptive statistics and Chi-square test were used for analysis. Results: The mean age was 36.86 ± 9.89 years, among them 98% were Hindu, 82.4% belonged to general caste, 62.7% had nuclear family, and 56.9% were married. It was observed that 94.2% of employees heard about NCDs such as diabetes, cancer, and cardiovascular diseases. About 86% knew about risk factors of NCDs; the major risk factors stated by them were tobacco and alcohol use and stress. About 40% of employees were chewing tobacco. The mean stress score was 16.10 ± 2.7. None of the employees were doing exercises or walking, and all were doing moderate activity at the workplace. Conclusion: Fair knowledge of behavioral risk factors of NCDs was found among women but practices related to healthy lifestyle were found inadequate. Interventions should be targeted to bring healthy lifestyle practices among female employees.
Keywords: Chronic diseases, women health, working women
|How to cite this article:|
Beura S, Patnaik L, Pattanaik S, Sahu T. Awareness about behavioral risk factors of noncommunicable diseases and practices related to healthy lifestyle among class IV female employees in a tertiary care hospital of Eastern India. J Datta Meghe Inst Med Sci Univ 2019;14:241-6
|How to cite this URL:|
Beura S, Patnaik L, Pattanaik S, Sahu T. Awareness about behavioral risk factors of noncommunicable diseases and practices related to healthy lifestyle among class IV female employees in a tertiary care hospital of Eastern India. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 May 28];14:241-6. Available from: http://www.journaldmims.com/text.asp?2019/14/3/241/283573
| Introduction|| |
Noncommunicable diseases (NCDs) produce unavoidable health challenge for the developing countries. In 2016, 71% (57 million) of deaths occurred due to NCDs. Adult population are facing health difficulties because of chronic NCDs in both developed and developing countries. According to the World Health Organization (WHO) report 2018, in India, NCDs are estimated to account for 63% of all deaths, among them, 27% in cardiovascular diseases (CVDs), 11% in chronic respiratory diseases, 9% in cancer, and 3% in diabetes.
The WHO has identified four major NCDs, i.e., diabetes, CVDs, cancer, and chronic lung disease/chronic obstructive pulmonary disease which share common lifestyle-related behavioral risk factors. These risk factors are tobacco use (smoking/chewing), physical inactivity, unhealthy diet, and alcohol use which lead to key metabolic and/or physiological changes such as raised blood pressure, overweight/obesity, raised blood glucose, and raised cholesterol levels. As a result of industrialization, socioeconomic development, urbanization, and changing lifestyles, India is facing a growing burden of NCDs.
NCDs represent the biggest threat to women's health, increasingly impacting women in developing counties in their most productive years (40–60). “In developing countries, the burden of problems is particularly severe for women as they were almost always illiterate, disproportionately poor and politically powerless“ Women are the most vulnerable groups in low- and middle-income countries. CVD causes 8.6 million deaths and cancer contributes to 4.8 million deaths among women annually. About 86% of women live with diabetes and 18%–25% of women having depression in LMICs. Sixty percent of the world's poor are women, twice as many women as men suffer from malnutrition, and two-thirds of illiterate adults are women. These underlying determinants are putting girls and women at a disadvantage in their capacity to protect themselves from the main NCD risk factors.
To reduce the burden of NCDs among women, we need to prevent all these risk factors by providing knowledge regarding risk factors. Awareness about NCDs and their risk factors among women will help to prevent the occurrence of NCDs. Female employees of a tertiary care hospital are selected because their awareness and healthy practices make not only themselves and their family members but also patients and their attendants coming to hospitals healthy. By keeping this in mind, this study was conducted to know the awareness about the behavioral risk factors and practices related to healthy lifestyle among Class IV female employees with the objective to assess the awareness about behavioral risk factors of NCDs and practices related to healthy lifestyle.
| Subjects and Methods|| |
This was a cross-sectional study conducted in a tertiary care hospital of Bhubaneswar city between September and October 2018. After getting necessary permission from the appropriate authorities, all Class IV female employees were approached. Those who gave consent (102 out of 126 inmates) for participating in the study were included. Some time was spent for establishing rapport with the female employees, and confidentiality was assured. Data were collected using a predesigned and pretested schedule which included personal characteristics, awareness about NCDs risk factors, and their lifestyle. The International Physical Activity Questionnaire (IPAQ) for assessing their physical activity and Cohen's Perceived Stress Scale (PSS) incorporated in the schedule to assess their physical activity and stress level.
A validated schedule was used to collect sociodemographic variables, knowledge about NCDs and the risk factors, and healthy behavioral lifestyle practices.
International Physical Activity Questionnaire
IPAQ short form is an instrument designed primarily for population surveillance of physical activity among adults.
Cohen's Perceived Stress Scale
The PSS developed by Cohen et al., consisting ten items, is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one's life are appraised as stressful. Items were designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number of direct queries about the current levels of experienced stress. The items are easy to understand, and the response alternatives are simple to grasp. Moreover, the questions are of a general nature and hence are relatively free of content specific to any subpopulation group. The questions in the PSS ask about feelings and thoughts during the past month. In each case, respondents are asked how often they felt a certain way, and the answers are given by the following format then summing across all scale items. 0 = Never, 1 = Almost Never, 2 = Sometimes, 3 = Fairly Often, 4 = Very Often.
Data were entered into Excel spreadsheet, and statistical analysis was performed using SPSS software version 20.0 (SPSS Inc., Chicago, IL, USA) licensed to the institution. Statistical measures such as mean, proportion, and Chi-square tests were used.
| Results|| |
In our study, 102 female Class IV employees out of 126 (80.9%) employees gave consent for participation.
The mean age of the participants was 36.86 ± 9.89 years, ranging from 20 to 57 years. Among 102 study participants, 98% were Hindus and 82.4% were of general caste. Most of them were from rural area (94.1%). About 62.7% of them belonged to nuclear family, 29.4% to joint family and 7.8% to broken family. The average family size was 4.5 ± 2.8 persons. Among them, 56.7% were married, 13.7% were single, 9.8% were divorcee or living separated from their husbands, and 19.6% were widows. Education of our study population was categorized according to the Indian Standard Classification of Education by the Government of India, the Ministry of Human Resource Development, and the Department of Higher Education, New Delhi, 2014. We found that among the female employees, around 23.5% were illiterate, 37.3% had primary education, and only two were graduate in the study population. When enquired about their position in the housekeeping department of the hospital, it was found out that 56.9% were working as sweepers, and 43.1% were working as attendant [Table 1]. The economic status was categorized based on per capita monthly income as per the modified BG Prasad socioeconomic classification scale (2018). In this study, 31.4% of the participants belonged to upper middle, 31.4% to middle, and 31.4% to lower middle socioeconomic background and 3.9% belonged to Class V (lower-economic status) and two participants were in upper socioeconomic background.
It was observed that 94.2% of employees heard about NCDs such as cancer (88.2%), CVDs (70.6), and diabetes (64.7) [Figure 1] and [Figure 2].
About 86% knew about risk factors of NCDs; the major risk factors stated by them were tobacco use, alcohol, and stress. Only 9.8% of them had knowledge about the normal range of blood sugar and blood pressure [Figure 3].
Tobacco was the most common form of addiction among these female workers. Nearly 39.2% of them were addicted to tobacco chewing (most commonly paan, gutkha, and khaini), and 2% of them were formerly using it. About 58.8% of them had never used tobacco, whereas 100% of female employees were never used any substances and alcohol in their life. The mean age of initiation of using tobacco was 17.2 ± 7.1 years. In this study, we found that 23.5% of female employees were exposed to passive smoking at home and 74.5% of participants were exposed to passive smoking at their workplace. In our study, i.e., 80.3% of them said that alcohol and tobacco consumption are associated with numerous diseases and injuries.
Among them who were not aware about the harmful effect of tobacco as a risk factor to NCD, 70% of them were using tobacco, and those who were aware, 36.59% of them were using tobacco (P = 0.006) which shows lack of awareness contributing to increased tobacco use [Table 2].
|Table 2: The association of knowledge on tobacco as a risk factor of noncommunicable diseases and tobacco use among participants|
Click here to view
A small group of the participants (15.7%) were taking vegetarian food in their regular diet and majority (84.3%) had mixed diet. There were 58.8% of the participants do not eat fruits or taking rarely in a typical week and 35.3% eaten only 1–2 servings/week which is inadequate as per the WHO recommendation of 2–3 servings/day. As we found that last week 60.8% of participants were not taking any fruits, 33.3% were taking once or twice, and only 5.9% among them were taking fruits more than twice in the last week. A healthy dietary habit starts with taking breakfast that is high in complex carbohydrates such as oatmeal, root crops, whole grain cereals, and bread with increased consumption of vegetables, particularly the leafy and yellow vegetables such as fresh salads and at least 2–3 servings of fruits rich in Vitamin C, beta-carotene, and potassium and to limit consumption of fatty foods, especially those from animal sources, sugar, and salt. Those who were taking mixed diet, majority of them taking nonvegetarian items 2–3 days in a week and 51% of female employees were taking fish. They all were using vegetable oil for cooking their food. In 2004, the institute of medicine set the amount at around 2.7 L, or 91 fluid ounces (fl oz) of total water a day for women and an average of around 3.7 L (125 fl oz) daily for men. In this study, majority (41.2%) of participants were drinking 2–3 L water/day and the average water intake of the participants was 2.8 ± 0.92 L/day. Among them, 27.5% of participants were never taking tea/coffee but 35.3% of them taking once/day and 21.6% of them were taking tea/coffee twice in a day.
None of the employees were doing regular exercise or walking; all participants were doing moderate activity in their workplace. In this study, majority of the participants had (66.7%) one or more morbid conditions. The most common problems expressed were as follows: generalized weakness (33.3%), acidity (19.6%), knee pain (5.9%), asthma (5.9%), and gastritis (3.9%). Two had diabetes, one had hypertension, and one had CVDs, and they were not taking regular medication. After taking their family history of any NCDs, we came to know that 19.6% had type II diabetes and 3.9% had CVDs to the parents, siblings, and grandparents.
[Figure 4] shows that 88.2% had moderate stress and 11.8% had low stress. However, no one of them had high stress. In this study, 72.5% of participants said that they have stress due to financial difficulties, 25.5% just because of their own health issues, and 23.5% of employees have stress for their alcohol-addicted husband [Figure 5].
Cohen's PSS scale was used to find out stress among respondents [Table 3]. Those women who scored ranging from 0 to 1 were considered having low stress, 14–26 considered as having moderate stress, and 27–40 considered to have high perceived stress. On the basis of this classification, we found that 88.2% of the participants had moderate stress.
|Table 3: Mean scores of the obtained score on Cohen's Perceived Stress Scale of the female employees|
Click here to view
The American Academy of Sleep Medicine and the Sleep Research Society recommend that an adult (18–60 years) should sleep 7 or more hours of sleep per night. In this study, we found that the average sleeping hours of the participants was 5.62 ± 1.01 h/night. When asked about the history of using any contraception to the employees, we found that 51% of respondents were never used any kind of contraception. Those who were using contraception, among them 21.6% of female employees were using oral contraceptive pills, 7.8% of them were using Intrauterine contraceptive device (IUCD), and 7.8% of participants had done permanent family planning method (Tubectomy).
| Discussion|| |
This study contributes to evaluate awareness and practice toward NCD risk factors among female Class IV employees. In this study, most of the employees had knowledge about NCDs which is consistent with the study done by Priyanwada et al. About one-third of the participants were illiterate, but they had heard about NCDs which may be due to they were working in a hospital. Only 7% women knew that taking extra salt may lead to hypertension and only 9.8% of them had knowledge about the normal range of blood pressure and blood sugar. A systematic review by Nethan et al., in India, found that many surveys reported that alcohol and tobacco use are the main risk factors of NCDs. This finding is corroborating with our study, i.e., 80.3% of them said that alcohol and tobacco consumption are associated with numerous diseases and injuries. Among them, who were not aware about the harmful effect of tobacco as a risk factor to NCD, 70% of them were using tobacco, and those who were aware, 36.59% of them were using tobacco (P = 0.006) which shows lack of awareness contribute to increased tobacco use. Another study done by Thakur et al. in South-East Asia Region (SEAR) revealed that out of 5.1 million tobacco attributable deaths in world, more than 1 million are in SEAR countries. The death rate due to NCDs attributable to tobacco per 100,000 populations is 190 among males and 12 among females, respectively, in India. However, tobacco exposes the health of not only those who actively smoke but also those who around them respire the smoke. Secondhand smoking is the main cause of at least 600,000 deaths in a year among nonsmokers, with more than six in ten deaths due to heart diseases.
According to the NCD Alliance, about 20% of the world's estimated 1 billion smokers are women, nearly half of the deaths from secondhand smoke occur among adult women and over a quarter among children under the age of five. Similarly, we found that a large proportion (74.5%) of female employees were exposed to passive smoking at their workplace, which contributing to increase the burden of NCDs among women.
The female employees had a poor dietary habit and low fruits and vegetable intake. Although they all were taking vegetables every day, there was lack of green vegetables in their diet as they considered potato as a vegetable. As per the WHO recommendation on daily fruits and vegetable intake, one should take at least three servings/day as a part of our healthy dietary requirement. The above results were comparable with a study conducted by Videon and Manning reported that the majority of participants reported eating less than the recommended amount of vegetables, fruits, and dairy foods. Many studies have reported similar findings on fruits and vegetables eating pattern which are comparable with the present findings.,,
In this study, it was observed that about 98% of women participants were not aware that lack of physical activity is a major risk factor of NCDs. No one was doing regular exercise or walk during their leisure time similar to the study by AL-Daboony. Results of many studies stated that there is a high prevalence of physical inactivity and sedentary lifestyle among the study participants and unfavorable attitude toward physical activity and could be a major challenge for improving the level of physical activity and healthy lifestyle.,
In our study, a large number of women employees presented with moderate stress and the reasons behind their stress due to financial difficulties and own health issues. About 74.5% of female employees said that they feel more stress at their home in comparison to their workplace and only 21.6% of them said opposite. According to AL-Daboony, participants lead a stressful life for their family issues. Majority of the participants were having weakness and gastritis problems due to inadequate sleeping and poor dietary habit.
| Conclusion|| |
The knowledge regarding behavioural risk factors of NCDs were found to be fair but practices related to healthy lifestyle was found inadequate among participants Class IV female employees. To improve the health of women effectively, health education programs and behavior change communication activities should be done, and they should be encouraged to get actively involved. Topics related to diet, physical exercise, health promotion, and healthy lifestyle should be incorporated in the awareness programs directed toward them. Awareness about risk factors of NCDs should be increased, and interventions should be targeted to bring healthy lifestyle practices among female employees.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Khuwaja AK, Fatmi Z, Soomro WB, Khuwaja NK. Risk factors for cardiovascular diseases in school children: A pilot study. J Pak Med Assoc 2003;53:396-400.
World Health Organization. Global Health Estimates 2016: Disease Burden by Cause, Age, Sex, by Country and by Region, 2000-2016. Geneva: World Health Organization; 2018.
Park JE. Park's Text Book of Preventive and Social Medicine. 24th
ed. India: M/s Banarsidas Bhanot Publishers; 2016.
World Health Organization. Noncommunicable Diseases Country Profiles 2018. Geneva: World Health Organization; 2018.
Chakma JK, Gupta S. Lifestyle practice and associated risk factors of noncommunicable diseases among the students of Delhi University. Int J Health Allied Sci 2017;6:20-5. [Full text]
Nongkynrih B, Patro BK, Pandav CS. Current status of communicable and non-communicable diseases in India. J Assoc Physicians India 2004;52:118-23.
NCD Alliance. The Taskforce on Women and Non-Communicable Diseases; May, 2016. Available from: http://www.womenandncds.org
[Last assessed in 2019 May 05].
Nath PR. Reproductive and Child Health. New Delhi: APH Publishing Corporation; 2002. p. 192.
Jonathan SM, Soon-Young Y. Gender, Women and the Tobacco Epidemic. Geneva: World Health Organization; 2010.
Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al
. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-7.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.
Pandey VK, Aggarwal P, Kakkar R. Modified BG Prasad's Socio-economic Classification-2018: The need of an update in the present scenario. Indian J Community Health 2018;30:82-4.
MacGill M. Water: Do we Really need 8 Glasses a Day? Reviewed by Marcin Judith, MD. Medical News Today; 2018.
Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al
. Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016;12:785-6.
Priyanwada A, de Angela S, Hasinthi S, Upul S, Prasad K. Knowledge, attitudes, and practices on lifestyle and cardiovascular risk factors among metabolic syndrome patients in an urban tertiary care institute in Sri Lanka. National Hospital of Sri Lanka and University of Colombo. Asia Pac J Public Health 2016;28 Suppl 1:32S-40S.
Nethan S, Sinha D, Mehrotra R. Non Communicable Disease Risk Factors and their Trends in India Asian Pac J Cancer Prev 2017;18:2005-10.
Thakur JS, Garg R, Narain JP, Menabde N. Tobacco use: A major risk factor for non communicable diseases in South-East Asia region. Indian J Public Health 2011;55:155-60.
] [Full text]
Oberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries. Lancet 2011;377:139-46.
Videon TM, Manning CK. Influences on adolescent eating patterns: The importance of family meals. J Adolesc Health 2003;32:365-73.
Ferrari CK, Ferreira RF. Quality of life and exposition to unhealthy lifestyle risk factors of nocturnal university students from a greater metropolitan city. J Biol Environ Sci 2011;5:129-34.
Al-Naggar RA, Bobryshev YV, Mohd Noor NA. Lifestyle practice among Malaysian university students. Asian Pac J Cancer Prev 2013;14:1895-903.
AL-Daboony SJ. Knowledge, attitude and practices towards noncommunicable disease risk factors among medical staf. Glob J Med Res 2016;16:5-19.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]