Factors Influencing Health Promoting Behavior among Peripheral Arterial Disease Patients

Article information

Korean J Health Promot. 2016;16(1):37-47

Publication date (electronic) : 2016 January 20

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

Yonju Yoo ¹^,, Ju Hee Lee ², Sang Hui Chu ², Donghoon Choi ³

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 2015 April 01; Accepted 2015 December 15.

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)

Table 2.

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

Table 3.

Difference of variables according to general characteristics of study participants

Table 4.

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

Table 5.

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

Table 6.

Factors influencing health promoting behaviors (N＝128)

References

1. Schirmang TC, Ahn SH, Murphy TP, Dubel GJ, Soares GM. Peripheral arterial disease: update of overview and treatment. Med Health R I 2009;92(12):398–402.

2. Abdulhannan P, Russell DA, Homer-Vanniasinkam S. Peripheral arterial disease: a literature review. Br Med Bull 2012;104:21–39.

3. Kohlman-Trigoboff D. Management of lower extremity peripheral arterial disease: interpreting the latest guidelines for nurse practitioners. J Nurse Pract 2013;9(10):653–60.

4. Lovell M, Harris K, Forbes T, Twillman G, Abramson B, Criqui MH, et al. Peripheral arterial disease: lack of awareness in Canada. Can J Cardiol 2009;25(1):39–45.

5. Carman TL, Fernandez BB Jr. Contemporary management of peripheral arterial disease: II. Improving walking distance and quality of life. Cleve Clin J Med 2006;73(Suppl 4):S38–44.

6. Haas TL, Lloyd PG, Yang HT, Terjung RL. Exercise training and peripheral arterial disease. Compr Physiol 2012;2(4):2933–3017.

7. Olin JW, Sealove BA. Peripheral artery disease: current insight into the disease and its diagnosis and management. Mayo Clin Proc 2010;85(7):678–92.

8. Warren E. Ten things the practice nurse can do about Peripheral Arterial Disease. Practice Nurse 2013;43(12):14–8.

9. Armstrong EJ, Wu J, Singh GD, Dawson DL, Pevec WC, Amsterdam EA, et al. Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease. J Vasc Surg 2014;60(6):1565–71.

10. Bush RL, Kallen MA, Liles DR, Bates JT, Petersen LA. Knowledge and awareness of peripheral vascular disease are poor among women at risk for cardiovascular disease. J Surg Res 2008;145(2):313–9.

11. Buckley T, McKinley S, Gallagher R, Dracup K, Moser DK, Aitken LM. The effect of education and counselling on knowledge, attitudes and beliefs about responses to acute myocardial infarction symptoms. Eur J Cardiovasc Nurs 2007;6(2):105–11.

12. McKinley S, Dracup K, Moser DK, Riegel B, Doering LV, Meischke H, et al. The effect of a short one-on-one nursing intervention on knowledge, attitudes and beliefs related to response to acute coronary syndrome in people with coronary heart disease: a randomized controlled trial. Int J Nurs Stud 2009;46(8):1037–46.

13. Mooney LA, Franks AM. Impact of health screening and education on knowledge of coronary heart disease risk factors. J Am Pharm Assoc (2003) 2011;51(6):713–8.

14. Kayaniyil S, Ardern CI, Winstanley J, Parsons C, Brister S, Oh P, et al. Degree and correlates of cardiac knowledge and awareness among cardiac inpatients. Patient Educ Couns 2009;75(1):99–107.

15. Wang L, Chen CM, Liao WC, Hsiao CY. Evaluating a com-munity-based stroke nursing education and rehabilitation programme for patients with mild stroke. Int J Nurs Pract 2013;19(3):249–56.

16. Long AF, Gambling T. Enhancing health literacy and behavioural change within a telecare education and support intervention for people with type 2 diabetes. Health Expect 2012;15(3):267–82.

17. Weinman J, Petrie KJ, Moss-Morris R, Horne R. The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychol Health 1996;11(3):431–45.

18. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res 2006;60(6):631–7.

19. American Heart Association. Peripheral Artery Disease American Heart Association Dallas: American Heart Association; 2014. [Accessed Aug 27, 2014]. http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Peripheral-Artery. -Disease-PAD_UCM_002082_SubHomePage.jsp.

20. Song R, June KJ, Kim CG, Jeon MY. Comparisons of motivation, health behaviors, and functional status among elders in residential homes in Korea. Public Health Nurs 2004;21(4):361–71.

21. Petrie KJ, Weinman J. Why illness perceptions matter. Clin Med (Lond) 2006;6(6):536–9.

22. Kang YO, Cho YC. Factors related to knowledge, health belief and sick role behavior to the coronary artery disease among patients with coronary artery disease. J Korea Acad Industr Coop Soc 2011;12(11):4985–94.

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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)

Calculated by independent t-test.

Calculated 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.

Calculated by independent t-test.

Calculated 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.

Data are presented as correlation coefficient r.

Calculated by Pearsons's correlation analysis.

P＜0.050.

P＜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

Assessed with multiple stepwise linear regression analysis.