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Zulianello dos Santos R, Scheafer Korbes A, Batista Bonin CD, Marques Vieira A, Karsten M, Benetti M, Oh P, Ghisi GLDM. Preliminary Effects of a Structured Educational Program in Cardiac Patients at Different Stages of Enrollment in Cardiovascular Rehabilitation. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:365-376. [PMID: 38817096 PMCID: PMC11143761 DOI: 10.1177/0272684x221080119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
This quasi-experimental study investigated the preliminary effects of a structured education intervention in a pooled sample of cardiovascular rehabilitation (CR) patients in Brazil. Recently enrolled (RE) and long-term enrolled (LTE) patients attended 12 weekly education sessions in addition to three weekly exercise sessions. Patients completed surveys assessing disease-related knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was assessed by the 6-minutes walking test. All outcomes were assessed at pre-,post-CR, and 6-months follow-up. Bonferroni correction was applied. In total, 69 (69.7%) patients completed all three assessments. There were significant improvements in knowledge pre-to post-test in both subgroups (p < 0.001), and in functional capacity (p ≤ 0.001) and food intake (p ≤ 0.001) pre-to post-test in the RE subgroup. Post-test knowledge was correlated to physical activity, functional capacity and health literacy. This preliminary study suggests the importance of structured education for CR patients. A larger study using a randomized controlled design is needed to determine efficacy.
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Affiliation(s)
| | - Andrea Scheafer Korbes
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Christiani D. Batista Bonin
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Ariany Marques Vieira
- Montreal Behavioural Medicine Centre, Hôpital Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Marlus Karsten
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Magnus Benetti
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Law JH, Sultan N, Finer S, Fudge N. Advancing the communication of genetic risk for cardiometabolic diseases: a critical interpretive synthesis. BMC Med 2023; 21:432. [PMID: 37953248 PMCID: PMC10641935 DOI: 10.1186/s12916-023-03150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Genetics play an important role in risk for cardiometabolic diseases-including type 2 diabetes, cardiovascular disease and obesity. Existing research has explored the clinical utility of genetic risk tools such as polygenic risk scores-and whether interventions communicating genetic risk information using these tools can impact on individuals' cognitive appraisals of disease risk and/or preventative health behaviours. Previous systematic reviews suggest mixed results. To expand current understanding and address knowledge gaps, we undertook an interpretive, reflexive method of evidence synthesis-questioning the theoretical basis behind current interventions that communicate genetic risk information and exploring how the effects of genetic risk tools can be fully harnessed for cardiometabolic diseases. METHODS We obtained 189 records from a combination of database, website and grey literature searches-supplemented with reference chaining and expert subject knowledge within the review team. Using pre-defined critical interpretive synthesis methods, quantitative and qualitative evidence was synthesised and critiqued alongside theoretical understanding from surrounding fields of behavioural and social sciences. FINDINGS Existing interventions communicating genetic risk information focus predominantly on the "self", targeting individual-level cognitive appraisals, such as perceived risk and perceived behavioural control. This approach risks neglecting the role of contextual factors and upstream determinants that can reinforce individuals' interpretations of risk. It also assumes target populations to embody an "ascetic subject of compliance"-the idea of a patient who strives to comply diligently with professional medical advice, logically and rationally adopting any recommended lifestyle changes. We developed a synthesising argument-"beyond the ascetic subject of compliance"-grounded in three major limitations of this perspective: (1) difficulty applying existing theories/models to diverse populations, (2) the role of familial variables and (3) the need for a life course perspective. CONCLUSIONS Interventions communicating genetic risk information should account for wider influences that can affect individuals' responses to risk at different levels-including through interactions with their family systems, socio-cultural environments and wider health provision. PROTOCOL REGISTRATION PROSPERO CRD42021289269.
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Affiliation(s)
- Jing Hui Law
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Najia Sultan
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Nina Fudge
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Zwack CC, Smith C, Poulsen V, Raffoul N, Redfern J. Information Needs and Communication Strategies for People with Coronary Heart Disease: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1723. [PMID: 36767091 PMCID: PMC9914653 DOI: 10.3390/ijerph20031723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies, including digital interventions. We conducted a scoping review involving a search of four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages, hence flexibility and a suite of resources and strategies is optimal.
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Affiliation(s)
- Clara C. Zwack
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Carlie Smith
- National Heart Foundation of Australia, Brisbane, QLD 4006, Australia
| | - Vanessa Poulsen
- National Heart Foundation of Australia, Adelaide, SA 5000, Australia
| | - Natalie Raffoul
- National Heart Foundation Australia, Sydney, NSW 2011, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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Muacevic A, Adler JR, Sakhawalkar S, Tembhurne S, Deshpande P, Umate L. Test-Retest Reliability and Internal Consistency of the Coronary Artery Disease Education Questionnaire Short Version in the Marathi Language. Cureus 2022; 14:e32815. [PMID: 36699787 PMCID: PMC9870181 DOI: 10.7759/cureus.32815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Patient education specific to the disease must be incorporated into the management of coronary artery disease (CAD) or any other disease as the patients understand the education provided in their native language better. The brief version of the CAD education questionnaire is a valid and reliable instrument for evaluating patients' understanding of the condition. To the best of our knowledge and understanding from the literature review, no questionnaire evaluating the knowledge of CAD in the Marathi language had been found because of which this study was carried out. Methods For the process of translation and cross-cultural adaptation, the framework for self-report measures was taken into consideration in which qualified translators translated both ways forward into the Marathi language and backward into the English language. The translators and a recording observer combined their efforts to create one synthesized version. The questionnaire was fine-tuned by the expert group to produce the final version and 30 diagnosed cases of CAD were tested with the pre-final version. The Marathi version of the questionnaire's validity and reliability were evaluated using Cohen's kappa (k) and Cronbach's alpha (α). Results Thirty individuals with CAD were recruited (mean age 68±12.36, consisting of 22 males and 08 females) to test the pre-final version, and equivalence was tested for every item by probing the participants for the understanding of the item. The Likert scale demonstrated that patients understood the purpose of each question. A total of 200 participants - 153 males population and 47 females with a mean age of 66.64±5.6094 years who can read and speak in the Marathi language were considered to assess the test-retest reliability and internal consistency who completed the questionnaire twice, with a gap of two weeks but only 188 participant's data was analyzed as twelve participants dropped out of the study because they could not report due to transportation and health-related issues. The obtained α value demonstrated satisfactory internal consistency, while the k value indicated almost perfect agreement. Conclusion The study concluded that the Marathi version of the CAD education questionnaire short version is reliable and cross-culturally adapted; therefore, it is an effective tool for evaluating the knowledge of CAD among Marathi language-speaking patients.
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Vanzella LM, Pakosh M, Oh P, Ghisi G. Health-related information needs and preferences for information of individuals with cardiovascular disease from underserved populations: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:3398-3409. [PMID: 36167758 DOI: 10.1016/j.pec.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This systematic review aimed to identify the information needs and preferences of individuals with CVD from underserved populations. METHODS Five databases were searched from data inception to February 2022. Pilot and case report studies, non-peer-reviewed literature, and studies published in a language other than English, Portuguese, or Spanish were excluded. Structured and thematic analysis of all included studies were performed. The Critical Appraisal Skills Program and the Downs and Black Checklist were used to assess the quality of the qualitative and quantitative studies, respectively. RESULTS Of 35,698 initial records, 19 studies were included, most in observational design and classified as "fair" quality. Underserved populations - women, people living in rural areas, ethnic minority groups, older people, and those with low socioeconomic status - presented unique needs in four main groups, with some similarities across them: information about CVD, primary and secondary prevention of CVD, CVD management, and health care, policies and practices. Across the studies there was a lack of standardization on how individuals' needs were assessed and reported. CONCLUSION Underserved populations with CVD have unique information needs and preferences that should be address during their care. PRACTICAL IMPLICATION Information from this study may assist health care professionals with the development of comprehensive strategies to improve their provision of care for specific CVD patient groups.
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Affiliation(s)
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehabilitation Institute, Ontario, Canada
| | - Glm Ghisi
- University Health Network, Toronto Rehabilitation Institute, Ontario, Canada.
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Al-Zaru IM, Shahrour G, Masha'al D, Hayajneh AA. Depression and adherence to healthy lifestyle behaviors among patients with coronary artery diseases in Jordan. Heliyon 2022; 8:e09752. [PMID: 35800254 PMCID: PMC9253920 DOI: 10.1016/j.heliyon.2022.e09752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/22/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ibtisam M. Al-Zaru
- Adult Health Nursing Department, Faculty of Nursing/ WHO Collaborating Center, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
- Corresponding author.
| | - Ghada Shahrour
- Community and Mental Health Department, Faculty of Nursing/ WHO Collaborating Center, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Dina Masha'al
- Adult Health Nursing Department, Faculty of Nursing/ WHO Collaborating Center, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Audai A. Hayajneh
- Adult Health Nursing Department, Faculty of Nursing/ WHO Collaborating Center, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
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Bernal-Jiménez MÁ, Calle-Pérez G, Gutiérrez-Barrios A, Gheorghe L, Solano-Mulero AM, Trujillo-Garrido N, Rodríguez-Martín A, Tur JA, Vázquez-García R, Santi-Cano MJ. Design and Validation of a Scale of Knowledge of Cardiovascular Risk Factors and Lifestyle after Coronary Event. J Clin Med 2022; 11:jcm11102773. [PMID: 35628900 PMCID: PMC9147543 DOI: 10.3390/jcm11102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: It is important for health professionals to have tools available to assess patients’ knowledge of lifestyle and cardiovascular risk factors after they have suffered a coronary event and determine whether educational interventions are effective. This study aims to design and validate a scale to evaluate this knowledge. Methods: Four-phase instrument design: (A) Conceptual review. (B) Review by experts. (C) Pilot test–retest. (D) Psychometric validation of the final version of the questionnaire with 24 items. A panel of experts performed the content validity. The reliability of the scale was measured using Cronbach’s alpha score and criterion validity was evaluated by comparing the total scores for knowledge obtained by the participants among the three education level groups. The construct and dimensional structure validity were assessed using exploratory factor analysis. Results: A total of 143 people participated, 30 in the pilot study and 113 (68% male, 60.2 ± 9 years) in the psychometric validation of version 3 of the scale. A Cronbach’s alpha score of 0.887 was reached for this version. The factor analysis showed that the items were distributed into five factors that explained 57% of the variance. Significant differences were observed in the level of knowledge among the patients of the three levels of education (low, moderate and high) (99.20 ± 11.93, 105.92 ± 7.85, 109.78 ± 8.76 points, p = 0.003), as there was a negative correlation between age and knowledge level (r = −0.213, p = 0.024). Conclusions: The scale presents psychometric properties that are evidence of its reliability and validity. The relationship demonstrated between the level of knowledge and age, sex and level of education shows the importance of emphasizing educational interventions for elderly people and those with a lower level of education.
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Affiliation(s)
- María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11003 Cádiz, Spain
| | - Germán Calle-Pérez
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | - Alejandro Gutiérrez-Barrios
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | - Livia Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | | | - Nuria Trujillo-Garrido
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11003 Cádiz, Spain
| | - Amelia Rodríguez-Martín
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Biomedicine, Biotechnology and Public Health Department, University of Cádiz, 11003 Cádiz, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS, IDISBA & CIBEROBN, 07122 Palma de Mallorca, Spain;
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11003 Cádiz, Spain
- Correspondence: ; Tel.: +34-956-019042; Fax: +34-956-015685
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M. Ghisi G, Loures J, S. Chaves G, Ribas R, Britto R, Marchiori M. Socioeconomic and clinical factors associated with disease-related knowledge of cardiac rehabilitation patients in Brazil. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hutzler S, Simmons M, Guardiola J, Richman PB. Accuracy of Emergency Department Chest Pain Patients' Reporting of Coronary Disease History. J Emerg Trauma Shock 2022; 15:35-40. [PMID: 35431479 PMCID: PMC9006720 DOI: 10.4103/jets.jets_78_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction History is an important component of emergency department risk stratification for chest pain patients. We hypothesized that a significant portion of patients would not be able to accurately report their history of coronary artery disease (CAD) and diagnostic testing. Methods We prospectively enrolled a convenience sample of a cohort of adult ED patients with a chief complaint of chest pain. They completed a structured survey that included questions regarding prior testing for CAD and cardiac history. Study authors performed a structured chart review within the electronic medical record for our 6-hospital system. Results of testing for CAD, cardiac interventions, and chart diagnoses of CAD/acute myocardial infarction (AMI) were recorded. Categorical data were analyzed by Chi-square and continuous data by logistic regression. Results About 196 patients were enrolled; mean age 57 ± 15 years, 48% female, 67% Hispanic, 50% income <$20,000/year. About 43% (95% confidence interval [CI] 35%-51%) of patients stated that they did not have CAD, yet medical records indicated that they were CAD+. With increasing age, patients were more likely to accurately report the absence of CAD (P < 0.001). There was no association between patients reporting no CAD, but CAD+ in records with respect to the following characteristics: female gender (P = 0.37), Hispanic race (P = 0.73), income (P = 0.41), less than or equal to high school education (P = 0.11), and private insurance (P = 0.71). For patients with prior AMI, 7.2% (95% CI 2.7%-11%) reported no prior history of AMI. Conclusions Within our study group from a predominantly poor, Hispanic population, patients had a poor recall for the presence of CAD in their medical history.
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Affiliation(s)
- Sean Hutzler
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Michael Simmons
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Jose Guardiola
- Department of Mathematics, Texas A and M University-Corpus Christi, Corpus Christi, TX, USA
| | - Peter B Richman
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
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Karaman E, Kalkım A, Şarer Yürekli BP. Determining the Cardiovascular Disease Risk Factor Knowledge and Related Factors Among Adults With Type 2 Diabetes Mellitus. Clin Nurs Res 2021; 31:579-587. [PMID: 34569310 DOI: 10.1177/10547738211046441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study was to determine knowledge of cardiovascular disease (CVD) risk factors and to explore related factors among adults with type 2 diabetes mellitus (DM) who have not been diagnosed with CVD. This descriptive study was conducted with 175 adults. Data were collected individual identification form and Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale. A negative correlation was found between age and CARRF-KL score. A significant difference was found between educational status and CARRF-KL score. The individuals described their health status as good, managed their condition with diet and exercise, received information from nurses, adults with DM in their family and those with no DM complications had significantly higher scores in CARRF-KL. The knowledge of an individual with DM about CVD risk factors should be assessed, CVD risks should be identified at an early stage, and individuals at risk should be subjected to screening.
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Affiliation(s)
| | - Aslı Kalkım
- Ege University Faculty of Nursing, Izmir, Turkey
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Nanayakkara GL, Rai T, Kirincic L, Lightfoot R, Senaratne JM, Senaratne M. Differences in Clinical Measures and Outcomes in South Asians vs Caucasians Attending Cardiac Rehabilitation. CJC Open 2021; 3:1019-1024. [PMID: 34505041 PMCID: PMC8413229 DOI: 10.1016/j.cjco.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background South Asians have a greater predisposition to cardiac events, compared to Caucasians. Although cardiac rehabilitation programs (CRPs) are known to improve outcomes, data are sparse regarding benefits acquired by South Asians vs Caucasians. The objective of the current study was to determine the outcomes of South Asian patients undergoing CRPs, compared to Caucasian patients. Methods This study compared baseline characteristics and outcomes in all patients attending a CRP in Edmonton, Canada with a proportionately large South Asian population. Results From 1998 to 2016, a total of 811 South Asians and 5406 Caucasians attended CRPs. Baseline characteristics revealed that there were more nonsmokers (73.4% vs 29.4%, P < 0.001), with a lower body mass index (26.8 ± 0.1 vs 29.6 ± 0.1, P < 0.001), but higher prevalence of diabetes (37.7% vs 20.5%, P < 0.001) in the South Asian population. Outcome measures revealed that South Asians spent less time in the CRP (6.9 weeks ± 0.1 vs 7.3 weeks ± 0.1, P < 0.001), attended the nutrition class less (36.2% vs 53.4%, P < 0.001), and had a lower 6-minute walk improvement (66.9 m vs 73.6 m, P < 0.001). Frequency of use of β-blockers (86.9% vs 86.1%, P > 0.05), antiplatelet agents (96.3% vs 97.1%, P > 0.05), angiotensin-converting enzyme inhibitors (79.9% vs 80.0%, P > 0.05), and cholesterol-lowering agents (91.4% vs 93.8%, P > 0.05) was not significantly different. Conclusions Although South Asians seem to be prescribed and use proven pharmacologic treatments to the same extent as Caucasians, they appeared to benefit less from CRPs. Given higher event rates in South Asians, consideration should be given to altering the delivery of CRPs to South Asians to improve their efficacy.
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Affiliation(s)
| | - Tracey Rai
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | - Lena Kirincic
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | | | - Janek M Senaratne
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada.,Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Manohara Senaratne
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada.,Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Ghisi GLDM, Aultman C, Konidis R, Foster E, Sandison N, Alavinia M, Sarin M, Oh P. Development and Validation of the DiAbeTes Education Questionnaire (DATE-Q) to Measure Knowledge Among Diabetes and Prediabetes Patients Attending Cardiac Rehabilitation Programs. J Cardiopulm Rehabil Prev 2021; 41:224-229. [PMID: 33512977 DOI: 10.1097/hcr.0000000000000546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Knowledge assessment tools are highly useful in clinical practice, as they help health care teams to customize education and clinical care plans based on the needs of patients. The objective of this study was to develop and validate the DiAbeTes Education Questionnaire (DATE-Q) to measure knowledge among diabetes and prediabetes patients attending cardiac rehabilitation (CR). METHODS Based on patient information needs, other validated tools and diabetes education standards and current practices, experts developed 20 items to comprise the first version of the DATE-Q. To establish content validity, they were reviewed by an expert panel (n = 12) and patients. Refined items were psychometrically tested in 84 diabetes and prediabetes patients attending CR. The internal consistency was assessed via regularized factor analysis and Cronbach α, and criterion validity with regard to patient education and family income. For interpretability analysis, the minimal clinically important difference (MCID) was estimated using distribution- and anchor-based methods. RESULTS All items were appropriate for administration in this population according to experts and patients. Three factors were extracted and were generally internally consistent and well defined by the items. Criterion validity was supported by significant differences in mean scores by family income (P < .05). Results showed that increases in knowledge can moderately increase mean steps/d and peak oxygen uptake, with an MCID of 2.13. CONCLUSIONS This study demonstrated preliminary validity of the DATE-Q. Future research is needed to assess other measurement properties to confirm the applicability of this tool in clinical and research settings.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Santos RZD, Korbes AS, Martins ETC, Lucca MD, Lucca LD, Karsten M, Benetti M. Does Hypertension Knowledge Influence Levels of Physical Activity in Hypertensive Patients From a Southern Brazilian Community? INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Felix CMDM, Ghisi GLDM, Seixas MB, Batalha APDB, Ezequiel DGA, Trevizan PF, Pereira DAG, Silva LPD. Translation, cross-cultural adaptation, and psychometric properties of the Brazilian Portuguese version of the DiAbeTes Education Questionnaire (DATE-Q). Braz J Phys Ther 2021; 25:583-592. [PMID: 33824060 DOI: 10.1016/j.bjpt.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/08/2021] [Accepted: 03/13/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The DiAbeTes Education Questionnaire (DATE-Q) is a self-administered tool developed to evaluate disease-related knowledge and to assess knowledge of five core components of rehabilitation programs: physical exercise, diet, psychosocial well-being, disease self-management, and complications. OBJECTIVE To translate and cross-culturally adapt into Brazilian Portuguese, and to test the psychometric properties of the DATE-Q for its use in Brazil. METHODS The process of translation and cross-cultural adaptation consisted of five steps: translation into Brazilian Portuguese, synthesis of translation, back translation, expert committee, and pilot test of pre-final version. The pre-final version was applied to a sample of 30 patients with diabetes. Psychometric properties (internal consistency, reliability, construct validity, and ceiling and floor effects) of the final version of the Brazilian Portuguese version of the DATE-Q were tested in a sample of 200 adults with diabetes. RESULTS There was no conceptual divergence between the original and the translated versions. Ten (50%) items of the DATE-Q were culturally adapted. Internal consistency (Cronbach's alpha coefficient = 0.6), reliability (intraclass correlation coefficient = 0.5), and construct validity (correlation between Diabetes Knowledge Scales and DATE-Q total scores: ρ = 0.7; P < 0.001) were confirmed. Ceiling or floor effects were not identified. The highest scoring item was about healthy eating. The average time for completion of the DATE-Q was 5 min and 51 s, and the completion rate was 100% for all items. CONCLUSION The Brazilian Portuguese version of the DATE-Q showed adequate psychometric properties, and results suggested that the tool can be used to assess disease-related knowledge in adults with diabetes in Brazil.
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Affiliation(s)
| | - Gabriela Lima de Melo Ghisi
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mariana Balbi Seixas
- Faculty of Physical Therapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil; Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | | | | - Patrícia Fernandes Trevizan
- Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | | - Lilian Pinto da Silva
- Faculty of Physical Therapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil; Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
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Friedrich O, Kunschitz E, Pongratz L, Wieländer S, Schöppl C, Sipötz J. Classification of illness attributions in patients with coronary artery disease. Psychol Health 2021; 36:1368-1383. [PMID: 33410711 DOI: 10.1080/08870446.2020.1851688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine patient-reported causal attributions in patients with coronary artery disease and classify them according to attribution theory. DESIGN Patients with angiographically verified coronary artery disease (n = 459) were asked to report causal attributions by answering the respective open-ended item of the Brief Illness Perception Questionnaire. MAIN OUTCOME MEASURES Groups resulting from classifications were characterised with regard to sociodemographic and clinical variables, Quality of Life (SF-12), depression (PHQ-9), anxiety (GAD-7), and illness perception (BIPQ). RESULTS Stress emerged as the single most important attribution followed by various behavioural factors and genetic predisposition. There was a remarkable mismatch between the presence of modifiable risk factors (smoking, obesity) and patient-reported illness attributions. Based on the results of the descriptive categorisation of illness attributions we developed a transparent, easily reproducible scheme for dimensional classification of the fifteen most common responses according to attribution theory. The classification resulted in four groups: Behaviour/Emotional State, Past Behaviour/Emotional State, Physical/Psychological Trait and External. CONCLUSION We found a pattern of illness attributions largely in line with previous trials. The dimensional classification resulted in four groups and highlighted potential entry points for physician-patient communication aimed at establishing beneficial disease self-management.
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Affiliation(s)
- Oliver Friedrich
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria
| | - Evelyn Kunschitz
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria.,II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Lisa Pongratz
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Sophia Wieländer
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Christine Schöppl
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Johann Sipötz
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria.,II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
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Shrestha R, Rawal L, Bajracharya R, Ghimire A. Predictors of cardiac self-efficacy among patients diagnosed with coronary artery disease in tertiary hospitals in Nepal. J Public Health Res 2020; 9:1787. [PMID: 33437751 PMCID: PMC7789426 DOI: 10.4081/jphr.2020.1787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Cardiac self-efficacy determines how people feel, think, motivate themselves and behave with regards to improving their cardiac health subsequently preventing complications of coronary artery disease (CAD). Given almost one-third of global death is contributed by CAD with 10% of disability adjusted life years lost in low- and middle-income countries (including Nepal), it is important to identify factors that can promote cardiac self-efficacy. There are no studies in Nepal focusing on predictors of self-efficacy. Therefore, we aim to determine the predictors of cardiac self-efficacy of CAD patients in Nepal. Design and Methods: This is a cross-sectional study where we recruited 170 patients (≥30 years) diagnosed with CAD from two tertiary level hospitals. Multiple linear regression model was used to identify the predictors of cardiac self-efficacy. Results: The mean age of the participants was 60.45±10.39 years (range, 31-83). Most of the participants were diagnosed as myocardial infarction (91.2%), rest with unstable angina (6.5%) and stable angina (2.4%). The multivariate analysis shows age (p<0.001), health behaviors (p<0.001) and knowledge of the disease (p<0.001) were statistically significant predictors to cardiac self-efficacy. Every 1-year increase in age was associated with 0.23 units increase in cardiac self-efficacy score. Similarly, every unit increase in health behavior score and knowledge of disease score was associated with 0.432 units and 0.475 units increase in cardiac self-efficacy score respectively. Conclusion: Age and health behaviors were the strongest predictors of cardiac self-efficacy followed by knowledge of the disease. We conclude that those with poor health behavior are at a greater risk of poorer cardiac self-efficacy compared to those with relatively good level of self-efficacy. Public health interventions such as awareness raising about cardiac disease and health behavior modification along with early screening, diagnosis and appropriate care are essential to improving self-efficacy and cardiac care outcomes.
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Affiliation(s)
- Rabina Shrestha
- Dhulikhel Hospital Kathmandu University Hospital, Kathmandu, Nepal
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
| | | | - Anup Ghimire
- BP Koirala Institute of Health Sciences, Dharan, Nepal Research carried out in: Manmohan Cardiothoracic and Vascular Transplant Center, Maharajgunj and BP Koiral Institue of Health Science, Dharan, Nepal
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Huynh QNP, Nguyen T, Truong TTA, Huynh MNH, Nguyen TH, Ghisi GLDM, Taxis K. Vietnamese version of the coronary artery disease education questionnaire-Short version: Translation, adaptation and validation. J Clin Pharm Ther 2020; 45:691-697. [PMID: 32356381 DOI: 10.1111/jcpt.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/07/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Coronary artery disease (CAD) is the leading cause of mortality worldwide. Patient education is an essential part of cardiac patients' care targeting self-management behaviour to reduce risk factors and subsequent events. There has been no Vietnamese questionnaire to assess patient's knowledge about CAD; therefore, the purpose of this study was to translate, cross-culturally adapt and validate the Coronary Artery Disease Education Questionnaire-Short Version (CADE-Q SV) for use in Vietnam. METHODS Translation and cross-cultural adaption of the tool were carried out in five stages: (a) two independent translations from English into Vietnamese were produced; (b) these two translations were then synthesized; (c) two translators blinded to the outcome measurements independently created separate back translations into English; (d) nine experts reached consensus on all items of the Vietnamese version of the CADE-Q SV; and (e) a pilot study was conducted on 35 patients with acute coronary syndrome (ACS). The validity and reliability of the questionnaires were then evaluated in 117 Vietnamese patients with ACS. The internal consistency and test-retest reliability were assessed by Cronbach's alpha and Cohen's kappa coefficient, respectively. Construct validity was determined by examining the relationship between knowledge scores and patient characteristics. RESULTS The Vietnamese version of CADE-Q SV was created, including 20 items divided into two domains: medical and psychological condition, and nutrition and exercise. There was good equivalence between the original and the Vietnamese versions in all four areas: semantic, idiomatic, experiential and conceptual equivalence. Cronbach's alpha coefficients were acceptable for the questionnaire as a whole (0.78) and for the two domains: medical and psychological condition (0.71) and nutrition and exercise (0.52). All Cohen's kappa coefficients confirmed test-retest reliability (Kappa > 0.600; P < .001). Construct validity was confirmed by a significant correlation of knowledge scores with education level (P = .004). WHAT IS NEW AND CONCLUSION The Vietnamese version of CADE-Q SV can be considered a valid and reliable questionnaire to evaluate patient's knowledge of CAD. Further studies could investigate the influence of knowledge scores on adherence to medications and clinical outcomes of patients with CAD.
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Affiliation(s)
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thu Tran Anh Truong
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - My Ngoc Hoang Huynh
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thao Huong Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Katja Taxis
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Zhang KM, Prior PL, Swartzman LC, Suskin N, Unsworth KL, Minda JP. Can causal explanations about endothelial pathophysiology benefit patient education? A cluster randomized controlled trial in cardiac rehabilitation. PATIENT EDUCATION AND COUNSELING 2019; 102:1672-1679. [PMID: 31031098 DOI: 10.1016/j.pec.2019.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/04/2019] [Accepted: 04/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine whether explaining causal links among endothelial pathophysiology, cardiac risk factors, symptoms and health behaviors (termed causal information) enhances patients' depth of knowledge about cardiovascular disease self-management and their perceptions of the cardiac rehabilitation and secondary prevention (CRSP) program. METHODS Newly referred CRSP patients (N = 94) were cluster randomized to usual care (control; UC) or usual care with causal information (intervention; UC + CI). Depth of knowledge (factual vs. deep) was measured with an adapted cognitive-reasoning task. Patients' cardiovascular knowledge and beliefs about the efficacy of a CRSP program were assessed. RESULTS After controlling for education level, patients in UC + CI demonstrated deeper knowledge about cardiovascular management than did those in UC. The UC + CI group showed higher factual knowledge than their counterparts after covarying education, occupation status and BMI. The UC + CI group also rated the CRSP program as more credible than those in UC, after controlling for age. Deep knowledge mediated the relationship between group conditions and perceived credibility of CRSP. CONCLUSION Causal information can enhance the depth of patients' understanding of cardiovascular disease management and perceived treatment credibility of the CRSP program. PRACTICE IMPLICATIONS Explaining causal links may help improve patient education delivery and enhance patient engagement in CRSP.
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Affiliation(s)
- Karen M Zhang
- Department of Psychology, University of Western Ontario, London, ON, N6G 2K3, Canada; Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, L8V 5C2, Canada.
| | - Peter L Prior
- Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Healthcare London, London, ON, N6A 4V2, Canada; Lawson Health Research Institute, London, ON, N6A 4V2, Canada
| | - Leora C Swartzman
- Department of Psychology, University of Western Ontario, London, ON, N6G 2K3, Canada
| | - Neville Suskin
- Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Healthcare London, London, ON, N6A 4V2, Canada; Lawson Health Research Institute, London, ON, N6A 4V2, Canada
| | - Karen L Unsworth
- Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Healthcare London, London, ON, N6A 4V2, Canada; Lawson Health Research Institute, London, ON, N6A 4V2, Canada
| | - John Paul Minda
- Department of Psychology, University of Western Ontario, London, ON, N6G 2K3, Canada
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Dinh HTT, Bonner A, Ramsbotham J, Clark R. Cluster randomized controlled trial testing the effectiveness of a self-management intervention using the teach-back method for people with heart failure. Nurs Health Sci 2019; 21:436-444. [PMID: 31190459 DOI: 10.1111/nhs.12616] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 12/28/2022]
Abstract
In this study, we examined the effectiveness of a self-management intervention delivered to people with heart failure in Vietnam. It used teach-back, a cyclical method of teaching content, checking comprehension, and re-teaching to improve understanding. A single-site cluster randomized controlled trial was conducted, and six hospital wards were randomized into two study groups. On the basis of ward allocation, 140 participants received either usual care or the teach-back heart failure self-management intervention plus usual care. The intervention involved, prior to discharge, an individual educational session on heart failure self-care, with understanding reinforced using teach-back, a heart failure booklet, weighing scales, diary, and a follow-up phone call 2 weeks post-discharge. The control group received usual care and the booklet. Outcomes were heart failure knowledge, self-care (maintenance, management and confidence), and all-cause hospitalizations assessed at 1 and 3 months (end-point). Upon completion of the study, the intervention group had significantly greater knowledge and self-care maintenance than the control group. Other outcomes did not differ between the two groups. The teach-back self-management intervention demonstrated promising benefits in promoting self-care for heart failure patients.
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Affiliation(s)
- Ha T T Dinh
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne Ramsbotham
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Robyn Clark
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Validation of a Scale to Assess Patients' Comprehension of Frequently Used Cardiology Terminology: The Cardiac TERM Scale in Brazilian Portuguese. Rehabil Nurs 2019; 44:87-95. [PMID: 30830884 DOI: 10.1097/rnj.0000000000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to psychometrically validate the translation of a questionnaire on patient understanding of cardiology terminology (TERM) to Brazilian Portuguese. DESIGN After piloting the translation and cross-cultural adaptation, the 16-item TERM questionnaire was psychometrically tested. METHODS Internal and test-retest reliability, as well as validity, were assessed in 322 cardiac patients. FINDINGS Internal (α = .88) and test-retest reliability (all weighted Kappa > 0.63) exceeded the minimum recommended standards. Criterion validity was supported by significant differences in mean scores by socioeconomic indicators (p < .01). Discriminant validity was supported in that cardiac rehabilitation participants had significantly higher TERM scores (p < .001). Participants did not correctly define any of the terms, and a floor effect was identified in all terms. CONCLUSIONS The Cardiac TERM Scale was demonstrated to have good reliability and validity. CLINICAL RELEVANCE The scale can be used by healthcare professionals, such as nurses. Results can be used to inform patient education, which could in turn impact patient adherence to medical advice and hence outcomes.
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Santos RZD, Ghisi GLM, Bonin CDB, Chaves G, Haase CM, Britto RR, Benetti M. Validation of the Brazilian Version of CADE-Q II to Assess Knowledge of Coronary Artery Disease Patients. Arq Bras Cardiol 2018; 112:78-84. [PMID: 30570063 PMCID: PMC6317624 DOI: 10.5935/abc.20180244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background The Coronary Artery Disease Education Questionnaire (CADE-Q), an instrument
aimed at assessing patients’ knowledge about coronary artery disease (CAD),
was originally developed and psychometrically validated in Brazil. It was
later translated, cross-culturally adapted, and validated to English.
Although both versions demonstrated good reliability and validity, new
studies in the area have pointed out the need of implementing the CADE-Q
with other components of cardiac rehabilitation (CR) programs, such as
psychologic factors, which had not been considered in previous version and
were added in the subsequent, adapted version. Thus, a second version of
CADE-Q was developed in English, the CADE-Q II. Objective to translate, culturally adapt and psychometrically validate the CADE-Q II in
Brazilian Portuguese. Methods After translation and review by a Committee of specialists in CR, a version
in Brazilian Portuguese was generated and tested in 307 patients in CR.
Test-retest reliability was assessed by intraclass correlation coefficient
(ICC) in 49 patients; internal consistency was assessed using Cronbach’s
alpha (α); and, criterion validity was assessed regarding patients’
educational level and family income. The level of significance adopted for
all tests was 5%. Results After the ICC analysis, 4 items were excluded. The questionnaire was
considered internally consistent (α > 0.7). Associations were
found between the mean total scores and the variables schooling (p <
0.001) and income (p < 0.001). Median total score was 53 (14) points
corresponding to 65.4% of the total possible score. Conclusion The Portuguese version of the CADE-Q II showed sufficient reliability,
consistency and validity, supporting its use in future studies.
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Affiliation(s)
| | | | | | - Gabriela Chaves
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Clarissa Machado Haase
- Centro da Ciência da Saúde e do Esporte - Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | | | - Magnus Benetti
- Centro da Ciência da Saúde e do Esporte - Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
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Schröder SL, Fink A, Richter M. Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients. BMJ Open 2018; 8:e024151. [PMID: 30429146 PMCID: PMC6252635 DOI: 10.1136/bmjopen-2018-024151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This qualitative study aims to analyse socioeconomic differences in patients' experiences along the treatment pathway for coronary heart disease (CHD). DESIGN A longitudinal qualitative study using in-depth semistructured interviews to explore patients' experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives. SETTING The University Hospital in Halle (Saale), Germany. PARTICIPANTS 41 elderly patients (aged 59-80 years) who suffered from CHD. RESULTS From various patient's experiences along the pathway of care which were found to differ according to SES we derived three major themes: (1) information: patients with higher SES had greater knowledge about treatment and could use medical records as sources of information; (2) illness perception: patients with lower SES focused on improving symptoms and survival, while patients with higher SES focused on physical performance and disease management; and (3) perceived role in healthcare: patients with lower SES tended to delegate responsibility to healthcare professionals. CONCLUSIONS Differences in the patient's knowledge about treatment, their perceived role in healthcare and illness perception can be the factors and mechanisms that contribute to explain socioeconomic inequalities in the treatment of CHD. These factors should be considered in quantitative studies to better understand the disparities in treatment and mortality. We suggest that improving patient-physician communication and patient knowledge can change the patient's understanding of CHD and their perceived role in healthcare and reduce inequalities in CHD treatment. TRIAL REGISTRATION NUMBER DRKS00007839.
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Affiliation(s)
- Sara Lena Schröder
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
| | - Astrid Fink
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
| | - Matthias Richter
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
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Chen Z, Geng J, Wang M, Hu L, de Melo Ghisi GL, Yu H. The Chinese version of the Coronary Artery Disease Education Questionnaire-II (CADEQ-II): translation and validation. Patient Prefer Adherence 2018; 12:1587-1596. [PMID: 30214161 PMCID: PMC6118335 DOI: 10.2147/ppa.s176639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES It is necessary to assess disease-related knowledge in patients with coronary artery disease (CAD) for tailored patient education; however there is a lack of a well-validated measurement in China. The objective of this study was to translate and validate a Chinese version of the Coronary Artery Disease Education Questionnaire-II (CADEQ-II). METHODS The Chinese version of CADEQ-II was translated and culturally adapted. Then, it was tested for psychometric properties through a convenient sampling. Content validity was examined based on a panel of five experts. The item difficulty index and item discrimination index were calculated to assess the item difficulty and item discrimination. Internal consistency reliability was measured with the Cronbach's alpha coefficient. Criterion-related validity was established through comparing scores in patients with different education levels. Construct validity was assessed through confirmatory factor analysis (CFA). RESULTS The Chinese version of the CADEQ-II was finalized after deleting three items and modifying two items from the original version. Three hundred and sixteen participants completed the whole questionnaire. Content validity index of the whole questionnaire was 0.87. The Cronbach's alpha coefficient of the overall questionnaire was 0.907. The significant difference of the knowledge scores among patients with different education levels supported criterion-related validity. CFA confirmed the proposed four-factorial structure of the questionnaire. CONCLUSION The Chinese version of CADEQ-II had an acceptable reliability and validity among Chinese patients with CAD. It could be used to develop individualized health education for Chinese patients with CAD. Also, it could serve as a suitable outcome measurement to evaluate the effectiveness of education interventions related to CAD.
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Affiliation(s)
- Zi Chen
- School of Health Sciences, Wuhan University, Wuhan, Hubei, 430071, China,
| | - Jing Geng
- Department of Cardiovascular Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Mian Wang
- Infrastructure Management Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Liu Hu
- Department of Nursing, Wuhan Asian Heart Hospital, Wuhan, Hubei, 430022, China
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), University of Toronto, Toronto, ON, Canada
| | - Huidan Yu
- School of Health Sciences, Wuhan University, Wuhan, Hubei, 430071, China,
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Ma C, Yan J, Wu Y, Huang W. Illness perceptions of Chinese women with breast cancer and relationships with socio-demographic and clinical characteristics. Int J Nurs Pract 2018; 24:e12677. [DOI: 10.1111/ijn.12677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/09/2017] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Chunhua Ma
- School of Medical Technology and Nursing; Shenzhen Polytechnic College; Shenzhen China
| | - Jun Yan
- School of Nursing; Sun Yat-Sen University; Guangzhou China
| | - Yan Wu
- School of Nursing; Sun Yat-Sen University; Guangzhou China
| | - Wanbing Huang
- School of Nursing; Sun Yat-Sen University; Guangzhou China
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Tawalbeh LI, Al-Smadi AM, AlBashtawy M, AlJezawi M, Jarrah M, Musa AS, Aloush S. The Most and the Least Performed Self-Care Behaviors Among Patients With Heart Failure in Jordan. Clin Nurs Res 2018; 29:108-116. [PMID: 29862838 DOI: 10.1177/1054773818779492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessing self-care is important aspects among patients with heart failure. However, few studies were conducted to assess self-care among patients with heart failure in Jordan. Therefore, this study aimed to assess the most and the least performed maintenance self-care behaviors and to examine the relationship between maintenance self-care behaviors and selected sociodemographics. A cross-sectional design utilizing a convenience sample of 226 patients with heart failure was used. The maintenance self-care mean was 53.89 and considered below the clinical target level (≥70). Asking for low salt item and performing physical exercises were the most performed self-care behaviors, while "trying to avoid getting sick" and "checking ankles for swelling" were the least performed self-care behaviors. Limited self-care behaviors indicated the need to implement cardiac education that may improve self-care behaviors. Cardiac education should target mainly patients with low income, low educational level, elderly, living alone, unemployed, and who are using traditional treatment.
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Affiliation(s)
| | | | | | | | - Mohamad Jarrah
- Jordan University of Science and Technology, Irbid, Jordan
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Ammouri AA, Abu Raddaha AH, Tailakh A, Kamanyire J, Achora S, Isac C. Risk Knowledge and Awareness of Coronary Heart Disease, and Health Promotion Behaviors Among Adults in Oman. Res Theory Nurs Pract 2018. [DOI: 10.1891/1541-6577.32.1.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose:The purpose of this study was to assess the relationships between an individual’s characteristics and experiences (age, gender, level of education, income, and employment), knowledge of coronary heart disease (CHD) risk factors, perception of health status, awareness of CHD, and health promotion behaviors among adult Omanis.Methods:Using Pender’s health promotion model, a cross-sectional and correlational survey design was employed. A self-administered questionnaire was distributed to 180 participants in Muscat, the capital of Oman. Descriptive and multivariate linear regression analyses were employed.Results:Increasing age was associated with high levels of awareness about CHD. Participants who were employed and knowledgeable about CHD risk factors were more likely to have lower perceptions of health. The regression model showed that knowledge of CHD risk factors and awareness of CHD had positive associations with health promotion behaviors. Meanwhile, employed participants had lower health promotion behaviors scores.Implications for Practice:Interventions to increase health promotion behaviors should include application of behavioral change strategies that are suitable for age and employment status. The strategies must focus on providing information to enhance knowledge and awareness about CHD.
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Nicolai J, Müller N, Noest S, Wilke S, Schultz JH, Gleißner CA, Eich W, Bieber C. To change or not to change - That is the question: A qualitative study of lifestyle changes following acute myocardial infarction. Chronic Illn 2018; 14:25-41. [PMID: 29226696 DOI: 10.1177/1742395317694700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective The purpose of this study was to investigate key factors related to lifestyle changes following acute myocardial infarction (AMI) by eliciting survivors' subjective needs for, attitudes towards and experiences with behaviour changes in their everyday life to improve future interventions promoting lifestyle changes. Methods Semi-structured interviews were conducted with 21 individuals who had recently experienced an AMI. The interviews were audio-recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results The data analysis revealed that lifestyle changes following AMI are influenced by a combination of individual (physical and psychological) and social factors that can be grouped into facilitators and barriers. The interviews indicated the need for more personalised information regarding the causes and risk factors of illness, the benefits of lifestyle changes and the importance of including significant others in lifestyle advice and education and of individualising support. Discussion Lifestyle change is a continuous process that is not completed within a few months after a cardiac event. Considering the identified themes when developing interventions to promote lifestyle changes following AMI may enhance the effectiveness and sustainability of such interventions.
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Affiliation(s)
- Jennifer Nicolai
- 1 Department of Psychology III - Cognition and Individual Differences, School of Social Sciences, University of Mannheim, Germany
| | - Nicole Müller
- 2 Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Stefan Noest
- 3 Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany
| | - Stefanie Wilke
- 2 Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- 2 Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | | | - Wolfgang Eich
- 2 Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Christiane Bieber
- 2 Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany
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Tchicaya A, Lorentz N, Demarest S, Beissel J. Persistence of socioeconomic inequalities in the knowledge of cardiovascular risk factors five years after coronary angiography. Eur J Cardiovasc Nurs 2018; 17:136-147. [PMID: 28696137 PMCID: PMC5802545 DOI: 10.1177/1474515117720789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/21/2017] [Accepted: 06/25/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular diseases are important causes of death, morbidity, and years of potential life lost in most developed countries. AIMS The purpose of this study was to assess trends in knowledge of cardiovascular risk factors among patients five years after coronary angiography and to investigate the impact of educational level on knowledge level. METHODS The study included 1289 of 4391 patients admitted for cardiac events in 2008/2009 at the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg. A follow-up study was conducted by post five years later (2013/2014). Data were obtained from 1837 of the contacted patients (with 548 reported deaths) (response rate=42%). Logistic regression models were used to evaluate the association between educational level and knowledge of cardiovascular risk factors. Educational level was used as a surrogate for socioeconomic status. RESULTS In total, 39.9% of patients could list at least three risk factors in 2013/2014, a much higher percentage than the 8.5% observed during the initial survey. In both sexes, knowledge of cardiovascular risk factors increased between 2008/2009 and 2013/2014. Patients with higher educational levels were more likely (odds ratio=2.33, 95% confidence interval: 1.63-3.34) to cite at least three risk factors than patients with lower education levels. CONCLUSION Knowledge level was associated with educational level, and improved for all educational groups five years after coronary angiography. Educational differences in knowledge persisted, but the gaps decreased. Improving knowledge of cardiovascular risk factors among patients with cardiovascular disease will help increase awareness and promote lifestyle changes.
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Affiliation(s)
- Anastase Tchicaya
- Living Conditions Department/Health Research Team, Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg
| | - Nathalie Lorentz
- Living Conditions Department/Health Research Team, Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg
| | | | - Jean Beissel
- National Institute of Cardiac Surgery and Interventional Cardiology, Luxembourg
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dos Santos RZ, Bonin CDB, Martins ETC, Pereira Junior M, Ghisi GLDM, de Macedo KRP, Benetti M. Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation. Arq Bras Cardiol 2018; 110:60-67. [PMID: 29412242 PMCID: PMC5831303 DOI: 10.5935/abc.20170183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/19/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. OBJECTIVE To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. METHODS A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis. RESULTS The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. CONCLUSION The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.
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Affiliation(s)
| | | | - Eliara Ten Caten Martins
- Centro da Ciência da Saúde e do Esporte -
Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Moacir Pereira Junior
- Centro da Ciência da Saúde e do Esporte -
Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | | | | | - Magnus Benetti
- Centro da Ciência da Saúde e do Esporte -
Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
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Cardiac health knowledge and misconceptions among nursing students: implications for nursing curriculum design. BMC Nurs 2017; 16:46. [PMID: 28814940 PMCID: PMC5557078 DOI: 10.1186/s12912-017-0241-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac misconceptions are common among healthcare professionals. The development of professional knowledge is considered an essential component of nursing education. Nurses, regardless of their grade, skills, and experience, should be updated with information so as to be able to rectify their misconceptions, as these could affect patient health outcomes. As the literature evaluating the cardiac knowledge and misconceptions of nursing students is sparse, a study of the subject seems warranted. METHODS A cross-sectional sample survey was used to study the cardiac knowledge and cardiac misconceptions of nursing students in Hong Kong. The study sample included 385 senior nursing students from three universities. Their level of knowledge of cardiac disease was assessed using the modified Coronary Heart Disease Knowledge Test. The York Cardiac Beliefs Questionnaire (YCBQv1) was used to examine cardiac misconceptions. RESULTS The scores for the nursing students' level of knowledge were diverse. Their mean score in the Cardiac Knowledge Test was 12.27 out of 18 (SD 2.38), with a range of 2-17. For cardiac misconceptions, their mean score in the YCBQv1 was 6.98 out of 20 (SD 2.84), with a range of 0-14. A negative correlation, r = -0.33 was found among students with more knowledge and fewer misconceptions. (p < 0.001). The Chi-square tests found some associations between the students' experiences of caring for cardiac patients and misconceptions about stress and physiology. CONCLUSIONS The results of our analyses indicate a diversity in levels of knowledge among the nursing students. Students with higher scores in cardiac knowledge did not necessarily have fewer misconceptions. There were associations between the students' misbeliefs and their caregiving experiences with cardiac patients. This study presents a framework for designing the contents of cardiac nursing programmes and is a starting point for promoting research on misconceptions held by undergraduate nursing students. A new paradigm of teaching should include inputs from both perspectives to help students to make critical use of theoretical knowledge to rectify their misconceptions and pursue excellence in the working world.
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Trevethan R. Deconstructing and Assessing Knowledge and Awareness in Public Health Research. Front Public Health 2017; 5:194. [PMID: 28824900 PMCID: PMC5545880 DOI: 10.3389/fpubh.2017.00194] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022] Open
Abstract
When people's knowledge and awareness are the subject of public health research, the meanings applied to the words knowledge and awareness are often unclear. Although frequently used interchangeably without that being problematic, these words sometimes appear to have different intended meanings but those meanings are not made explicit or, despite the meanings having been made explicit, they are not adhered to. It is necessary to overcome obscurities when knowledge and awareness are intended to represent different domains. This occurs when they are compared with each other; it also occurs when knowledge and awareness are assessed separately in relation to such variables as health behavior; physical, psychological, or socioeconomic statuses; gender; age; and ethnic backgrounds. For those particular research ventures, recommendations are made that knowledge be used to refer to information that is, to a greater or lesser extent, detailed and factual, and that awareness be associated with information that is personally relevant. Some suggestions are made, and issues are raised, about how the psychometric foundations for each of those two domains might be established prior to use in empirical research. Adopting the recommendations and suggestions made in this article provides opportunities for greater conceptual and empirical clarity and success.
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Affiliation(s)
- Robert Trevethan
- Independent academic researcher and author, Albury, NSW, Australia
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Tawalbeh LI, Al Qadire M, Ahmad MM, Aloush S, Abu Sumaqa Y, Halabi M. Knowledge and self-care behaviors among patients with heart failure in Jordan. Res Nurs Health 2017; 40:350-359. [DOI: 10.1002/nur.21805] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/04/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Sami Aloush
- Faculty of Nursing; Al-AlBayt University; Al-Mafraq Jordan
| | | | - Marawa Halabi
- Faculty of Nursing; Al-AlBayt University; Al-Mafraq Jordan
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Tran DMT, Zimmerman LM, Kupzyk KA, Shurmur SW, Pullen CH, Yates BC. Cardiovascular risk factors among college students: Knowledge, perception, and risk assessment. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:158-167. [PMID: 27911653 DOI: 10.1080/07448481.2016.1266638] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess college students' knowledge and perception of cardiovascular risk factors and to screen for their cardiovascular risks. PARTICIPANTS The final sample that responded to recruitment consisted of 158 college students from a midwestern university. METHODS A cross-sectional, descriptive study was performed using convenience sampling. RESULTS College students were knowledgeable about cardiovascular risk factors but did not perceive themselves at risk for cardiovascular disease (CVD). Knowledge of cardiovascular risk factors was correlated with the lifetime risk estimates (ρ = .17, p = .048), and perception of cardiovascular risk was positively associated with 30-year CVD risk estimates (ρ = .16, p = .048). More than 50% of the participants had 1 or more cardiovascular risk factors. CONCLUSIONS High knowledge level of cardiovascular risk factors was not sufficient to lower cardiovascular risks within this study population, but changing perception of cardiovascular risk factors may play a bigger role in reducing long-term cardiovascular risks.
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Affiliation(s)
- Dieu-My T Tran
- a School of Nursing , University of Nevada , Las Vegas , Las Vegas , Nevada , USA
| | - Lani M Zimmerman
- b College of Nursing , University of Nebraska Medical Center , Lincoln , Nebraska , USA
| | - Kevin A Kupzyk
- b College of Nursing , University of Nebraska Medical Center , Lincoln , Nebraska , USA
| | - Scott W Shurmur
- c School of Medicine , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
| | - Carol H Pullen
- b College of Nursing , University of Nebraska Medical Center , Lincoln , Nebraska , USA
| | - Bernice C Yates
- b College of Nursing , University of Nebraska Medical Center , Lincoln , Nebraska , USA
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Influence of an extended education program on the knowledge of cardiovascular risk factors among subjects undergoing rehabilitation following acute coronary syndrome. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 13:386-392. [PMID: 28096844 PMCID: PMC5233777 DOI: 10.5114/kitp.2016.64892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/18/2016] [Indexed: 12/02/2022]
Abstract
Introduction Health education is a component of complex cardiac rehabilitation (CCR). Aim To evaluate the influence of an authorial extended educational program on the knowledge of cardiovascular risk factors among subjects undergoing early in-hospital rehabilitation following acute coronary syndrome treated with percutaneous intervention. Material and methods This prospective study covered 205 consecutive subjects (153 men and 52 women, aged 62 ±9 years) undergoing CCR. They were randomly allocated to the control group (105 patients receiving standard education during CCR) or the study group (100 patients participating in the extended education program). The extended education program was conducted in the 2nd and 3rd week of CCR and included a package of educational materials and additional lectures. Results Knowledge of basic rules for secondary cardiac prevention was better in the study group, both on admission and after CCR. Notwithstanding, a positive influence of the extended educational program was found with regard to awareness of recommended blood pressure levels and blood lipid profile (improvement of 15–20% in the study group). At baseline, the knowledge of risk factors was comparable between the groups (the percentage of correct questionnaire answers was 50 ±17% among the controls vs. 49 ±16% in the study group; p = 0.77), but improved significantly after education (52 ±17% among controls vs. 58 ±19% in the study group; p = 0.009) and remained better in the study group after a 3-month follow-up (56 ±19% among controls vs. 64 ±19% in the study group). Conclusions Extended education during CCR significantly improves the knowledge of cardiovascular risk factors in patients after acute coronary syndrome.
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Feinberg JL, Russell D, Mola A, Bowles KH, Lipman TH. Developing an Adapted Cardiac Rehabilitation Training for Home Care Clinicians: PATIENT PERSPECTIVES, CLINICIAN KNOWLEDGE, AND CURRICULUM OVERVIEW. J Cardiopulm Rehabil Prev 2016; 37:404-411. [PMID: 28033165 PMCID: PMC5671786 DOI: 10.1097/hcr.0000000000000228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease. METHODS Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semistructured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. Transcripts were analyzed with the constant comparative method. A 15-item questionnaire was administered to home care nurses and rehabilitation therapists pre- and posttraining, and responses were analyzed using a paired sample t test. RESULTS Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers' importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge posttraining compared with pretraining among home care clinicians (pretest mean = 12.81; posttest mean = 14.63, P < .001). There was no significant difference between scores for nurses and rehabilitation therapists. CONCLUSIONS Home care clinicians respond well to an adapted CR training to improve care for homebound patients with cardiovascular disease. Clinicians who participated in the training demonstrated an increase in their knowledge and skills of the core competencies for CR.
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Affiliation(s)
- Jodi L Feinberg
- President's Engagement Prize Fellowship, University of Pennsylvania, Philadelphia (Ms Feinberg); Visiting Nurse Service of New York, Center for Home Care Policy & Research, New York (Drs Russell and Bowles); NYU Langone Medical Center, Department of Care Transitions & Population Health, New York (Dr Mola); School of Nursing, University of Pennsylvania, Philadelphia (Drs Lipman and Bowles)
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Strömbäck U, Vikman I, Lundblad D, Lundqvist R, Engström Å. The second myocardial infarction: Higher risk factor burden and earlier second myocardial infarction in women compared with men. The Northern Sweden MONICA study. Eur J Cardiovasc Nurs 2016; 16:418-424. [PMID: 28029268 DOI: 10.1177/1474515116686229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have examined various parameters and experiences when patients suffer their first myocardial infarction (MI), but knowledge about when they suffer their second MI is limited. AIM To compare risk factors for MI, that is, diabetes, hypertension and smoking, for the first and second MI events in men and women affected by two MIs and to analyse the time intervals between the first and second MIs. METHODS A retrospective cohort study of 1017 patients aged 25-74 years with first and second MIs from 1990 through 2009 registered in the Northern Sweden MONICA registry. RESULTS More women than men have diabetes and hypertension and are smokers at the first MI. Similar differences between the genders remain at the time of the second MI for diabetes and hypertension, although both risk factors have increased. Smoking decreased at the second MI without any remaining difference between genders. Women suffer their second MI within a shorter time interval than men do. Within 16 months of their first MI, 50% of women had a second MI. The corresponding time interval for men was 33 months. CONCLUSION Patients affected by an MI should be made aware of their risk of recurrent MI and that the risk of recurrence is highest during the first few years after an MI. In patients affected by two MIs, women have a higher risk factor burden and suffer their second MI earlier than men do and thus may need more aggressive and more prompt secondary prevention.
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Affiliation(s)
- Ulrica Strömbäck
- 1 Department of Health Science, Luleå University of Technology, Sweden
| | - Irene Vikman
- 1 Department of Health Science, Luleå University of Technology, Sweden
| | - Dan Lundblad
- 2 Sunderby Research Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Robert Lundqvist
- 3 Department of Research, Norrbotten County Council, Luleå, Sweden
| | - Åsa Engström
- 1 Department of Health Science, Luleå University of Technology, Sweden
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Validation of the Knowledge and Perception of Cardiovascular Risk Factors Questionnaires for College Students. J Nurs Meas 2016; 24:202-14. [PMID: 27535309 DOI: 10.1891/1061-3749.24.2.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To test the psychometric properties of two measures of knowledge and perception of cardiovascular risk factors (CRFs). METHODS A methodological study using a modified version of the Heart Disease Fact Questionnaire (HDFQ) and the Health Beliefs Related to Cardiovascular Disease (HBCVD) questionnaires was administered to 100 college-aged students. RESULTS The HDFQ Kuder-Richardson-20 reliability estimate was .73. The HBCVD Cronbach's alpha was .70. Principal component analysis demonstrated the HBCVD questions load onto components representing the perceived susceptibility and severity of CRFs. There was an inverse relationship between knowledge and perception of CRFs (ρ = -.26, p = .009), as knowledge increased, perception of risk decreased. CONCLUSIONS The HDFQ and HBCVD questionnaires had adequate internal consistency reliability and documented construct validity for use in college students.
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Ghisi GLDM, Britto R, Motamedi N, Grace SL. Disease-related knowledge in cardiac rehabilitation enrollees: correlates and changes. PATIENT EDUCATION AND COUNSELING 2015; 98:533-539. [PMID: 25577470 DOI: 10.1016/j.pec.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/16/2014] [Accepted: 12/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe (1) patients' disease-related knowledge at cardiac rehabilitation (CR) entry; (2) correlates of this knowledge; (3) whether CR completion is related to knowledge; and (4) behavioral correlates of knowledge. METHODS For this prospective, observational study, a convenience sample of new CR patients was approached at 3 programs to complete a survey. It consisted of sociodemographic items, heart-health behavior surveys, and the CADE-Q. Patients were provided a similar survey 6 months later. RESULTS 214 patients completed the CADE-Q at both points, with scores demonstrating "acceptable" to "good" knowledge. Higher knowledge at CR entry was significantly associated with greater education, being married, greater English-language proficiency, and history of percutaneous coronary intervention (p≤0.05). The 118 (55.1%) patients that completed CR demonstrated significantly higher knowledge than non-enrollees at post-test (p≤0.05). There was a significant positive association between knowledge and physical activity (p≤0.01) and nutrition (p≤0.05) at post-test, but no association with smoking or medication adherence. CONCLUSIONS CR adherence ensures patients sustain knowledge needed to optimize their disease management, and perhaps ultimately their health outcomes. PRACTICE IMPLICATIONS CR completion should be promoted so patients remain educated about their disease management, and the health behaviors observed will be practiced in a greater proportion of patients.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiac Rehabilitation and Prevention Program, University Health Network, Toronto, Canada; Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada.
| | - Raquel Britto
- Physical Therapy Department, Federal University of Minas Gerais, Belo Horizonte, Brazil; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Nickan Motamedi
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
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Ghisi GLDM, Grace SL, Thomas S, Evans MF, Oh P. Development and psychometric validation of the second version of the Coronary Artery Disease Education Questionnaire (CADE-Q II). PATIENT EDUCATION AND COUNSELING 2015; 98:378-383. [PMID: 25481574 DOI: 10.1016/j.pec.2014.11.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/10/2014] [Accepted: 11/17/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To develop and psychometrically-validate a revised version of the Coronary Artery Disease Education Questionnaire (CADE-Q)--a tool to assess patients' knowledge about CAD in cardiac rehabilitation (CR). METHODS After a needs assessment, a literature review and focus group with CR experts, the revised questionnaire was developed. It underwent pilot-testing in 30 patients, which lead to further refinement. The questionnaire was then psychometrically-tested in 307 CR patients. Internal consistency was assessed using Cronbach's alpha, the dimensional structure through exploratory factor analysis, and criterion validity with regard to educational level. RESULTS Cronbach's alpha was 0.91. Criterion validity was supported by significant differences in mean scores by educational level (p<0.001). Factor analysis revealed four factors, which were internally-consistent (0.65-0.77), and well-defined by items. The mean total score was 64.2±18.1/93. Patients with a history of heart failure, cardiomyopathy and percutaneous coronary intervention (p<0.05) had significantly higher knowledge scores compared with patients without such a history. Knowledge about exercise and their medical condition was significantly higher than risk factors, nutrition and psychosocial risk. CONCLUSIONS The CADE-QII has good reliability and validity. PRACTICAL IMPLICATIONS This tool may be useful to assess CR participants' knowledge gaps, and to evaluate the efficacy of educational delivery in CR.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada; Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | | | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Abstract
OBJECTIVE Investigate workers' knowledge and beliefs about cardiometabolic risk. METHODS A survey on the risks of diabetes, cardiovascular disease, and chronic kidney disease was disseminated among Dutch construction workers and employees from the general working population. RESULTS We had 482 respondents (26.8%) among construction workers and 738 respondents (65.1%) among the general working population. Employees showed reasonable basic knowledge, especially about cardiovascular disease risk factors and risk reduction. Nevertheless, they also had knowledge gaps (eg, specific dietary intake) and showed misconceptions of what elevated risk entails. Employees having lower education, being male, and having lower health literacy demonstrated less adequate knowledge and beliefs. CONCLUSION To improve the potential effect of health risk assessments in the occupational setting, physicians should explain what it means to be at elevated cardiometabolic risk and target their messages to employee subgroups.
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Kang Y, Yang IS, Kim N. Correlates of health behaviors in patients with coronary artery disease. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 4:45-55. [PMID: 25030792 DOI: 10.1016/s1976-1317(10)60005-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 02/17/2010] [Accepted: 03/09/2010] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the effect of cardiac knowledge and cardiac self-efficacy on health behaviors after controlling for influences from associating factors of health behaviors in patients with coronary artery diseases (CADs). METHODS A descriptive correlational and cross-sectional design was used. Subjects with CADs were recruited from outpatient clinics of three academic medical centers. The cardiac knowledge, cardiac self-efficacy, and health behaviors were measured by Coronary Heart Disease Awareness and Knowledge Questionnaire, Cardiac Self-Efficacy Scale, and Health-Promoting Lifestyle Profile II respectively. The data collected were statistically analyzed by descriptive statistics, t test, Kruskal-Wallis test, analysis of variance, Pearson's correlation analysis, and the hierarchical multiple regression analysis. RESULTS A total of 157 subjects were recruited for this study. The mean age of subjects was 59.38 ± 10.04 years, and three-fourths (75.2%) were male. Subjects showed relatively low cardiac knowledge, moderately high cardiac self-efficacy, and moderate level of health behaviors. The overall model significantly explained 48% of variance in health behaviors (F = 14.52, p < .001). Among predictors, age, education, smoking status, experience of receiving patient education, and cardiac self-efficacy significantly affected health behaviors, and cardiac self-efficacy had the greatest effect on health behaviors (β= .39). However, cardiac knowledge had no statistically significant influence on health behaviors after controlling for the other factors. CONCLUSION The findings suggested that cardiac self-efficacy was shown to be the most influencing factor on health behaviors but cardiac knowledge had no influence on health behaviors. The nursing interventions tailored on the patient characteristics should be developed in order to improve the health behaviors of patients with CADs.
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Affiliation(s)
- Younhee Kang
- Associate Professor, Division of Nursing Science, College of Health Sciences, Ewha Womans University, Seoul, Korea
| | - In-Suk Yang
- Docotoral Student, Division of Nursing Science, College of Health Sciences, Ewha Womans University, Seoul, Korea
| | - Narae Kim
- Master's Student, Division of Nursing Science, College of Health Sciences, Ewha Womans University, Seoul, Korea
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Badir A, Tekkas K, Topcu S. Knowledge of cardiovascular disease in Turkish undergraduate nursing students. Eur J Cardiovasc Nurs 2014; 14:441-9. [PMID: 24982434 DOI: 10.1177/1474515114540554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/29/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiovascular disease is the number one cause of death worldwide. However, there is not enough data exploring student nurses' understanding, knowledge, and awareness of cardiovascular disease. AIMS To investigate knowledge of cardiovascular disease and its risk factors among undergraduate nursing students, with an emphasis on understanding of cardiovascular disease as the primary cause of mortality and morbidity, both in Turkey and worldwide. METHODS This cross-sectional survey assessed 1138 nursing students enrolled in nursing schools in Istanbul, Turkey. Data were collected using the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale and questions from the Individual Characteristics Form about students' gender, age, level of education, and family cardiovascular health history, as well as smoking and exercise habits. RESULTS Respondents demonstrated a high level of knowledge about cardiovascular disease, with years of education (p < 0.001), gender (p < 0.001), and high school type (p < 0.05) all significantly associated with CARRF-KL scores. However, more than half of the students were not aware that cardiovascular disease is the primary cause of mortality and morbidity in Turkey and worldwide. The majority of the respondents' body mass index (87%) and waist circumference values (females: 90.3%, males: 94.7%) were in the normal range and most were non-smokers (83.7%). However, more than half of the students did not exercise regularly and had inadequate dietary habits. CONCLUSIONS Although students were knowledgeable about cardiovascular disease and associated risk factors, there were significant gaps in their knowledge; these should be addressed through improved nursing curricula. While students were generally healthy, they could improve their practice of health-promoting behaviors.
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Rana A, de Souza RJ, Kandasamy S, Lear SA, Anand SS. Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis. CMAJ Open 2014; 2:E183-91. [PMID: 25295238 PMCID: PMC4183167 DOI: 10.9778/cmajo.20130064] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND South Asians represent about 3% of the Canadian population and have a higher burden of certain cardiovascular risk factors and cardiovascular disease (CVD) compared with white people. The objective of this study was to review the literature to compare cardiovascular risk factors and disease management practices among adult South Asian and white Canadians. METHODS We searched MEDLINE, Embase, Cochrane and Cumulative Index to Nursing and Allied Health Literature databases from their inception through Feb. 17, 2014 and the reference lists of the selected articles. English-language studies of interventions and observational studies of biological mechanisms underlying CVD risk in South Asians conducted in Canada were eligible for inclusion. Where appropriate, we used random-effects meta-analyses to integrate results comparing the CVD risk profiles of South Asian and white Canadians. RESULTS We included 50 articles (n = 5 805 313 individuals) in this review. Compared with white Canadians, South Asian Canadians had a higher prevalence and incidence of CVD, an increased prevalence of diabetes (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.81 to 2.80, p < 0.001) and hypertension (OR 1.11, 95% CI 1.02 to 1.22, p = 0.02), lower high-density lipoprotein cholesterol levels (mean difference -0.19 mmol/L, 95% CI -0.25 to -0.13 mmol/L, p < 0.001) and a higher percentage of body fat (men: absolute mean difference 3.23%, 95% CI 0.83% to 5.62%, p = 0.008; women: absolute mean difference 4.09%, 95% CI 3.46% to 4.72%, p < 0.001). South Asian people are also more sedentary, consume higher levels of carbohydrates and are less likely to smoke tobacco (OR 0.38, 95% CI 0.24 to 0.60, p < 0.001]) than white Canadians. No differences in access to diagnostic tests, outcomes following cardiovascular surgery or use of cardiac rehabilitation programs were apparent. INTERPRETATION Compared with white people, South Asian people living in Canada have a higher prevalence and incidence of CVD and possess a unique cardiovascular risk profile.
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Affiliation(s)
- Ayesha Rana
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ont. ; Chanchlani Research Centre, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Russell J de Souza
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ont. ; Chanchlani Research Centre, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont. ; Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont
| | - Sujane Kandasamy
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ont. ; Chanchlani Research Centre, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC ; Division of Cardiology, Providence Health Care, Vancouver, BC
| | - Sonia S Anand
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ont. ; Chanchlani Research Centre, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont. ; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ont
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Ghisi GLDM, Abdallah F, Grace SL, Thomas S, Oh P. A systematic review of patient education in cardiac patients: do they increase knowledge and promote health behavior change? PATIENT EDUCATION AND COUNSELING 2014; 95:160-74. [PMID: 24529720 DOI: 10.1016/j.pec.2014.01.012] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/20/2013] [Accepted: 01/18/2014] [Indexed: 05/26/2023]
Abstract
OBJECTIVE (1) To investigate the impact of education on patients' knowledge; (2) to determine if educational interventions are related to health behavior change in cardiac patients; and (3) to describe the nature of educational interventions. METHODS A literature search of several electronic databases was conducted for published articles from database inception to August 2012. Eligible articles included cardiac patients, and described delivery of educational interventions by a healthcare provider. Outcomes were knowledge, smoking, physical activity, dietary habits, response to symptoms, medication adherence, and psychosocial well-being. Articles were reviewed by 2 authors independently. RESULTS Overall, 42 articles were included, of which 23 (55%) were randomized controlled trials, and 16 (38%) were considered "good" quality. Eleven studies (26%) assessed knowledge, and 10 showed a significant increase with education. With regard to outcomes, educational interventions were significantly and positively related to physical activity, dietary habits, and smoking cessation. The nature of interventions was poorly described and most frequently delivered post-discharge, by a nurse, and in groups. CONCLUSIONS Findings support the benefits of educational interventions in CHD, though increase in patients' knowledge and behavior change. PRACTICE IMPLICATIONS Future reporting of education interventions should be more explicitly characterized, in order to be reproducible and assessed.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada; Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Flavia Abdallah
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Ghisi GLDM, dos Santos RZ, Bonin CBD, Roussenq S, Grace SL, Oh P, Benetti M. Validation of a Portuguese version of the Information Needs in Cardiac Rehabilitation (INCR) scale in Brazil. Heart Lung 2014; 43:192-7. [DOI: 10.1016/j.hrtlng.2014.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Bonin CDB, dos Santos RZ, Ghisi GLDM, Vieira AM, Amboni R, Benetti M. Construction and validation of a questionnaire about heart failure patients' knowledge of their disease. Arq Bras Cardiol 2014; 102:364-73. [PMID: 24652054 PMCID: PMC4028939 DOI: 10.5935/abc.20140032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/11/2013] [Accepted: 10/22/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The lack of tools to measure heart failure patients' knowledge about their syndrome when participating in rehabilitation programs demonstrates the need for specific recommendations regarding the amount or content of information required. OBJECTIVES To develop and validate a questionnaire to assess heart failure patients' knowledge about their syndrome when participating in cardiac rehabilitation programs. METHODS The tool was developed based on the Coronary Artery Disease Education Questionnaire and applied to 96 patients with heart failure, with a mean age of 60.22 ± 11.6 years, 64% being men. Reproducibility was obtained via the intraclass correlation coefficient, using the test-retest method. Internal consistency was assessed by use of Cronbach's alpha, and construct validity, by use of exploratory factor analysis. RESULTS The final version of the tool had 19 questions arranged in ten areas of importance for patient education. The proposed questionnaire had a clarity index of 8.94 ± 0.83. The intraclass correlation coefficient was 0.856, and Cronbach's alpha, 0.749. Factor analysis revealed five factors associated with the knowledge areas. Comparing the final scores with the characteristics of the population evidenced that low educational level and low income are significantly associated with low levels of knowledge. CONCLUSION The instrument has satisfactory clarity and validity indices, and can be used to assess the heart failure patients' knowledge about their syndrome when participating in cardiac rehabilitation programs.
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Affiliation(s)
| | | | | | | | - Ricardo Amboni
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC
- Brazil
| | - Magnus Benetti
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC
- Brazil
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de Melo Ghisi GL, Grace SL, Thomas S, Evans MF, Sawula H, Oh P. Healthcare providers' awareness of the information needs of their cardiac rehabilitation patients throughout the program continuum. PATIENT EDUCATION AND COUNSELING 2014; 95:143-150. [PMID: 24457175 DOI: 10.1016/j.pec.2013.12.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/22/2013] [Accepted: 12/26/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To (1) describe cardiac rehabilitation (CR) participant information needs, (2) investigate whether CR providers are cognizant of patient's information needs and preferred delivery formats, and (3) investigate whether patient information needs change over the course of CR. METHODS In this cross-sectional study, 306 CR patients and 28 CR providers completed a survey. The survey consisted of the Information Needs in CR (INCR) questionnaire, and items about preferred education delivery formats. RESULTS Low-income CR participants had significantly greater information needs than high-income participants. CR providers were cognizant of patient information needs, except patients did desire more information on diagnosis and treatment than providers perceived (p<0.01). Books, lectures and discussion were identified as the preferred delivery formats by both patients and providers. There were some significant differences in patient information needs over the course of the program, particularly in relation to concerns and risk factors. CONCLUSION CR patients desire information in many areas, particularly regarding emergency/safety and diagnosis/treatment. CR providers were highly cognizant of patient information needs; however, these do change over time. PRACTICE IMPLICATIONS These findings could inform evaluation and improvement of CR education programming, to ensure programs are meeting patient information needs across all stages of recovery.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada; Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | | | - Heather Sawula
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Wakefield B, Drwal K, Scherubel M, Klobucar T, Johnson S, Kaboli P. Feasibility and effectiveness of remote, telephone-based delivery of cardiac rehabilitation. Telemed J E Health 2013; 20:32-8. [PMID: 24161003 DOI: 10.1089/tmj.2013.0079] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Cardiac rehabilitation (CR) provides significant benefit for persons with cardiovascular disease. However, access to CR services may be limited by driving distance, costs, need for a driver, time away from work, or being a family primary caregiver. The primary aim of the project was to test the reach (i.e., patient and provider uptake), effectiveness (safety and clinical outcomes), and implementation (time and costs) of a remote telephone-based Phase 2 CR program. A secondary aim was to compare outcomes between patients attending the remote program (home-CR) and those attending an on-site program (comparison group). SUBJECTS AND METHODS Subjects were given a choice of the remote or face-to-face program. Remote CR participants (n=48) received education and assessment during 12 weekly by telephone calls. Data were compared with those for face-to-face CR program participants (n=14). Independent t tests and chi-squared tests were used for continuous and categorical variables, respectively. Repeated-measures analysis of covariance models were used to assess differences in outcomes. Costs were analyzed using a cost-minimization analysis. RESULTS Of 107 eligible patients, 45 refused participation, 5 dropped out, and 1 died unrelated to the study. Participants had a mean age of 64 (standard deviation 7.5) years. Remote CR participants were highly satisfied with their care and had a higher completion rate (89% of authorized sessions versus 73% of face-to-face). Costs for each program were comparable. There were no significant changes over time in any measured outcome between groups at 12 weeks except medication adherence, which decreased over time in both groups; face-to-face patients reported a greater decrease (p=0.05). CONCLUSIONS This is the first study to test a remote CR program in a population of older Veterans. Many hospitals do not provide comprehensive CR services on-site; thus remote CR is a viable alternative to bring services closer to the patient.
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Affiliation(s)
- Bonnie Wakefield
- 1 Iowa City VA Healthcare System, Veterans Rural Health Resource Center-Central Region , VA Office of Rural Health, Iowa City, Iowa
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Ghisi GLDM, Oh P, Thomas S, Benetti M. Assessment of patient knowledge of cardiac rehabilitation: Brazil vs Canada. Arq Bras Cardiol 2013; 101:255-62. [PMID: 23887735 PMCID: PMC4032306 DOI: 10.5935/abc.20130145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/18/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Much of the relationship between health status and knowledge about health and disease can be attributed to the combined effects of disparate health-related behavior, environmental conditions, and socioeconomic structures as well as contact with and delivery of health care. OBJECTIVE The aim of this study was to describe and compare knowledge of patients with coronary artery disease (CAD) enrolled in cardiac rehabilitation (CR) programs in Brazil and Canada about CAD-related factors. METHODS Two samples of 300 Brazilian and 300 Canadian patients enrolled in CR were compared cross-sectionally. Brazilian patients were recruited from 2 CR centers in Southern Brazil, whereas Canadian patients were recruited from 1 CR center in Ontario. Knowledge was assessed using the Coronary Artery Disease Education Questionnaire (CADE-Q), psychometrically validated in Portuguese and English. The data were processed through descriptive statistics, post-hoc and the Student's t-tests. RESULTS The mean total knowledge score for the whole sample was 41.42 ± 9.3. Canadian respondents had significantly greater mean total knowledge scores than Brazilian respondents. The most highly knowledgeably domain in both samples was physical exercise. In 13 of 19 questions, Canadian respondents reported significantly greater knowledge scores than Brazilian respondents. CONCLUSIONS Canadian outpatients reported significantly greater knowledge than their Brazilian counterparts. The results also suggest that having a structured educational curriculum in CR programs may contribute to increased patient knowledge, which may ultimately facilitate behavioral changes.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Exercise Sciences Department, Faculty of Kinesiology & Physical
Education, University of Toronto, Toronto, Canada
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation
Institute, University Health Network, Toronto, Canada
- Mailing Address: Gabriela Lima de Melo Ghisi, 347 Rumsey Road, N/A. Postal
Code M4G 1R7, Toronto - Canada. E-mail:
| | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation
Institute, University Health Network, Toronto, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology & Physical
Education, University of Toronto, Toronto, Canada
| | - Magnus Benetti
- Centro de Ciências da Saúde e Esportes, Universidade Estadual de Santa
Catarina, Florianópolis, Brazil
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Ghisi GLDM, Grace SL, Thomas S, Evans MF, Oh P. Development and psychometric validation of a scale to assess information needs in cardiac rehabilitation: the INCR Tool. PATIENT EDUCATION AND COUNSELING 2013; 91:337-343. [PMID: 23433734 DOI: 10.1016/j.pec.2013.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/17/2013] [Accepted: 01/20/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To develop and psychometrically validate a tool to assess information needs in cardiac rehabilitation (CR) patients. METHODS After a literature search, 60 information items divided into 11 areas of needs were identified. To establish content validity, they were reviewed by an expert panel (N=10). Refined items were pilot-tested in 34 patients on a 5-point Likert-scale from 1 "really not helpful" to 5 "very important". A final version was generated and psychometrically tested in 203 CR patients. Test-retest reliability was assessed via the intraclass correlation coefficient (ICC), the internal consistency using Cronbach's alpha, and criterion validity was assessed with regard to patient's education and duration in CR. RESULTS Five items were excluded after ICC analysis as well as one area of needs. All 10 areas were considered internally consistent (Cronbach's alpha>0.7). Criterion validity was supported by significant differences in mean scores by educational level (p<0.05) and duration in CR (p<0.001). The mean total score was 4.08 ± 0.53. Patients rated safety as their greatest information need. CONCLUSION The INCR Tool was demonstrated to have good reliability and validity. PRACTICE IMPLICATIONS This is an appropriate tool for application in clinical and research settings, assessing patients' needs during CR and as part of education programming.
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