The effects of a cardiovascular disease prevention program on knowledge and adoption of a heart healthy lifestyle in Jordanian working adults

Use of the Health Promotion Model by Nursing in Primary Care: an integrative review

OBJECTIVE

To summarize the scientific literature in nursing that has utilized Nola Pender's Health Promotion Model in primary care.

METHOD

An integrative review conducted in March 2023, using databases such as Embase, Elsevier's Scopus, Biblioteca Virtual em Saúde, Medline via PubMed, Web of Science, and Ovid.

RESULTS

A total of 660 articles were identified, with eight articles included in the final sample. The evidence highlighted the applicability of the Health Promotion Model in various contexts: dietary behaviors in individuals with hypertension, healthy aging, breastfeeding in first-time mothers, and educational programs aimed at improving behavior and increasing knowledge in individuals living with HIV.

CONCLUSIONS

The synthesis of the nursing literature that applied Nola Pender's Health Promotion Model in primary care demonstrated that the model provides a valuable framework for implementing nursing interventions focused on health-promoting behaviors and increasing individuals' engagement in their own health care.

Effect of Comprehensive Educational Program on Preeclamptic Women's Risk Perception of Cardiovascular Disease, Self-Efficacy, and Adherence to Healthy Lifestyle Behaviors

PURPOSE

To evaluate the effect of a comprehensive educational program on preeclamptic women's knowledge, risk perception of cardiovascular disease, self-efficacy, and adherence to healthy lifestyle behaviors.

PATIENTS AND METHODS

This study employed a pretest-posttest design. One hundred and two women who previously had preeclampsia were enrolled from July 2022 to December 2022 from outpatient obstetrics, gynecology, and family planning clinics. The primary and secondary outcomes were measured at baseline, after eight weeks, and after three months of the educational intervention. The data were analyzed using SPSS version 23, descriptive and inferential statistics, specifically the Chi-square test, independent t-tests, and repeated measures ANOVA.

RESULTS

A statistically significant difference was found between the two groups immediately post-intervention and the three-month follow-up, with a significant improvement among the intervention group than control group regarding cardiovascular disease knowledge (p < 0.001), risk perception (p < 0.001), self-efficacy (p < 0.001), and healthy lifestyle behaviors (p < 0.001). There was a statistically significant interaction between group and time regarding total cardiovascular disease risk perception (F = 203.67, p < 0.001, η2 = 0.673), self-efficacy (F = 70.06, p < 0.001, η2 = 0.405), and adherence to healthy lifestyle behaviors (F = 145.08, p < 0.001, η2 = 0.597).

CONCLUSION

This study concluded that the comprehensive educational program had a positive effect on improving preeclamptic women's knowledge and risk perception of CVD, self-efficacy, and adherence to healthy lifestyle behaviors following preeclampsia.

The burden of Cardiovascular diseases in Jordan: a longitudinal analysis from the global burden of disease study, 1990-2019

BACKGROUND

Cardiovascular Disease (CVD) is the leading cause of mortality worldwide. While countries in the Arab world continue to lack public health data and be severely understudied in health research, previous research has shown that compared to 1990, CVDs had a higher burden of disease in the Arab World in 2010. Jordan, a middle-income Arab country, is profiled with unique attributes such as a dual-sector healthcare system, political stability, and its role as a haven for refugees and migrants. These distinctive factors emphasize Jordan's suitability as a case study. This investigation aims to quantify CVD burden in Jordan and identify risk factors, contributing to a broader understanding of health challenges in the Arab region and beyond.

METHODS

The Global Burden of Disease (GBD) dataset was used to estimate prevalence, death, and disability-adjusted life-years (DALYs) as age-standardized rates from 1990 to 2019. We calculated percentage change for nine specific CVDs and reported trends by gender and age groups. Additionally, data on twelve a priori selected behavioral, clinical, and environmental risk factors attributing to overall age-standardized CVDs DALY were reported per 100,00 population.

RESULTS

In 2019, the age-standardized CVD prevalence, death, and DALYs rates in Jordan were 7980 (95% uncertainty interval [UI] 7629, 8360), 248 (95% UI 211, 288), and 4647 (95% UI 4028, 5388), respectively. Despite an increase in the absolute number of mortality and prevalence, between 1990 and 2019, the age-standardized prevalence, death, and DALYs rates all decreased by 5.5%, 45.1%, and 46.7%, respectively. In 2019, the leading risk factors contributing to overall age-standardized CVDs DALY per 100,000 population were high systolic blood pressure, high BMI, dietary risks, and high LDL cholesterol.

CONCLUSION

Despite decreasing burden rate of CVDs in Jordan between 1990 and 2019, CVDs remain the leading cause of mortality in Jordan, with an increase in the total number of prevalence and mortality. Overall, this contributes to increased healthcare costs. Further research is required to quantify the burden of CVDs and understand it better. Intervention measures and policies tailored to specific CVDs should be designed to reduce the burden of CVDs in Jordan.

Patient's learning needs and self-efficacy level after percutaneous coronary intervention: A descriptive study

AIMS AND OBJECTIVES

Identify and compare learning needs, levels of self-efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital.

BACKGROUND

After primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self-efficacy must be considered when developing effective therapeutic patient education (TPE).

METHODS

Learning needs and self-efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self-Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross-sectional studies was used in reporting this study.

RESULTS

Ninety-three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p < .001. In both units, participants declared that the most important need was related to 'anatomy and physiology' of the heart. Despite the high score, the least important need was about 'physical activity' for inpatients and 'miscellaneous information' for outpatients. No statistically significant differences were found among patients from both units regarding their self-efficacy level.

CONCLUSIONS

This study shows that after PCI, patients have high learning needs and moderate levels of self-efficacy that require addressing.

RELEVANCE TO CLINICAL PRACTICE

Patient's individual learning needs and self-efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self-efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process.

NO PATIENT OR PUBLIC CONTRIBUTION

For feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research.

The effects of a nurse-led lifestyle intervention program on cardiovascular risk, self-efficacy and health promoting behaviours among patients with metabolic syndrome: Randomized controlled trial

BACKGROUND

Metabolic syndrome is a cluster of cardio-metabolic risk factors and a major burden for public health due to its increasing prevalence and adverse effects on cardiovascular health. Lifestyle modification is the first-line intervention for metabolic syndrome management. However, adopting healthy behaviours is challenging among patients with metabolic syndrome.

OBJECTIVE

To examine the effects of a nurse-led lifestyle intervention program on cardiovascular risks, self-efficacy and the implementation of health promoting behaviours.

DESIGN

A two-armed randomized controlled trial.

SETTINGS AND PARTICIPANTS

A total of 173 patients that satisfied the metabolic syndrome definition of International Diabetes Federation was recruited from a hospital in North China.

METHODS

The participants were randomly assigned to either attend the lifestyle interventions (n = 86) or receive usual care from the study hospital (n = 87). The lifestyle intervention followed the framework of Health Promotion Model and consisted of one face-to-face education session (30-40 min), one educational booklet and six telephone follow-ups (bi-weekly, 20-30 min per call) in three months. The Framingham 10-year risk score was calculated to measure the participants' cardiovascular risks at baseline and 3-month. The Self-rated Abilities for Health Practices and Health Promoting Lifestyle Profile II was employed to measure the self-efficacy and health promoting behaviours at baseline, 1-month, and 3-month. The generalized estimating equation model was employed to examine the effects of the lifestyle intervention program.

RESULTS

No difference was detected in the baseline characteristics between the two groups. Decreased cardiovascular risk was found in the lifestyle intervention group, but no significant group-by-time effect was detected. The self-efficacy for nutrition, stress dimension and sum score of health promoting behaviours revealed significant improvements at 1-month (all p < 0.05). Significant improvements were also detected in all subscales, total scale of self-efficacy, all dimensions and the sum score of health promoting behaviours at 3-month (all p < 0.05).

CONCLUSIONS

The nurse-led Health Promotion Model guided lifestyle intervention program effectively improved the self-efficacy and implementation of health promoting behaviours in patients with metabolic syndrome. We recommend that nurses apply lifestyle interventions in routine care for patients with metabolic syndrome. Tweetable abstract: The RCT revealed that nurse-led lifestyle intervention was effective to improve self-efficacy and healthy behaviours among 173 MetS patients.

Evaluating the impact of HBM-based education on exercise among health care workers: the usage of mobile applications in Iran

BACKGROUND

Mechanical life made us witness the growing increase of chronic diseases despite the prominent scientific developments in the field of health, treatment and control. The aim of this study was to evaluate the impact of educational intervention based on Health Belief Model (HBM) using mobile applications (Telegram messenger) on doing exercise among the health care workers of Ilam university of medical sciences in 2017.

METHODS

In this interventional study, 114 people working in Ilam University of medical sciences participated in two groups of intervention and control (employed at two different cities) after providing the informed consent form. HBM-ISCS questionnaire was used to collect the required data and its reliability was approved using Cronbach's alpha. Descriptive statistics, chi square, t test, repeated measures ANOVA (RMANOVA) and structural equation model (SEM) were used.

RESULTS

Half of the participants were men, 58.77% of them were undergraduate. The mean and SD of their age was 37.61 ± 4.88 years. Based on the results of the repeated measures analysis of variance test (before and after the intervention) in the intervention group, there were significant difference in all of the HBM constructs (perceived barriers was excepted), daily and weekly exercises, blood biochemical markers of the participants (P > 0.05). The above changes were not significant in the control group (P ≥ 0.05).

CONCLUSION

Exercise is closely related to the beliefs of people, so implementing educational interventions based on Telegram messenger with emphasis on health beliefs and using HBM can lead to have exercise. Therefore, this application can be a suitable tool to deliver trainings, especially when holding in-person classes is difficult.

Hypertension-related Knowledge and Its Relationship with Blood Pressure Control in Hypertensive Patients Visiting a Semi-private Tertiary-care Charity Hospital in Karachi, Pakistan

Introduction Hypertension is one of the leading causes of mortality worldwide. Fifty-four percent of strokes and forty-seven percent of cardiovascular deaths are caused by suboptimal control of blood pressure. Economically developing countries like Pakistan are heavily burdened with an ever-rising epidemic of cardiovascular disease and stroke morbidity and mortality. Therefore, urgent steps are required to treat, as well as modify, risk factors for cardiovascular disease, including hypertension. Purpose The objective of this study was to ascertain the knowledge of hypertension and other sociodemographic variables and their impact on controlling blood pressures in the hypertensive population belonging to the low socioeconomic strata. Methods This cross-sectional study was conducted in the general medicine and cardiology outpatient clinics of a tertiary care charity hospital. Three-hundred thirty-five hypertensive patients of age >24 years were selected and informed consent was obtained. Hypertension-related knowledge was assessed using the Modified "Hypertensive Knowledge-Level Scale (HK-LS)" via a 15-20 min interview. Secondary variables in the questionnaire included social demographics, medical history, and assessment of body mass index (BMI) and blood pressure average values, which were measured during the interview. Knowledge was recorded based on the 33-point modified HK-LS scale, whereas secondary variables were not counted toward the assessment of knowledge. Results The frequencies of low, moderate, and high levels of hypertension-related knowledge were recorded as 2.1%, 79.4%, and 62%, respectively. Among 335 patients, (57.3%) were male, the mean age was 52.5 ± 11.5 years, and 63.6% were professionally active. Median systolic blood pressure (SBP) and diastolic blood pressure (DBP) in hypertensive patients were 140 and 86 mmHg, respectively. Sixty-nine percent of patients reported existing comorbidities, 54% had diabetes, 20.7% had cardiovascular disease, and 24% reported renal disease. No significant association was observed between the levels of knowledge of hypertension and gender, blood pressure (BP) status, professional activity, and age groups (p=0.877, p=0.863, p=0.125, and p=0.400, respectively). Conclusion The majority had adequate knowledge of hypertension but only 64.8% had controlled BP status. This depicts not a lack of knowledge and awareness but rather a lack of prevention of risk factors related to hypertension. Thus, further studies are advised to look into the preventive strategies employed by patients to control their BP and assess their effectiveness.

Impact of a brief psychological intervention on lifestyle, risk factors and disease knowledge during phase I of cardiac rehabilitation after acute coronary syndrome

INTRODUCTION

This study examined the efficacy of a brief inpatient psychoeducational intervention on knowledge about acute coronary syndromes (ACS), control of risk factors, and adaptive health habits and lifestyle. The intervention was intended to facilitate rehabilitation after ACS and its short- and medium-term impact was assessed.

METHODS

One hundred and twenty-one patients with ACS, admitted to a central cardiology unit in Portugal, were randomized to an experimental group (EG, n=65) or a control group (CG, n=56). We used the Portuguese versions of the Knowledge Questionnaire and the Health Habits Questionnaire. Patients were assessed at hospital admission, hospital discharge and one- and two-month follow-up.

RESULTS

The intervention had a significant impact, increasing knowledge about ACS (F=500.834; p=0.000) in the EG, which was maintained at two-month follow-up, and changing health habits at two-month follow-up (F=218.129; p=0.000). The CG demonstrated decreased knowledge (F=3.368; p=0.069) during the same period.

CONCLUSIONS

A brief inpatient psychoeducational intervention has a positive effect on knowledge about ACS, risk factor control and promotion of positive health habits, and is effective in improving cardiac rehabilitation.

Perceived Benefits and Intakes of Protein, Vitamin C and Iron in Preventing Anemia among Pregnant Women

Introduction: Nutritional adequacy is essential in ensuring the normal growth and development of the fetus. Perceived benefits will be able to strengthen pregnant women to meet optimum nutritional intake to prevent anemia. Adequacy of protein, vitamin C and iron will reduce the risk of iron deficiency anemia in pregnancy. This study aims to examine the association between perceived benefits with protein, vitamin C, and iron intake in preventing pregnancy anemia.Methods: This study used a cross-sectional design and was conducted in August-October 2017 among105 pregnant women. This study used the multistage random sampling method. The population of this study was pregnant women who had antenatal care in four Community Health Centre in Surabaya namely Jagir, MedokanAyu, SidotopoWetan, and Gundih. Results: The average daily protein intake was 76.34 (SD = 35.88) gram/day. There was a significant association between perceived benefits with protein intake (r = 0.272; p = 0.005). The average daily vitamin C intake was 90.67 (SD = 116.54) mg/day. There was no significant association between perceived benefits and vitamin C intake (r = 0.175; p = 0.074). The average daily iron intake was 64.73 (SD = 23.13) mg/day. There was a significant association between perceived benefits and iron intake (r = 0.219; p = 0.025).Conclusion: The knowledge of pregnant women about the benefits of nutrition will affect the adequacy of pregnancy nutrition. Health workers need to provide health education on the importance of nutrition for pregnant women to prevent anemia during pregnancy.

Risk Knowledge and Awareness of Coronary Heart Disease, and Health Promotion Behaviors Among Adults in Oman

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.

Investigating cardiovascular patients' preferences and expectations regarding the use of social media in health education

BACKGROUND

To reach more people in the community, health educators have considered employing social media alongside traditional health education methods.

AIMS

To understand the preferences and expectations of patients with cardiovascular diseases (CVDs) regarding the use of social media in health education. To assess the association between patients' socio-demographics with their preferences and expectations about the use of social media in health education.

METHODS

This is a cross-sectional descriptive study, which included 135 subjects with an established diagnosis of CVDs. The subjects were met at three cardiac outpatient clinics and recruited through a convenience sampling technique. They were recruited if they were adults, oriented and diagnosed with the CVDs for at least six months.

RESULTS

Most subjects (50.3%) were interested in receiving health education through social media, and 74.8% of them felt that using social media in health education would improve the process and lead to better outcomes. Preference for social media was significantly related to younger age, higher education, lower income, watching health education programmes on television, positive family history of CVDs, and currently has a job. Furthermore, higher positive expectations regarding using social media in health education were significantly related to higher education, watching health education programmes on television, being single, and currently has a job.

CONCLUSIONS

Subjects with CVDs are enthusiastic about health education through social media, believing that it will be good for educating them and providing them with the up-to-date information they need to live with their diseases. Findings of this study may positively contribute to the international efforts of improving health education through employing social media to improve accessibility to health education materials, and consequently decrease the burden of CVDs.

Yoga-Based Postoperative Cardiac Rehabilitation Program for Improving Quality of Life and Stress Levels: Fifth-Year Follow-up through a Randomized Controlled Trial

Objectives:

This study was aimed to assess the efficacy of yoga-based lifestyle program (YLSP) in improving quality of life (QOL) and stress levels in patients after 5 years of coronary artery bypass graft (CABG).

Methodology:

Three hundred patients posted for elective CABG in Narayana Hrudayalaya Super Speciality Hospital, Bengaluru, were randomized into two groups: YLSP and conventional lifestyle program (CLSP), and follow-up was done for 5 years.

Intervention:

In YLSP group, all practices of integrative approach of yoga therapy such as yama, niyama, asana, pranayama, and meditation were used as an add-on to conventional cardiac rehabilitation. The control group (CLSP) continued conventional cardiac rehabilitation only.

Outcome Measures:

World Health Organization (WHO)-QOL BREF Questionnaire, Perceived Stress Scale, Positive and Negative Affect Scale (PANAS), and Hospital Anxiety and Depression Scale (HADS) were assessed before surgery and at the end of the 5^th year after CABG. As data were not normally distributed, Mann–Whitney U-test was used for between-group comparisons and Wilcoxon's signed-rank test was used for within-group comparisons.

Results:

At the end of 5 years, mental health (P = 0.05), perceived stress (P = 0.01), and negative affect (NA) (P = 0.05) have shown significant improvements. WHO-QOL BREF score has shown improvements in physical health (P = 0.046), environmental health (P = 0.04), perceived stress (P = 0.001), and NA (P = 0.02) in YLSP than CLSP. Positive affect has significantly improved in CLSP than YLSP. Other domains of WHO-QOL-BREF, PANAS, and HADS did not reveal any significant between-group differences.

Conclusion:

Addition of long-term YLSP to conventional cardiac rehabilitation brings better improvements in QOL and reduction in stress levels at the end of 5 years after CABG.

Self-reported adherence to therapeutic regimens among patients with hypertension

OBJECTIVES

To assess Jordanian hypertensive patients' adherence rate to hypertension therapeutic regimen (HTR) and to identify the strongest predictors of adherence rate among such patients.

DESIGN AND SAMPLE

A descriptive comparison design and convenience sampling were used. The sample comprised 192 participants who came to their regular appointments in a public healthcare center.

MEASUREMENT

The Hill-Bone Compliance to High Blood Pressure Therapy Scale and the Hypertension Knowledge-Level Scale were used to assess adherence to HTR and knowledge of hypertension, respectively.

RESULTS

The mean total score for adherence to HTR was 87.3, and 82.8% of participants reported good adherence overall. Adherence scores were significantly higher among women, less educated, unemployed participants, those with comorbidities, those with a negative family history of hypertension, and those who visited their physicians regularly. To identify the most significant predictors of adherence to HTR, multiple linear regression analysis was performed. Results indicated that good adherence to HTR was predicted by greater knowledge about hypertension and regularly visiting a physician.

CONCLUSIONS

Adherence to taking antihypertensive medications was good overall among the study participants; these participants, however, were less interested in adherence to reduced sodium intake and keeping up with medical appointments. Hypertensive patients appear to follow instructions related to pharmacological management and are less likely to comply with other elements of HTR.

Knowledge, attitudes, beliefs and patterns of waterpipe use among Jordanian adults who exclusively smoke waterpipes

BACKGROUND

Widespread waterpipe smoking (WPS) is reported worldwide. Although remarkable numbers of waterpipe smokers do not smoke cigarettes, very few studies have explored the phenomenon of WPS in people who smoke water pipes exclusively. The aim of this study was to assess levels of knowledge, attitudes, beliefs and patterns of WPS among Jordanian waterpipe-only smokers.

METHODS

A cross-sectional descriptive design was used; with 247 participants who were recruited through convenience sampling from 23 cafés offering waterpipes. An interview and self-reported questionnaire was used to collect data.

RESULTS

The average age for starting WPS was 19.4 ± 5.6 years, of whom 71% started as teenagers. Participants like WPS because they like its flavor and social environment (46.3% and 29.5% respectively). The majority of participants reported that they smoked a waterpipe for the first time with their friends (66.8%), they usually smoke in the company of others (63.2%), and believe that quitting cigarettes smoking is harder than quitting WPS (61.6%). More than half (56.7%) of participants have extremely poor knowledge about the health effects of WPS. Participants who had smoked cigarettes in the past, were more knowledgeable than those who had never smoked cigarettes. The majority of participants, and specifically women, have high positive feelings and emotions (attitude) toward WPS, and 88.3% of them reported that it is a socially acceptable behavior.

CONCLUSIONS

Waterpipe smoking participants started WPS at an early age, and are attracted to the social environment that accompanies WPS. Participants have high positive attitude about WPS however they lack knowledge about harmful health effects of WPS.

Patient education in the management of coronary heart disease

BACKGROUND

Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and improve prognosis. Cardiac rehabilitation is a complex multifaceted intervention which aims to improve the health outcomes of people with CHD. Cardiac rehabilitation consists of three core modalities: education, exercise training and psychological support. This is an update of a Cochrane systematic review previously published in 2011, which aims to investigate the specific impact of the educational component of cardiac rehabilitation.

OBJECTIVES

1. To assess the effects of patient education delivered as part of cardiac rehabilitation, compared with usual care on mortality, morbidity, health-related quality of life (HRQoL) and healthcare costs in patients with CHD.2. To explore the potential study level predictors of the effects of patient education in patients with CHD (e.g. individual versus group intervention, timing with respect to index cardiac event).

SEARCH METHODS

We updated searches from the previous Cochrane review, by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 6, 2016), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) in June 2016. Three trials registries, previous systematic reviews and reference lists of included studies were also searched. No language restrictions were applied.

SELECTION CRITERIA

1. Randomised controlled trials (RCTs) where the primary interventional intent was education delivered as part of cardiac rehabilitation.2. Studies with a minimum of six-months follow-up and published in 1990 or later.3. Adults with a diagnosis of CHD.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened all identified references for inclusion based on the above inclusion criteria. One author extracted study characteristics from the included trials and assessed their risk of bias; a second review author checked data. Two independent reviewers extracted outcome data onto a standardised collection form. For dichotomous variables, risk ratios and 95% confidence intervals (CI) were derived for each outcome. Heterogeneity amongst included studies was explored qualitatively and quantitatively. Where appropriate and possible, results from included studies were combined for each outcome to give an overall estimate of treatment effect. Given the degree of clinical heterogeneity seen in participant selection, interventions and comparators across studies, we decided it was appropriate to pool studies using random-effects modelling. We planned to undertake subgroup analysis and stratified meta-analysis, sensitivity analysis and meta-regression to examine potential treatment effect modifiers. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro GDT) to create summary of findings tables.

MAIN RESULTS

This updated review included a total of 22 trials which randomised 76,864 people with CHD to an education intervention or a 'no education' comparator. Nine new trials (8215 people) were included for this update. We judged most included studies as low risk of bias across most domains. Educational 'dose' ranged from one 40 minute face-to-face session plus a 15 minute follow-up call, to a four-week residential stay with 11 months of follow-up sessions. Control groups received usual medical care, typically consisting of referral to an outpatient cardiologist, primary care physician, or both.We found evidence of no difference in effect of education-based interventions on total mortality (13 studies, 10,075 participants; 189/5187 (3.6%) versus 222/4888 (4.6%); random effects risk ratio (RR) 0.80, 95% CI 0.60 to 1.05; moderate quality evidence). Individual causes of mortality were reported rarely, and we were unable to report separate results for cardiovascular mortality or non-cardiovascular mortality. There was evidence of no difference in effect of education-based interventions on fatal and/or non fatal myocardial infarction (MI) (2 studies, 209 participants; 7/107 (6.5%) versus 12/102 (11.8%); random effects RR 0.63, 95% CI 0.26 to 1.48; very low quality of evidence). However, there was some evidence of a reduction with education in fatal and/or non-fatal cardiovascular events (2 studies, 310 studies; 21/152 (13.8%) versus 61/158 (38.6%); random effects RR 0.36, 95% CI 0.23 to 0.56; low quality evidence). There was evidence of no difference in effect of education on the rate of total revascularisations (3 studies, 456 participants; 5/228 (2.2%) versus 8/228 (3.5%); random effects RR 0.58, 95% CI 0.19 to 1.71; very low quality evidence) or hospitalisations (5 studies, 14,849 participants; 656/10048 (6.5%) versus 381/4801 (7.9%); random effects RR 0.93, 95% CI 0.71 to 1.21; very low quality evidence). There was evidence of no difference between groups for all cause withdrawal (17 studies, 10,972 participants; 525/5632 (9.3%) versus 493/5340 (9.2%); random effects RR 1.04, 95% CI 0.88 to 1.22; low quality evidence). Although some health-related quality of life (HRQoL) domain scores were higher with education, there was no consistent evidence of superiority across all domains.

AUTHORS' CONCLUSIONS

We found no reduction in total mortality, in people who received education delivered as part of cardiac rehabilitation, compared to people in control groups (moderate quality evidence). There were no improvements in fatal or non fatal MI, total revascularisations or hospitalisations, with education. There was some evidence of a reduction in fatal and/or non-fatal cardiovascular events with education, but this was based on only two studies. There was also some evidence to suggest that education-based interventions may improve HRQoL. Our findings are supportive of current national and international clinical guidelines that cardiac rehabilitation for people with CHD should be comprehensive and include educational interventions together with exercise and psychological therapy. Further definitive research into education interventions for people with CHD is needed.

Assessing Public's Knowledge About Hypertension in a Community-Dwelling Sample

BACKGROUND

Hypertension is one of the major risk factors for cardiovascular diseases that affect a high proportion of people worldwide. Understanding people's levels of knowledge about hypertension might contribute effectively to nurses' efforts to prevent, treat, and control the disease.

OBJECTIVES

The objectives of this study were to identify the levels of knowledge about hypertension disease among Jordanian adults and to identify differences in knowledge about hypertension on the basis of sociodemographic and clinical variables.

METHODS

A convenience sample was used in this descriptive comparison design as was the Hypertension Knowledge-Level Scale, which measures 6 dimensions of knowledge about hypertension (definition, treatment, drug compliance, lifestyle, diet, and complications).

RESULTS

There were 284 participants, and the mean total knowledge about hypertension was 73.65. The participants had higher levels of knowledge about lifestyle and complications; lower scores were recorded for definition of hypertension as well as the relationship between diet and hypertension. Participants with higher education levels, who watched health programs, exercised regularly, visited their physicians regularly, and had other chronic diseases, had greater knowledge about hypertension.

CONCLUSIONS

Although the total level of knowledge about hypertension is good among the participants, more efforts are needed to improve all dimensions of hypertension-related knowledge. Sociodemographic and clinical variables have significant relationships with levels of knowledge about hypertension. This necessitates the importance of considering these variables when designing and providing health educational programs.

Efetividade da intervenção educativa no conhecimento de homens relacionado às doenças cardiovasculares

Resumo Objetivo Comparar o conhecimento sobre fatores de risco para doenças cardiovasculares antes e após intervenção educativa realizada com homens metalúrgicos. Métodos Estudo de intervenção, realizado com 135 metalúrgicos, com idades entre 18 e 70 anos. O conhecimento sobre doenças cardiovasculares foi determinado pelo questionário Heart Disease Fact Questionnaire (HDFQ-2). Foram utilizados testes t de Student para amostras independentes e de Mann-Whitney, na comparação entre grupos, e testes t de Student para amostras dependentes e de Wilcoxon, na avaliação pareada. Resultados Tanto no grupo intervenção quanto no controle houve aumento estatisticamente significativo de 1,4 pontos na média do conhecimento entre o momento de base e o de seguimento. Conclusão A intervenção educativa, realizada em grupo, no local de trabalho e em horário de almoço, mostrou-se uma estratégia possível e eficaz para aumentar o conhecimento de homens sobre fatores de risco para doenças cardiovasculares.

Predictors of delay in seeking treatment by Jordanian patients with acute coronary syndrome

BACKGROUND

ACS management aims for early coronary reperfusion, which should be within one hour from symptoms onset. This time was found to be relatively long, and many patients died before hospital arrival. In Jordan, this phenomenon is not clearly understood with a discrepancy between the reported durations of delay time.

AIMS

To evaluate Jordanian ACS patients' delay time in seeking medical care, along with predictors of delay.

METHODS

A descriptive, cross-sectional design was utilized to conveniently recruit 160 Jordanian ACS patients. Data were collected using chart review and the Modified ACS Response Questionnaire.

RESULTS

The mean delay time was 7.8 hours (SD =3.5), with none of participants presenting within one hour. Delay time correlated negatively with ACS history, knowledge, attitudes, beliefs, and perceived risk (r = -0.448, r = -0.400, r = -0.408, r = -0.261, r = -0.411, respectively) and positively with health perception (r = 0.469). A 4-predictor model (history, beliefs, health perception, STEMI diagnosis) was revealed explaining 40% of variance in delay time (R(2)=.400, F (14,145) = 6.908, P < .001).

CONCLUSION

Improving ACS patients' health seeking behaviors can be achieved when all components of care are considered together.

Casual dock work: profile of diseases and injuries and perception of influence on health

The present study aimed to identify the profile of diseases and injuries that affect casual dock workers and identify casual dock workers’ perceptions of positive and negative work influences on their health. This study consisted of two phases. The first phase was a quantitative study composed of a retrospective analysis, conducted with 953 medical records. The second phase of the research is a non-random sample with 51 casual dock workers. Data analysis was performed with SPSS 19.0. The average age of the casual dock workers was 48.7. Concerning working time, the majority had more than 19.6 years of dock work experience. In the first phase, 527 pathologic diagnoses were identified. The diagnoses that affected the musculoskeletal system (15.8%, N = 152; p < 0.01) were highlighted. Consequences to physical health produced by accidents stood out, with fracture registration predominating (12.8%, N = 122; p < 0.05). Significant differences were found for positive work influence on the cardiovascular system and family health. It was concluded that the diagnoses obtained are related to the influence of dock work perception and have motivated an introduction of preventive measures.

The Effect of Cardiac Education on Knowledge and Adherence to Healthy Lifestyle

The purpose of this study was to test the effect of cardiac educational program on the level of knowledge and adherence to healthy lifestyle among patients with coronary artery disease in the north of Jordan. Pretest–posttest design was used. Eighty-four patients completed the posttest questionnaire. Knowledge and adherence to healthy lifestyle were measured at baseline and at 1 month after the application of the program. Paired t-test was used to analyze the data. The results showed that the change in the mean knowledge scores (10.50), p < .01 was statistically significant 1 month after the application of the program. In addition, the change in the mean adherence to healthy lifestyle scores (33.30), p < .01 was statistically significant 1 month after the application of the cardiac educational program. Implementing cardiac educational programs help enhance knowledge and adherence to healthy lifestyle among patients with coronary artery disease in north of Jordan.

Predischarge education improves adherence to a healthy lifestyle among Jordanian patients with acute coronary syndrome

Risk factor reduction and modification of patient lifestyle have become the focus of secondary prevention and cardiac rehabilitation programs. Considering the scarcity of resources in developing countries, nurses can potentially provide great benefit to acute coronary syndrome patients by utilizing hospital time to teach the patients how to lower their risk for recurrence and adopt healthier lifestyles after discharge. The purpose of this study was to identify the effectiveness of a predischarge education on acute coronary syndrome patients' lifestyles. Quasi-experimental pretest-post-test design was used. The patients assigned to the experimental group were offered predischarge education that stimulates lifestyle modification and adoption of a healthier lifestyle. The experimental group scored significantly higher than the control group in three lifestyle components - health responsibilities, nutrition, and interpersonal relations. In conclusion, predischarge education helps motivate acute coronary syndrome patients to adhere to a healthy lifestyle postdischarge. Therefore, nurses must be educated and prepared to be qualified health educators, and health education should continue as one of the most important daily nursing practices, thus it is invested in the preparation of acute coronary patients' discharge plan.

Relationship between lifestyle and lifestyle-related factors in a rural-urban population of Japan

OBJECTIVE

To clarify the actual state of residents' lifestyle in a mixed rural-urban area in Japan, and to investigate the relationship between residents' lifestyle and lifestyle-related factors.

METHODS

The Japanese version of Health Promoting Lifestyle Profile-II (HPLP-II), lifestyle-related factors developed through group work with residents of Town A, and demographic variables were used to evaluate 1176 community residents' lifestyles and associated factors.

RESULTS

Factor analysis revealed that there were 4 factors related to healthy lifestyle. Nonparametric analysis revealed that female and elderly groups showed higher overall HPLP-II score than male and young groups. A significant correlation coefficient was seen between scores of overall HPLP-II and lifestyle-related factors (r = 0.611, p < 0.001). Multiple linear regression analysis demonstrated that HPLP-II was significantly associated with each lifestyle-related factor, showing a similar order in both gender and age groups. Finally, covariance structure analysis demonstrated that the score of health cognition and regional factors increased the score of HPLP-II, which then increased the score of self-rated health.

CONCLUSIONS

The present research clarified the actual state of residents' lifestyles by age and gender in a mixed rural-urban area in Japan, demonstrating a vector model from health cognition and regional factors to self-rated health, via residents' lifestyle.

Development of an evaluation scale for self-management behavior related to physical activity of patients with coronary heart disease

BACKGROUND

To provide patients with effective self-management education that takes their lifestyle into account, medical personnel need to provide education and evaluation of self-management behaviors which patients can apply to their daily life.

AIM

This study aimed to assess the reliability and validity of the evaluation scale for self-management behavior related to physical activity of patients with coronary heart disease (ES-SMBPA-CHD).

METHODS AND RESULTS

Outpatients with coronary heart disease (n = 76) completed a self-administered questionnaire supported by a previous study of ours. The ES-SMBPA-CHD was divided into two domains, the first dealing with self-management behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-CHD was associated with the International Physical Activity Questionnaire (IPAQ) subscales and activity energy expenditure (measured by Lifecorder EX). Cronbach's α coefficient was between 0.71 and 0.90. The intraclass test-retest correlation coefficient of the subscale was between 0.75 and 0.93.

CONCLUSIONS

The ES-SMBPA-CHD is reasonably reliable and valid and is expected to prove useful for the assessment of patients' self-management behavior and for individualized instruction.

Work-related cardiovascular disease risk factors using a socioecological approach: implications for practice and research

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of mortality. Numerous investigations have linked occupational factors and CVD. Occupational factors such as overtime work have an enormous effect on the CVD risk of industrial workers. However, risk factors for CVD are not systematically reviewed in the workplace. The purpose of the paper is to review work-related risk factors for CVD.

METHODS

A systematic review of work-related CVD risk factors was performed, yielding 180 articles. All articles were assessed in relation to inclusion and exclusion criteria, resulting in 44 articles being reviewed. The sole inclusion criteria was work-related environmental factors and intra/inter-personal factors (psychosocial factors), which is based on the socioecological perspective. The articles were also assessed regarding the quality of each study using the scoring methods developed by Cesario et al. and Brown et al.

CONCLUSION

The literature review demonstrated that work environment factors such as shift work, overtime work, and noise and chemical exposures; and psychosocial factors such as job stress, social support, and socioeconomic status cannot be explained or intervened by one single risk factor. Furthermore, certain occupational factors were shown to aggravate or attenuate other risk factors. The implication of these findings is to incorporate work-related environmental and psychosocial factors into assessment of the patient's CVD risks and intervention plan. Future research should also incorporate a well-defined conceptual framework to address the effects of work-related environmental and psychosocial factors on CVD among CVD patients.

Jordanian acute coronary syndrome patients' learning needs: Implications for cardiac rehabilitation and secondary prevention programs

The identification of patients' learning needs is an essential step for nurses in order to facilitate the recovery of acute coronary syndrome survivors. This study aimed to identify and prioritize the actual learning needs of these patients and to explore the differences in learning needs on the basis of sociodemographic and clinical variables. Descriptive comparative design was used, and patients' learning needs data were collected through the Patient Learning Needs Scale. The results showed that patients need a high amount of information after this syndrome. The 10 most needed educational topics belonged to the medications and treatment and activities of daily living categories. Older patients and those from lower socioeconomic backgrounds requested less information than others did. In conclusion, topics perceived by patients as important and sociodemographic variables should be considered in preparing and providing cardiac rehabilitation and secondary prevention programs. Furthermore, these programs should be redesigned considering patients' actual learning needs rather than the expected needs, and they should incorporate medications, treatment and activities of daily living, complications and symptoms, illness-related concerns, and support in the community.