RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / NAME OF THE CANDIDATEAND
ADDRESS / MS. RICADALYNE DOHLING
1st YEAR M.Sc. NURSING,
COMMUNITY HEALTH NURSING DEPARTMENT
THE OXFORD COLLEGE OF NURSING
NO. 6/9 & 6/11 1ST CROSS, BEGUR ROAD, HONGASANDRA,
BENGALURU- 560068
2 / NAME OF THE INSTITUTION / THE OXFORD COLLEGE
OF NURSING,
NO. 6/9 & 6/11 1ST CROSS,
BEGUR ROAD, HONGASANDRA, BENGALURU- 560068
3 / COURSE OF STUDY
AND
SUBJECT / DEGREE OF MASTER OF NURSING.
COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION
TO COURSE / 17-05-2012
5 / TITLE OF THE TOPIC / A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING LIFESTYLES CHANGES TO REDUCE CARDIOVASCULAR RISKS AMONG YOUNG ADULTS IN SELECTED COLLEGES OF BENGALURU
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
"Change is hard because people overestimate the value of what they have—and underestimate the value of what they may gain by giving that up."
James Belasco and Ralph Stayer Flight of the Buffalo (1994)
Good health is the fundamental right of every human being. Internal and external growth of an individual is not possible without good health. Good health is essential to lead a quality and successful life. Beyond being personal responsibility, health is a national and international responsibility, and also, a worldwide social goal. The World Health Organization define “Health as a state of complete physical, mental and social well-being, and not merely an absence of disease or infirmity”1
Cardiovascular disease (CVD) refers to a group of disorders of the heart and blood vessels. CVD affects the heart's ability to function normally. The most common cause of heart disease is narrowing or blockage of the coronary arteries, which supply blood to the heart These disorders include coronary heart disease (CHD), hypertension, cerebrovascular disease, peripheral artery disease, heart failure, rheumatic heart disease, and congenital heart disease .2
About two-third of the global estimated 14.3 million annual cardiovascular death occurs in the developing world. By the year 2015, cardiovascular diseases could be the most important cause of mortality in India. There is an increase in the prevalence of cardiovascular risks in the young population which eventually leads to an increase in the absolute numbers of people with cardiovascular disease and increased health awareness and demand for health care facilities. In India reports on the prevalence or incidence are often incomplete and unreliable.3
The most important behavioral risk factors that are responsible for 80% of CVD are unhealthy diet, physical inactivity and tobacco use, which cause raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. CVD deaths are associated with these risk factors, which are multiple and interrelated conditions. When these conditions co-exist, they increase the probability of the development of heart disease. The increased prevalence of CVD risk factors has occurred at alarming rates and has ignited concerns that the trends may reverse movement toward the decline in CVD related deaths.4
Of growing concern is the increasing prevalence of the modifiable conditions in individuals prior to adulthood. For example, recent research utilizing data from the National Health and Nutrition Examination Surveys (NHANES) has demonstrated an increase in blood pressure as well as an increase in the prevalence of excessive weight in children and adolescents over the past decade. If this increase cannot be reversed, our society will face major challenges. Cardiovascular disease and its risk factors are generally not salient concerns of adolescents and young adults. There exists a common misperception that the physiological processes and risk factors that contribute to CVD only occur in the aged and/or are inevitable consequences of the aging process. However, longitudinal research has clearly demonstrated that the personal behaviours and resultant physiological processes that contribute to the development of CVD often begin in childhood, even as
early as 5 to 8 years of age. Because of the young ages at which CHD risk factors begin to develop, it is important to target these prevention efforts at young people. Young adults are at an age where they either already are or are becoming solely responsible for their own health and health-care decisions.5
Lifestyle modification was highlighted as a major strategy for prevention of cardiovascular diseases during late 20th century. To a large extent, health is governed by the physical, social, cultural and economic environment in which people live and work. Modest alterations of lifestyle risk factors have powerful effects on cardiovascular risk.6
Benefits of physical activity are remarkable. Physical activity raises high-density lipoprotein cholesterol, lowers low-density lipoprotein cholesterol and triglycerides, lowers blood pressure, improves fasting and postprandial glucose-insulin homeostasis, induces and maintains weight loss, improves psychological well-being, and likely lowers inflammation, improves endothelial function, and facilitates smoking cessation.6
Dietary habits also powerfully affect cardiovascular risk. In randomized trials, dietary habits affect both established and many other intermediary risk factors. Prospective studies indicate consistent and substantial reductions in cardiovascular risk related to lower trans fat consumption; consumption of whole grains, legumes, and cereal fibre and consumption of fruits and vegetables. Other dietary habits that may lower cardiovascular risk include modest consumption of nuts, alcohol, plant-derived ω-3 fatty acids, and dairy products and replacement of saturated fat or refined carbohydrates with unsaturated (ω-6 polyunsaturated or monounsaturated) fats.6
Financially, CVDs place a heavy burden on the economies of low- and middle-income countries. CVD remains the leading cause of morbidity and mortality for both men and women in the
U.S., Europe, and worldwide. Cardiovascular diseases have assumed epidemic proportions in India as well. The Global Burden of Diseases (GBD) study reported the estimated mortality from coronary heart disease (CHD) in India at 17.3 million in the year 2008. A total of nearly 64 million cases of CVD are likely in the year 2015, of which nearly 61 million would be CHD cases (the remaining would include stroke, rheumatic heart disease and congenital heart diseases). Cardiovascular death continues to rise mainly because preventive measures are inadequate. With increasing number of young Indians falling prey to cardiovascular disease and millions hooked to a roller-coaster lifestyle, the future looks even more grim.7
6.1 NEED OF THE STUDY
“If we are not able to help young adults understand the relevance of their actions now and their risk of tomorrow, then we could be looking at an increase in diagnoses and deaths within the next 10 to 20 years,”
Sacco
Young adults have higher levels of unhealthy behaviour such as eating junk food, sleeping badly and not exercising, which are linked to heart problems. College life is a transitional period, offering opportunities for cementing healthy lifestyle behaviours in young adults. However, most health professionals do not view this relatively healthy stage of life as a priority for health promotion efforts or for strengthening the positive attitude. Many researchers have tried to ascertain the determinants of health promoting behaviours and of the individual positive health outcomes.8
A high prevalence of cardiovascular risk factors was found in the population of young adults, especially among women. A fast-paced lifestyle as a result of professional over-ambition,
coupled by an unhealthy food habits is taking a toll on the hearts of large number of people in the country, especially at urban centres. It has become a cause for concern for all as many patients of heart disease are between 25 and 35 years. The reason is over-stress, over-focusing on career goals and taking fast food.9
A number of health-related behaviours practiced by people every day contribute markedly to cardiovascular disease. Their statements are as follows:
· Tobacco Use: Smokers have twice the risk of heart attack as nonsmokers. One-fifth of the annual 1,000,000 deaths from CVD are attributable to smoking. Surveillance data indicate that an estimated 1,000,000 young people become "regular" smokers each year.
· Lack of Physical Activity: People who are sedentary have twice the risk of heart disease as those who are physically active. Despite these risks, America remains a predominantly sedentary society. Surveys show that more than half of American adults do not practice the recommended level of physical activity, and more than one-fourth are completely sedentary.
· Poor Nutrition: Between 20% and 30% of the nation’s adults (some 58 million people) are obese and thus have a higher risk for heart disease, high blood pressure, high cholesterol, and other chronic diseases and conditions such as diabetes. Only 27% of women and 19% of men report eating the recommended five servings of fruits and vegetables each day.10
India has become the capital of the world heart disease. According to a recent survey the rate of heart attacks in India are more than those in the US. One landmark study demonstrated that a majority of heart attacks, over 90% of which is associated with nine main risk factors identified as smoking, abnormal blood lipid levels, hypertension, diabetes, abdominal obesity, a lack of physical activity, low daily fruit and vegetable consumption and alcohol overconsumption.11
A new survey conducted by the Associated Chambers of Commerce and industry of India states that the silicon valley of India (Bangalore) stands second in the lists with the highest number afflicted with heart disease. The reports further states that around 55% of the survey respondents fall under the age bracket of 20-29 years.12
The situation of young adult’s low CVD knowledge supports the fact that more theoretically based research is needed to better describe and predict contributions to health promoting behaviours of various populations of young adults. The emerging concern that young adults may not have full recognition of their risk for CVD suggests that theoretical approaches to understanding contributors to health promoting behaviours in young adults must include their subjective perceptions of susceptibility and the related constructs. At the same time, there is limited understanding about the outcome of risk information on future behaviour. A better understanding of young adult’s thoughts and feelings about their CVD risk is needed.13
One of the most effective strategies is to concentrate efforts on children and adolescents given that many of the risk factors for chronic diseases have their roots early in life. Lifetime patterns of diet and physical activity often are established and reinforced in childhood, and 75% of adult cigarette smokers begin before age 18. It is thus reasonable to initiate healthful lifestyle changes in childhood and in young adults to promote improved cardiovascular health in late adult life.14
6.2 REVIEW OF LITERATUREReview of Literature is categorized under the following headings:
6.2.1 Studies related to knowledge of young adults on cardiovascular diseases
6.2.2. Studies related to lifestyle risk factors
6.2.3 Studies related to effectiveness of information booklets
6.2.1 Studies related to knowledge of young adults on cardiovascular diseases
A study was conducted to assess cardiovascular disease (CVD) risk factor knowledge in young adults, its association with 10-year changes in risk factor levels, and variables related to risk factor knowledge. A total of 4,193 healthy persons (55% female, 48% Black; mean age=30 years) from four urban US communities were queried about risk factor knowledge. Of six risk factors considered (hypertension, hyperlipidemia, smoking, overweight, sedentary lifestyle, and unhealthy diet), participants mentioned a mean of two; more than 65% were not aware of any risk factors, and less than 35% recognized being overweight as a risk factor. After adjustment, variables associated with mentioning more than two CVD risk factors versus one or fewer were Black race (OR=0.52, 95% confidence interval (CI): 0.44, 0.61), having a high school education or less (OR=0.88, 95% CI: 0.80, 0.95), having one or two (vs. zero) risk factors (OR=1.27, 95% CI: 1.05, 1.53), and having three or more (vs. zero) risk factors (OR=1.79, 95% CI: 1.35, 2.38). More knowledge was marginally associated with less increase in body mass index 10 years later (p=0.06) but was unrelated to other risk factor changes. Knowledge of CVD risk factors was very low in these young adults but increased with the presence of risk factors. Knowledge alone did not predict 10-year changes in risk factors. 15
A survey research was conducted to explore college students' attitudes about heart disease risks and preventive strategies. The survey population consisted of students enrolled in selected lecture courses at Arizona State University. A total of 1481 surveys were used in data analysis. Respondents indicated a lower perception of heart disease risk for women than for men, and a majority of students incorrectly believed that breast cancer is a more significant health concern for women than heart disease. Respondents in most ethnic groups believed that whites are most at risk for developing heart disease. Students overall had relatively low levels of knowledge about heart disease and its risk factors compared to other health issues, such as sexually transmitted diseases (STDs) and psychological disorders. The results suggest that educational intervention is necessary to increase college students' knowledge about heart disease; and, in particular, efforts need to be made to raise awareness about heart disease among women and minorities. Guidelines for future educational intervention must address common misconceptions about which demographic groups are at risk for developing heart disease and address gaps in knowledge that young people have regarding heart disease prevention.16
A cross-sectional study was conducted for a population of 270 South Asian adults Interviews were conducted in English, Hindi, or Urdu using a standardized questionnaire. Multivariate regression models were used to examine the associations between socio demographics and CHD knowledge and attitudes about preventability. Eighty-one percent of respondents had one or more CHD risk factors. Most participants (89%) said they knew little or nothing about CHD. Stress was the most frequently mentioned risk factor (44%). Few mentioned controlling blood pressure (11%); cholesterol (10%); and diabetes (5%) for prevention. Fifty-three percent said that heart attacks are not preventable. Low education level, being interviewed in Urdu or Hindi, and low level of acculturation were associated with less knowledge and believing that CHD is not preventable.17
6.2.2. Studies related to lifestyle risks factors
A cross-sectional study was carried out among first year medical students and house surgeons of K.V.G Medical College, Sullia, D.K., Karnataka. A self administered structured questionnaire was used to obtain information.. The data analysis was done using SPSS version 17. The study subjects were 60 interns belonged to 21- 25yrs age group and 58 first year medical students belonged to 17-20yrs age group. Consumption of at least 3 servings of fruits or vegetables per day was less among interns. Frequent consumption of soft drinks was significant among interns (p=0.001). Low physical activity and> 4hrs of sedentary activity (p=0.002) was reported by interns. Current smoking and alcohol users were more among interns. Cardiovascular risk behaviours are widely prevalent among medical students and increase with years spent in the medical college. Health education is essential to target these risk behaviours by encouraging all the future doctors to adopt healthy lifestyle.18
In a survey, 1,248 American citizens aged between 18 and 44 were questioned about the opinions they had on healthy behaviours, and on health in general. Experts were seeking to assess the attitudes that the general population has on these issues. The study group was further divided between adults and young adults (aged 18 to 24). In the latter, experts discovered a will to live a long life. Young adults tended to express their wish to live until the age of 98, and to be healthy all the way. Of people in this subgroup, about 18 percent were unable to name a single factor that could increase their risk of suffering a stroke later in life. Nearly 33 percent of young adults said that they do not believe in engaging in healthy behaviours early in life, in order to reduce their risk of stroke later. This survey shows the dangerous disconnect that many young Americans have about how their behaviours affect their risks for stroke and other cardiovascular diseases.19
A cross sectional study was conducted in department of Physiology, J N Medical College, Belgaum, Karnataka from January 2009 to December 2009, with a sample size of 427 young adult medical students aged 17 –20 years. Obesity indices measured were BMI, WC, WHpR and WHtR using standard protocol. Blood pressure and fasting blood glucose levels were measured using standard techniques. Data analysis was done using unpaired’t’ test to compare the mean of two groups. Chi-square test was used to compare the rates of different groups. Differences were considered significant at p < 0.05 level. 'F' test (ANOVA) was used to compare means of more than two groups followed by Bonferroni multiple comparison test. The results of the study revealed a significant correlation of BMI with both systolic and diastolic blood pressure. WC and WHtR were significantly associated with systolic and diastolic blood pressure among males while there was statistically significant correlation between WHpR and systolic blood pressure among females. Results of the study reveal the increased risk of development of hypertension in young adult age group at an earlier age. Hence, it's necessary for implementing an effective prevention and health promotion programs targeted towards young adult age group.20