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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 247-249

Knowledge, attitude, and practice regarding risk factors and lifestyle modifications in people with coronary artery disease in a rural area of Western Maharashtra


Department of Cardiovascular and Respiratory Physiotherapy, M.A.E.E.R.S Physiotherapy College, Pune, Maharashtra, India

Date of Submission06-Apr-2019
Date of Decision02-May-2019
Date of Acceptance25-Jun-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Urmila Jain
194, Shriramkrupa, Opposite Balaji Mandir, Yashwant Nagar, Shivaji Chowk, Talegaon Dabhade, Pune - 410 507, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_68_19

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  Abstract 


Aims: This study was done to assess knowledge, attitude, and practice (KAP) regarding risk factors and lifestyle modifications among people with coronary artery disease using a self-validated questionnaire.
Design: It was a cross-sectional study. The sampling type was simple random sampling. A sample size of 82 was obtained. Methods: A self-validated questionnaire was used to conduct the survey. Informed consent was obtained from participants before filling of the questionnaire. Statistical Analysis: Frequency and percentages were calculated. Results: Only a few respondents had knowledge regarding exercising in exercise class/gym and that walking and gardening cannot be considered as exercises. A similar trend was seen for practice where few percent of the participants exercised for more than 20 min 3 days/week and under the supervision of a physiotherapist. An overall fair attitude was seen toward lifestyle modifications among the respondents. Conclusion: From this study, it was concluded that the lack of knowledge regarding certain factors also influenced the attitude and practice toward it. Furthermore, despite having knowledge regarding certain factors, people showed less willingness to make lifestyle changes which also affected their practices. Hence, it is necessary to study KAP of the population to educate people better and aid the planning of health promotion activities.

Keywords: Attitude, coronary artery disease, knowledge, lifestyle modifications, practice


How to cite this article:
Jain U, Jaiswal V, Ghuman S, Ghodey S. Knowledge, attitude, and practice regarding risk factors and lifestyle modifications in people with coronary artery disease in a rural area of Western Maharashtra. J Datta Meghe Inst Med Sci Univ 2019;14:247-9

How to cite this URL:
Jain U, Jaiswal V, Ghuman S, Ghodey S. Knowledge, attitude, and practice regarding risk factors and lifestyle modifications in people with coronary artery disease in a rural area of Western Maharashtra. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Sep 28];14:247-9. Available from: http://www.journaldmims.com/text.asp?2019/14/3/247/283596




  Introduction Top


Coronary artery disease (CAD) is usually due to atherosclerosis which may lead to angina or heart attack.[1] With around 17.5 million deaths recorded globally, more than 75% of these deaths have occurred in developing countries such as India.

Risk factors leading to CAD are dyslipidemia, diabetes mellitus, hypertension, obesity, unhealthy eating patterns, smoking, alcohol consumption, and lack of physical activity.[2] The American Heart Association emphasized the importance of lifestyle modifications and the development of strategies that help to modify health behaviors in CAD.[3]

Inadequate knowledge regarding the disease will affect attitude toward disease, assent with medical advice, and practice necessary for the prevention and treatment of CAD.[4]


  Methods Top


It was a cross-sectional survey, with simple random sampling done and a sample size of 82. Ethical consent was obtained before conducting the study. Participants diagnosed with CAD and who knew to read and write English were only selected. Informed consent was given to each participant before filling of the questionnaire.

The questionnaire comprised three sections: knowledge, attitude, and practice (KAP), respectively. The sections had 9, 11, and 11 questions, respectively, with yes/no options for response.

Statistics were computed by frequency and percentages for each question separately.


  Results Top


The study was conducted in a sample of 82 participants in view of finding KAP regarding risk factors and lifestyle modifications in people with CAD.

About 91.2% of them considered walking and gardening as exercises to lower the risk of CAD which is not true. Exercising at a gym or exercise class is important to lower the risk of CAD.

The results of willingness for making dietary changes and cessation of alcohol and smoking are 46% and 42.5%, respectively, which are not satisfactory.

It is seen that only 22.5% of them exercise >20 min 3 days/week and just 15% of them exercise under the supervision of a physiotherapist, which shows a lack of practice of exercising despite being willing to do so.


  Discussion Top


The present study was conducted to assess the KAP regarding risk factors and lifestyle modifications in people with CAD using a self-validated questionnaire.

The findings in the knowledge section showed that more than half of the respondents could answer the general questions regarding CAD correctly. Ninety percent of them knew that high cholesterol was a risk factor for CAD. Knowledge regarding risk factors such as tobacco chewing/smoking, alcohol intake, hypertension, and diabetes was 88.75%, 81.25%, 86.25% respectively. A lack of knowledge was seen for the risk factors age and family history, which was 57.5% and 50%, respectively. Eighty-four percent of the participants knew that physical activity helps lower the risk of CAD, but only 8.75% knew that gardening and light walking cannot be considered as exercises to prevent CAD. A study conducted in Malaysia[5] also showed a lack of knowledge regarding light walking to be not considered as an exercise. Only 57.75% of them knew that the risk of CAD could be lowered by exercising at a gym or exercise class. At the same time, only 50% had the knowledge of exercise centers nearby their locality. This could be due to the lack of knowledge regarding exercising in a gym/exercise center.

Overall, a positive attitude was seen in participants to make lifestyle changes to prevent CAD. Respondents showed relatively fair knowledge of high cholesterol being a risk factor for CAD, but only 30% of them thought that it was necessary to be aware about their lipid levels. A similar pattern of results was seen for making dietary changes. Although more than half of the participants knew that unhealthy eating patterns were a risk factor for CAD, only 46% of the participants were willing to make dietary changes. Furthermore, it was seen that 31.25% of them were not willing to exercise under the supervision of a physiotherapist. This could be due to the lack of knowledge regarding exercising in a gym or exercise class. The attitude to quit smoking and alcohol was seen to be low. Only 42.5% of the respondents were willing to quit smoking and alcohol despite having the knowledge that alcohol and smoking were potential risk factors for CAD [Table 1], [Table 2], [Table 3].
Table 1: Basic knowledge regarding coronary artery disease

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Table 2: The attitude regarding the risk factors and lifestyle modifications in people with coronary artery disease

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Table 3: The practice regarding the risk factors and lifestyle modifications in people with coronary artery disease

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The overall results for practice of lifestyle changes of modifiable risk factors were seen to be the lowest as compared to the results of knowledge and attitude regarding CAD. About 93.75% of them answered that they follow the treatment prescribed by their doctors. It was only 35% of them who actually made dietary changes, such as 72.5% of them still continued to eat fatty/junk food for more than 3 days/week. Around 80% of them quit alcohol and smoking. When it comes to exercising, the results were low as seen for knowledge and attitude. It was only 22.5% of the participants who exercised for more than 20 min 3 days/week and 15% of the participants who exercised under the supervision of a physiotherapist. In the studies done by Ansa et al.[6] and Menotti,[7] it was inferred that lifestyle modification strategies are still not widely accepted despite having knowledge regarding certain risk factors.

Education for cardiovascular risk factors and prevention is a very important element of the strategies toward improving cardiovascular health in the community.[8] Patient education can help people with chronic disease to better self-manage their disease. We can conduct certain campaigns, workshops, presentations to aid the awareness regarding risk factors for CAD, and promotion for lifestyle modification.

Physiotherapists join cardiologists and surgeons, nurses, and other members of the multidisciplinary team in order to promote patients’ health and help them return to their activities of daily life. Physiotherapists play an important role in cardiac rehabilitation. The first two phases are the inpatient phase. Phase 3 is the outpatient phase. Before Phase 3, the physiotherapist undertakes risk stratification assessment according to ASCM guidelines, in which the patient is categorized into high-, low-, or moderate-risk categories, respectively. A supervised exercise session is offered at least two times per week, in addition to one session per week of education.[9]. Hence, it is of utmost importance for the participants to have knowledge regarding exercising under the supervision of a physiotherapist and also be willingness to do so.

A few limitations to the study were that it was confined only to people who could read and write English. All answers were self-reported. The participants for the present study have been delimited to 82 participants with CAD. The measures for amount of alcohol and number of cigarettes were subjective, i.e., self-reported.


  Conclusion Top


Conclusions from multiple-choice responses can result in better knowledge. In the future, the study can be carried out in various regional languages with a larger sample size.[10],[11],[12]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Heart-Encyclopedia – Coronary Heart Disease. Available from: http://www.heart.org/HEARTORG/Encyclopedia/Heart-Encyclopedia_UCM_445084_ContentIndex.jsp?title=coronaryheartdisease. [Last accessed on 2019 Feb 13].  Back to cited text no. 1
    
2.
Gupta R, Mohan I, Narula J. Trends in Coronary Heart Disease Epidemiology in India. Ann Glob Health 2016;82:307-15.  Back to cited text no. 2
    
3.
Habibović M, Broers E, Piera-Jimenez J, Wetzels M, Ayoola I, Denollet J, et al. Enhancing Lifestyle Change in Cardiac Patients Through the Do CHANGE System (“Do Cardiac Health: Advanced New Generation Ecosystem“): Randomized Controlled Trial Protocol. JMIR Res Protoc 2018;7:e40.  Back to cited text no. 3
    
4.
Kayaniyil S, Ardern CI, Winstanley J, Parsons C, Brister S, Oh P, et al. Degree and correlates of cardiac knowledge and awareness among cardiac inpatients. Patient Educ Couns 2009;75:99-107.  Back to cited text no. 4
    
5.
Mohammad NB, Rahman NA, Haque M. Knowledge, attitude, and practice regarding the risk of cardiovascular diseases in patients attending outpatient clinic in Kuantan, Malaysia. J Pharm Bioallied Sci 2018;10:7-14.  Back to cited text no. 5
    
6.
Ansa VO, Oyo-Ita A, Essien OE. Perception of ischaemic heart disease, knowledge of and attitude to reduction of its risk factors. East Afr Med J 2007;84:318-23.  Back to cited text no. 6
    
7.
Menotti A. Knowledge, attitude and practice regarding coronary cardiopathy. The Italian section of the HELP (Heart European Leaders Panel) study. G Ital Cardiol 1997;27:1125-32.  Back to cited text no. 7
    
8.
Chaves G, Britez N, Munzinger J, Uhlmann L, Gonzalez G, Oviedo G, et al. Education to a Healthy Lifestyle Improves Symptoms and Cardiovascular Risk Factors-AsuRiesgo Study. Arq Bras Cardiol 2015;104:347-55.  Back to cited text no. 8
    
9.
Themistocleous I, Stefanakis M, Douda HT. Coronary Heart Disease Part II: Role of Physiotherapy Coronary Heart Disease Part II: Role of Physiotherapy. J Phys Act Nutr Rehabil 2017;10:176-89.  Back to cited text no. 9
    
10.
Yadav YK. Exercise in the Management of Coronary Artery Disease. Med J Armed Forces India 2007;63:357-61.  Back to cited text no. 10
    
11.
Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, et al. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res 2017;120:366-80.  Back to cited text no. 11
    
12.
Muhamad R, Yahya R, Mohamed Yusoff H. Attitude and practice on cardiovascular disease among women in north-eastcoast Malaysia. Int J Collab Res Int Med Public Heal 2012;4: 85-98. Available from: http://iomcworld.com/ijcrimph/ijcrimph-v04-n01-08.htm. [Last accessed on 2019 Feb 16].  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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