Risk Behaviours of Cardiovascular Diseases Study

Title of the Study

To identify the prevalence of ineffective physical activity and unhealthy dietary pattern among MSc Nursing students; could lead to cardiovascular diseases.

Significance of the Research Problem

Global Burden of Cardio Vascular Diseases:

There are many risk factors associated with coronary heart disease. Some risk factors such as age, ethnicity and family history, cannot be changed. Additional risk factors that can be treated or changed which include tobacco exposure, hypertension, high cholesterol, obesity, physical inactivity, diabetes, unhealthy diets, and harmful use of alcohol. In terms of attribute global deaths, the leading CVD risk factor is raised blood pressure 13%, tobacco use 9%, raised blood glucose 6%, physical inactivity 6 % and overweight and obesity 5% (World Health Organization, 2012).

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Low- and middle-income countries are disproportionally affected: over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women (Mendis, Puska & Norving, 2011). The number of people, who die from CVDs, mainly from heart disease and stroke, will increase to reach 23.3 million by 2030 (Mendis, Puska & Norving, 2011). Most cardiovascular diseases can be prevented by addressing risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, high blood pressure, diabetes and raised lipids.

Cardiovascular diseases and Ineffective physical activity:

Insufficient physical activity is the fourth leading risk factor for mortality. People who are insufficiently physically active have a 20 to 30 percent increased risk of all-cause mortality compared to those who engage in at least 30 minutes of moderate intensity physical activity most days of the week. In 2008, 31.3% of adults aged 15 or older (28.2% men and 34.4%) were insufficiently physically active.

Cardiovascular diseases and unhealthy dietary patterns:

Approximately 16 million and 1.7 million of deaths worldwide are attributing to low fruit and vegetable consumption (Mendis, Puska & Norving, 2011). Frequent consumption of high-energy foods, such as processed foods that are high in fat and sugar, promotes obesity compared to low-energy foods. Adequate consumption of fruit and vegetables reduces the risk of Cardio Vascular Disease. A healthy diet can contribute to a healthy body weight, a desirable lipid profile and a desirable blood pressure (Mendis, Puska & Norving, 2011).

Risk Behaviors

The vulnerable populations of MSc Nursing students are at high risk of developing such risky behaviors that might endanger their own lives. Although, the above behaviors are modifiable but due to shortage of time and increase load of studies, students are seems careless of their diets and physical activity.

Purpose

The purpose of this study is to look for the two main risk behaviors of cardio vascular diseases among MSc Nursing students. These are:

• Ineffective physical exercise.
• Unhealthy diet.

Research Questions

1. What is the prevalence of ineffective physical activity among MSc Nursing students?
2. What is the Prevalence of unhealthy dietary pattern among MSc Nursing students?

Target Population

The target population for this study would be the existing students of, Masters of Science in Nursing of the Aga Khan University, Karachi, Pakistan.

Study Design

This would be a descriptive cross sectional study design.

Key Study Variables

The key variables of the study would be ineffective physical activity and unhealthy diet.

Operational Definitions of the Study Variables

Ineffective Physical Activity

Ineffective physical activity can be defined as ‘less than five times 30 minutes of moderate*activity per week, or less than three times 20 minutes of vigorous activity** per week, or equivalent(Mendis, Puska & Norving, 2011).

*Moderate activity level

Your heart beats faster than normal; you can talk but not sing. Examples include fast walking, aerobics class, doing weights, or swimming gently.

**Vigorous activity level

Your heart beat increases a lot; you can’t talk or your talk is broken up by large breaths.

Examples include jogging, running, basketball, or hiking up a steep hill (World Heart Federation Organization, 2014).

Unhealthy Diet:

High dietary intakes of saturated fat*, trans-fats** and salt, and low intake of fruits, vegetables and fish (white meat) are linked to cardiovascular risk (Mendis, Puska & Norving, 2011).

• *Saturated fats found primarily in animal sources including red meat and whole milk dairy products.
• **Trans fats found in vegetable shortenings, some margarines, crackers, candies, cookies, snack foods, fried foods, baked goods, and other processed foods made with partially hydrogenated vegetable oils (World Heart Federation Organization, 2014).

Hypothesis

1. There is a prevalence of unhealthy diet among MScN students.
2. There is a prevalence of ineffective physical activity among MScN students.

Description of the Questionnaire

A questionnaire is formulated to test the hypothesis under the light of the research question. The questionnaire comprises of the following three parts.

Demographic information:

The first part addresses the basic demographic information. The aim of acquiring the demographic information from the participants is to gather a baseline data about the key characteristics of the sample. Moreover demographic variables will be needed to assess the similarities and differences between the participants and characterize them accordingly.

A total of 6 items are included in this section. The demographic characteristics included in the questionnaire comprises of name which is kept optional. The other components of this part include age, gender, ethnicity, family history related to (angina, stroke, diabetes, and kidney disorder), use of any medications, language, and family relationships. We make this form with the help of available literature and exclude other points like education level, because it is already known from sample.

Physical Activity

The second part consists of 12 items modified and derived from the Healthy heart questionnaire, which develops by Colorado Public Health Research. We modified it according to the developing country life style. We adopt the pattern of multiple choice and nominal scale for clarification of analysis (Colorado Public Health Research, 2010). For fulfilling the purpose we include the questions related to WHO definitions and for making user friendly, we have given the conceptual definition of the moderate, light and vigorous exercises in easy English words, and these definitions are also derived from American Heart Association guidelines.

Dietary Pattern

The third part of the questionnaire comprises questions related to dietary pattern. These questions are derived and modified from American Heart Association and American Nutrition guidelines. The scale includes; more than once a day, about once a day, 2-3 times a week, about once a week, 1-3 times a month, and less than once a month, for accuracy of the data of the nutritional status (Colorado Public Health Research 2010).

Assumptions underlying the Statistical tests to be used

The analysis of the data would be done through available valid statistical software like SPSS 19.0. For the purpose of analyzing the data three statistical tests would be applied in order to measure different levels of association between the key variables. The demographic information would be presented through descriptive statistical analysis (Beitz, 2008). This would include measures of central tendency like (mean, median and mode) to describe the overall demographic characteristics of the study population. Apart from the measures of central tendency, percent analysis (Beitz, 2008) would be used to determine the presence and overall prevalence of ineffective physical activity among study participants. Also percent analysis would be used to determine the unhealthy dietary pattern. In order to determine the association between various demographic variables like age, gender, height and weight of sample size individuals, univariate analysis would be used while determining that the observations would be independent of each other. Population is normally distributed and assuming the homogeneity among the population variances (Bluman, 2011). Moreover, Pearson correlation analysis would be used to examine the strength and nature (positive, negative, inverse, none) of 2 variables of cardio vascular disease. With unhealthy dietary habit, keeping in mind the four assumptions of correlation i.e. the variables should be measured in interval and ratio scale, variables should have a linear relationship between the two, there, all significant outliers should be predicted and removed and the variables should be approximately normally distributed (Beitz, 2008).

Effectiveness and Correctness of the Tool

Pre –testing of the tool

In order to test the effectiveness and correctness of the tool, the tool was pilot tested among three fellows from the MScN students from our class. The tool was distributed for filling the form. The feedback which was received from fellows is quite helpful .While testing the questionnaire; we identified a few components that needed to be modified. Firstly, they identified that in dietary pattern, if we add the instruction that tick the examples mention in bullets so it would be helpful to analyze that which type of ingredient is more common in our population. Secondly they suggest that the BMI should be added in the questionnaire with that feedback we respond that we asked in our questionnaire about weight and height which is equivalent to BMI therefore it was not added in the questionnaire. The feedback was taken as a positive critical reflection and first advice would be incorporated in the final questionnaire for the study purpose.

Reflection

Overall the questionnaire development was a stimulating and challenging task. The process of questionnaire development in itself is quite difficult as it requires researchers to critically analyze the hypothesis and research questions and formulate such questions that fulfill the overall inquiry of the subject understudy while excluding the unnecessary those details which are not suitable for developing country.

In conclusion, the tool development task was a vigorous exercise that would help us to develop an effective tool for our thesis in particular. The pilot testing was an effective strategy to be kept in mind while developing the final tool.

Acknowledgement

We would like to thank Dr. Raisa Gul and Ms. Yasmin Parpio for their valuable support and guidance throughout the process of the questionnaire development. We would also like to acknowledge and thank all the three study participants who co-operated with us and provided us their valuable time and required data to test the questionnaire.