ORIGINAL RESEARCH / ORİJİNAL ARAŞTIRMA 2014 The Knowledge About Cardiovascular Risk Factors Among Students in a Faculty of Health Sciences Sağlık Bilimleri Fakültesi Öğrencilerinde Kardiyovasküler Risk Faktörleri Bilgi Düzeyleri AUTHORS / YAZARLAR Eylem Pasli Gurdogan Department of Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey Seda Kurt Department of Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey Serap Unsar Department of Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey ABSTRACT Aim: Cardiovascular diseases are among the most common reasons for mortalities and morbidities worldwide, and mortalities related to cardiovascular diseases have become more common in the younger population in recent years. This study was planned to determine the knowledge levels and affecting factors about cardiovascular risk factors among students in a faculty of health sciences. Methods: The study was performed between April-May 2013 with the participation of 665 students studying in the Nursing, Nutrition and Dietetics, and Physiotherapy and Rehabilitation departments of the Health sciences Faculty of a university. Data were collected by using the knowledge levels on risk factors related to cardiovascular diseases scale developed by Arıkan et al. Results: The average age of the students was 20.76±1.76, 81.8% were female, 31.7% studied in their 1st year, and 53.1% studied in the nursing department. 31.9% of the students stated that they had knowledge on cardiac risk factors. The average score of the students was 17.86±2.83. The knowledge level of students in their senior years, who had a history of cardiac disease in their families on cardiovascular disease risk factors was found to be higher in a statistically significant manner (p<0.005). Conclusion: In our study, the knowledge levels of the students on cardiovascular disease risk factors are above average. Giving more emphasis in the faculty of health sciences curriculum to the topic of cardiac risk factors and protection methods would increase awareness on the subject. Future members of health care teams educating the public on cardiac risk factors would provide a significant improvement in primary health care services. Keywords: students, cardiac risk factors, health knowledge ÖZET Amaç: Kardiyovasküler hastalıklar dünya çapında ölüm ve hastalıkların en sık nedenleri arasında yer almakta, son yıllarda kardiyovasküler hastalıklar ile ilişkili ölümler genç nüfusta artış göstermektedir. Bu çalışma Sağlık Bilimleri Fakültesi öğrencilerinin kardiyovasküler risk faktörleri bilgi düzeyleri ve etkileyen faktörleri belirlemek amacıyla planlanmıştır. Yöntemler: Çalışma Nisan-Mayıs 2013 tarihleri arasında bir üniversitenin Sağlık Bilimleri Fakültesi Hemşirelik, Beslenme ve Diyetetik, Fizyoterapi ve Rehabilitasyon bölümlerinde öğrenim gören 665 öğrenci ile gerçekleştirildi. Veriler Arıkan ve arkadaşları tarafından geliştirilen Kardiyovasküler hastalıklar ile ilgili risk faktörleri bilgi düzeyi ölçeği kullanılarak toplandı. Verilerin değerlendirilmesinde SPSS 16.0 paket programı kullanıldı. Bulgular: Öğrencilerin yaş ortalaması 20,76±1,76, %81,8'i kadın, %31,7'si 1. sınıf ve %53,1'i hemşirelik bölümü öğrencisidir. Öğrencilerin %31,9'u kardiyak risk faktörleri konusunda bilgi sahibi olduğunu ifade etti. Öğrencilerin ölçek puan ortalamaları 17,86±2,83'tü. Dördüncü sınıfta öğrenim gören ve ailesinde kardiyak hastalık öyküsü bulunan öğrencilerin kardiyovasküler hastalık risk faktörleri bilgi düzeyleri istatistiksel olarak anlamlı düzeyde daha yüksek bulundu (p<0,005). Sonuç: Çalışmamızda öğrencilerin kardiyovasküler hastalıklar risk faktörleri bilgi düzeyleri ortalamanın üzerindedir. Sağlık bilimleri fakültesi müfredat programlarında kardiyak risk faktörleri ve korunma yöntemlerine daha fazla yer verilmesi, bu konudaki farkındalık düzeyini arttıracaktır. Geleceğin sağlık ekibi üyelerinin, toplumu kardiyak risk faktörleri konusunda bilinçlendirilmesi primer sağlık hizmetlerine önemli katkı sağlayacaktır. Anahtar kelimeler: öğrenciler, kardiyak risk faktörleri, sağlık bilgisi Corresponding Author / İletişim için Assist. Prof. Eylem Pasli Gurdogan, PhD Trakya University Faculty of Health Sciences Department of Nursing, 22030, Edirne, Turkey E-mail: [email protected] Date of submission: 25.09.2013 / Date of acceptance: 31.10.2013 79 Pasli Gurdogan E et al. The Knowledge About Cardiovascular Risk Factors Among Students in a Faculty of Health Sciences Introduction Since the occurrence of cardiovascular diseases increases every day and such diseases have become the most common cause of death in the world, protection from such diseases has become a primary goal for health care services (1). In the beginning of the twenty first century, cardiovascular diseases are responsible for nearly half of the deaths in developed countries and 25% in developing countries. It is projected that, by the year 2020, such diseases will cause 25 million deaths every year, and be the primary cause of death in the world (2). According to the Cardiac Diseases and Risk Factors in Turkish Adults Report, cardiovascular diseases are the most common cause of death in our country for both men and women (3). Protection from cardiovascular diseases is a topical, ever increasing and urgent health care necessity (4). In the Prospective Urban Rural Epidemiology study performed by the Turkish Metabolic Syndrome Association, with the effects of social factors on lifestyle and cardiovascular risk factors, and the incidence of these neither chronic nor contagious disease groups are found increasing in our country (1,5). While a decrease in the prevalence of such diseases is observed in developed countries, where primary and secondary precautions to the risk factors of coronary artery disease are applied with diligence, the average prevalence of such diseases is reported to increase for both genders in our country, and it is reported that the changes in the lifestyle of Turkish people have an important effect in this increase (4,6). It is important to determine cardiovascular risk factors, using of primary protection measures for high risk individuals, and using of secondary prevention measures in individuals that are already sick (4,6). Lifestyle changes play an important role in primary and secondary prevention from cardiovascular diseases. Quitting smoking, regular physical activity, having a balanced body weight, and a regular diet are main goals in protection from cardiovascular diseases (7). Nurses, dieticians and physiotherapists, who are all a part of the health care team, have important responsibilities in preventing of cardiovascular or 80 other chronic diseases, delaying the development of such diseases in high risk individuals, and reducing possible complications. Creating public awareness on such diseases, educating healthy and ill individuals, promoting healthy lifestyle habits, and helping with compliance to treatments in case of the disease presenting are among the main responsibilities of the health care team members (4,8). For the health care team members to fulfill those responsibilities, they have to be educated and aware about cardiovascular and other chronic diseases starting from their college years. In the light of these facts, this study was planned to determine the knowledge levels of nursing, nutrition and dietetics, and physiotherapy and rehabilitation students, on cardiovascular risk factors and affecting factors. Methods The study was conducted between April-May 2013 with the participation of 665 students studying in the Nursing, Nutrition and Dietetics, and Physiotherapy and Rehabilitation departments of the health sciences faculty of a university who volunteered for the study. Data were collected by using a 10 item questionnaire developed by the researchers including socio-demographic characteristics, stories of cardiac diseases in the family or the student related to cardiovascular risk factors, smoking status, exercise status, and body mass index (BMI), together with the knowledge level on risk factors related to cardiovascular diseases (CARRF-KL) scale. The CARRF-KL scale was developed and tested for validity and reliability by Arıkan et al. The scale consists of 28 items. While the first four items of the scale regard the properties of cardiovascular diseases, the likelihood of protection, and the age factor, 15 items question the risk factors (items 5, 6, 9, 11, 12, 14, 18, 19, 20, 23, 24, 25, 27, 28), and nine items question the results of changes in risk behavior (items 7, 8, 13, 15, 16, 17, 21, 22, 26).The items in the scale were presented to the participants in a true-false questionnaire composed of full sentences. The participants were asked to answer "Yes", "No", or "I don't know". Every "correct answer" corresponded to 1 point, and every "wrong answer" or "I don't know" Euras J Fam Med 2014; 3(2):79-84 statement corresponded to 0 points. The highest possible score in the scale was 28, and items 11-12-16-17-24-26 were scored so that affirmative answers gave 0 points while negatory answers gave 1 point (reverse coding). The total scores were calculated by giving 1 point to the rest of the affirmative answers. A higher score means a better level of knowledge. Arıkan et al found the Cronbach alpha value of the scale to be 0.76 (9). In this study the Cronbach alpha value was found to be 0.70. Data were evaluated with the SPSS 16.0 program using percentages, average values, student’s t-tests, and one way analysis of variance (ANOVA). In order to compare significance of differences between groups, the Bonferroni multiple comparison test was used. Results The mean age of the students participating in the study was 20.76±1.76 (min: 18, max: 32). Among the participants, 81.8% were female, 31.7% were freshmen and 53.1 % were studying in the department of nursing. It was determined that 91.6% of the students do not smoke, 56.4% do not exercise regularly and 74.3 % have a normal weight according to BMI, 31.9% of the students have a family history of cardiac disease and 58.9% reported that they knew the risk factors associated with cardiovascular diseases (Table 1). There were significant differences according to the grade that the students are studying (p=0.003), having a history of cardiac disease (p=0.013), Table 1. Descriptive Characteristics and Comparison of the CARRF-KL Mean Scores (n=665) Features Gender Female Male Grade 1st 2nd 3rd 4th Department Nursing Nutrition and Dietetics Physiotherapy and Rehabilitation Smoking Status Smoking Not smoking Exercise status Exercises Does not exercise BMI Thin Normal weight Slightly overweight Family history of chronic disease Present None History of chronic disease Present None Knowing cardiac risk factors Yes No Partially n (%) CARRF-KL Mean ± SD p 544 (81.8) 121 (18.2) 17.79 ± 2.92 18.14 ± 2.39 0.23* 211 178 176 100 (31.7) (26.8) (26.5) (15.0) 17.32 ± 2.47 17.87 ± 3.12 18.14 ± 2.76 18.47 ± 2.98 353 (53.1) 178 (26.8) 134 (20.2) 17.64 ± 3.33 18.21 ± 1.85 17.95 ± .41 56 (8.4) 609 (91.6) 17.64 ± 2.88 17.88 ± 2.83 0.55* 290 (43.6) 375 (56.4) 17.80 ± 2.95 17.90 ± 2.75 0.671* 90 (13.5) 494 (74.3) 81 (12.2) 18.04 ± 3.07 17.92 ± 2.77 17.25 ± 2.90 212 (31.9) 453 (68.1) 18.25 ± 2.50 17.67 ± 2.96 59 (8.9) 606 (91.1) 18.52 ± 1.89 17.79 ± 2.90 392 (58.9) 44 (6.6) 229 (34.4) 18.32 ± 2.61 15.795 ± 3.55 17.46 ± 2.83 0.003** 0.079** 0.118** 0.013* 0.06* <0.001** * Student’s t-test, ** One-Way ANOVA 81 Pasli Gurdogan E et al. The Knowledge About Cardiovascular Risk Factors Among Students in a Faculty of Health Sciences knowing the cardiovascular risk factors (p<0.001), and the mean CARRF-KL scores. According to this study, the CARRF-KL scores of the 4th grade students were higher than the other grades and scores of the students with a history of cardiac disease in the family were higher than the students who do not have a family history of cardiac disease. Scores of the students who know the cardiac risk factors were also higher than those who does not know the risks. In this study, a significant difference was not found in mean CARRF-KL scores according to gender, department, smoking status, exercising, BMI, and presence of chronic diseases among the students (Table 1). The mean CARRF-KL score of the students was found to be 17.86±2.83 (Table 2). CARRF-KL total scores range was between 4 and 22. Discussion The mean CARRF-KL score of the students was found to be 17.86 ± 2.83. Arikan et al. reported in their study which recruited medical staff that the mean score obtained from the scale was 19.3±3.2. Tan et al. carried out with rural women that the mean score obtained from the scale was 13.05±6.93 (9, 10). Hacıalioğlu at al. (11) carried out with collage students, the knowledge of cardiac risk factors was at medium level. In another study carried out with high school students, it was determined that 55.6% had a medium level of knowledge regarding cardiac risk factors (12). It can be stated that those studying in health-related areas have a high level of knowledge of cardiovascular risk factors. This study showed that the CARRF-KL scale scores increases while the students’ grade increases too. This study releaved that CARRF-KL scale scores of fourth grade students were higher than other students. In a study evaluating the level of knowledge of cardiovascular risk factors which was carried out with collage students, the senior students had higher levels of knowledge than the first grade students (11). This shows the importance of education in enhancing the level of knowledge of cardiovascular risk factors. In our study, the CARRF-KL scale scores of the students who had a family history of cardiac disease were significantly higher than the students who did not have a family history of cardiac disease. Tan et al. stated in a study that was conducted with women that CARRF-KL scale scores of the women who had a history of cardiac disease in the family were higher (10). Similarly, in another study including medical staff, it is found that people who had a family history of cardiac disease had higher CARRF-KL scale scores (9). Having a history of cardiac disease increases the level of knowledge of risks for other members of the family. In our study, CARRF-KL scale scores of the students with a chronic disease were higher than those without a chronic disease, but the difference was not statistically significant. In a study conducted on patients with heart disease, patients identified very low levels of cardiovascular risk factors (13). It is expected that the interest in and awareness of people regarding chronic diseases should increase. In this study, CARRF-KL scale scores of the students who knew about cardiovascular risk factors were found to be higher than those who did not know and those who knew partially. In a study carried out with medical students, it was stated that 41.7 % of the students in the early years of education have knowledge about the risk factors of cardiovascular diseases and also stated that this score is declined to 13.6% in the last year of education (14). This can be explained with the education of the students who study health sciences and therefore having a high level of knowledge about this subject. Clinical nutrition and healthy eating habits play an important role on primary and secondary prevention of cardiovascular disease (15). Responsibilities and duties of dietitians are becoming more and more important each day on the treatment and prevention of cardiovascular diseases. Although there was no significant difference between the Table 2. Distribution of CARRF-KL Mean Scores Scale CARRF-KL 82 Possible maximum and Maximum and minimum minimum scores scores in our study 0-28 4-22 Mean ± SD Cronbach’s Alpha 17.86 ±2 .83 0.70 Euras J Fam Med 2014; 3(2):79-84 department of the students which they study and their CARRF-KL scores, the CARRF-KL scale scores of nutrition and dietetics department students were higher. This situation can be explained by the training about nutrition and exercise of Nutrition and Dietetics students that they have taken during their education. In many industrialized countries, total calorie intake continues to increase while physical activity decreases and this causes the obesity epidemic. Obesity increases cardiovascular risk alone due to the structural changes that obesity cause on the heart. The trends that cause obesity are increasing while noticeable improvements happen on other risky behaviors and risk factors such as smoking (2, 16). In our study, 74.3% of the students had a normal weight. Although there was a significant difference, the students in the thin group had higher scores on the scale of CARRF-KL. In a study, it was expressed that there was no difference between the scores of the CARRF-KL and body mass index (10). Most of the known risk factors for cardiovascular disease can be arranged with the primary prevention before the disease occurs. Preventing approaches such as nonsmoking and in case of smoking, quitting are among the aims of cardiovascular protection (17). In this study, no significant difference was found between smoking status and CARRF-KL scale scores. In a study, women who smoked had higher scores on the scale of CARRF-KL (10). 91.6% of the students who participated in the study were not smoking. In the study carried out by Hacıalioğlu et. al. (11) 79.3% of the students were not smoking. Non-smoking is important for reducing the cardiovascular risk factors. In the last few years, policy on the restriction of smoking places in our country can be considered to be effective on reducing tobacco use. Conclusion In our study, the knowledge level of students about cardiovascular risk factors was found to be above the average. This study showed that the grade in which the students trained, the presence of cardiac disease in the family, and the status of knowing cardiovascular risk factors increases the level of knowledge in a positive way. Cardiovascular disease is a disease group with high mortality and morbidity. Prevention from these diseases may be possible by fighting against the risk factors. Physicians, nurses, dietitians, physical therapists, who are members of the medical care team, play an important role on achieving and developing healthy life style habits such as healthy nutrition, quitting smoking and exercise behaviors within the society. Training programs to increase the level of awareness of cardiac risk factors can be recommended to medical care professionals working in primary health care. References 1. Canpolat U, Tokgözoğlu L. Cardiovascular protection: what did happen in 2010? [in Turkish]. Türk Kardiyoloji Seminerleri 2011;11(1):115-26. 2. Gaziano JM. Kardiyovasküler hastalığın global morbiditesi [Global burden of cardiovascular disease]. In: Aslanger E, Şirinoğlu I, editors. Braunwald kalp hastalıkları [Braunwald’s heart disease a textbook of cardiovascular medicine]. Istanbul (Turkey): Nobel Tıp Kitabevleri; c2007. p. 1-19. Turkish. 3. Onat A, Aydın M, Köroğlu B, Örnek E, Altay S, Çelik E, et al. TARF Survey 2011: mortality and performance in the long-term follow-up [in Turkish]. Türk Kardiyol Dern Arş 2012;40(50):117-21. 4. Türkmen E, Badır A, Ergün A. Coronary artery diseases risk factors: role of nurses on primary and secondary prevention [in Turkish]. ACU Sağlık Bil Derg 2012;3(4):223-31. 5. Teo K, Chow CK, Vaz M, Rangarajan S, Yusuf S. The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries. Am Heart J 2009;158(1):1-7. 83 Pasli Gurdogan E et al. The Knowledge About Cardiovascular Risk Factors Among Students in a Faculty of Health Sciences 6. Onat A, Ugur M, Cicek G, Ayhan E, Dogan Y, Kaya H, et al. The Turkish adult risk factor survey 2009: similar cardiovascular mortality in rural and urban areas [in Turkish]. Turk Kardiyol Dern Ars 2010;38(3):159-63. 7. Teyyareci Y, Aytekin S. Diettary patterns in primary and secondary prevention of cardiovascular disease [in Turkish]. Turkiye Klinikleri J Cardiol-Special Topics 2010;3(2):10-8. 8. International Council of Nurses (CH). Delivering quality, serving communities: nurses leading chronic care. International Nurses Day 2010. Geneva: ICN;2010. 9. Arıkan İ, Metintaş S, Kalyoncu C, Yıldız Z. The cardiovascular disease risk factors knowledge level (CARRF-KL) scale: a validity and reliability study. Türk Kardiyol Dern Arş 2009;37(1):35-40. 84 10. Tan M, Dayapoğlu N, Şahin ZA, Cürcani M, Polat H. Determining cardiovascular disease risk factors knowledge level of women living in rural area [in Turkish]. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2013;2(3):331-41. 11. Hacıalioğlu G, Mert N, Deniz S, Orak E. The investigation of awareness of the students of a private university about myocardial infarction risk factors [in Turkish]. I.U.F.N. Hem Derg 2011;19(2):99-104. 12. Yadav KD, Wagle RR. Knowldge and attitude regarding major risk factors of cardiovascular diseases among 15-19 years old students of Kathmandu district. Health Prospect 2012;11(1):7-10. 13. Momtahan K, Berkman J, Sellick J, Kearns SA, Lauzon N. Patients’ understanding of cardiac risk factors: a 14. 15. 16. 17. point-prevalence study. J Cardiovasc Nurs 2004;19(1):13-20. Reiner Z, Sonicki Z, Reiner ET. The perception and knowledge of cardiovascular risk factors among medical students. Croat Med J 2012;53(3):278-84. Stone NJ. Diet and nutritional issues. Ulker T, Yuksel A, Talay M (Eds.). In: Textbook of cardiovascular medicine. 3th ed. Philadelphia: Lippincott Williams&Wilkins; 2007:13-26. Samur G, Yıldız E. Obezite ve kardiyovasküler hastalıklar/hipertansiyon. Ankara: Klasmat Matbaacılık, 2008. Türkmen E, Güven GS. Principles of primary prevention of cardiovascular diseases [in Turkish]. Hacettepe Tıp Dergisi, 2010;41(3):179-85.