Modelling knowledge, health beliefs, and health-promoting behaviours related to cardiovascular disease prevention among Malaysian university students

Factors Associated with Healthy Behavior for Preventing Non-Communicable Diseases

Background

The increasing burden of Non-Communicable Diseases (NCDs) in both low- and high-income ASEAN countries highlights an urgent need for effective management and prevention strategies. These strategies are critical for reducing premature deaths, alleviating the healthcare costs, and saving lives. Unhealthy lifestyle behaviors, such as poor dietary habits, lack of physical activity, alcohol consumption, and inadequate sleep, significantly elevate the risk of metabolic syndrome and other NCDs.

Purpose

Mapping the literature on factors related to healthy behaviors for preventing and managing NCDs among college students in ASEAN countries.

Methods

A Scoping Review with a PCC (Population-Concept-Context) framework and was referred to the Scoping Review Framework by Arksey and O'Malley. This article reviewed both qualitative and quantitative studies, restricted to full-text articles in English and Indonesian published from 2020 to 2024, focused on University Students, Healthy Behaviour, conducted in ASEAN countries.

Results

Of the 1166 articles, 7 studies, involving 71,923 participants, met the criteria. The findings indicate that internal (eg, dietary habits, sleep quality, and mental well-being) and external factors, (eg, student knowledge and perception, and the Health University Framework (HUF)) are significantly associated with health behaviors among university students. Several studies also demonstrate a relationship between healthy behavior and students' psychological conditions and susceptibility to cardiovascular disease.

Conclusion

This review found that internal factors, such as dietary habits, sleep quality, BMI, along with external factors, including HUF Implementation and students' knowledge and perceptions, significantly influence healthy behaviors among university students in ASEAN. These factors related with psychological well-being and cardiovascular disease risk. Therefore, effective interventions and implementation of the holistic AUN-HPN HUF framework in universities are essential for preventing and managing NCDs among young adults.

Factors influencing health-promoting behavior among single mothers in Northeastern Malaysia: a cross-sectional study

INTRODUCTION

Health-promoting behaviors (HPB) play a vital role in maintaining and enhancing overall well-being. Single mothers are at higher risk of cardiovascular disease (CVD) and less involvement in HPB due to psychosocial disadvantages.

OBJECTIVE

This study aimed to determine the HPB scores and factors influencing HPB among single mothers in Kelantan (Northeastern, Malaysia).

METHODS

This study employed a cross-sectional design, selecting 242 single mothers from Kelantan through proportional stratified sampling. Data were gathered through questionnaires covering sociodemographic details, the Health-Promoting Lifestyle Profile-II (HPLP-II), the Malay Version of Health Beliefs Related to Cardiovascular Disease (HBCVD-M), and Multidimensional Perceived Social Support (MPSS). The relationships between the dependent variable (HPB) and independent variables were analyzed using multivariable linear regression models.

RESULTS

The respondents achieved an average HPB score of 118.03 (SD = 19.2), with the highest mean scores in spiritual growth (22.46 [SD = 3.70]) and interpersonal relationships (22.05 [SD = 3.67]). Physical activity had the lowest mean score at 15.09 (SD = 4.62). Significant positive associations were found between HPB and perceived severity of CVD (adjusted β = 1.60; 95% CI [0.68-2.53]; p < 0.001) as well as perceived social support (adjusted β = 0.63; 95% CI [0.37-0.90]; p < 0.001). Conversely, educational level (adjusted β = -10.36; 95% CI [-16.06 to -4.67]; p < 0.001) and perceived benefits of reducing CVD risk (adjusted β = -1.43; 95% CI [-2.37 to -0.48]; p < 0.001) were negatively associated with HPB.

CONCLUSIONS

The findings highlight the importance of health beliefs, social support, and education in shaping HPB among single mothers. Community health initiatives targeting this population should develop strategies to strengthen individuals' health beliefs and promote a supportive environment.

Optimal self-protection and health risk perceptions: Exploring connections between risk theory and the Health Belief Model

In this contribution to the longstanding risk theory debate on optimal self-protection, we aim to enrich the microeconomic modeling of self-protection, in the wake of Ehrlich and Becker (1972), by exploring the representation of risk perception at the core of the Health Belief Model (HBM), a conceptual framework extremely influential in Public Health studies (Janz and Becker, 1984). In our two-period model, we highlight the crucial role of risk perception in the individual decision to adopt a preventive behavior toward a generic health risk. We discuss the optimal prevention effort engaged by an agent displaying either imperfect knowledge of the susceptibility (probability of occurrence) or the severity (magnitude of the loss) of a health hazard, or facing uncertainty on these risk components. We assess the impact of risk aversion and prudence on the optimal level of self-protection, a critical issue in the risk and insurance economic literature, yet often overlooked in HBM studies. Our results pave the way for the design of efficient information instruments to improve health prevention when risk perceptions are biased.

Structural equation models of health behaviour, psychological well-being, symptom severity and quality of life in abdominal bloating

Background

The objective of this study was to investigate the inter-relationship between psychosocial variables and their impact on symptom severity and quality of life (QoL) concerning abdominal bloating.

Methods

The study adopted a cross-sectional design with purposive sampling. Participants who consented and met the criteria for bloating based on the Rome IV classification completed designated questionnaires. Independent variables comprised health beliefs, intentions, health-promoting behaviors, social support, depression, and anxiety, while dependent variables included bloating severity (general and within 24 h) and QoL. Structural Equation Modeling (SEM) was conducted utilizing Mplus 8.0 to analyze the relationships between these factors.

Results

A total of 323 participants, with a mean age of 27.69 years (SD = 11.50), predominantly females (64.7%), volunteered to participate in the study. The final SEM model exhibited good fit based on various indices (CFI = 0.922, SRMR = 0.064, RMSEA (95% CI) = 0.048 (0.041-0.054), p-value = 0.714), with 15 significant path relationships identified. The model explained 12.0% of the variance in severity within 24 h, 6% in general severity, and 53.8% in QoL.

Conclusion

The findings underscore the significant influence of health beliefs, intentions, behaviors, social support, depression, and anxiety on symptom severity and QoL in individuals experiencing abdominal bloating.

Using the Health Belief Model to Predict Self-Care Behaviors Among Patients With Cardiovascular Disease Post COVID-19 Pandemic: A Perspective From the United Arab Emirates

Introduction

Data on how the health belief model constructs might predict the self-care behavior of patients with cardiovascular disease (CVD) post-coronavirus disease (COVID-19) 2019 pandemic are scarce.

Objective

This study determines the predictors influencing patients' intention to adhere to self-care for CVD in the United Arab Emirates after the COVID-19 pandemic.

Methods

A descriptive cross-sectional design was used. A total of 222 patients with CVD were purposively selected. Three scales were used: Health Beliefs Related to Cardiovascular Disease, Physical Activity Measurement, and Behavioral Intention Measurement. Various socio-demographic and clinical characteristics and the participants' health belief components were considered potential factors in the multivariate analysis to identify the independent predictors of the intention of self-care behaviors.

Results

The participants had a high level of perceived CVD risk (M = 4.02, SD = 0.714) and high level of perceived benefits regarding adopting healthy behavior (M = 4.30, SD = 0.817). The multiple linear regression revealed that not performing regular sweating exercises (β = 0.230), not receiving smoking cessation instructions (β = 0.214, p = .005), being sufficiently active (β = 0.304), and having no history of heart surgery (β = 0.155) were the independent predictors of low intention scores. The perceived benefits and perceived cues to the action of the Health Belief Model (HBM) were significant independent predictors of behavior intention and were responsible for a 22% increase in the participants' intention variances.

Conclusions

In a post-COVID CVD, this investigation delineated perceived benefits and cues to action derived from the HBM as the most robust prognosticators of behavioral intention (accounting for 47% of the variance), superseding sociodemographic and clinical parameters (explaining 25% of the variance). These results advocate for tailored interventions accentuating individual advantages and explicit prompts for behavioral modifications within this demographic.

Cardiovascular disease risk perceptions and influencing factors among Chinese systemic lupus erythematosus patients

BACKGROUND

Systemic Lupus Erythematosus patients (SLE) are at a higher risk of cardiovascular events than the general population. This study aimed to investigate the risk perception of cardiovascular disease (CVD) and to analyze its influence factors among Chinese SLE patients.

METHODS

This was a cross-sectional study. Convenience sampling was used to select 201 patients with SLE who had attended the outpatient and inpatient departments of the Department of Rheumatology and Immunology at the First Affiliated Hospital of the University of Science and Technology of China from November 2022 to March 2023. The following were used in the study: the Chinese version of the Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire, the Social Support Rating Scale, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Health Literacy Management Scale, and sociodemographic and disease-related data.

RESULTS

The mean (standard deviation) risk perception score of CVD patients with SLE was 57.18 ± 13.02. A Pearson correlation analysis showed that CVD risk perceptions were positively correlated with health literacy (r = 0.152, p < .05) and depression (r = 0.277, p < .05), and negatively correlated with social support (r = -0.393, p < .05) and psychological resilience (r = -0.374, p < .05). A multiple linear regression analysis showed that body mass index (BMI), family history, health literacy, depression, social support, and psychological resilience were the main factors influencing CVD risk perceptions among Chinese SLE patients (p < .05).

CONCLUSIONS

Body mass index, family history, health literacy, depression, social support, and psychological resilience influenced CVD risk perceptions among Chinese SLE patients. Healthcare workers should objectively and accurately assess the levels of CVD risk perception among SLE patients, identify the risk factors of CVD, adopt effective health risk communication strategies to help patients develop appropriate risk perceptions, and raise risk awareness to adopt active coping approaches to reduce risk.

The Impact of Heart Attack and Sudden Cardiac Death Risk Perception on Lifestyle Modification Intention Among Adults in Jazan Province

Purpose

This study aimed to assess the perception of sudden cardiac death (SCD) and heart attack risk and its influence on the intention to adopt healthy lifestyle behaviors among the general population in Jazan province, Saudi Arabia. SCD refers to an abrupt and unexpected loss of heart function resulting in death, and its incidence has been alarmingly increasing worldwide. Several factors, including smoking, hypertension, diabetes, obesity, and specific medications, have been associated with an elevated risk of SCD.

Methods

A descriptive cross-sectional study was conducted using a pretested questionnaire distributed among the general population in Jazan province. Descriptive statistics, chi-square, and t-tests were employed for data analysis.

Results

The study included 974 participants with a mean age of 27.90 ± 9.32 years, of whom 56% were female. More than half of the participants perceived themselves as highly susceptible to SCD, and all participants demonstrated a moderate willingness and readiness to modify their unhealthy lifestyle behaviors. Age, gender, marital status, body mass index (BMI), history of hypertension, dyslipidemia, medication use, physical exercise, and family history of chronic diseases and SCD were statistically associated with the perception of SCD.

Conclusion

The study revealed a high-risk perception and a moderate readiness to adopt lifestyle modifications. These findings can inform the development of effective strategies and support programs aimed at reducing the burden of SCD.

The Effect of Base Theory Educational Intervention on Health-Promoting Lifestyle in Women Susceptible to Cardiovascular Diseases: Application of the Theory of Planned Behavior

BACKGROUND

Cardiovascular diseases are the second leading cause of mortality, disability, and reduced productivity in women over 40 years and the first cause of mortality in women over 60 years. Therefore, the present study aimed to determine the effect of educational intervention based on theory of planned behavior (TPB) on health-promoting lifestyle in women susceptible to cardiovascular diseases.

METHODS

This quasiexperimental study was conducted on 200 women susceptible to cardiovascular diseases referred to health centers in Fasa city, Fars province, Iran. The available sampling was performed on women who referred to the centers and had a family record. In this study, two health-promoting lifestyle questionnaires consisting of 49 questions and the theory of planned behavior questionnaire consisting of 50 questions were used. The obtained data were analyzed by using the SPSS software version 24 in two stages before and six months after the educational intervention through paired t-test, independent t-test, chi-square test, and McNemar test.

RESULTS

The mean age of women in the experimental and control groups was 38.74 ± 9.22 and 39.14 ± 9.08 years, respectively. The results showed a significant increase in the experimental group after six months of intervention in terms of health-promoting lifestyle and constructs of the theory of planned behavior. Also, mean blood pressure, fasting blood sugar, and smoking of experimental group decreased six months after the educational intervention.

CONCLUSION

Considering the irreplaceable role of education in adopting healthy behaviors and the role of women in strengthening the family foundation, quality educational programs should be designed and regularly implemented by health care providers for women.

Predictors of participation in atrial fibrillation screening among community residents in China

BACKGROUND

Atrial fibrillation (AF) is associated with increased stroke risk, but many cases of AF remain undiagnosed. Screening is suggested for early detection of AF. However, nonparticipation in screening is frequently reported, and the underlying causes of why patients choose to participate or not are poorly understood.

OBJECTIVES

To explore factors associated with participation in AF screening in a high-risk population in China.

METHODS

A cross-sectional study was conducted among community residents who were at risk for AF in Guangzhou, China, from February to September 2022. Data on AF knowledge, attitude, subjective norms, perceived behavioral control, and willingness to participate in AF screening were collected. Sociodemographic and clinical data were also collected. Multiple linear stepwise regression analysis was performed to explore predictors for participation in AF screening.

RESULTS

In total, 420 participants were included, with a mean age of 74.4 (±7.43) years old. The results showed that 77.4% of participants reported that they were likely to participate in AF screening. The results of multiple linear regression showed that perceived behavioral control (β =0.591, 95% CI: 0.071, 0.094), attitude (β =0.085, 95% CI: 0.001, 0.025), and having an AF diagnosis (β =0.098, 95% CI: 0.068, 0.494) were positively associated with willingness to participate in AF screening.

CONCLUSIONS

Chinese patients are more likely to participate in AF screening when they perceive great control over their behavior, hold a positive attitude, and have an AF diagnosis. The findings provide clues for future interventions aimed at improving the AF screening participation rate.

The Malaysian HEalth and WellBeing AssessmenT (MyHEBAT) Study Protocol: An Initiation of a National Registry for Extended Cardiovascular Risk Evaluation in the Community

Cardiovascular disease (CVD) has been a burden to many developing countries for decades, including Malaysia. Although various steps have been taken to prevent and manage CVD, it remains the leading cause of morbidity and mortality. The rising prevalence of CVD risk factors such as hypertension, hypercholesterolaemia, diabetes, overweight and obesity is the main driving force behind the CVD epidemic. Therefore, a nationwide health study coined as the Malaysian Health and Wellbeing Assessment (MyHEBAT) was designed. It aimed to investigate the prevalence of CVD and the associated risk factors in the community across Malaysia. The MyHEBAT study recruited participants (18-75 years old) through community health screening programmes from 11 states in Malaysia. The MyHEBAT study was further divided into two sub-studies, namely, the Cardiovascular Risk Epidemiological Study (MyHEBAT-CRES) and the MyHEBAT Familial Hypercholesterolaemia Study (MyHEBAT-FH). These studies assessed the prevalence of CVD risk factors and the prevalence of FH in the community, respectively. The data garnered from the MyHEBAT study will provide information for healthcare providers to devise better prevention and clinical practice guidelines for managing CVD in Malaysia.

Translation and validation of the Chinese ABCD risk questionnaire to evaluate adults' awareness and knowledge of the risks of cardiovascular diseases

BACKGROUND

Assessment of health beliefs and risk perception is a critical means to prevent coronary heart disease, but there are few such studies on assessment in the Chinese population. Given the demonstrated value and widespread use of the Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire (ABCD), this study was designed to translate it into Chinese, and to evaluate its reliability and validity in a Chinese population.

METHODS

The Chinese version of the ABCD was created using the Beaton translation model, which included forward and backward translation. The reliability and construct validity of the Chinese ABCD were examined in a sample of 353 adults who participated in the public welfare projects of the Chinese National Center for Cardiovascular Diseases in Guilin city, Guangxi. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure of the Chinse ABCD. The internal consistency of the questionnaire was assessed using Cronbach's α and corrected item-total correlations.

RESULTS

We deleted item 7 in the knowledge dimension of the Chinese ABCD and added two items about smoking and sleep knowledge, while retaining 25 of the original items, so that it finally included 27 items. The correlations were .20-.90; the correlations between each item and the total score of the ABCD were .34-.86; and the item-level Content Validity Index (I-CVI) was .86-1.00. The results of the EFA showed that all items were close to .40, and the cumulative variance contribution rate was 63.88%. The model fit was acceptable (χ² = 698.79, df = 243, χ²/df = 2.87, P < 0.001, SRMR = 0.06, RMSEA = 0.05, CFI = 0.96, and TLI = 0.94) according to the CFA. The Cronbach' s α of the entire questionnaire was .86, and the α of each of dimension was .65, .90, .88, and .78. The split-half reliability of the entire the ABCD was .67, and the test-retest reliability was .97 (P < 0.05). The questionnaire had good reliability and validity and was associated with sociodemographic and health-related characteristics (smoking and Body Mass Index).

CONCLUSION

The Chinese version of the ABCD has good reliability and validity, and provides a reliable assessment tool for measuring public health beliefs about the risk of cardiovascular disease, promoting the primary prevention of coronary heart disease.

Eating Behaviors, Depressive Symptoms and Lifestyle in University Students in Poland

Young adulthood is the period from the late teens through the twenties and is associated with life transitions that could contribute to the development of obesity. Targeting this group will be critical to reversing the obesity epidemic. The aim of the study was to investigate the eating behaviors and lifestyle of healthcare students in Poland. We enrolled 227 students in the study. Convenience sampling was employed. Diet (Food Frequency Questionnaire), physical activity (International Physical Activity Questionnaire), depressive symptoms (Beck Depression Inventory), impulsivity (Barratt Impulsivity Scale), and eating behaviors (Three-Factor Eating Questionnaire) were assessed. One in three students exhibited depressive symptoms, one in four showed low levels of physical activity. More than 40% of the students did not consume vegetables at least once a day, and more than half did not consume fruit. Only approximately 50% of the students ate fish several times a month. There was an association between high scores of specific eating behaviors and body weight, adherence to the Mediterranean diet, and consumption of specific product groups (sweets, alcohol). The results of our study are expected to contribute to a better understanding of dietary habits and overweight/obesity in university students, and support the development of programs to promote healthy lifestyles in that population.