Impact on enhanced patient education program among surgical coronary heart disease patients at Nork Marash Medical Center

Abstract

The term, coronary heart disease (CHD), is used to describe the effect of impaired or absent blood supply to the heart muscle. It is a major health problem all over the world. According to the World Health Organization, CHD causes about 12 million deaths in the world each year. CHD is the leading cause of death in the United States accounting for one-fourth of deaths in the age group over 35 years. CHD is the leading cause of morbidity and mortality in Armenia, accounting for around 8,838 deaths per year. The cause of CHD is largely unknown. However, a number of epidemiologic studies have identified the major risk factors that increase the likelihood of CHD development. The management and control of CHD modifiable risk factors help to prevent CHD and decrease its morbidity and mortality. According to the literature, during 1968-1976, a 25 percent decline in CHD mortality was mostly due to preventive efforts addressed to modify risk factors through lifestyle changes. The control and management of CHD risk factors are of utmost importance for patients with established coronary heart disease since they are ten times more likely to develop a second myocardial infarction. Cardiac rehabilitation provides means for modifying the risk factors and offers patients a healthier and improved quality of life. Patient education is considered a cornerstone of cardiac rehabilitation because knowledge of the causative factors motivates the modification of health related behavior and reduces CHD morbidity and mortality. A number of studies have proven the effectiveness of educational programs on selected risk factors. Taking into account the importance of CHD risk factors management and the fact that the NMMC (Nork Marash Medical Center), a tertiary health clinic for CHD patients, provides only verbal instructions to its patients, it was proposed to conduct an enhanced patient education program for CHD surgical patients and to test its effectiveness. The research question of the study was to determine whether the enhanced in-hospital education program on selected risk factors among coronary heart disease surgical patients at NMMC increase their knowledge and awareness, improve their quality of life and increase scores on a locus of control questionnaire. The objective of the study was to test the impact of the enhanced patient education program on CHD surgical patients’ knowledge/awareness about heart disease and their perceived locus of control in an intervention group compared to the standard education provided in the control group. A quasi-experimental design with static group comparison was selected. The study population were surgical patients at NMMC. The control group included patients that had already undergone surgery, while the intervention group comprised current CHD patients, candidates for surgery. The sample size was calculated to be 27 in each study group. For testing the effectiveness of the education program knowledge/awareness, A Health Locus of Control, and the short form SF-36 questionnaires were used. The intervention group received the enhanced education program and was provided with pre and post-questionnaires to assess its effectiveness. The control group received standard patient education and only post-test questionnaires. Prior to study implementation the study protocol was approved by the Institutional Review Board/committee on Human research of the American University of Armenia. Based on the study results, it was concluded that the enhanced patient education on selected coronary heart disease risk factors increased the CHD surgical patients’ knowledge-awareness and improved their scores on the health locus of control questionnaire. Higher knowledge scores in the intervention group versus the control group demonstrated the effectiveness of the enhanced education program compared with the standard patient education held at NMMC.