part 3
Discussion
This study aimed to identify people’s knowledge about coronary heart disease, their attitude towards prevention and main risk reduction barriers. In disagreement with the study prevalence findings for CHD and risk factors in participants, an American report in 2003 indicated that a high proportion of the US population had multiple risk factors for heart disease (11). Moreover, a study in Jordan reported that more than half of the sample had a family history of hypertension and diabetes mellitus (12). These figures are much higher than those within the present study. The differences between these studies might be due to the different prospective of each study, the targeted population, and the methods of data collection and interpretation.
In studying the knowledge of the studied sample, in the present study, about the risk factors related to CHD, smoking was the most recognized factor by the majority of the studied participants. Moreover, the great majority of them had positive attitudes towards smoking cessation as a preventive measure for CHD. This may be due to the increased preventive measures targeting smoking and spreading awareness among the population all over the country through all mass media also another explanation can be due to high female participants in the present study which are mostly non-smokers.
As regards to the knowledge about the modifiable risk factors of CHD among the present study participants, the studied factors were recognized by about half of the participants each of them and total knowledge scored to be satisfactory by the majority of the participants. Moreover, the data shows that the great majority of them had positive attitudes towards all preventive measures. However, the study also reported several barriers to prevention and achieving risk reduction. In this context, surveys of CHD prevention-related services such as smoking cessations advice, measurement and treatment of lipid disorders, and physical activity assessment and counselling are disappointing (13). We should also note that individuals expect a lot from the system, and less from their own selves’ which affect their actions and decisions and consequently their lives (14)
Knowledge about the disease presentation was correct among the great majority of the participants in the present study. This high awareness might be due to that chest pain, which is one of the most important symptoms in CHD, and the most feared symptom. The high level of awareness about this symptom is quite expected, and is line with the current trends that any patient with a recent onset of chest pain, especially when the symptoms are ongoing, should be transported immediately to the emergency (15).
Also in agreement with the present study findings, the data reported on the signs and symptoms of heart attack and stroke in New York State 2003 had demonstrated that recognition of symptoms ranged from 42% to 93 %. Chest pain or discomfort was the most often recognized symptom (93%) (16) Furthermore, and in accordance with this present study finding, data from the 2001 study of the CDC showed that 95% of respondents recognized chest pain as a heart attack symptom (17), compared to (88.8%) in the present study.
Although a good percentage of the studied participants, in the present study, recognized the disease presentation, only slightly more than half of them recognized the seriousness of the disease, whereas the majority of the participants recognized the importance of early treatment and control. This discrepancy might lead to the delay in time to treatment. It should be kept in mind that knowing the disease presentation is not the only factor that affects the time to treatment. Other factors also need to be considered (16).
Within this study, a satisfactory total knowledge level about CHD was revealed among four fifths of the participants. Moreover, the great majority of them had positive total attitude. These figures are higher than the corresponding ones in other studies. Surveys conducted by the AHA between 1997 and 2003 have shown that the awareness of heart disease ranges from 30% in 1997 to 46% in 2003. Excellent awareness was reported by less than half of the population (18).
As regards to attitudes towards CHD, in 1997, a telephone survey of 1000 US households found that only 8% of population respondents identified heart disease as their greatest health concern; less than one third identified heart disease as the leading cause of death (19). Another international survey revealed a considerable degree of indifference to coronary heart disease, despite the possession of a reasonable level of knowledge of the risks involved, even among patients who had suffered a myocardial infarction (20). These findings are in disagreement with the present study results where the attitude was much higher than the knowledge about CHD among participants.
According to the present study findings, the association between attitude towards prevention among participants and their personal and family histories revealed no association except from the association to the family history of coronary heart disease. This is in disagreement with the claim that patients who did not experience chest pain during the acute event had significantly different attitudes than those who did (21).
In the present study, it is evident that the total knowledge score was associated to marital status and educational level. Moreover, it was not associated to age, gender and income level. The latter which in contrast with 2003 results which emphasized that people from lower income and certain age groups appear to lag behind the rest in their recognition of these symptoms and should be considered for targeted health education efforts (16).
The findings are also in line with the results of a study done in two New England communities where knowledge was higher among more educated individuals (22). Similar findings were reported in three population-based cross-sectional surveys in two northern California cities were conducted between 1980 and 1990 (23), and in Pakistan (24). Differences or similarities between these studies might be due to the prospective of each study, the targeted population, and the methods of data collection and interpretation.
In the present study, the relation between participants’ attitude towards prevention and their socio-demographic characteristics pointed that there was no association between attitude and gender. As well as between age and total attitude, where there was no association. These findings are in contrast with the results of 2005 which had also suggested that educating women and interpreting the symptoms of CHD remain significant obstacles in reducing decision time (15). Also, older age, female sex, low education level, low socioeconomic status, and black race were reported to be associated with increased delays in seeking treatment as reported by Moser 2006 (25).
These discrepancies between the results of the previous studies and the current study might be explained by individual characteristics, social, psychological and cultural differences.
The data of the present study showed that there was an association between knowledge about CHD and attitude towards prevention among participants in the current study. This means that increased knowledge would lead to improved attitude. This is in line with the findings that has emphasized that interventions based on simple messages, for example knowledge about diseases presentations and dealing with it are still being recommended (26).
Lastly, self-reported information subjected to recall and social desirability biases (27), inability to examine neither the actual cardiovascular risk factors nor the actual control of the participants, besides unawareness of some of them about their risk factors (high cholesterol, diabetes, or high blood pressure .etc), and unequal access to the health care services due to any possible obstacles, are the most probably limitations of the current study.
Finally, this study only examined modifiable risk factors and did not include other established risk factors, e.g., age, gender and family history of coronary heart disease (9), (17).
Conclusion
It is concluded that the level of satisfactory knowledge about CHD and positive attitude towards prevention were higher than expected, but with no statistical significant related to gender or education. There were a high reported percentage of medical setting related barriers and patient related barriers that were preventing from achieving the risk reduction actions. Therefore, it is recommended to strength the role of physicians in development and application of health prevention and promotion programs towards CHD and engage patients and families into the risk reduction plans. Further in depth studies are needed for more accurate results and confirming the findings and cover the limitations of the quantitative studies, by using focus group discussions or interviews and using qualitative methods as well.