Factors Influencing Health Promoting Behavior among Peripheral Arterial Disease Patients

Yonju Yoo; Ju Hee Lee; Sang Hui Chu; Donghoon Choi

doi:10.15384/kjhp.2016.16.1.37

Korean J Health Promot > Volume 16(1); 2016 > Article

Yoo, Lee, Chu, and Choi: Factors Influencing Health Promoting Behavior among Peripheral Arterial Disease Patients

Original Article

Korean Journal of Health Promotion 2016;16(1):37-47.

Published online: January 20, 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.1.37

Factors Influencing Health Promoting Behavior among Peripheral Arterial Disease Patients

Yonju Yoo^1,, Ju Hee Lee², Sang Hui Chu², Donghoon Choi³

¹University of Virginia School of Nursing, Charlottesville, VA, USA

²Nursing Policy and Research Institute, Division of Clinical Nursing Science, Yonsei University College of Nursing, Seoul, Korea

³Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: Yonju Yoo, MSN University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
Tel: +1-434-284-1165, Fax: +1-434-924-0528 E-mail: yy5ke@virginia.edu

Received April 01, 2015 Accepted December 15, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

The purpose of this study was to examine illness perception, knowledge about the disease and health promoting behaviors, and to identify factors influencing health promoting behaviors among Peripheral Arterial Disease (PAD) patients.

Methods

The participants were 128 PAD patients who had been treated as an outpatient or an inpatient at the department of cardiology in a tertiary hospital in Seoul, Korea. Data were collected from October to December 2014, regarding general characteristics, disease related characteristics, illness perception and knowledge on PAD, health promoting behaviors by using a structured questionnaire.

Results

The number of subjects who had an awareness of PAD diagnosis was 70 (54.7%) among 128. In this study, knowledge on PAD was significantly correlated with health promoting behaviors (r＝0.205, P＝0.020). Especially, knowledge on PAD had a significant correlation with health responsibility (r＝0.353, P＜0.001) and exercise (r＝0.230, P＝0.009). In the regression analysis, knowledge on PAD was a factor that influences the health promoting behavior in this study subjects (R²＝0.212, P＝0.032).

Conclusions

We could determine the degree of perception, knowledge, and health promoting behaviors among participants and the influence of PAD-related knowledge on health promoting behaviors. Conclusively, the results of this study support the development of education intervention to ameliorate disease perception and PAD related knowledge in order to improve health promoting behaviors among PAD patients.

Keywords: Peripheral arterial disease, Perception, Knowledge, Health behavior

Table 1.

General and disease related characteristics of study participants (N＝128)

Characteristics	Categories	N (%)	Mean (±SD)	Range
Gender	Male	104 (81.3)
	Female	24 (18.8)
Age, y			68.52 (±12.87)	20–89
	＜60	23 (18.0)
	60–69	33 (25.8)
	70–79	47 (36.7)
	≥80	25 (19.5)
Living with spouse	Yes	109 (85.2)
	No	19 (14.8)
Education level	＜ Elementary	22 (17.2)
	Middle, High	56 (43.8)
	≥ College	49 (38.3)
	No response	1 (0.8)
Employment status	Employed	47 (36.7)
	Non-employed	81 (63.3)
Monthly income, won	＜1 million	59 (46.1)
	1–4 million	44 (34.4)
	≥ 4 million	22 (17.2)
	No response	3 (2.3)
Smoking	Yes	39 (30.5)
	No	89 (69.5)
Alcohol use	Yes	46 (35.9)
	No	81 (63.3)
	No response	1 (0.8)
Comorbidity			4.08 (±1.33)	0–7
	Dyslipidemia	113 (88.3)
	HTN	106 (82.8)
	CHD	102 (79.7)
	DM	70 (54.7)
	Kidney disease	34 (26.6)
	CVD	33 (25.8)
	Cancer	12 (9.4)
	Etc.	52 (40.6)
PTA	Yes	94 (73.4)
	No	34 (26.6)
Surgery	No	115 (89.8)
	Yes	13 (10.2)
Rutherford's Classification	0	51 (39.8)
	1–3	42 (32.8)
	4–6	35 (27.4)
ABI (n＝117)	Right		0.91 (±0.24)	0.30–1.38
	Left		0.88 (±0.24)	0.30–1.54
Resting pain (n＝85)			1.75 (±2.85)	0–10
Walking pain (n＝85)			4.34 (±3.46)	0–10

Abbreviations: HTN, hypertension; CHD, coronary heart disease; DM, diabetes mellitus; CVD, cerebral vascular disease; PTA, percutaneous transluminal angioplasty; ABI, ankle brachial index.

Table 2.

PAD related illness perception, knowledge and health behavior of study participants (N＝128)

Characteristics	N (%)	Mean (±SD)	Range	Possible range
PAD related Illness perception (n＝70)		46.13 (±16.29)	9–76	0–100
Consequences		6.14 (±3.35)	0–10	0–10
Timeline		6.51 (±3.73)	0–10	0–10
Personal control		5.46 (±3.37)	0–10	0–10
Treatment control		2.81 (±3.10)	0–10	0–10
Identity		5.57 (±3.57)	0–10	0–10
Concern		5.67 (±3.57)	0–10	0–10
Coherence		5.19 (±3.33)	0–10	0–10
Emotional representation		5.22 (±3.81)	0–10	0–10
PAD related knowledge		11.63 (±3.41)	0–15	0–15
Definition	93 (72.7)
Cause	69 (53.9)
High risk of stroke	92 (71.9)
Symptom	82 (64.1)
Treatment: PTA/Surgery	100 (78.1)
Treatment: amputation	77 (60.2)
Treatment goal	92 (71.9)
Care: medication	113 (88.3)
Care: walking exercise	105 (82.0)
Care: exercise	104 (81.3)
Care: rest	105 (82.0)
Care: low cholesterol diet	116 (90.6)
Care: high fiber diet	117 (91.4)
Care: smoking	96 (75.0)
Risk factors	105 (82.0)
Health behavior		70.61 (±11.19)	40–95	25–100
Health responsibility		2.95 (±0.64)	1.50–4.00	1.00–4.00
Healthy diet		2.66 (±0.61)	1.20–4.00	1.00–4.00
Exercise		2.28 (±0.85)	1.00–4.00	1.00–4.00
Stress management		2.66 (±0.61)	1.20–4.00	1.00–4.00
Smoking cessation		2.72 (±1.06)	1.00–4.00	1.00–4.00

Abbreviations: PAD, peripheral arterial disease; PTA, percutaneous transluminal angioplasty.

Table 3.

Difference of variables according to general characteristics of study participants

Categories	Illness perception (n＝70)			Disease knowledge (n＝128)			Health promoting behavior (n＝128)
Categories	Mean (±SD)	t/F	P	Mean (±SD)	t/F	P	Mean (±SD)	t/F	P
Gender^a		–1.375	0.174		1.706	0.099		1.005	0.317
Male	41.34 (±13.41)			11.78 (±3.34)			71.09 (±10.83)
Female	46.69 (±14.50)			10.04 (±1.72)			68.54 (±12.67)
Age, y^b		3.331	0.025		4.518	0.005		2.359	0.075
＜60	49.47 (±7.90)			13.26 (±1.98)			65.09 (±10.82)
60–69	45.17 (±11.25)			12.30 (±2.85)			71.76 (±11.33)
70–79	38.30 (±14.88)			10.61 (±4.11)			72.00 (±11.39)
≥ 80	37.15 (±17.15)			10.20 (±4.22)			71.60 (±9.97)
Living with spouse^a		1.700	0.094		1.191	0.236		1.669	0.098
Yes	43.74 (±13.04)			11.61 (±3.55)			71.29 (±11.30)
No	36.18 (±16.29)			10.53 (±4.34)			66.68 (±9.89)
Education level^b		0.039	0.962		2.196	0.116		1.781	0.173
＜Elementary	41.11 (±18.29)			10.09 (±4.94)			72.32 (±10.94)
Middle, High	42.54 (±12.92)			11.55 (±3.47)			68.52 (±11.38)
≥ College	42.23 (±13.29)			12.04 (±3.12)			72.27 (±11.01)
Employment status^a		–0.643	0.522		–3.109	0.002		1.678	0.096
Employed	43.83 (±12.27)			12.62 (±2.66)			68.45 (±10.57)
Non-employed	41.67 (±14.79)			10.78 (±4.02)			71.86 (±11.41)
Monthly income, won^b		0.094	0.910		5.096	0.007		0.313	0.732
＜1 million	42.86 (±14.77)			10.54 (±3.91)			71.58 (±11.28)
1–4 million	44.13 (±12.92)			11.73 (±3.87)			69.95 (±10.30)
≥ 4 million	42.14 (±11.71)			13.36 (±1.59)			71.64 (±11.93)
Smoking^a		–0.302	0.763		–2.311	0.023		1.797	0.075
Yes	43.21 (±10.26)			12.41 (±2.61)			67.95 (±12.41)
No	42.27 (±15.17)			11.03 (±4.00)			71.78 (±10.47)
Alcohol use^a		0.646	0.521		–2.210	0.029		–0.760	0.449
Yes	41.04 (±13.70)			12.43 (±3.21)			71.72 (±11.30)
No	43.31 (±13.86)			10.96 (±3.81)			70.15 (±11.11)

^aCalculated by independent t-test.

^bCalculated by one-way analysis of variance.

Table 4.

PAD related Illness perception, knowledge and health promoting behavior by disease related characteristics (N＝128)

Characteristics	Illness perception			Disease knowledge			Health promoting behavior
	(n＝ 70)			(n＝＝128)			(n＝＝128)
	Mean (±SD)	t/F	P	Mean (±SD)	t/F	P	Mean (±SD)	t/F	P
Awareness of PAD diagnosis^a					–3.168	0.002		2.031	0.044
Yes				12.42 (±2.87)			68.72 (±10.94)
No				10.39 (±4.17)			72.69 (±11.17)
Comorbidity, ea^a		–2.34	0.022		0.789	0.713		–0.369	0.713
0–4	40.04 (±14.33)			11.66 (±3.61)			70.31 (±11.37)
5–7	48.07 (±10.73)			11.14 (±3.78)			71.06 (±11.00)
PTA^a		–0.298	0.767		9.702	0.002		2.703	0.103
Yes	42.80 (±13.67)			12.04 (±2.98)			69.64 (±11.23)
No	41.53 (±14.59)			9.82 (±4.84)			73.29 (±10.79)
Surgery^a					0.498	0.482		2.402	0.124
Yes	45.50 (±5.68)			10.77 (±4.53)			66.08 (±13.35)
No	42.19 (±14.45)			11.53 (±3.59)			71.12 (±10.86)
Rutherford's^b		8.116	0.001		0.257	0.774		0.432	0.650
0	31.77 (±12.42)			11.18 (±3.84)			71.55 (±11.63)
1–3	40.75 (±13.05)			11.71 (±3.49)			70.60 (±10.09)
4–6	49.11 (±11.89)			11.54 (±3.74)			69.26 (±11.94)
ABI (right)^b		0.788	0.505		0.034	0.991		0.998	0.397
≥ 0.97	39.43 (±16.36)			11.75 (±3.57)			72.19 (±10.34)
0.75–0.96	41.87 (±12.24)			11.52 (±3.93)			71.66 (±11.68)
0.50–0.74	44.41 (±9.21)			11.78 (±3.32)			67.70 (±10.81)
＜0.50	47.60 (±11.67)			11.71 (±1.70)			69.57 (±13.25)
ABI (left)^b		0.062	0.980		0.533	0.661		0.389	0.761
≥ 0.97	40.91 (±16.54)			11.51 (±3.86)			70.36 (±11.99)
0.75–0.96	42.56 (±13.95)			12.19 (±3.08)			72.03 (±9.22)
0.50–0.74	41.66 (±10.74)			11.67 (±3.37)			71.71 (±11.86)
＜0.50	42.80 (±9.09)			10.63 (±3.78)			68.00 (±10.30)

Abbreviations: PAD, peripheral arterial disease; PTA, percutaneous transluminal angioplasty; ABI, ankle brachial index.

^aCalculated by independent t-test.

^bCalculated by one-way analysis of variance.

Table 5.

Correlation between PAD related illness perception, knowledge and health promoting behavior (N＝128)^a,b

	PAD related	PAD related	Health promoting behavior
	illness perception	knowledge	Health responsibility	Exercise	Healthy diet
PAD related knowledge	0.006
Health promoting behavior
Total score	–0.032	0.205^c
Health responsibility	0.087	0.353^d
Exercise	–0.171	0.230^d	0.248^d
Healthy diet	0.071	0.008	0.257^d	0.142^d
Smoking cessation	–0.050	–0.171	0.009	0.244^d	0.142

Abbreviations: PAD, peripheral arterial disease.

^aData are presented as correlation coefficient r.

^bCalculated by Pearsons's correlation analysis.

^cP＜0.050.

^dP＜0.010.

Table 6.

Factors influencing health promoting behaviors (N＝128)

Health promoting behavior
Characteristics	B	S.E	β	t	P^a
	37.343	12.826		2.911	0.005
PAD related knowledge	1.101	0.479	0.287	2.300	0.025
PAD related illness perception	0.048	0.116	0.060	0.414	0.680
Age	–3.989	3.213	–0.152	–1.242	0.219
Current smoking	0.826	0.981	0.106	0.842	0.403
R²＝0.212, F＝2.385, P＝0.032

^aAssessed with multiple stepwise linear regression analysis.

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