INTRODUCTION:

Coronary artery disease is the narrowing or blockage of the coronary arteries usually caused by atherosclerosis. Atherosclerosis (sometimes called "hardening" or "clogging" of the arteries) is the build-up of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries. These plaques can curb blood flow to the heart muscle by physically clogging the artery or by causing abnormal artery tone and function. Without adequate blood supply, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. If the blood supply to a portion of the heart muscle is disconnected entirely, or if the energy needs of the heart become much greater than its blood supply, a heart attack (injury to the heart muscle) may occur.¹

A community based cross-sectional study on 418 persons (212 males and 206 females) observed that prevalence of tobacco use was the most significant risk factor (42.3%) among subjects. The prevalence of other coronary risk factors ranged from 10-20%. Tobacco use, alcoholism and sedentary life style were considerably more amongst males while truncal obesity and systolic hypertension were more among females.²

The Global Burden of Disease study estimated of age-standardized CVD death rate of 272 per 100000 populations in India was higher than the global average of 235 per 100000 populations. Premature mortality in terms of years of life lost because of CVD in India increased by 59%, from 23.2 million (1990) to 37 million (2010). Regardless of wide heterogeneity in the prevalence of cardiovascular risk factors across different regions, CVD has come out as the leading cause of death in all parts of India. The progression of the CVD epidemic is characterized by the reversal of socioeconomic gradients; tobacco use, low fruit and vegetable intake have become more prevalent among those from lower socioeconomic backgrounds. In addition, individuals from lower socioeconomic backgrounds frequently do not receive proper treatment, leading to poorer outcomes.³

A cross-sectional study was carried out on 3771 study subjects to examine the prevalence of CHD using WHO Rose Angina questionnaire and WHO STEP approach. Study revealed prevalence of Coronary heart disease among the study subject was 226 (6.0 %). Male and female ratio was 123 (6.3% to 103 (5.7 %). Higher risk factor for coronary artery disease among males were smoking, smokeless tobacco and alcohol consumption while hypertension, obesity, sedentary type of physical activity, low fruits and vegetable consumption were the risk factors which were higher among females.⁴

Findings of a study result revealed that only 15.33% of subjects had good level of knowledge, and 84.67% subject had poor level of knowledge regarding prevention of CAD. The study recommends the requirement of awareness raising program regarding preventive measures of CAD to decrease the burden of such devastating disease.⁵

It is in this background and by clinical experience; the researcher is encouraged to undertake a study to design an educational package which will be useful and informative to the patients on CAD and its prevention.

OBJECTIVES:

1. To assess the pre-test and post-test level of knowledge and practice regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD.

2. To implement and evaluate the effectiveness of Planned Teaching Program (PTP) regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD.

3. To correlate post-test knowledge scores and practice scores regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD.

4. To find out the association between the pre-test level of knowledge and practice score regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD with their selected demographic variables.

MATERIALS AND METHOD:

A quantitative approach, pre-experimental research design was used in the present study. 120 patients with modifiable risk factors of CAD were chosen by using purposive sampling technique who were attending medical OPDs in the selected hospitals at Udaipur, Rajasthan.

The tools for the present study included socio-demographic variables, structured knowledge questionnaire and three point scale to assess practice regarding prevention of coronary artery disease (CAD) among patients with modifiable risk factors of CAD. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (chi-square, paired‘t’ test) were used to analyze the data and to test hypothesis. “Split half method” (spearman brown formula) was used to test the reliability of the tool and tool was found to be reliable (r = 0.7291). Prior to tool administration all subjects were explained about the purpose, nature and outcome of study. Informed consent was taken from the participants.

RESULTS:

The data given in Table 1 shows that according to age, 48 (40%) subjects were in the age group of more than 50 years and 40 (33.33%) were in the age group of 40-50 years. 68 (56.70%) subjects were male and 52 (43.30%) were female. 44 (36.70%) subjects had graduation. 72 (60%) subjects were moderate worker, 32 (26.70%) were sedentary worker and 16 (13.30%) were heavy worker. Majority of subjects were Hindus. Regarding marital status 100 (83.33%) samples were married. 100 (83.33%) subjects were vegetarian and 20 (16.67%) were mix vegetarian. According to personal habits, 72 (60%) subjects had no such habits, 26 (21.66%) had habit of smoking and tobacco, 17 (14.17%) had habit of alcoholism while 5 (4.17%) had habit of drug abuse. 37 (30.83%) subjects were known case of hypertension while 32 (26.67%) were known case of diabetes. 34 (28.33%) subjects had family history of heart disease, while 44 (36.67%) were diagnosed with high cholesterol. In connection with BMI, 68 (56.67%) subjects were overweight, 36 (30%) were obese. With regard to waist circumference 56 (36.70%) male subjects had more than 39 inch waist circumference while 48 (40%) female subjects had more than 34.50 inch waist circumference.

Table: 1. Distribution of subjects according to socio demographic variables (n=120)

S. No.

Demographic Variables

Freq.

Age (in years)

20-30 years

30-40 years

40-50 years

> 50 years

10%

16.67%

33.33%

40%

Gender

Male

Female

56.70%

43.30%

Educational status

Primary education

Secondary education

Graduation

Post Graduation

20%

30%

36.70%

13.30%

Occupation

Sedentary worker

Moderate worker

Heavy worker

26.67%

60%

13.33%

Religion

Hindu

Muslim

Christian

Others

60%

26.70%

13.30%

00%

Marital status

Single

Married

Divorced/ Widowed

100

6.67%

83.33%

10%

Dietary Habits

Vegetarian

Mix Vegetarian

100

83.33%

16.67%

Personal Habits

Alcoholic

Smoking/ Tobacco

Drug abuse

No such habits

14.17%

21.66%

04.17%

60%

Known case of Hypertension

Yes

30.83%

69.17%

10.

Known case of Diabetes

Yes

26.67%

73.33%

11.

Family history of heart disease

Yes

28.33%

71.67%

12.

Diagnosed with high cholesterol

Yes

36.67%

63.33%

13.

BMI measure

Underweight <18.5

Normal 18.5-24.9

Overweight 25-29.99

Obese 30-39.99

Over 40

13.33%

56.67%

30%

14.

Waist Circumference

More than 39 Inch in males

More than 34.50 Inch in females

Less than 39 Inch in males

Less than 34.50 Inch in females

46.67%

40%

03.33%

10%

Table-2 Assessment of pre-test knowledge score and practice score among subjects (n=120)

S. No	Pre test	Max. score	Mean	SD	Range	Mean score %
1	Knowledge regarding prevention of CAD	30	13.52	2.62	10-22	45.06%
2	Practice regarding prevention of CAD	30	12.36	2.46	10-22	41.20%

Table- 3 Assessment of post-test knowledge score and practice score among subjects (n=120)

S. No	Post test	Max. score	Mean	SD	Range	Mean score %
1	Knowledge regarding prevention of CAD	30	24.52	2.83	16-29	81.73%
2	Practice regarding prevention of CAD	30	24.28	2.67	16-28	80.90%

Table 2 depicts that mean pre-test knowledge on prevention of coronary artery disease among patients with modifiable risk factors of CAD were 13.52 with standard deviation 2.62 and range from 11-22. The mean pre-test practice score was 12.36 with standard deviation 2.46 and range from 11-22.

Table 3 shows that mean post-test knowledge on prevention of coronary artery disease among subjects with modifiable risk factors of CAD was 24.52 with standard deviation 2.83 and range from 16-29. The mean post-test practice score was 24.28 with standard deviation 2.67 and range from 16-30.

Table-4 Description of subjects according to their pre-test and post-test score of knowledge (n=120)

Knowledge score level	Pre-test scores		Post-test scores
Knowledge score level	Freq.	%	Freq.	%
Inadequate	92	76.67%	0	0%
Moderately adequate	28	23.33%	24	20%
Adequate	0	0%	96	80%

Table 4 depicts that, in pre-test majority of subjects 92 (76.67 %) had inadequate knowledge level and 28 (23.33%) had moderately adequate knowledge level. But in post-test majority of subjects 96 (80%) had adequate knowledge level and 24 (20%) had moderately adequate knowledge level.

Table -5 Description of subjects according to their pre-test and post-test score of practice (n=120)

Practice score level	Pre-test scores		Post- test scores
Practice score level	Freq.	%	Freq.	%
Inadequate	90	75%	00	0%
Moderately adequate	30	25%	25	20.83%
Adequate	0	0%	95	79.17%

Table 5 reveals that in pre-test majority of subjects 90 (75 %) had inadequate practice level and 30 (25%) had moderately adequate practice level. But in post test majority 95 (79.17%) of subjects had adequate practice score and 25 (20.83%) had moderately adequate practice score.

The effectiveness of planned teaching programme was tested by using paired‘t’ test. The mean pre-test knowledge score was 13.52 and mean post –test score was 24.52, with mean difference was 11.00, the Paired‘t’ test value was 33.67 was greater than table value at .05 level of significance. The mean pre-test practice score was 12.36 and mean post –test score was 24.28, with mean difference was 11.92, the Paired‘t’ test value was 29.41 was greater than table value at .05 level of significance.

The calculated Karl Pearson’s Correlation value of r = 0.570 shows a positive correlation among post test knowledge and practice score regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD.

Chi-square test was calculated to find out the association between pre-test score of knowledge and practice regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD with demographic variables. Study result found that there was no significant association between the pre-test knowledge score and practice score regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD with demographic variables.

DISCUSSION:

Present study revealed that 60% subjects were moderate worker, 26.70% were sedentary worker while 21.66% of the subjects had habit of smoking and tobacco, and 14.17% had habit of alcoholism. Among subjects 30.83% were known case of hypertension, 26.67% were known case of diabetes and 28.33% subjects had family history of heart disease while 36.67% were diagnosed with high cholesterol. More than 50% subjects were overweight and 30% were obese. Around 36.70% male subjects and 40% female subjects had beyond normal waist circumference. Our study findings supported by a cross-sectional study carried out by Sinha U, Bhardwaj SD (2016)⁴ to examine prevalence and risk factors of CAD. Rao M et al., (2015)⁶ also presented similar findings in a systematic review on the prevalence, risk factors, treatments and outcomes of Coronary Artery Disease (CAD) in Indians.

Our study found that 76.67 subjects had inadequate knowledge score with 13.52 mean knowledge score in pre test while 75% subjects had inadequate practice score with 12.36 mean practice score in pre test. Similar results found in a cross-sectional study conducted by Verma, A. Mehta, S et al (2019)⁷ and a descriptive study conducted by Baby Elizebeth, L M Sams (2015)⁸. Gagan Sharma, Manisha Kammar (2019)⁹ and Ramya K. R., Kiran Batra (2015)¹⁰ found similar results regarding knowledge on coronary artery diseases among bank employees and adolescents respectively, they concluded with strong nned of educational initiative for knowledge enhancement regarding coronary artery disease.

After educational intervention in the form of planned teaching program on prevention of coronary artery disease among patients with modifiable risk factors of CAD, we found adequate improvement in both knowledge and practice aspects of our study subjects. Our study found that 80% subjects had adequate knowledge score with 24.52 mean knowledge score in post test while 79.17% of subjects had adequate practice score with 24.28 mean practice score in the post-test. Pre-test and post-test knowledge score Paired‘t’ test value was 33.67 while Pre-test and post-test practice score Paired ‘t’ test value was 29.41. Both the values were greater than table value at .05 level of significance. Hence our findings were statistically significant. Similar findings stated by a study conducted by Sudhir Singh (2020)¹¹ with the objective to assess the effectiveness of STP on knowledge and practice regarding prevention of CAD. Nandhini Devi1, A. Rathiga (2020)¹² also established effectiveness of structured computer based education programme to develop and enhance the knowledge on CAD among Hypertensive population. Timila Manandhar et.al. (2019)¹³ also found effectiveness of education intervention in the form of self-instructional module on knowledge regarding prevention of coronary artery disease among middle aged women. Nidhi Abraham (2017)¹⁴ and Payal Vaghela et al (2021)¹⁵ also found effectiveness of educational package on knowledge and prevention of coronary artery disease.

Our study found a positive correlation among post-test knowledge and practice score regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD. This finding was supported by a study conducted by Dahal Poonam, Karki Rekha (2017)¹⁶ on knowledge and practice regarding prevention of myocardial infarction in which they found positive correlation between knowledge and practice score.

CONCLUSION:

Study identified that the most of the patients with modifiable risk factors of CAD had below average knowledge and practice score regarding prevention of coronary artery disease in pre test which was increased after educational intervention, thus the study suggests the need for regular continue education programs for patients with modifiable risk factors of CAD.

SOURCE OF FUNDING:

Researchers had self-financed the present study.

CONFLICT OF INTEREST:

There was no conflict of interest involved while conducting the present study.

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Received on 20.04.2021 Modified on 22.06.2021

Asian J. Nursing Education and Research. 2022; 12(1):37-41.

DOI: 10.52711/2349-2996.2022.00007