INTRODUCTION:
Coronary
heart disease is the leading cause of mortality and morbidity in both
developing and developed countries. Coronary heart disease will take epidemic
and be a major cause of death in developing countries by the year of 2020.(1)
The
risk of CHD increases day by day in developing countries, where modernization
and industrialization is under process and people are migrating from rural to
urban area for betterment of life and which are changing the life style. Effect
of changing lifestyle can lead to major systemic disorders such as CHD, DM,
Cancer, Hypertension and CVA.(2)
It
is globally estimated that approximately 17 million people die due to
cardiovascular disease like CHD and stroke every year and, in India 3 million
people die per year because of CHD. The incidence, prevalence, morbidity and
mortality from coronary heart disease among Asian Indians have been reported to
be higher than among Europeans, Americans, and other Asian irrespective of
whether they live in India or Abroad.(3)
The
prevalence of associated life style risk behavior such as diet, physical
activity, sedentary life style, stress can lead CVD. The urgent based on the
primary prevention need to be taken to modify the lifestyle and behavior of the
people of the urban community otherwise emergence of CVD cases may be out of
hand. Hence developing strategies against these risk behavior and determining
factors is necessary to promote healthy lifestyle among men and women. (4)
In
fact in the European work force 18% of workers are on shift or overtime, about
40% of the working population work in banking sector. Bank employees are certainly
one group to be considered where the work situation would allude to their
health status (5). In this study undertake 100 bank employees so as
to quantify their knowledge and attitude regarding CHD and bring out
appropriate interventional measures.
OBJECTIVES:
1. To assess the level of knowledge regarding
primary prevention of coronary heart disease among bank employees.
2. To assess the attitude score regarding
primary prevention of coronary heart disease among bank employees.
3. To find out the correlation between the level
of knowledge and attitude score regarding primary prevention of coronary heart
disease among bank employees.
4. To find out the association between the
knowledge and attitude regarding primary prevention of coronary heart disease
among bank employees.
5. To develop a self instructional module on
primary prevention of coronary heart disease among bank employees.
Assumption:
1. Knowledge and attitude are interrelated
which will felicitate the positive practice.
2. SIM will help to increase knowledge about
primary prevention of coronary heart disease.
Hypothesis:
H1:
There is significant association between the knowledge and attitude with their
selected demographic variables
H2:
There is significant correlation between the knowledge and attitude regarding
primary prevention of coronary heart disease among bank employee.
Conceptual
Framework:
Health
Promotion Model adopted in this study, which is explaining disease prevention
behavior, and expands to encompass behavior for enhancing health. Health
promotion model describe the multidimensional nature of person as they interact
with in their environment to pursue health.
DELIMITATION:
·
This study
limited to those who are employees of selected banks of Pune city
·
The study is confined
to employees not having history of coronary artery disease.
·
There is no control
over certain extraneous variable.
REVIEW
OF LITERATURE:
Review
of literature was divided into following parts:
1. Study related to prevalence and risk
factor of CHD
2. Study related to primary prevention of CHD
3. Study related to effectiveness of SIM
4. Study related to Bank employees
MATERIAL
AND METHODS:
Qualitative
research approach was adopted and descriptive survey design was used in this
study. Population consisted of selected 8 banks of Pune city with sample size of
100 bank employees by using non- probability purposive sampling technique. Validity
and reliability: structured knowledge questionnaire and attitude scale with
blue print were given to 8 experts of Nursing and Medical field. Reliability
was established out of 10 samples by using Cronbach’s alpha r = 0.83, which is
consider as reliable and adequate. Inclusive criteria: 1. Bank employees
between age group of 25-55 years. 2. Those who are employees of selected banks
in Pune city. Exclusive criteria: Employees those who all are having
coronary heart disease. Ethical consideration: Permission was taken from
HR Manager of 8 selected banks. Well informed consent was obtained from bank
employees before collecting the research data. Data collection was done
within 20 days from HDFC, BOI, ICICI, Axis, Bank of Maharashtra, Karad Urban
Bank, SBI and Vidya Sahkari bank respectively in Pune city.
Description
of the tool: tool was organized into
two parts:
Section
I:
Socio-demographic
variables: age, gender, educational status, designation, family history, preventive
measures of CHD, stress, smoking, intake of alcohol and exercise increase blood
sugar and high BP.
Section
II:
Physiological
measures: blood pressure, weight, height, BMI, Waist-Hip ratio.
Section
III:
Self
structured knowledge questionnaire consisted of 16 items related to anatomy and
physiology of heart, risk of coronary heart disease, prevention of Coronary
heart disease. Correct response was scored as 1.The response were scored and
graded as follows: Poor knowledge (0-5), Average Knowledge (6-11), Good
Knowledge (12-16).
Section
IV: Attitude scale consists of 19 items regarding primary prevention of
coronary heart disease. 5 point Likert Scale: strongly agree, agree undecided,
disagree, and strongly disagree. Attitude score wise distribution: Negative
attitude (19-58), Positive attitude (59-95).
RESULTS:
Section I: Frequency and distribution of socio
demographic variables:
Shows the distribution of bank employees according to
their age and depict that majority (37%) of participant were between the age
group of 25-35 years and 29% participant were in the age group of 45-55 years, gender
shows that maximum participants (56%) were male. 51% educational status of
graduation, 44% postgraduate and 5% higher secondary, designation shows 14% chief
manager, 18% assist branch manager,19% operational manager, 20% accountant, 14%
cashier and 15% were clerk. In family history 17% hypertension, 23% diabetes,
and 6% heart disease. 70% were aware of preventive measure, only 13% subject
have habits of smoking and 23% are consuming alcohol, experience of work
related stress 42% occasionally, 20% daily, 17% more often, and 42% experience
personal family life stress, only 15% were having high BP,4% having increased blood
sugar level, and 56% are doing exercise.
Section II: Table-1
FREQUENCY AND % DISTRIBUTION OF PHYSIOLOGICAL MEASURES:
Table -1:
(N=100)
|
Parameters
|
Percentage
|
|
Body
Mass Index
|
<18.5
18.5
– 25
25.1
– 29.99
≥
30
|
6
53
31
10
|
|
Waist-Hip
ratio
|
At
risk
Normal
|
44
56
|
Table
-1 shows that BMI depicts that 53% have healthy weight, 31% obese and 10% were
overweight. 44% have abnormal Waist-Hip ratio.
SECTION
III:
Distribution
of Bank Employees according to level of knowledge and attitude regarding
primary prevention of coronary heart disease.
Figure 1: Distribution of Bank Employees according to
level of knowledge score: shows that
majority 59% of bank employee had average knowledge and 7% didn’t have
knowledge regarding primary prevention of coronary heart disease.
Figure: 1
Bar diagram shows distribution of knowledge score of bank employees in study
Table
-2: Distribution of attitude score of bank employee: 100% bank employee having positive attitude towards primary
prevention of coronary heart disease.
Table-2
N=100
|
Attitude score
|
No of cases
|
Percentage
|
|
19
– 58 (Negative)
|
0
|
0
|
|
59
– 95 (Positive)
|
100
|
100
|
SECTION
IV:
To
find out correlation between knowledge and attitude score among bank employees
Figure
-2, Table- 3:
depicts
that there were positive correlation between knowledge and attitude scare
regarding primary prevention of coronary heart disease.
Figure
-2: Scatter diagram shows correlation
between knowledge and attitude score
Table
-3: correlation between knowledge and
attitude score among bank employees
|
Correlation between
|
r Value
|
P Value
|
|
Knowledge and Attitude
|
0.23
|
<0.05
|
SECTION
V: Find out the association between level of knowledge and attitude score in
relation to selected variables: Study shows
that only major difference found in the level of knowledge i.e 42% (9.17+ 2.77)
and mean attitude score( 69.33+4.92) as per work related stress and no significant
difference found with other variables such as age , gender, educational status,
designation, family history, personal family stress, high BP, Increase Blood
sugar level etc.
SECTION
VI: Preparation of SIM: Based upon
the above findings the researcher has prepared module on “prevention and
control of coronary heart disease”. A criterion checklist was used to assess the
validity of module in terms of agreement and disagreement for selection of
content, organization of content, language and audio visual aids. It was given
to expert for validation as per expert suggestion content was reorganized and
modified. Module prepared under following format: anatomy and physiology of
heart, cause and risk factor, pathophysiology, sign and symptoms, investigation
and primary prevention of CHD.
DISCUSSION:
Gupta
R, Joshi P, et al. Conducted a case control study on Epidemiology and causation
of coronary heart disease and stroke in India. Case–control studies
indicate that tobacco use, obesity with high waist: hip ratio, high blood
pressure, and high LDL cholesterol, low HDL cholesterol, abnormal lipoprotein,
and diabetes, low consumption of fruits and vegetables, sedentary lifestyles
and psychosocial stress are important determinants of cardiovascular diseases
in India. These risk factors have increased substantially over the past 50
years and to control further escalation it is important to prevent them. In
present study 15% have high blood pressure, 4% have increase Blood sugar level
and 44% have abnormal waist: hip ratio, 31% were obese.(3)
Krishna Shivarama, Wantamutte, Sangolli
and Mallapur. Risk factor of coronary heart disease among bank employees of
Belgum City. The prevalence
of risk factors of CHD was as follows: hypertension 31%, diabetes 21%, high
serum total cholesterol 29%, high triglycerides 39%, high LDL cholesterol
19.3%, low HDL cholesterol 17.7%, smoking 26%, sedentary habits 44%, positive
family history 12%, overweight / obesity (BMI >25 kg/m2) 33% and 26% of the
study subjects had truncal obesity. Among these, 55% of the study subjects had
at least two of these risk factors.(4)
CONCLUSION:
The following conclusion was drawn on the
basis of the study that majority of bank employees have average knowledge and a
positive attitude towards primary prevention of coronary heart disease. But
still there is a need to increase the knowledge of bank employees regarding
primary prevention of coronary heart disease as they are under stressed,
sedentary life style, high BP, increase blood sugar level and family history of
hypertension, DM, CHD and cancer irrespective of their level of knowledge and
attitude.
IMPLICATION:
Nursing practice:
with the help of SIM the Nurse can provide
education to individual, family and community regarding primary prevention and
control of coronary heart disease.
Nursing education:
Should emphasize on preparation of nurses,
to impart information about prevention of CHD and to assist the individual,
family and community. Arrange workshop and awareness programmes for different
group.
Nursing administration:
Spread awareness of primary prevention and
control of risk factor of CHD and also contribute in planning the state and
national health programs for primary prevention of CHD.
Nursing
research:
Finding
of the study will serve as a basis for the professional and student nurse to
conduct further interventional studies on primary prevention of CHD.
RECOMMENDATION:
1. An interventional study can be conducted
to assess the effect of SIM on prevention and control of coronary heart disease
on knowledge and attitude of young people
2. A true experimental study can be conducted
to assess the risk factor among bank employee and post office worker.
3. A comparative study to see the effect of
SIM and Planned Teaching programme on primary prevention of CHD.
4. A similar study may be conducted using
visual aid teaching on knowledge of primary prevention of coronary heart
disease among IT professional.
REFERENCES:
1.
Reddy S S, Prabhu G R. Prevalence and risk factor of hypertension in
adults in an urban slum in Tirupati AP. Ind J community Medicine 2005
jul-sep;30(3):84-5.
2.
Muhammad
Abdur- Rauf, Wahaj Aman, Noman Khan,Syed tahir, Shah. How successful is
secondary prevention for coronary artery disease in the real world.Pak heart
J.2012; 45(01):5-10. Available from: URL http://www.pkheartjournal.com/index.php/pkheart/article/download/.../130
3.
Gupta R, Joshi P, Mohan
P, Gupthe soneil . case control study on Epidemiology and causation of coronary
heart disease and stroke in India. J heart bmj.2008; 94(1): 16-26. Doi:10.1136/hrt.2007.132951
(Access on 2/2/13)
4.
Dowse GK,Gareeboo H.Changes in population cholesterol concentration and
other cardiovascular risk factor levels after five years of the non
communicable disease intervention programme .Mauritius non communicable disease
study group.BMJ1995,311:694-5-697.
5.
Krishna Shivarama, Wantamutte, Sangolli and Mallapur. Risk factor of
coronary heart disease among bank employees of Belgum City. Al Ame en J Med Sci
2010;3(2):152-59. (PubMed)
