A study to assess the effectiveness of community health nurse led educational module on modifiable risk factors of cardiovascular diseases among adults residing at selected urban areas, Chennai

INTRODUCTION

The developing world faces heavy burden of cardiovascular diseases (CVD). Greater urbanization and shift to western life style possibly contribute to such an increase in CVD. People of Asian region, particularly from India show increased visceral adiposity and they are more susceptible to CVD. Therefore, CVD, a non-communicable disease becomes one of the major public health problems and affects community wise health.^1-3

Knowledge of modifiable risk factors (smoking, lack of exercise, obesity and consumption of fatty foods) for heart diseases need to be made aware to the community and the common public as a preventive measure. Prevention becomes an effective approach to control the spread of CVD in developing nations with poor economic resources.^4-9

One such preventive measure is the adoption and application of educational module carrying holistic information regarding risk factors related to cardiac health. The adoption and implementation of such module is effective when a community nurse recruits and educates a section of a community. India has many primary community health centres catering to well-defined community in different areas of an urban city.

In the present preliminary study, the knowledge of participants before and after intervention is analysed to bring out the importance of educating the public, about cardiac health and wellness.

METHODS

The current study was undertaken during the month of August 2023. Males and females from 30-60 years residing at selected urban areas under the control of urban primary health centre, Choolai, Chennai taken for the present study

Hypothesis

H1 There will be a significant difference between pre-test and post-test level of knowledge on modifiable risk factors of cardiovascular disease among adults. H2 There will be a significant association between the post level of knowledge regarding modifiable risk factors of cardiovascular disease among adults and selected socio demographic variables.

Assumption

Adults may have verified the level of knowledge regarding cardio vascular disease and its prevention. Explaining education module may help to enhance knowledge and bring out desirable changes in the lifestyle to prevent the cardiovascular disease among adults.

Delimitation

The study is limited to only among adults both male and female in the age of 30-60 years. The study duration limited to 4 weeks only. The sample size is limited to 60 adults.

Conceptual frame work

A conceptual frame work can be defined as a set of concept and assumptions that integrate them into a meaningful configuration. A conceptual frame designed by Bertalanfyy and Kenny was adopted. It consists of four factors, input, throughput, output and feedback.

The research design selected for this study is quasi experimental one group pre-test post-test design.

O1-pre-test, X-provide education on physical and psychosocial problem among adolescent boys and O2-post-test.

Research variables

The variables mainly include in this study are independent and dependent variable. Dependent variable explained the effect of independent variables.

Independent variable

The independent variable in this study is community health nurse led educational module.

Dependent variable

Dependent variable in the study is knowledge of adults regarding modifiable risk factors of cardiovascular disease.

Demographic variable

Demographic variable in study are adult’s age, sex, education, religion, marital status, type of family, occupation, monthly income, family history, dietary pattern, habits, and type of activities of adults and source of information

The obtained data have been classified, grouped and analysed statistically based on the objectives of the study.

Section I: Description of demographic variables of the study participants.

Section II: Assessing the pre-test level of knowledge on modifiable risk factors of cardiovascular disease among adults.

Section III: Determining the effectiveness of educational module on modifiable risk factors of cardiovascular disease.

Section IV: Comparing the pre- test and post -test level of knowledge regarding modifiable risk factors of cardiovascular disease among adults.

Section V: Associating between the post-test mean score level of knowledge on modifiable risk factors of cardiovascular disease with their selected demographic variables.

RESULTS

The majority of the adults belongs to 51 to 60 years which is n=21 (35.00%) and the educational qualification most of them are primary education which is n=19 (31.67%). Most of them belong to Hindu religion is n=49 (81.67%). While discussing the occupational status of the majority of the adults it was observed that the participants were self-employed n=14 (23.33%) with monthly income less than Rs. 15,000/-, n=29 (48.33%). They had no family history of cardiovascular disease n=41 (68.33%). Dietary pattern of adults are mostly mixed pattern n=41 (68.33%). Smoking and alcohol habits were not present in majority of the participants (n=7 (11.67%), habits of alcohol n=5 (8.33%) and no of adults n=48 (80.00%). Their life style was sedentary. (n=14 (23.33%). Common source of information received are from internet and health care workers (n=20 (33.34%) (Table 2).

Above table shows each question wise pre-test percentage of knowledge score on modifiable risk factors of cardiovascular disease among adults. They are having maximum knowledge score for the question “important of healthy diet 66.67%”, and they are having minimum score for question “risk factors of cardiovascular disease that cannot be modified are 23.33%”.

Most of them responded that diet play an important role in maintain cardiac health and they were ignorant of non-modifiable risk factors (Table 3).

Educational module adopted had the following

Flash cards and booklets consist of definition, risk factors of cardiovascular disease, non-modifiable risk factors gender, race, family history and advancing age, modifiable risk factors such as obesity, physical inactivity, smoking and harmful usage of alcohol, signs and symptoms of cardiovascular disease, clinical manifestation of cardiovascular disease, and preventive measures of cardiovascular disease: diet modification-salt restricted, low fat, high fiber diet, habits: quitting of smoking and alcohol and regular physical exercise such as brisk walking exercise 5-10 minutes.

The post-test revealed that the participants” knowledge had marked improvement to understand the role of modifiable risk factors in promoting cardiac health.

Table 6 shows the pre-test and post-test percentage of knowledge score on regarding modifiable risk factors of cardiovascular disease among adults. In pre-test, they are having maximum knowledge score for the question “the important of healthy diet 66.67%”, and they are having minimum score for the question “the risk factors of cardiovascular disease that cannot be modified are 23.33%” and in post-test they are having maximum knowledge score for the question “the important of healthy diet 66.67%”, and they are having minimum score for the question “the risk factors of cardiovascular disease that cannot be modified are 23.33%” (Table 4-9).

Above table shows each question wise pre-test percentage of knowledge score on modifiable risk factors of CVD among adults. They are having maximum knowledge score for the question “The important of healthy diet 66.67%”, and they are having minimum score for the question “The risk factors of CVD that cannot be modified are 23.33%”.

Above table shows each question wise post-test percentage of knowledge score on modifiable risk factors of CVD among adults after having community health nurse led educational module. They are having maximum knowledge score for the question “the healthy life style practices include all except 90.00%”, and they are having minimum score for the question “the CVD is common in age of 65.00%”.

*** very high significant at p≤0.001.

*P≤ 0.05 significant S=significant, **P≤0.01 highly significant, NS=not significant.

DISCUSSION

Increasing rates of prevalence of NCDs in India put a heavy toll on Indian economy and, a great concern for public health problem. This is compounded by inadequate health facilitates at the primary, secondary, and tertiary levels. Knowledge particularly about the visceral obesity is a major health problem of India and, is one of the main reasons for an increase in NCDs. Approximately 4 million premature deaths occur due to NCDs annually aged between 30-70 years.¹⁰

In the present preliminary study, the pre-test and post-test responses showed that knowledge is an important pre-requisite for implementing both primary as well as secondary preventive strategies for CVD. There are no estimates of the level of knowledge of risk factor of heart disease in patients with CVD. Therefore, the efforts and implementation of community-based education regarding cardiac health in particular and general wellness will help prevent and minimize the spread of NCDs. The present study indicates the value of educating the public about health. It is therefore necessary to conduct more studies with more number of participants in various communities will be better way to combat the spread of NCDs and help maintain the health of the public in general.^11,12

CONCLUSION

NAFLD is becoming one of the important public health issues. It is also implicated as one of the independent risk factors for CVD. Therefore, creating awareness about NAFLD and its association with CVD will help prevent and promote cardiac as well as hepatic health.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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