BACKGROUND OF THE PROBLEM:

Ischemic heart disease is a condition characterized by impaired myocardial function due to decreased blood flow through coronary artery secondary to coronary artery disease, Ischemic heart disease is the most common cause of death worldwide its prevalence and incidence continues to increase the US death rate for CAD has decreased the hospital discharge rates for acute myocardial infarction has remained constant in 1955,2.2 million patients were discharged from US hospitals with ischemic heart disease, of whom 350,000 had new onset angina.¹

A general term for diseases of the heart caused by the insufficient blood supply to myocardium, eg; atherosclerotic coronary artery disease, angina pectoris, unstable angina, and myocardial infarction.¹

NEED AND SIGNIFICANCE OF THE STUDY:

In recent years the dominance of chronic disease as major contributors to total global mortality has emerged ischemic heart disease is the main cause for death. Ischemic heart disease have been identified as the major health problems and accounts for a major proportion of all deaths during adulthood in both developed and developing countries. Although ischemic heart diseases global mortality 7.2 million deaths. The death due to coronary artery disease 7.6 million.²

The cardiovascular disease is the number one cause of death world wide causing 17.3 million deaths. Over 80% of these deaths in low-and middle-income countries. Cardiovascular disease occur almost equal in men and women. By 2030 almost 23.6 million people are predicted to die with cardiovascular disease.³

With the reference of the above evidence and details I find that the public knowledge and attitude towards self care among ischemic heart diseases is poor. For improving the knoweledge and attitude towards self care of ischemic heart disease, a thrust to take over the problem as the study

OBJECTIVES:

· To assess the knowledge level of self care among patients with ischemic heart disease.

· To assess the attitude towards self care among patients with ischemic heart disease.

· To assess the effectiveness of multi-component therapy on knowledge of self care among patients with ischemic heart disease.

· To assess the effectiveness of multi-component therapy on attitude towards self care among patients with ischemic heart disease.

· To find out the association between multi-component therapy with selected demographic variable

HYPOTHESES:

The following hypothesis will be tested at 0.05 level of significance

H1; There will be significant difference between pretest and post test knowledge score of experimental group after multi-component therapy

H2; There will be significant difference between pretest and post test attitude score of experimental group after multi-component therapy

H3; There will be significant difference between post test knowledge score of experimental and control group

H4; There will be significant difference between post test attitude score of experimental and control group

H5; There will be significant association between pretest knowledge score with selected demographic variable

H6; There will be significant association between pretest attitude score with selected demographic variable

MATERIALS AND METHODS:

Quantitative research approach was adopted to find effectiveness of multi-component therapy on knowledge and attitude towards self care among patients with ischemic heart disease

The research design used in the study was Quasi experimental non-equivalent pretest post test control group design.

A study subjects were selected from ischemic heart disease in out patient department selected hospitals at kollam. Multi-component therapy were used for assessing effectiveness on knowledge and attitude towards self care among ischemic heart disease.

The samples those who meet the inclusion criteria were identified and the investigator introduced him to the samples and informed consent were obtained.60 samples were selected for the study using purposive sampling techniques.The investigator makes them into two groups,one as experimental group and other as control group.Each group consist of 30 ischemic heart disease patients.30 samples took from Bishop benziger hospital in that 15 in experimental group and 15 in control group and also from Sree Narayana Trust Medical mission Hospital at Kollam, 30 samples took in that 15 in experimental group and 15 in control group. Samples were asked to give baseline profile,Pretest was conducted for both experimental and control group on first day followed by implementing multi-component therapy and 14th day post test were conducted.The multi-component therapy provided only experimental group,with 1 hour time duration in each patients.no interventions was given for control group.The researcher analyzed the data by using descriptive and inferential statistics based on the objectives and hypothesis.

Section A: Sample characteristics

This section deals with the frequency and distribution of sample characteristics.

Figure 1; percentage of age of patient suffering from ischemic heart disease

Figure 2; percentage distribution of sex of patient suffering from ischemic heart disease

Figure 3; percentage distribution of education of patient suffering from ischemic heart disease

Figure 4; percentage distribution of occupation of patient suffering from ischemic heart disease

Figure 5; percentage distribution of diet of patient suffering from ischemic heart disease

Figure 6; percentage distribution of habit of patient suffering from ischemic heart disease

Figure 7; percentage distribution of body weight of patient suffering from ischemic heart disease

Section B; Evaluation of Effectiveness of multi-component therapy on knowledge and attitude towards self care among patients with ischemic heart disease

Comparison of the pretest and post test knowledge score of the experimental group after multi-component therapy

Table 1; Mean standard deviation and ‘t’ value of pretest and post test knowledge score of the experimental group after multi-component therapy (n=30)

	Mean	SD	t -value
Pre-test	12.83	1.74	32.364
Post-test	20.17	1.53	32.364

Paired t test is used

Tabulated t (t29) = 2.05 *significant

The calculated paired ‘t’ value is greater than table t value (p<0.0.5). Hence research hypothesis H1was accepted.So there is a significant change occurs in pretest and post test knowledge score after multi-component therapy

Table 2; Mean standard deviation and ‘t’ value of pretest and post test attitude score of the experimental group after multi-component therapy (n=30)

	Mean	SD	t -value
Pre-test	40.80	8.63	20.815
Post-test	60.30	8.21	20.815

Paired t test is used

Tabulated t (t29) = 2.05 *significant

The calculated paired ‘t’ value is greater than table t value (p<0.0.5). Hence research hypothesis H2 was accepted. Sothere is a significant change occurs in pretest and post test attitude score after multi-component therapy.

Comparison of the post test knowledge score of experimental and control group

Table 3; Mean, standard deviation and ‘t’ value of the post test knowledge score of experimental and control group of self care among patients with ischemic heart disease in out patient department of selected hospitals at kollam (N=60)

	Mean	SD	t -value
Experimental group	20.17	1.53	21.2213
Control group	12.43	1.28	21.2213

Unpaired t test is used

Tabulated t (t58) = 2.00 *significant

The calculated paired ‘t’ value is greater than table t value (p<0.0.5). Hence research hypothesis H3 was accepted.So there is a significant change occurs in post test knowledge score of the experimental and control group.

Table 4; Mean, standard deviation and ‘t’ value of the post test attitude score of experimental and control group of self care among patients with ischemic heart disease in out patient department of selected hospitals at kollam (N=60)

	Mean	SD	t -value
Experimental group	60.30	8.21	10.6274
Control group	40.53	6.03	10.6274

Unpaired t test is used

Tabulated t (t58) =2.00 *significant

The calculated paired ‘t’ value is greater than table t value (p<0.0.5). Hence research hypothesis H4 was accepted.So there is a significant change occurs in post test attitude score of the experimental and control group.

Section-C; Association between knowledge and attitude score with selected demographic variable like age in years, sex, education, occupation, diet, habit, body weight

Table 5; Chi-square value showing association between knowledge score with selected demographic variable like age in years, sex, education, occupation, diet, habit, body weight. (N=60)

Demographic Variables

Knowledge score Poor Average

Chi-square

Significance

Age in years

30-40

41-50

50-60

61-70

71-80

3.78

0.287

Sex

Male

Female

1.86

0.173

Education

Illiterate

School level

UG/Diploma

PG & above

0.07

Occupation

Unemployed

Government Employee

Private employee

Others

11.1

0.11

Diet

Vegetarian

Non vegetarian

0.951

0.32

Habit

Smoking

Alcoholism

Tobacco

Drug abuse

No unhealthy habit

0.838

0.658

Body weight

Under weight

Normal weight

Over weight

1.96

0.161

*Significant at 0.05 level NS-Not Significant S-significant

Table 6; Chi-square value showing association between attitude score with selected demographic variable like age in years, sex, education, occupation, diet, habit, body weight. (N=60)