A Study to Assess the Effectiveness of An Information Booklet on Knowledge regarding Lifestyle Modification of Angina Pectoris among Adults at selected Rural Area, Raipur (C.G.)

Naveen Kumar

Nursing Tutor, Sri Sathya Sai Sanjeevani Institute of Nursing and Allied Healthcare Sciences,

Sector-2, Atal Nagar, Nava Raipur - 492101 (C.G.).

*Corresponding Author Email: sahunaveen671@gmail.com

ABSTRACT:

Background: Angina pectoris, a clinical manifestation of coronary artery disease (CAD), is a major contributor to global morbidity and mortality. In India, the prevalence is rising in both rural and urban populations due to sedentary lifestyles, tobacco use, unhealthy diet, and stress. In rural areas such as Raipur (Chhattisgarh), limited awareness and poor health literacy further increase the disease burden. Lifestyle modification is essential for prevention and management; however, lack of structured education limits its adoption. Objective: To assess the effectiveness of an information booklet on knowledge regarding lifestyle modification of angina pectoris among adults in a selected rural area of Raipur (C.G.). Methods: A quasi-experimental non-randomize control group pre-test post-test design was adopted. A total of 60 adults (30 experimental and 30 control) were selected using non-probability convenience sampling. A self-structured questionnaire was used to assess knowledge. The experimental group received an information booklet on lifestyle modification, while the control group received no intervention. Data were analyzed using descriptive and inferential statistics. Results: The experimental group showed a significant improvement in mean knowledge scores from 12.3±5.14 to 22.16±4.72 (t = 14.25, p< 0.001), whereas the control group showed no significant change. A significant difference was observed between the groups in post-test scores (t = 8.83, p<0.001). Significant associations were found between post-test knowledge scores and selected socio-demographic variables. Conclusion: The information booklet was found to be a simple, cost-effective, and effective intervention to improve knowledge regarding lifestyle modification of angina pectoris among rural adults. It can be integrated into community health programs to promote preventive practices and improve health outcomes.

KEYWORDS: Angina pectoris, Lifestyle modification, Information booklet, Knowledge, Rural adults, Quasi-experimental design.

INTRODUCTION:

Angina pectoris, commonly referred to as chest pain, is a significant clinical manifestation of coronary artery disease (CAD) and results from myocardial ischemia, a condition characterized by inadequate oxygen supply to the heart muscle. Although most commonly associated with CAD, angina may also arise due to non-cardiac conditions such as anemia, hyperthyroidism, valvular heart disease, and respiratory disorders. Epidemiological tools such as the Rose Angina Questionnaire have been widely used in population-based studies to identify individuals at risk. Evidence indicates that individuals presenting with angina are at increased risk of myocardial infarction, heart failure, and mortality; however, timely secondary prevention strategies can significantly reduce these adverse outcomes^1,2,3,4,5.

Angina is broadly classified into stable, unstable, variant (Prinzmetal), and microvascular types based on pathophysiology and clinical presentation. Stable angina typically occurs during physical exertion and is relieved by rest, whereas unstable angina may occur at rest and represents an acute coronary syndrome due to plaque rupture and thrombosis. Variant angina results from transient coronary vasospasm, while microvascular angina involves dysfunction of small coronary vessels and is more commonly observed in women. Studies suggest that 30–50% of patients with angina-like symptoms and normal coronary arteries may have microvascular dysfunction, highlighting the complexity and underdiagnosis of these conditions^{2,6,7, 8}.

Globally, ischemic heart disease remains the leading cause of mortality, as reported by the World Health Organization. Angina affects approximately 112 million individuals worldwide. In high-income countries, prevalence ranges from 2% to 4%, increasing significantly with age to 10–20% among older adults. Future projections indicate a continued rise in angina prevalence due to population aging and lifestyle changes^9,10,11,12.

In India, cardiovascular diseases represent a major public health burden. Studies report coronary artery disease prevalence of approximately 7% in rural and 14% in urban populations. National data indicate angina prevalence of around 8–9% among adults aged ≥45 years, with higher rates among women. Regional studies from Goa and Siliguri report prevalence ranging from 5% to 11.6%. Data from the Office of the Registrar General & Census Commissioner, India further highlight higher cardiovascular mortality rates in southern and eastern regions of the country^{13,14,15,16,17}.

Multiple modifiable and non-modifiable risk factors contribute to angina, including hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, sedentary lifestyle, and psychosocial stress. National surveys such as NFHS-5 and ICMR-INDIAB demonstrate rising trends in these risk factors in India. In regions such as Chhattisgarh, increasing prevalence of hypertension, diabetes, and obesity reflects the growing burden of cardiovascular disease. Additionally, early-onset CAD and angina are increasingly observed among younger adults due to lifestyle transitions and stress. Gender differences are also significant, with women often presenting atypical symptoms and experiencing delayed diagnosis^5,14,18,19.

The pathophysiology of angina involves an imbalance between myocardial oxygen supply and demand, leading to ischemia. The ischemic cascade includes metabolic, electrical, and mechanical changes resulting in chest pain due to release of mediators such as adenosine and bradykinin. Atherosclerosis remains the primary cause, with symptoms typically occurring when coronary artery narrowing exceeds 70%^1,2.

Public health interventions are essential to address this growing burden. In India, programs such as the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) focus on early detection, health education, and community-based management²⁰. Lifestyle modification including smoking cessation, healthy diet, physical activity, and stress management remains the cornerstone of prevention and management. Community-based educational strategies, particularly in rural areas, play a crucial role in improving awareness and promoting healthy behaviors.

NEED OF THE STUDY:

Angina pectoris, commonly referred to as chest pain resulting from inadequate blood supply to the myocardium, represents a major and growing public health concern, particularly in low- and middle-income countries such as India. The increasing prevalence of cardiovascular diseases (CVDs), especially among the working-age population, poses significant challenges in terms of healthcare accessibility, economic productivity, and overall public health planning. Although precise global incidence data for angina are difficult to isolate due to its overlap with coronary artery disease, global burden estimates indicate a substantial rise in angina cases, particularly in South Asia and other developing regions. According to the World Health Organization, ischemic heart disease remains the leading cause of mortality worldwide, accounting for approximately 9.4 million deaths annually. Despite advances in pharmacological and interventional therapies, a large proportion of patients especially in rural and underserved areas remain undiagnosed or inadequately treated^9,10.

Evidence consistently highlights the effectiveness of lifestyle modification in the prevention and management of angina pectoris. Interventions such as smoking cessation, adoption of a heart-healthy diet, regular physical activity, stress management, and weight control have been shown to reduce the frequency and severity of angina episodes and prevent progression to myocardial infarction and premature mortality⁵. However, awareness and adherence to these lifestyle practices remain suboptimal, particularly in resource-constrained settings where health literacy is limited.

The Institute for Health Metrics and Evaluation Global Burden of Disease (GBD) study (2021) reaffirms that ischemic heart disease continues to be the leading cause of death globally, with angina pectoris serving as an early clinical indicator¹⁰. In India, rapid urbanization, sedentary lifestyles, unhealthy dietary patterns, and increased psychosocial stress have further amplified the burden of cardiovascular diseases. Despite this, public awareness and access to preventive education remain inadequate, particularly in rural populations.

The World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2030) emphasizes reducing premature mortality from cardiovascular diseases through cost-effective strategies, including health education and behavioral interventions²¹. Low-cost, culturally appropriate educational tools such as information booklets have been recommended as effective means of improving knowledge and promoting healthy lifestyle practices in resource-limited settings.

In India, cardiovascular diseases are projected to result in an economic loss exceeding 2 trillion USD by 2030 due to reduced workforce productivity and premature deaths²². The age group most affected by angina (35–65 years) constitutes a vital segment of the national workforce. Poor disease management leads to increased healthcare expenditure, loss of productivity, and long-term socioeconomic burden on families and the healthcare system.

Several studies have highlighted the gap in knowledge and the effectiveness of educational interventions. Malavika D. (2022) reported that 67% of patients with coronary artery disease had inadequate knowledge regarding lifestyle modification. Similarly, Ahmed Waquar (2023) identified a high prevalence of undiagnosed and uncontrolled angina among rural adults, largely associated with poor health literacy. Patel V. (2021) demonstrated that printed educational materials significantly improved knowledge scores among cardiac patients (p<0.05). Furthermore, Selvi Thanga Jeya and Rosy Shanthi Juliana (2021), in a pre-experimental study among 60 adults with angina in Tamil Nadu, observed a statistically significant improvement in knowledge following an educational intervention (p<0.01). Gaikwad (2022) also reported a 45% improvement in awareness levels among rural cardiac patients after structured teaching programs.

These findings underscore the urgent need for structured, evidence-based educational interventions to enhance knowledge regarding lifestyle modification among individuals with angina pectoris. Therefore, the present study aims to evaluate the effectiveness of an information booklet in improving knowledge and promoting healthy lifestyle practices among adults, particularly in rural settings.

OBJECTIVES:

1. To assess the pre-test and post-test level of knowledge score regarding Lifestyle Modification of Angina Pectoris among Adults in experimental and control group.

2. To assess the effectiveness of an Information booklet on lifestyle modification of Angina Pectoris among Adults in experimental group.

3. To find out association between post-test levels of knowledge score regarding lifestyle modification of Angina Pectoris among Adults in experimental and control group with their selected socio-demographic variable.

HYPOTHESES:

H₁ - There will be significant difference between the pre-test and post-test level of knowledge score regarding lifestyle modification of Angina Pectoris among Adults in experimental and control group.

H₂ - There will be significant association between post-test levels of knowledge score with their selected socio demographic variables.

MATERIAL AND METHODS:

Research design: The aims of present research are to study of knowledge level of lifestyle modification of angina pectoris among adults. The research design adopted for the study was quasi experimental non randomized control group design.

Study population: The study sample comprised of 60 rural adults of Paloud Raipur, (C.G) and those, who fulfilled the inclusion criteria.

Sampling technique: In the present study, a non-probability convenience sampling technique was used to select adults who fulfilled the inclusion criteria and were available during the time of data collection.

Inclusion Criteria:

· Adults residing in Paloud village, Raipur (Chhattisgarh)

· Available during data collection period

· Willing to participate and gave written informed consent

· Physically and mentally fit

· Able to read, write, and understand Hindi

Exclusion Criteria:

· Refused to participate or did not give consent

· Not available during data collection

· Unwilling to participate in study/intervention

Description of the tool:

Section A: Socio-Demographic Variables: This section included basic background details of participants such as age, gender, marital status, education, occupation, and income. It also covered habits (smoking, alcohol, tobacco), medical history (hypertension, diabetes), and prior knowledge of angina pectoris along with its source.

Section B: Knowledge Questionnaire: This section consisted of a self-structured questionnaire to assess knowledge regarding angina pectoris and its lifestyle modification. It included 30 multiple-choice questions, each with one correct answer and three distractors.

Scoring Procedure:

· 30 self-structured knowledge questions (MCQs)

· Each correct answer = 1 mark; incorrect = 0

· <36% = Poor knowledge

· 36–70% = Average knowledge

· >70% = Good knowledge

RESULTS:

The findings are presented in the following sections:

Section A: The analysis level of knowledge scores of adults in both experimental and control groups.

Table-1 Analysis of pre-test and post-test level of knowledge scores regarding Lifestyle Modification of Angina Pectoris among adults in both experimental and control groups. N=60

Level of Knowledge Score	Experimental Group (n=30)				Control Group (n=30)
	Pre-test		Post-test		Pre-test		Post-test
	f	%	f	%	f	%	f	%
Poor	13	43.33	1	3.33	11	36.67	12	40
Average	16	53.33	12	40	19	63.33	18	60
Good	1	3.33	17	56.67	0	0	0	0
TOTAL	30	100	30	100	30	100	30	100
Mean	12.3		22.16		11.93		12.06
SD	5.14		4.72		5.63		4.11
Mean knowledge score (%)	41		73.89		39.78		40.22

Table 4: Comparison of pre-test and post-test knowledge scores in experimental group and control group (intra-group comparison)

N=60

Comparison of Pre-Test and Post-Test Knowledge Scores in Intra-Group (N=60)	Experimental Group (n=30)				Control Group (n=30)
	Pre-test		Post-test		Pre-test		Post-test
	f	%	f	%	f	%	f	%
Poor (0–10)	13	43.33	1	3.33	11	36.67	12	40
Average (11–20)	16	53.33	12	40	19	63.33	18	60
Good (21–30)	1	3.33	17	56.67	0	0	0	0
TOTAL	30	100	30	100	30	100	30	100
Mean	12.3		22.16		11.93		12.06
SD	5.14		4.72		5.63		4.11
Mean Knowledge Score (%)	41		73.89		39.78		40.22
Mean Gain Score (%)	9.86 (32.89%)				0.13 (0.44%)
Paired t-test / Critical value (df)	14.25 / 3.66 (30)				0.19 / 2.04 (30)
t-test Significance	*P<0.001 HS**				P>0.05 NS
Chi-square value / Critical value (df)	25.07 / 13.81 (2)				0.07 / 5.99 (2)
Chi-square Significance	*P<0.001 HS**				P>0.05 NS

*HS= Highly significant, NS= Not significant

Table 5: Comparison of pre-test and post-test knowledge scores in experimental group and control group (inter-group comparison)

N=60

Comparison of Pre-Test and Post-Test Knowledge Scores in Inter-Group (N=60)	Experimental Group (n=30)		Control Group (n=30)		Experimental Group (n=30)		Control Group (n=30)
	Pre-test		Pre-test		Post-test		Post-test
	f	%	f	%	f	%	f	%
Poor (0–10)	13	43.33	11	36.67	1	3.33	12	40
Average (11–20)	16	53.33	19	63.33	12	40	18	60
Good (21–30)	1	3.33	0	0	17	56.67	0	0
TOTAL	30	100	30	100	30	100	30	100
Mean	12.3		11.93		22.16		12.06
SD	5.14		5.63		4.72		4.11
Mean (%)	41		39.78		73.89		40.22
Gain (%)	0.37 (1.22%)				10.1 (33.67%)
Unpaired t-test / Critical value (df)	0.26 / 2.00				8.83 / 3.46 (58)
Unpaired t-test Significance	P>0.05 NS				*P<0.001 HS**
Chi-square value / Critical value (df)	1.42 / 5.99 (2)				27.50 / 13.81 (2)
Chi-square Significance	P>0.05 NS				*P<0.001 HS**

*HS= Highly significant, NS= Not significant

Table –5 shows that in the experimental group, the pre-test knowledge scores ranged from 3 to 22 with a median of 12.5, a mean of 12.3(41%), and SD = 5.14, whereas the post-test scores ranged from 16 to 28 with a median of 22, a mean of 22.16(73.89%), and SD = 4.72. The calculated unpaired t-value of 8.83 at p<0.001 indicates a highly significant difference in knowledge scores between experimental and control groups in the post-test, confirming the effectiveness of the information booklet.

In contrast, the control group’s pre-test scores ranged from 2 to 20 with a median of 13, a mean of 11.93 (39.78%), and SD = 5.63, while the post-test scores ranged from 4 to 19 with a median of 12, a mean of 12.06(40.22%), and SD = 4.11. The calculated unpaired t-value of 0.26 at p>0.05 indicates no statistically significant difference between pre-test and post-test scores in the control group.

Section D:

Finding association between post-test levels of knowledge score regarding lifestyle modification of angina pectoris among adults in experimental and control group with their selected socio-demographic variable.

Chi-square analysis showed that education (χ² = 22.60, p <0.05) and history of illness (χ² = 10.91, p<0.05) were significantly associated with post-test knowledge levels in the experimental group, while other socio-demographic variables such as age, gender, marital status, income, substance use, and previous knowledge showed no significant association (p>0.05). Hence, H₂ is accepted.

Chi-square analysis showed that age (χ² = 11.94, p< 0.05), education (χ² = 8.39, p<0.05), gender (χ² = 5.00, p <0.05), and previous knowledge (χ² = 4.00, p<0.05) were significantly associated with post-test knowledge levels in the control group. Other socio-demographic variables such as marital status, income, and occupation showed no significant association (p>0.05). Hence, H₂ is accepted.

DISCUSSION:

This chapter discusses the findings of the study based on its objectives and statistical analysis. The results showed that both experimental and control groups had average knowledge in the pre-test, but the experimental group showed significant improvement after receiving the information booklet. The intervention was found to be highly effective in enhancing knowledge regarding lifestyle modification of angina pectoris (p<0.001). There was also a significant association between post-test knowledge and variables like educational status and history of illness. Overall, the study confirms that structured educational materials are effective in improving knowledge among rural adults.

CONCLUSION:

The findings of the study indicate that the information booklet was effective in significantly improving the knowledge of adults regarding lifestyle modification of angina pectoris in the experimental group. No such improvement was observed in the control group. Therefore, it can be concluded that structured educational interventions, such as information booklets, are a practical, low-cost, and efficient tool to enhance awareness about cardiovascular disease prevention and lifestyle modification practices in rural populations.

REFERENCES:

1. Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia: Elsevier; 2022.

2. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison’s Principles of Internal Medicine. 21st ed. New York: McGraw-Hill; 2022.

3. Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962; 27: 645–658.

4. Hemingway H, Langenberg C, Damant J, Frost C, Pyörälä K, Barrett-Connor E. Prevalence of angina in women versus men: a systematic review and meta-analysis. BMJ. 2008; 336(7638): 778–781.

5. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (INTERHEART study). Lancet. 2004; 364(9438): 937–952.

6. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2020; 42(14): 1289–1367.

7. Crea F, Lanza GA, Camici PG. Mechanisms of coronary microvascular dysfunction. Circulation. 2014; 129(9): 1044–1057.

8. Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, et al. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2017; 38(33): 2565–2568.

9. World Health Organization. Cardiovascular diseases (CVDs) [Internet]. Geneva: WHO; 2023 [cited 2026 Apr 14]. Available from: https://www.who.int

10. GBD 2010 Study Collaborators. Global and regional mortality from 235 causes of death. Lancet. 2012; 380(9859): 2224–2260.

11. Decision Resources Group. Angina pectoris: disease forecast report. Waltham (MA): Decision Resources Group; 2020.

12. Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India. Circulation. 2016; 133(16): 1605–1620.

13. Huffman MD, Prabhakaran D, Osmond C, Fall CH, Tandon N, Lakshmy R, et al. Prevalence of angina in India: a cross-sectional study. PLoS One. 2011; 6(5): e19337.

14. Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, et al. Chronic diseases and injuries in India. Lancet. 2011; 377(9763): 413–428.

15. Das S, Banerjee A, Roy S. Prevalence of angina and associated risk factors in Siliguri, West Bengal: a community-based study. Indian J Public Health. 2022; 66(2): 123–128.

16. Office of the Registrar General & Census Commissioner, India. Sample Registration System Statistical Report 2021. New Delhi: Government of India; 2022.

17. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019–21: India. Mumbai: IIPS; 2021.

18. Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in India (ICMR-INDIAB study). Lancet Diabetes Endocrinol. 2017; 5(8): 585–596.

19. Indian Council of Medical Research (ICMR). Young coronary artery disease in India: clinical analysis report. New Delhi: ICMR; 2022.

20. Ministry of Health and Family Welfare. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). New Delhi: Government of India; 2021.

21. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2030. Geneva: WHO; 2013.

22. Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, et al. The global economic burden of noncommunicable diseases. Geneva: World Economic Forum; 2011.

Received on 23.04.2026 Revised on 27.05.2026

Accepted on 30.06.2026 Published on 27.07.2026

Available online from August 01, 2026

Asian J. Nursing Education and Research. 2026;16(3):213-218.

DOI: 10.52711/2349-2996.2026.00043

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

	Significance level of knowledge score regarding Lifestyle Modification of Angina Pectoris among adults in experimental group. (n=30)
	Min-Max	Median	Mean	Mean%	SD	t-value	p-value
Pre-test	3-21	13.5	12.3	41	5.14	14.25	p<0.001 HS
Post-test	9-28	23.5	22.16	73.89	4.72	14.25	p<0.001 HS