INTRODUCTION:

Cardiovascular disease is a major cause of mortality and disability despite widespread efforts to control cardiac risk factors through diet, exercise, and medications. Though death rates due to cardiovascular disease (CVD) declined 30.6% between 1998 and 2008, in 2008, 82.6 million U.S. citizens had CVD and 811,900 died from it, its associated direct and indirect costs totaled $297.7 billion.

In 2009, 416,000 underwent coronary artery bypass graft (CABG) surgery and 596,000 received percutaneous coronary interventions (PCIs).¹

The morbidity and mortality of cardiovascular diseases is high in the developed countries. The lifestyle changes are capable to decrease it by 50 %²,It has outgrown the boundaries of gender, location of dwelling etc.³

A recent study which analyzed all major world ethnic groups in relation to heart disease found that Indians have the highest risk of coronary heart disease, with rates three to four times higher than Americans, six times more than the Chinese and 20 times more than the Japanese. In North India, 7–10% of people have coronary heart disease while the prevalence is as high as 14% in South India.⁴

Nursing education of Steinhard school of education of education New York University advices nurses to focus on evidence based strategies designed to promote cardiovascular disease in children and adolescents and reduce the risk and burden of cardio vascular disease in adult life. Health education is the social responsibility of each health professionals and each contact of the health personal to the general public should be health informative⁵

Review of literature:

Bayne Smith M etal., (2004), Testing was conducted before and after 12 weeks programe of vigerous exercise integrated with lectures and discussion on diet ,exercise, stress and smoking. Result showed a benefical effect on the health knowledge and health behavior to reduce to the risk of C V D.⁶

Fathima L (2004) conducted a study among 30 cardiac patients to assess the effectiveness of structured teaching programme on knowledge regarding the risk factors of cardiovascular diseases among adults in India. The result of the study showed that the post test knowledge scores about the risk factors of the condition were from 38% of pre test knowledge scores to 76.8% among the study group. The study concluded that structured teaching programme was effective in improving the knowledge about risk factors of cardiovascular diseases among adults⁷

Vishwanath Iyer (2008) conducted a study among 60 cardiac patients to assess the effectiveness of structured teaching programme on knowledge regarding prevention of cardiovaspost test knowledge scores about the preventive measures of the condition was from 34.[5] 5% of pre test knowledge scores to 79.3% among the study group. The study concluded that structured teaching programme was effective in improving the knowledge about preventive measures of cardiovascular diseases among adolescents.⁷

This study was conducted by Shahamfar (2010) to the effect of a teaching program on patients with myocardial infarction by modification of risk factors or behavior changes: 100 patients out of those who admitted to the CCU ward of Shahyd Madani Heart Hospital from January to September, 2004 were assigned to a teaching group and 50 to a control group. An individualized teaching program was delivered to the teaching group during the hospitalization period. After discharge they received educational package for 6 month. The lifestyle and risk factors of patients as smoking, blood pressure, pulse, blood lipid profile, BMI waist hip ratio (WHR) were measured before and after the teaching program. Initially, there was no significant difference in the number of non-smokes. After post testing the result revealed that the number of non smokers had significantly increased in teaching group from 66% to 90.1%⁸.

Nidal F. Eshah etal., (2010) conducted a study to evaluate the effectiveness of an education, counseling and behavioral skill-building program in Jordanian working adults' knowledge, attitudes, and beliefs about CHD and adoption of a healthy lifestyle. One hundred six subjects completed the posttest questionnaires. Experimental group showed significantly better cardiac related knowledge, better scores for attitudes, and better scores for the health responsibility, nutritional behaviors, interpersonal relationships and total HPLP-II score. Subject's beliefs, physical activity, spiritual growth and stress management were not improved significantly. Men had better scores in beliefs and women had better scores for health responsibility.⁹

Jafar Shahamfar etal., (2010), This study was conducted to the effect of a teaching program on patients with myocardial infarction by modification of risk factors or behavior changes: 100 patients out of those who admitted to the CCU ward of Shahyd Madani Heart Hospital from January to September, 2004 were assigned to a teaching group and 50 to a control group Initially, there was no significant difference in the number of non-smokes. After post testing the result revealed that the number of non smokers had significanty increased in teaching group from 66% to 90.1%. The number of patients, who exercised, significantly increases after teaching program from 30% to 88%¹⁰.

As per Norfidah Mohamad etal., ( 2012) the aim of this study is to assess the effectiveness of health education program on knowledge of coronary heart disease (CHD) among public in Puncak Alam, Selangor. This research proved general knowledge of public at an acceptable knowledge during pre-test and increase to a good level of knowledge in post-test after giving health education.¹¹

Loai I. Tawalbeh, Muayyad M. Ahmad (2013), the purpose of this study was to test the effect of cardiac educational program on the level of knowledge and adherence to healthy lifestyle among patients with coronary artery disease in the north of Jordan. Pretest–posttest design was used. The results showed that the change in the mean knowledge scores (10.50), p < .01 was statistically significant 1 month after the application of the program. In addition, the change in the mean adherence to healthy lifestyle scores (33.30), p < .01 was statistically significant 1 month after the application of the cardiac educational program. Implementing cardiac educational programs help enhance knowledge and adherence to healthy lifestyle among patients with coronary artery disease in north of Jordan.¹²

According to Richard J Melamed etal., (2014) evaluated, disease-specific education and treatment program for patients with coronary heart disease (CHD) in Germany. The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week (MET=metabolic equivalent of task), compared to 2.5 MET/week in the control group; the difference of 6.8 MET/week was statistically significant (p = 0.015). The patients in the intervention group also rated their quality of life higher than those in the control group (0.2 ± 0.56 vs. 0.09 ± 0.53 [mean ± standard deviation], p = 0.056). They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency.¹³

Solmaz Aminpour (2014) conducted to study and assess lifestyle behavior in selected cases of Coronary Heart Disease (CHD) patients in Iran. Hundred patients were randomly selected among patients with first attack of Myocardial Infarction, who admitted to the CCU ward of Madani Heart Hospital from January to September, 2011. Fifty were assigned to a teaching group and the other fifty to a control group. Initially there was no significant difference in the number of nonsmokers. After post testing the results revealed that the number of non-smokers had significantly increased in teaching group from 66% to 90.1% (CI95% 0.55-0.81 vs. 0.82-0.98)¹⁴

More Ujwala Ramchandra etal., (2015) conducted evaluative study on 30 adult of Kale rural population by using interview schedule method.and found that there was deficit in knowledge about coronary Artery Disease among adults during pre test percentage (46.17%), and post test knowledge percentage (70 %), and actual gain score was 23.83 The mean post – test knowledge score was found to be significantly higher than the pre test score that the gain in knowledge score is statistically significant P value.¹⁵

Gabriela Lima de Melo Ghisio (2015) conducted an observational study, a convenience sample of new CR patients was approached at 3 programs to complete a survey. It consisted of socio demographic items, heart-health behavior surveys, and the CADE-Q. Patients were provided a similar survey 6 months later. 214 patients completed the CADE-Q at both points, with scores demonstrating "acceptable" to "good" knowledge. Higher knowledge at CR entry was significantly associated with greater education, being married, greater English-language proficiency, and history of percutaneous coronary intervention (p≤0.05). The 118 (55.1%) patients that completed CR demonstrated significantly higher knowledge than non-enrollees at post-test (p≤0.05). ¹⁶

Muayyad Ahmad1, LoaiTawalbeh (2015) reported that the purpose of this study was to explore the educational intervention for patients with CAD at the north of Jordan toward healthy lifestyle. Pretest-posttest design was used. A convenience sample of 84 patients with coronary artery disease was recruited from the cardiac clinic in a large educational hospital in Jordan. The results showed that the mean of knowledge was 8.7 and for adherence was 27.3 to healthy lifestyle among patients with CAD. Findings showed a significant improvement in the knowledge and adherence after implementing the educational program.¹⁷

Samjhana Shrestha etal., (2016 ) reported that ‘t’ value was higher than the table value which shows that it was statistically significant (p <0.05,so the intervention was very effective. The obtained correlation coefficient t value was 0.580 which showed there was positive correlation knowledge and practicing healthy life style pratices for the prevention of cardiovascular diseases. Thus the study concluded that awareness package was effective in improving knowledge and attitude regarding healthy lifestyle practices for the prevention cardiovascular diseases. ¹⁸

Methodology:

Research approach adopted was experimental type and research design,pre-experimental(one group pre-test post-test design) as under.

0₁(Day1)	Planned Teaching Programme	0₂ (Day7)
(Pre-test)	x	(Post-test)

Independent variable refers to planned teaching programme and dependent variable refers to knowledge of the drivers before and after the planned teaching programme.T hirty drivers working in Sree Vidyanikethan Educational Trust (SVET), at A. Rangampet, Chandragiri Mandal, Chittoor(District), were selected as study sample. Sampling technique was non-probability convenience sampling technique. For data collection structured knowledge questionnaire was used The tool was divided into two parts. Part I deals with demographic data and Part II deals with knowledge questionnaire.

Development of tool:

The tool was developed through extensive review of books, journals, published and unpublished articles and report suggestions. The tool was divided into of two parts.

Part – I: demographic data (7 items); Part II – structured knowledge questionnaire (30 multiple choice items). Each correct response carried 1 mark and incorrect response 0 marks. The total score was 30 and minimum score was 0.

Data collection method:

Formal permission was obtained. Main study was conducted 12-19 March, 2016. pre test was conducted on day 1 on 12 March 2016 and drivers took about 15-20 minutes to answer the questions. This was followed by planned teaching programme. Post test was conducted on day 7 on 19 March 2016.

Data analysis:

The demographic profile of the drivers was, out of 30 subjects, majority were belongs to above 45 years age group (60%) followed by 36-45 years (23%), belongs to Hindu (76.7%), with secondary education (46.7%), followed by primary education (30%), getting Rs.5000-10,000/- income per month (53.3%) and Rs.11000-15000/- (46.7%) income per month, from nuclear family (56.7%), 100% were nonvegetarians, smokers(70%) followed by alcoholics(30%).

Frequency and percentage distribution of level of knowledge regarding life style modifications to prevent cardiovascular diseases in pre test

Table- 1. Frequency and percentage distribution of level of knowledge regarding life style modifications to prevent cardiovascular diseases in pre test.

S. NO	LEVEL OF KNOWLEDGE	FREQUENCY	PERCENTAGE
1	In adequate	17	56.66%
2	Moderate	12	40%
3	Adequate	01	3.34%

Table 1 shows in pre test out of 30 drivers 17 (56.66%) of them had inadequate knowledge, 12 (40%) of them had moderate and 1 (3.33%) had adequate knowledge.

Frequency and percentage distribution of level of knowledge regarding life style modifications to prevent cardiovascular diseases in post test.

Table-2. Frequency and percentage distribution of level of knowledge regarding life style modifications to prevent cardiovascular diseases in post test.

S.NO	LEVEL OF KNOWLEDGE	FREQUENCY	PERCENTAGE
1	Inadequate	0	0%
2	Moderate	04	13.33%
3	Adequate	26	86.67%

Table 2 shows in post test out of 30 drivers none (0%) of them had inadequate knowledge, 4 (13.33%) of them had moderate and 26 (86.67%) of them had adequate knowledge regarding life style modifications which indicates that the level of knowledge was increased.

Mean, standard deviation and paired‘t’ value regarding effect of structured teaching programme between pre and post tests

Table 3 shows that the pre-test Mean value was 9.6 with standard deviation of 3.8 and C.V = 0.0384.

The post-test Mean value was 19.1 with standard deviation of 3.7 and C.V was 0.729. Further Paired ‘t’ value was 1.01836 which is acceptable and statistically significant. The findings indicate that the difference between the post test score and pre test scores was a true difference and not by chance. The planned teaching programme was effective in increasing the knowledge of drivers of SVET.

Association of pre test knowledge score of drivers with selected demographic variable There was no significant relationship between the pre test level of knowledge regarding life style modifications to prevent cardio vascular diseases among drivers with selected demographic variables like age, educational status, religion and income.

CONCLUSION:

It was found that knowledge regarding life style modifications among drivers significantly improved after conducting planned teaching programme. This proves the effectiveness of planned teaching programme.

RECOMMENDATIONS:

· Similar studies can be conducted over a large population of drivers for better generalization of the findings.

· Comparative studies can be done.

· Co relational studies can be done in between government and private institutions in different settings.

ACKNOWLEDGEMENT:

I extend my heartfelt thanks to Management of Sree Vidyanikethan Educational Trust permitting me to conduct study.

CONFLICT OF INTEREST:

Author did not had any conflict of interest during this study.

Source of funding:

self

Ethical clearance:

Informed consent has been obtained before data collection. Confidentiality maintained throughout the study.

REFERENCES:

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17. file:///C:/Documents%20and%20Settings/Principal/Desktop/CHD_patients.htm

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Received on 17.04.2017 Modified on 01.05.2017

Int. J. Adv. Nur. Management. 2017; 5(3):246-250.

DOI: 10.5958/2454-2652.2017.00053.1

Pre-test			Post test			‘t’ value
Mean	Standard deviation	Calculated value	Mean	Standard deviation	Calculated value	1.01836 (significant)
9.633333	3.8000938	0.0384	19.1	3.707867	0.729034	1.01836 (significant)