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

Original Article

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 Yoo1,, 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

Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention

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.

Key words: 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)
Mean (±SD) t/F P Mean (±SD) t/F P Mean (±SD) t/F P
Gendera   –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, yb   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 spousea   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 levelb   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 statusa   –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, wonb   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)    
Smokinga   –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 usea   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 diagnosisa         –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, eaa   –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)    
PTAa   –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)    
Surgerya         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'sb   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 0.205c      
Health responsibility 0.087 0.353d      
Exercise –0.171 0.230d 0.248d    
Healthy diet 0.071 0.008 0.257d 0.142d  
Smoking cessation –0.050 –0.171 0.009 0.244d 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 Pa
  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.

REFERENCES
REFERENCES

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.
[PubMed]
2. Abdulhannan P, Russell DA, Homer-Vanniasinkam S. Peripheral arterial disease: a literature review. Br Med Bull 2012;104:21-39.
[Article] [PubMed]
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.
[Article]
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.
[Article] [PubMed] [PMC]
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.
[Article] [PubMed]
6. Haas TL, Lloyd PG, Yang HT, Terjung RL. Exercise training and peripheral arterial disease. Compr Physiol 2012;2(4):2933-3017.
[Article] [PubMed] [PMC]
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.
[Article] [PubMed] [PMC]
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.
[Article] [PubMed]
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.
[Article] [PubMed]
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.
[Article] [PubMed]
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.
[Article] [PubMed] [PMC]
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.
[Article] [PubMed]
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.
[Article] [PubMed] [PMC]
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.
[Article] [PubMed]
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.
[Article] [PubMed] [PMC]
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.
[Article]
18. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res 2006;60(6):631-7.
[Article] [PubMed]
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.
[Article] [PubMed]
21. Petrie KJ, Weinman J. Why illness perceptions matter. Clin Med (Lond) 2006;6(6):536-9.
[Article] [PubMed] [PMC]
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.
[Article]

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