HEALTH PROMOTING EXHIBITED BY THE INDIVIDUAL

DIAGNOSED WITH CORONARY ARTERY DISEASE : A CROSS-

SECTIONAL STUDY .

Submitted By
STUDENT NAME: Areej Fatima
REG NO: 2019- ICN-0020-UHS

In The Partial Fulfillment for the Award of Bachelor Science in Nursing

SUPERVISOR 1: ASSISTANT PROF. MS. SHAHEEN NAZAKAT

PHD(SCH), MSN, MPH, CHPE.

SUPERVISOR 2: Ms. Sana

(BSN)

INDEPENDENT COLLEGE OF NURSING FAISALABAD

SESSION 2020-2024
 CHAPTER # 02

2.1 LITERATURE REVIEW

A descriptive study was conducted about Health promoting behaviors among patient with
coronary artery disease from three primary governmental healthcare clinics in three central
governorates in the northern region of Palestine. A convenient sampling of 178 patients with
coronary artery disease was selected. The instrument used in this study consist of group of scales
and items that measures the study variables. The entire study survey was presented to the
participants in a paper and pencil self –report format. Health promoting Lifestyle Profile II was
used to measure the health promoting behaviors, the Behavior-specific Cognitions and Affect
scale to measure Cognition and Affect and Multidimensional scale of perceived Social Support
was used. Hierarchical multiple regression analysis was performed to examine the predictive
behaviors on health-promoting behaviors. For the first time in Palestine, it was demonstrated in
this study that HPB level CAD patients are moderate to good. The authors underline the
significance of developing policies to improve HPB practices. (Al Aqtam, I., 2023)

A descriptive cross sectional study was conducted the effect of educational intervention
based on pander’s health promotion model on treatment adherence in the patient with coronary
Artery disease at educational hospital in Isfahan.64 patient were selected by convenience
sampling technique. The tool was used for data collection included treatment adherence
questionnaire and a checklist Pender’s HPM. The study group received dietary, exercise, and
medication education based on Pender’s HPM in four sessions which were held in 4 weeks. The
data was analyzed using descriptive statistics, repeated measures ANOVA, independent
Chi-square, and Mann–Whitney tests via SPSS software. Study finding show that after the
intervention, in one (z = 5.28, df = 2, p < 0.001) and three (z = 4.51, df = 2, p < 0.001) months,
there was a significant difference in the mean treatment adherence score between the two groups.
Three months following the trial, the study group's mean (SD) treatment adherence was 139.82
(27.44). Involvement. On the basis of finding researcher suggest that when it comes to treatment
adherence, educational interventions based on Pender's HPM outperform regular methods in
patients with CAD. For these patients, it is advised to incorporate the Pender's HPM into the
nursing care regimen (Faroughi et al., 2021).

A previous study was conducted on health promoting behavior, health literacy and level
of knowledge about smoking related disease among smokers and non-smokers at
Cardiopulmonary Rehabilitation Unit of the Hacettepe University Faculty of Physical Therapy.
The study included 71 smokers (mean age, 32.69±8.55 years) and 72 non-smokers (mean age,
31.88±9.94 years) between the ages of 20 and 60 years. The following tests were administered as
part of the assessment process: the Godin Leisure-Time Physical Activity Questionnaire, the
Asthma/COPD Awareness Questionnaire, the World Health Organization Quality of Life-Bref
(WHOQoL-Bref [TR]), the Cardiovascular Risk Factors Knowledge Level Scale (CARRF-KL),
the 6-minute walking test (6MWT), and the Health Literacy Questionnaire (HLQ). The study's
findings demonstrate that, in comparison to members of the non-smoker group, smokers had a
considerably higher number of coronary artery disease risk factors (p=0.001). Compared to non-
smokers, smokers exhibited a substantially lower %6MWT distance (84.83±4.72 and
93.45±7.16, respectively; p<0.05). However, there were no statistically significant differences in
physical activity, overall scores (p>0.05), WHOQoL-Bref, CARRF-KL, HLQ, and HPLP-II
subscales between smokers and non-smokers. Furthermore, 48 people in the non-smoker group
were active (66.7%), compared to just 41 smokers (57.7%).on the basis of finding researcher
suggest that . health practitioners should keep highlighting the value of physical activity and
exercise for preserving cardiovascular health as well as raising people's knowledge of the risk
factors associated with smoking.( Celebi C et al ., 2021).

A descriptive study was conducted Psycho social Adjustment to Cardiovascular Diseases

and Spiritual Well-Being in Iranian Patients admitted to the cardiac ward of a teaching
Hospital .admitted to the cardiac ward of a teaching hospital . 150 male and female patients who
were admitted to the cardiac ward of a teaching hospital in Iran by convenient sampling The tool
used for data collection was variables checklist developed and two standard questionnaires of
Psychosocial Adjustment to Illness Scale and Ellison-Paloutzian Spiritual Well-Being Scale. :
Study finding showed that the final score of psychosocial adjustment to cardiovascular diseases
was 62.78±6.8 (range 48-83), indicating a moderate level of psychosocial adjustment to
cardiovascular diseases. The mean score of psychosocial adjustment to cardiovascular diseases
was significantly higher in women than in men (p=0.03). In this study, the mean of overall
spiritual well-being was 74.93 indicating a moderate level of spiritual well-being. The mean of
overall spiritual well-being was significantly higher in women than in men (p=0.001). The
results showed a significant negative relationship between the participants’ psychosocial
adjustment to cardiovascular diseases and spiritual well-being (rr=-0.21, p=0.01). On the basis of
findings researchers showed that patients with cardiovascular diseases a poor level of
psychosocial adjustment. Patients with higher level of spiritual well-being reported better
psychosocial adjustment (Rafiei, H et al., 2021).

A Descriptive study was conducted Health Related knowledge and Behaviors among
Patients with Coronary Artery Disease.90 adult patient were selected by convenient sampling.
Two tool used for data collection were structured interview schedule. Data collected were used
using Statistical Package for Social Sciences (SPSS) version 20 program. Study finding show
that patient have poor knowledge about coronary artery disease and had negative health
behavior. It was a significant static positive relation between socio demographic characteristics
and patient score of overall knowledge and overall health related behavior. On the basis of
finding researcher suggest that development and application of education session for patient to
improve their knowledge about coronary artery disease as well as handout booklet and audio
video material should be provided( Abd Elhafeez et al ., 2023).

A descriptive study was conducted Influence of uncertainty in illness on health behavior

in individuals with coronary artery disease. 228 patients with coronary artery disease were
selected by simple random a technique. The tool used for data collection was questionnaire. Data
collection were analyzed using SPSS 25 and AMOS 25.Study findings shows that for the data,
our final model worked well. 11 of the 12 pathways were judged to be statistically significant.
Risk was positively impacted by uncertainty, whereas opportunity and self-efficacy were
negatively impacted. Perceived risk was positively impacted by danger. Opportunity had a
negative impact on perceived risk and a favorable impact on social support, self-efficacy,
perceived benefit, and intention. Health-related behavior was positively impacted by intention,
perceived benefits, self-efficacy, and social support. In the link between uncertainty and health
behavior, perceived benefit and intention had the strongest direct effects, whereas self-efficacy
had the strongest indirect effects. The path model performed well in forecasting the health-
related behavior. On the basis of findings researchers suggests that programs to improve social
support and self-efficacy by focusing on the perceived benefit t and intention of health behavior
are needed. (Jeong, H et al., 2023).

A descriptive crossectional survey was conducted to explore the effect of self-control on

health-promotion behaviors in patients with coronary heart disease (CHD) from the department
of cardiology of a grade III class a hospital in Chengde city, Hebei province, China. 277 patients
with CAD was selected by simple convenient sampling. The tool used for data collection was

Questionnaire. Data collection were analyzed by using Self-Regulatory Fatigue Scale (SRF-s),
Dual Mode of Self-Control Scale (DMSD-s) and Health Promotion Lifestyle Profile-II (HPLP-
II)

Study findings shows that to some extent, the patients' HP behaviors were improved by self-
control. Ego-depletion is the mediating variable that self-control in CHD patients utilizes to
indirectly and positively predict the degree of HP behavior; the mediating effects of self-control
account for 15.6% of the total effects in the control system and 47.76% in the impulsive system,
respectively. On the basis of findings researchers suggests that Scientifically based and
efficacious intervention strategies can be implemented to augment their psychological arsenal,
mitigate patients' ego depletion, and empower patients with a high degree of self-regulation to
engage in behaviors that promote health(Li, X et al .,2022).

A descriptive crossectional study was conducted about Health-Related Quality of Life in

Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention at the
cardiovascular center of a tertiary hospital in Korea. 210 patients was selected by simple
convenient technique. The tool used for data collection was questionnaire and patients' medical
records. Data collection were analyzed by using descriptive statistics, independent t test, one-
way analysis of variance, the Scheffé test, and the Pearson correlation test .Study finding shows
that Age, marital status, subjective economic position, primary caregiver, length of time after
first PCI, New York Heart Association class, anxiety, depression, and social support were found
to significantly affect HRQoL. The three main characteristics that were found to have a
substantial impact on HRQoL in patients who had PCI were age, marital status, and primary
caregiver. The major psychosocial traits that were shown to have an impact on HRQoL were
depression and anxiety. The New York Heart Association class and primary caregiver were
found to have the biggest effects on HRQoL in the PCI patients in this study. On the basis of
findings researchers suggests that Patients who have had PCI should have regular evaluations of
their post-PCI physical and psychological symptoms in order to improve their HRQoL.
Intervention techniques are also required for patients receiving family care and those with severe
functional limitations in order to improve their quality of life (Yujeong, et al., 2022).

A descriptive crossectional study was conducted health promoting behaviors in patients

after percutaneous coronary intervention (PCI) at department of Cardiovascular Internal
Medicine of the First Affiliated Hospital of Chongqing Medical University in Chongqing. 120
patients was selected by simple random technique. The tool used for data collection was
questionnaire. Data were analyzed using descriptive statistic by t-test, analysis of variance, and
multiple linear stepwise regression analyses Study findings show that the level of health-
promoting lifestyle was

Higher for people with higher income and a diagnosis of stable angina. On the basis of findings
researchers suggests that Healthcare providers should focus on promoting physical exercise and
stress management for patients after PCI. It is also necessary to keep an eye out for patients with
low income and severe illness to encourage a health-promoting lifestyle in these subsets of
patients (Xiao, L et al 2018).

A descriptive crossectional study was conducted at Health Promoting Lifestyle Behaviors

among Women at High Risk for Cardiovascular Diseases at different outpatient’s clinics at
Menofia University teaching hospital. 70 patient was selected by simple convenient sampling.
The tool used for data collection was demographic data and medical records. Data were analyzed
using The Health-Promoting Lifestyle Profile II (HPLP II) used to measure current health
promoting practices. Study findings showed that the majority of the women had Diabetes Miletus
74%, hypertension 71% and 10% were obese. Regarding the CVD risk scores, 51% of the
women in the sample were classified as high-risk subjects. G that women did not practice health
promoting behaviors. Women in the present study reported the highest scores in the subscale of
nutrition 2.83 and the lowest scores in the subscale of physical activity 1.77. On the basis of
findings researchers suggests that Health care providers must be influential in risk factor
reduction and promoting cardiovascular health for women of all ages(El Mokadem,et al ., 2013).
2.2 SEARCH STRATEGIES

Search strategies of this study are GOOGLE SCHOLAR, PUBMED, OPERA, SCIHUB,
SCIENCE DIRECT and SCOPUS.

2.3 GAP ANALYSIS

By identifying the gaps between current and recommended behaviors, health care professionals
can develop personalized interventions and strategies to help individuals improve their health
promoting behaviors. This may include providing education, counseling and support to
encourage life style changes. Such as adopting a heart healthy diet, engaging in regular exercise,
managing stress and adhering to prescribed medication.
References:

Abd Elhafeez, D. M., Mohamed, M. A. F., EL Shatby, A. M., & Shaheen, S. R. (2023). Health
Related knowledge and Behaviors among Patients with Coronary Artery
Disease. Alexandria Scientific Nursing Journal, 25(1), 165-177.

Al-Aqtam, I., Darawad, M., Alshraideh, J., Nabolsi, M., Shoqirat, N., & Ayed, A. (2023).
Health-promoting behaviors among patients with coronary artery disease in
Palestine. Palestinian Medical and Pharmaceutical Journal, 8(1), 6.

Celebi, C., Calik-Kutukcu, E., Saglam, M., Bozdemir-Ozel, C., Inal-Ince, D., & Vardar-Yagli, N.
(2021). Health-Promoting behaviors, health literacy, and levels of knowledge about
smoking-related diseases among smokers and non-smokers: a cross-sectional study.
Tuberculosis and respiratory diseases, 84(2), 140.

Faroughi, F., Shahriari, M., Keshvari, M., & Shirani, F. (2021). The effect of an educational
intervention based on pender's health promotion model on treatment adherence in the
patients with coronary artery disease. Iranian Journal of Nursing and Midwifery
Research, 26(3), 216.

Jeong, H., Lee, Y., Park, J. S., & Lee, Y. (2023). Influence of uncertainty in illness on health
behavior in individuals with coronary artery disease: a path analysis.

Li, X., Gao, Q., Sun, L., & Gao, W. (2022). Effect of self-control on health promotion behavior
in patients with coronary heart disease: mediating effect of ego-depletion. Psychology,
Health & Medicine, 27(6), 1268-1276.

Rafiei, H., Senmar, M., Yousefi, F., & Nemati, Z. (2021). Psychosocial adjustment to
cardiovascular diseases and spiritual well-being in Iranian patients. Turk J Cardiovasc
Nurs, 12(28), 75-80.

Xiao, L., Wang, P., Fang, Q., & Zhao, Q. (2018). Health-promoting lifestyle in patients after
percutaneous coronary intervention. Korean Circulation Journal, 48(6), 507.

Yujeong, K. I. M. (2022). Health-related quality of life in patients with coronary artery disease
undergoing percutaneous coronary intervention: a cross-sectional study. Journal of
Nursing Research, 30(1), e186.