kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.1.37 kjhp-16-37 Original Article Factors Influencing Health Promoting Behavior among Peripheral Arterial Disease Patients YooYonju 1 LeeJu Hee 2 ChuSang Hui 2 ChoiDonghoon 3 University of Virginia School of Nursing, Charlottesville, VA, USA Nursing Policy and Research Institute, Division of Clinical Nursing Science, Yonsei University College of Nursing, Seoul, Korea Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Corresponding author: Yonju Yoo, MSN University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903, USA Tel: +1-434-284-1165, Fax: +1-434-924-0528 E-mail: yy5ke@virginia.edu 01 2016 20 01 2016 16 1 37 47 01042015 15122015 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The purpose of this study was to examine illness perception, knowledge about the disease and health promoting behaviors, and to identify factors influencing health promoting behaviors among Peripheral Arterial Disease (PAD) patients.

 Methods

The participants were 128 PAD patients who had been treated as an outpatient or an inpatient at the department of cardiology in a tertiary hospital in Seoul, Korea. Data were collected from October to December 2014, regarding general characteristics, disease related characteristics, illness perception and knowledge on PAD, health promoting behaviors by using a structured questionnaire.

 Results

The number of subjects who had an awareness of PAD diagnosis was 70 (54.7%) among 128. In this study, knowledge on PAD was significantly correlated with health promoting behaviors (r＝0.205, P＝0.020). Especially, knowledge on PAD had a significant correlation with health responsibility (r＝0.353, P＜0.001) and exercise (r＝0.230, P＝0.009). In the regression analysis, knowledge on PAD was a factor that influences the health promoting behavior in this study subjects (R2＝0.212, P＝0.032).

 Conclusions

We could determine the degree of perception, knowledge, and health promoting behaviors among participants and the influence of PAD-related knowledge on health promoting behaviors. Conclusively, the results of this study support the development of education intervention to ameliorate disease perception and PAD related knowledge in order to improve health promoting behaviors among PAD patients.

 Peripheral arterial disease Perception Knowledge Health behavior References Schirmang TC Ahn SH Murphy TP Dubel GJ Soares GM Peripheral arterial disease: update of overview and treatment Med Health R I 200992 12 398402 Abdulhannan P Russell DA Homer-Vanniasinkam S Peripheral arterial disease: a literature review Br Med Bull 2012104 2139 Kohlman-Trigoboff D Management of lower extremity peripheral arterial disease: interpreting the latest guidelines for nurse practitioners J Nurse Pract 20139 10 65360 Lovell M Harris K Forbes T Twillman G Abramson B Criqui MH Peripheral arterial disease: lack of awareness in Canada Can J Cardiol 200925 1 3945 Carman TL Fernandez BB Jr Contemporary management of peripheral arterial disease: II. Improving walking distance and quality of life Cleve Clin J Med 200673 Suppl 4 S3844 Haas TL Lloyd PG Yang HT Terjung RL Exercise training and peripheral arterial disease Compr Physiol 20122 4 29333017 Olin JW Sealove BA Peripheral artery disease: current insight into the disease and its diagnosis and management Mayo Clin Proc 201085 7 67892 Warren E Ten things the practice nurse can do about Peripheral Arterial Disease Practice Nurse 201343 12 148 Armstrong EJ Wu J Singh GD Dawson DL Pevec WC Amsterdam EA Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease J Vasc Surg 201460 6 156571 Bush RL Kallen MA Liles DR Bates JT Petersen LA Knowledge and awareness of peripheral vascular disease are poor among women at risk for cardiovascular disease J Surg Res 2008145 2 3139 Buckley T McKinley S Gallagher R Dracup K Moser DK Aitken LM The effect of education and counselling on knowledge, attitudes and beliefs about responses to acute myocardial infarction symptoms Eur J Cardiovasc Nurs 20076 2 10511 McKinley S Dracup K Moser DK Riegel B Doering LV Meischke H The effect of a short one-on-one nursing intervention on knowledge, attitudes and beliefs related to response to acute coronary syndrome in people with coronary heart disease: a randomized controlled trial Int J Nurs Stud 200946 8 103746 Mooney LA Franks AM Impact of health screening and education on knowledge of coronary heart disease risk factors J Am Pharm Assoc (2003) 201151 6 7138 Kayaniyil S Ardern CI Winstanley J Parsons C Brister S Oh P Degree and correlates of cardiac knowledge and awareness among cardiac inpatients Patient Educ Couns 200975 1 99107 Wang L Chen CM Liao WC Hsiao CY Evaluating a com-munity-based stroke nursing education and rehabilitation programme for patients with mild stroke Int J Nurs Pract 201319 3 24956 Long AF Gambling T Enhancing health literacy and behavioural change within a telecare education and support intervention for people with type 2 diabetes Health Expect 201215 3 26782 Weinman J Petrie KJ Moss-Morris R Horne R The illness perception questionnaire: a new method for assessing the cognitive representation of illness Psychol Health 199611 3 43145 Broadbent E Petrie KJ Main J Weinman J The brief illness perception questionnaire J Psychosom Res 200660 6 6317 American Heart Association Peripheral Artery Disease American Heart Association Dallas American Heart Association 2014 [Accessed Aug 27, 2014]. http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Peripheral-Artery -Disease-PAD_UCM_002082_SubHomePage.jsp. Song R June KJ Kim CG Jeon MY Comparisons of motivation, health behaviors, and functional status among elders in residential homes in Korea Public Health Nurs 200421 4 36171 Petrie KJ Weinman J Why illness perceptions matter Clin Med (Lond) 20066 6 5369 Kang YO Cho YC Factors related to knowledge, health belief and sick role behavior to the coronary artery disease among patients with coronary artery disease J Korea Acad Industr Coop Soc 201112 11 498594 Tables

General and disease related characteristics of study participants (N＝128)

Characteristics Categories N (%) Mean (±SD) Range
Gender Male 104 (81.3)    
  Female 24 (18.8)    
Age, y     68.52 (±12.87) 20–89
  ＜60 23 (18.0)    
  60–69 33 (25.8)    
  70–79 47 (36.7)    
  ≥80 25 (19.5)    
Living with spouse Yes 109 (85.2)    
  No 19 (14.8)    
Education level ＜ Elementary 22 (17.2)    
  Middle, High 56 (43.8)    
  ≥ College 49 (38.3)    
  No response 1 (0.8)    
Employment status Employed 47 (36.7)    
  Non-employed 81 (63.3)    
Monthly income, won ＜1 million 59 (46.1)    
  1–4 million 44 (34.4)    
  ≥ 4 million 22 (17.2)    
  No response 3 (2.3)    
Smoking Yes 39 (30.5)    
  No 89 (69.5)    
Alcohol use Yes 46 (35.9)    
  No 81 (63.3)    
  No response 1 (0.8)    
Comorbidity     4.08 (±1.33) 0–7
  Dyslipidemia 113 (88.3)    
  HTN 106 (82.8)    
  CHD 102 (79.7)    
  DM 70 (54.7)    
  Kidney disease 34 (26.6)    
  CVD 33 (25.8)    
  Cancer 12 (9.4)    
  Etc. 52 (40.6)    
PTA Yes 94 (73.4)    
  No 34 (26.6)    
Surgery No 115 (89.8)    
  Yes 13 (10.2)    
Rutherford's Classification 0 51 (39.8)    
  1–3 42 (32.8)    
  4–6 35 (27.4)    
ABI (n＝117) Right   0.91 (±0.24) 0.30–1.38
  Left   0.88 (±0.24) 0.30–1.54
Resting pain (n＝85)     1.75 (±2.85) 0–10
Walking pain (n＝85)     4.34 (±3.46) 0–10

Abbreviations: HTN, hypertension; CHD, coronary heart disease; DM, diabetes mellitus; CVD, cerebral vascular disease; PTA, percutaneous transluminal angioplasty; ABI, ankle brachial index.

PAD related illness perception, knowledge and health behavior of study participants (N＝128)

Characteristics N (%) Mean (±SD) Range Possible range
PAD related Illness perception (n＝70)   46.13 (±16.29) 9–76 0–100
Consequences   6.14 (±3.35) 0–10 0–10
Timeline   6.51 (±3.73) 0–10 0–10
Personal control   5.46 (±3.37) 0–10 0–10
Treatment control   2.81 (±3.10) 0–10 0–10
Identity   5.57 (±3.57) 0–10 0–10
Concern   5.67 (±3.57) 0–10 0–10
Coherence   5.19 (±3.33) 0–10 0–10
Emotional representation   5.22 (±3.81) 0–10 0–10
PAD related knowledge   11.63 (±3.41) 0–15 0–15
Definition 93 (72.7)      
Cause 69 (53.9)      
High risk of stroke 92 (71.9)      
Symptom 82 (64.1)      
Treatment: PTA/Surgery 100 (78.1)      
Treatment: amputation 77 (60.2)      
Treatment goal 92 (71.9)      
Care: medication 113 (88.3)      
Care: walking exercise 105 (82.0)      
Care: exercise 104 (81.3)      
Care: rest 105 (82.0)      
Care: low cholesterol diet 116 (90.6)      
Care: high fiber diet 117 (91.4)      
Care: smoking 96 (75.0)      
Risk factors 105 (82.0)      
Health behavior   70.61 (±11.19) 40–95 25–100
Health responsibility   2.95 (±0.64) 1.50–4.00 1.00–4.00
Healthy diet   2.66 (±0.61) 1.20–4.00 1.00–4.00
Exercise   2.28 (±0.85) 1.00–4.00 1.00–4.00
Stress management   2.66 (±0.61) 1.20–4.00 1.00–4.00
Smoking cessation   2.72 (±1.06) 1.00–4.00 1.00–4.00

Abbreviations: PAD, peripheral arterial disease; PTA, percutaneous transluminal angioplasty.

Difference of variables according to general characteristics of study participants

Categories Illness perception (n＝70) Disease knowledge (n＝128) Health promoting behavior (n＝128)
Mean (±SD) t/F P Mean (±SD) t/F P Mean (±SD) t/F P
Gendera   –1.375 0.174   1.706 0.099   1.005 0.317
Male 41.34 (±13.41)     11.78 (±3.34)     71.09 (±10.83)    
Female 46.69 (±14.50)     10.04 (±1.72)     68.54 (±12.67)    
Age, yb   3.331 0.025   4.518 0.005   2.359 0.075
＜60 49.47 (±7.90)     13.26 (±1.98)     65.09 (±10.82)    
60–69 45.17 (±11.25)     12.30 (±2.85)     71.76 (±11.33)    
70–79 38.30 (±14.88)     10.61 (±4.11)     72.00 (±11.39)    
≥ 80 37.15 (±17.15)     10.20 (±4.22)     71.60 (±9.97)    
Living with spousea   1.700 0.094   1.191 0.236   1.669 0.098
Yes 43.74 (±13.04)     11.61 (±3.55)     71.29 (±11.30)    
No 36.18 (±16.29)     10.53 (±4.34)     66.68 (±9.89)    
Education levelb   0.039 0.962   2.196 0.116   1.781 0.173
＜Elementary 41.11 (±18.29)     10.09 (±4.94)     72.32 (±10.94)    
Middle, High 42.54 (±12.92)     11.55 (±3.47)     68.52 (±11.38)    
≥ College 42.23 (±13.29)     12.04 (±3.12)     72.27 (±11.01)    
Employment statusa   –0.643 0.522   –3.109 0.002   1.678 0.096
Employed 43.83 (±12.27)     12.62 (±2.66)     68.45 (±10.57)    
Non-employed 41.67 (±14.79)     10.78 (±4.02)     71.86 (±11.41)    
Monthly income, wonb   0.094 0.910   5.096 0.007   0.313 0.732
＜1 million 42.86 (±14.77)     10.54 (±3.91)     71.58 (±11.28)    
1–4 million 44.13 (±12.92)     11.73 (±3.87)     69.95 (±10.30)    
≥ 4 million 42.14 (±11.71)     13.36 (±1.59)     71.64 (±11.93)    
Smokinga   –0.302 0.763   –2.311 0.023   1.797 0.075
Yes 43.21 (±10.26)     12.41 (±2.61)     67.95 (±12.41)    
No 42.27 (±15.17)     11.03 (±4.00)     71.78 (±10.47)    
Alcohol usea   0.646 0.521   –2.210 0.029   –0.760 0.449
Yes 41.04 (±13.70)     12.43 (±3.21)     71.72 (±11.30)    
No 43.31 (±13.86)     10.96 (±3.81)     70.15 (±11.11)    

Calculated by independent t-test.

Calculated by one-way analysis of variance.

PAD related Illness perception, knowledge and health promoting behavior by disease related characteristics (N＝128)

Characteristics Illness perception Disease knowledge Health promoting behavior
(n＝ 70) (n＝＝128) (n＝＝128)
Mean (±SD) t/F P Mean (±SD) t/F P Mean (±SD) t/F P
Awareness of PAD diagnosisa         –3.168 0.002   2.031 0.044
Yes       12.42 (±2.87)     68.72 (±10.94)    
No       10.39 (±4.17)     72.69 (±11.17)    
Comorbidity, eaa   –2.34 0.022   0.789 0.713   –0.369 0.713
0–4 40.04 (±14.33)     11.66 (±3.61)     70.31 (±11.37)    
5–7 48.07 (±10.73)     11.14 (±3.78)     71.06 (±11.00)    
PTAa   –0.298 0.767   9.702 0.002   2.703 0.103
Yes 42.80 (±13.67)     12.04 (±2.98)     69.64 (±11.23)    
No 41.53 (±14.59)     9.82 (±4.84)     73.29 (±10.79)    
Surgerya         0.498 0.482   2.402 0.124
Yes 45.50 (±5.68)     10.77 (±4.53)     66.08 (±13.35)    
No 42.19 (±14.45)     11.53 (±3.59)     71.12 (±10.86)    
Rutherford'sb   8.116 0.001   0.257 0.774   0.432 0.650
0 31.77 (±12.42)     11.18 (±3.84)     71.55 (±11.63)    
1–3 40.75 (±13.05)     11.71 (±3.49)     70.60 (±10.09)    
4–6 49.11 (±11.89)     11.54 (±3.74)     69.26 (±11.94)    
ABI (right)b   0.788 0.505   0.034 0.991   0.998 0.397
≥ 0.97 39.43 (±16.36)     11.75 (±3.57)     72.19 (±10.34)    
0.75–0.96 41.87 (±12.24)     11.52 (±3.93)     71.66 (±11.68)    
0.50–0.74 44.41 (±9.21)     11.78 (±3.32)     67.70 (±10.81)    
＜0.50 47.60 (±11.67)     11.71 (±1.70)     69.57 (±13.25)    
ABI (left)b   0.062 0.980   0.533 0.661   0.389 0.761
≥ 0.97 40.91 (±16.54)     11.51 (±3.86)     70.36 (±11.99)    
0.75–0.96 42.56 (±13.95)     12.19 (±3.08)     72.03 (±9.22)    
0.50–0.74 41.66 (±10.74)     11.67 (±3.37)     71.71 (±11.86)    
＜0.50 42.80 (±9.09)     10.63 (±3.78)     68.00 (±10.30)    

Abbreviations: PAD, peripheral arterial disease; PTA, percutaneous transluminal angioplasty; ABI, ankle brachial index.

Calculated by independent t-test.

Calculated by one-way analysis of variance.

Correlation between PAD related illness perception, knowledge and health promoting behavior (N＝128)a,b

  PAD related PAD related Health promoting behavior
  illness perception knowledge Health responsibility Exercise Healthy diet
PAD related knowledge 0.006        
Health promoting behavior          
Total score –0.032 0.205c      
Health responsibility 0.087 0.353d      
Exercise –0.171 0.230d 0.248d    
Healthy diet 0.071 0.008 0.257d 0.142d  
Smoking cessation –0.050 –0.171 0.009 0.244d 0.142

Abbreviations: PAD, peripheral arterial disease.

Data are presented as correlation coefficient r.

Calculated by Pearsons's correlation analysis.

P＜0.050.

P＜0.010.

Factors influencing health promoting behaviors (N＝128)

Health promoting behavior
Characteristics B S.E β t Pa
  37.343 12.826   2.911 0.005
PAD related knowledge 1.101 0.479 0.287 2.300 0.025
PAD related illness perception 0.048 0.116 0.060 0.414 0.680
Age –3.989 3.213 –0.152 –1.242 0.219
Current smoking 0.826 0.981 0.106 0.842 0.403
R2＝0.212, F＝2.385, P＝0.032

Assessed with multiple stepwise linear regression analysis.