Awareness, Knowledge & Health-lifestyle Behaviors Related To Coronary Heart Disease In Working Women In Singapore – A Descriptive Study Hadassah Joann Ramachandran
CHD in Women GLOBALLY:
§  Coronary Heart Disease (CHD) is the leading cause of death in women,
globally (WHO, 2013)
SINGAPORE:
§  1 in 3 women die of cardiovascular disease
(SHF, 2015)
A LIFESTYLE DISEASE:
§  Modification of CHD risk factors requires a change in lifestyle
behaviors informed by knowledge (Hammond et al., 2007; Reiner, 2008)
§  Personal risk perception
(Alm-Roijer, Stagmo, Udén & Erhardt, 2004; Cubbin & Winkleby,
2005; Meischke et al., 2000; Xhyheri & Bugiardini, 2010) §  Awareness & knowledge linked to risk perceptions - fundamental prerequisite for health behavior change (Alm-Roijer et al., 2006; Khavjou, Finkelstein, Farris,
R & Will, 2009; Powers et al., 2011) Aims & Objectives
THE AIM: Investigate the awareness, knowledge and health-lifestyle behaviors
related to CHD among working women, aged 21 to 65 years, in Singapore. THE OBJECTIVES:
§  Investigate the awareness of the prevalence of CHD among working women
in Singapore
§  Investigate the knowledge of the risk factors related to CHD in working
women in Singapore
§  Explore relationships between awareness, knowledge and health-lifestyle
behavior related to CHD in working women in Singapore.
§  Determine the demographic variations with respect to the above mentioned
variables
§  Identify predictors of health-lifestyle behavior related to CHD among working
women in Singapore
Methodology STUDY
DESIGN
A cross-sectional
descriptive design SETTING &
SAMPLE
- A quota sample
of 200 working
women in a
tertiary
university in
Singapore
-  40 (ad-hoc)
-  60 (administrative)
-  100 (faculty) Inclusion Criteria:
(1) working full-time
(2) aged 21 to 65 y/o
(3) fluency in the English
(4) no history of CHD Exclusion Criteria:
(1) employed in healthrelated departments or
environments (2) Prior or current
mental disabilities
Sample size calculation:
Logistic Regression’s Rule of thumb (min.160)
Methodology DATA
COLLECTION
- Structured
written
questionnaire
which included 4
sections
- Invitational
Email for faculty
DATA
ANALYSIS
- IBM SPSS 22.0 - Descriptive &
Inferential
statistics
ETHICAL
ISSUES
- Institutional
Review Board
- Participant
Information
Sheet
- Anonymity &
Confidentiality
Outcome Measures AWARENESS
5 factual questions replicated from American Heart
Association and the Singapore Heart Foundation’s Go
Red for Women 2013 survey KNOWLEDGE
§  25-item Heart Disease Fact questionnaire-2 (HDFQ-2)
& 2 questions from AHA
§  Cronbach’s alpha = 0.86
§  17 questions from the core component of the Behavioral Risk
Factor Surveillance System (BRFSS) Questionnaire §  Content validity = 0.92
§  Cronbach’s alpha = 0.621
HEALTHLIFESTYLE
BEHAVIOR
Awareness Question: CHD is the leading cause of death in Women
False
53%
True
47%
Awareness Greatest Health Problem in Women
Cervical
Cancer
12%
Breast Cancer
32%
Diabetes
2%
Cancer
(generally)
44%
Heart Disease/
Heart attack
10%
Awareness Sources of Information Regarding CHD
Internet
20.5%
Magazine/
Brochures/
Pamphlets
23.0%
Newspaper
33.0%
Radio
8.0%
Healthcare
Professionals
11.5%
Friend/Relative
19.5%
Television
23.5%
Library Others
2.5%
0.5%
Posters/Public
Area
9.0%
Knowledge §  Knowledge scores ranged from 0 to 26; mean = 17.7 (SD = 5.6)
Knowledge of specific CHD risk factors measured by HDFQ-2
100% 80% 60% 40% 20% 0% 88.0%
87.5%
87.0%
86.0%
83.5%
71.5%
62.5%
49.5%
39.0%
Knowledge Incomplete knowledge regarding certain risk factors: §  Smoking as a risk factor (86%)
v  Only 62% knew that stopping smoking lowers risk for CHD development
§  High cholesterol as a risk factor (88%)
v  79% were aware that fatty foods affect blood cholesterol levels
v  57% knew effects of HDL
v  69% knew effects of LDL
§  Diabetes as a risk factor (62.5%) v  70.5% identified that weight control reduces risk in people with diabetes
v  21.5% recognized the inverse relationship between HDL and diabetes
Health-lifestyle Behavior Blood pressure & blood cholesterol screening behavior, as
measured by BRFSS
80%
% of behavior
70%
60%
50%
74.0%
58.5%
40%
Not Screened
30%
20%
26.0%
41.5%
10%
0%
Screened
Blood Pressure
Blood Cholesterol
Health-lifestyle Behavior % of behavior
Tobacco use, as measured by BRFSS
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
91.5%
Never/Former
smoker
Current smoker
8.5%
Tobacco Use
Health-lifestyle Behavior % of behavior
Alcohol consumption, as measured by BRFSS
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
86.5%
Non/Moderate
drinker
Binge drinker
13.5%
Alcohol Consumtption
Health-lifestyle Behavior % of behavior
Alcohol consumption, as measured by BRFSS
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
86.5%
Non/Moderate
drinker
Binge drinker
13.5%
Alcohol Consumtption
Health-lifestyle Behavior Physical activity, as measured by BRFSS
70%
% of behavior
60%
64.5%
50%
40%
30%
20%
Physically active
35.5%
10%
0%
Physical Activity
Physically inactive
Health-lifestyle Behavior Statistically significant differences among socio-demographic subgroups
BRFSS blood pressure, blood cholesterol screening, tobacco use & alcohol
consumption:
§  Age & marital status
As compared to their counterpart subgroups:
v  21 – 34 years old and those unmarried sig. less likely to have blood pressure and blood
cholesterol screened v  21 – 34 years old and those unmarried sig. more likely to be current smokers and binge
drinkers
BRFSS physical activity:
§  Ethnicity & income level
As compared to their counterpart subgroups:
v  Malays and those with incomes < $1500 were sig. less likely to be physically active
Study Limitations §  Cross-sectional study design; single site study
§  Non-random quota sampling
§  Self-reported data à social desirability and recall bias
§  English speaking participants
§  Did not consider obesity, diet and blood sugar screening behavior
Study Implications Clinical Practice:
§  Opportunity for healthcare providers to be more proactive
§  Consider populations at risk and less likely to engage in HLB
§  Targeted education on primary & secondary preventive measures
Public Health Initiatives:
§  Age-specific, gender-sensitive §  Social determinants of health
Future Research Recommendations:
§  Structural inequalities in healthcare delivery system in SG context
§  Longitudinal studies on large sample sizes that objectively measure HLB
v  Role of cultural beliefs, age-specific cut-off points Conclusion •  Women need to be educated to the point that CHD kills.
•  Targeting subgroups in the population at risk
•  Greater engagement of women REFERENCES
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