The Effects of Smart Program for Patients Who Underwent Percutaneous Coronary Intervention (SP-PCI) on Disease-Related Knowledge, Health Behavior, and Quality of Life: A Non-Randomized Controlled Trial

Jueun Lee; Haejung Lee

doi:10.4040/jkan.2017.47.6.756

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Lee and Lee: The Effects of Smart Program for Patients Who Underwent Percutaneous Coronary Intervention (SP-PCI) on Disease-Related Knowledge, Health Behavior, and Quality of Life: A Non-Randomized Controlled Trial

Original Article

J Korean Acad Nurs 2017;47(6):756-769.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.6.756

The Effects of Smart Program for Patients Who Underwent Percutaneous Coronary Intervention (SP-PCI) on Disease-Related Knowledge, Health Behavior, and Quality of Life: A Non-Randomized Controlled Trial

Jueun Lee, Haejung Lee

College of Nursing, Pusan National University, Yangsan, Korea

Address reprint requests to : Lee, Haejung College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-51-510-8344 Fax: +82-51-510-8308 E-mail: haejung@pusan.ac.kr

Received 18 May 2017 Revised 9 November 2017 Accepted 9 November 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

To identify the effects of a smart program for the patients who underwent percutaneous coronary intervention (SP-PCI) on coronary disease-related knowledge, health behaviors, and quality of life.

Methods

A nonequivalent control group with a non-synchronized design was utilized and 48 participants (experimental=22, control=26) were recruited from a university hospital in Gyeongsang area from May to December, 2016. The 12-week SP-PCI consisted of self-study of health information using smart phone applications (1/week), walking exercise (>5/week) using smart band, feedback using Kakao talk (2/week), and telephone counseling (1/week). Patients in the control group received usual care from their primary health care providers and a brief health education with basic self-management brochure after the PCI. Data were analyzed using the SPSS 21.0 program through descriptive statistics, c² test, and t-test.

Results

After the 12-week SP-PCI, the experimental group showed higher levels of coronary disease-related knowledge (t=2.43, p=.019), heart-related health behaviors (t=5.96, p<.001), regular exercise (Z=-4.47, p<.001), and quality of life-MCS (t=3.04, p=.004) and showed lower levels of stress (Z=-3.53, p<.001) and sodium intake (t=-4.43, p<.001) than those in the control group. There were no significant group differences in medication adherence and food intake in total energy, lipids, and cholesterol.

Conclusion

The suggested SP-PCI provided easy access and cost-effective intervention for patients after PCI and improved their knowledge of the disease, performance of health behaviors, and quality of life. Further study with a wider population is needed to evaluate the effects of SP-PCI on disease recurrence and quality of life for patients after PCI.

Keywords: Percutaneous coronary intervention, Smartphone, Knowledge, Health behavior, Quality of life

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Figure 1.

Flow chart of the study.

Table 1.

Contents of the Smart Program for Patients Who Underwent Percutaneous Coronary Intervention (SP-PCI)

Wk	Self-learning	Walking exercise	Feedback
	“My family heart keeper”application	Smart band	Kakao talk	Telephone counseling
1W	Function of heart	Walking after wearing smart band	Twice/week	Once/week
	How is your heart?	Synchronizing exercise log with	Encouraging	15~20 minutes
	Understanding “heart”	Bluetooth	message	Checking the performance
		Frequency: thrice/week		and providing feedback
		Goal: 5,000 steps/day		1. Self-education using
				application and
				introducing weekly
				themes
2W	Types of coronary heart disease (CHD) Concepts and treatment options of CHD Brief introduction of coronary angiography and management after the procedure	Frequency: thrice/week Goal: 6,000 steps/day		2. Medication compliance 3. Walking 4. Diet 5. Stress management
3W	Exercise and heart	Frequency: 4 times/week
	Adequate exercise and precautions	Goal: 7,000 steps/day
	Preparation before exercise
	Walking exercise
	Conditions to stop exercise
4W	Basics for diet management	Frequency: 4 times/week
	Adequate lipid intake	Goal: 8,000 steps/day
	Food to be avoided
5W	Atherosclerosis and food	Frequency: 5 times/week
	Food that prevents atherosclerosis	Goal: 9,000 steps/day
	Precautions when eating red meat
6W	Smoking and heart	Frequency: 5 times/week
	The necessity to stop smoking	Goal: 10,000 steps/day
	Possible symptoms after stop smoking
	Strategies to stop smoking
7W	Stress and heart I
	Symptoms of stress
8W	Stress and heart II
	Strategies to manage stress
9W	Protocol for prevention of heart attack
10W	Diet management
11W	Exercise and heart
12W	Stop smoking and stress management

Table 2.

Homogeneity Test for Characteristics of Participants in Experimental and Control Groups (N=48)

Characteristics	Classification	Exp (n=22)	Cont (n=26)	χ² or t	p
		n (%)	n (%)
Age (yr) (range 42~70)	40~49	4 (18.2)	4 (15.4)	0.12	.943^†
	50~59	10 (45.5)	13 (50.0)
	≥60	8 (36.4)	9 (34.6)
	M±SD	55.91±6.16	56.08±6.99	−0.89	.931
Gender	Male	15 (68.2)	22 (84.6)	1.82	.177
	Female	7 (31.8)	4 (15.4)
Spouse	Yes	20 (90.9)	23 (88.5)	0.08	>.999^†
	No	2 (9.1)	3 (11.5)
Education	Middle school or lower	5 (22.7)	5 (19.2)	0.47	.968^†
	High school	8 (36.4)	12 (46.2)
	College or higher	9 (40.9)	9 (34.6)
Occupation	Yes	20 (90.9)	21 (80.8)	0.99	.429^†
	No	2 (9.1)	5 (19.2)
Monthly income (10,000 won)	<100	2 (9.1)	2 (7.7)	4.68	.328^†
	100~<200	4 (18.2)	3 (11.5)
	200~<300	6 (27.3)	3 (11.5)
	300~<400	7 (31.8)	8 (30.8)
	≥400	3 (13.6)	10 (38.5)
Diagnosis	MI	4 (18.2)	5 (19.2)	0.01	>.999^†
	Angina	18 (81.8)	21 (80.8)
Other diseases	Yes	16 (72.7)	22 (84.6)	1.02	.478^†
	No	6 (27.3)	4 (15.4)
Smoking	Current smoker	8 (36.4)	10 (38.5)	5.17	.076
	Ex-smoker	3 (13.6)	10 (38.5)
	Never smoked	11 (50.0)	6 (23.1)
Alcohol consumption	Yes	10 (45.5)	13 (50.0)	0.10	.753
	No	12 (54.5)	13 (50.0)

Cont=Control group; Exp=Experimental group; MI=Myocardial infarction.

^†Fisher’s exact test.

Table 3.

Homogeneity Test for Levels of Disease-Related Knowledge, Health Behavior, and Quality of Life in Experimental and Control Groups (N=48)

Characteristics	Exp (n=22)	Cont (n=26)	t or Z	p
	M ±SD/Median (IQR)	M ±SD/Median (IQR)
Disease-related knowledge	20.86±3.17	19.04±4.15	1.69	.098
Health behavior
Heart-related health behavior	59.55±13.38	59.85±12.10	−0.82	.935
Medication adherence	5.38±1.92	5.27±2.15	0.18	.857
Regular exercise (MET-min/week)	0 (461.25)	0 (1000.50)	−1.21	.227^†
Stress	24.50 (10.75)	25.00 (7.25)	−0.43	.670^†
Diet
Calorie (kcal)	2,030.12±372.43	2,084.62±393.32	−0.49	.626
Lipid (g)	35.28 (22.17)	37.07 (34.09)	−0.08	.934^†
Cholesterol (mg)	19.89 (26.17)	27.96 (51.06)	−1.41	.159^†
Sodium (mg)	3783.24±962.57	3907.63±1275.16	−0.38	.709
Quality of life
PCS	44.42±5.92	42.21±7.65	1.11	.275
MCS	46.97±8.00	49.04±10.22	−0.77	.445

Exp=Experimental group; Cont=Control group; IQR=Interquartile range; MET=Metabolic Equivalent Task; PCS=Physical Components Score; MCS=Mental Components Score.

^†Mann-Whitney U Test.

Table 4.

Effectiveness of the Smart Intervention Program on Disease-Related Knowledge, Health Behavior, and Quality of Life (N = 48)

Variables	Groups	Pre test	Post test	Differences (Post – Pre)	) t or Z	p
		M±SD/Median (IQR)	M±SD/Median (IQR)	M±SD/Median (IQR)
Disease-related knowledge	Exp	20.86±3.17	26.68±1.46	5.82±3.31	2.43	.019
	Cont	19.04±4.15	21.00±5.09	1.96±6.79
Health behavior
Heart-related health behav	vior Exp	59.55±13.38	84.05±6.43	24.50±12.96	5.96	<.001
	Cont	59.85±12.10	64.77±10.43	4.92±9.06
Medication adherence	Exp	5.39±1.92	6.84±0.15	1.45±1.89	0.19	.849
	Cont	5.28±2.15	6.63±0.54	1.35±2.01
Regular exercise (MET-min	/week) Exp	0 (461.25)	1,485.00 (9.25)	1,432.50 (573.00)	−4.47^†	<.001
	Cont	0 (1,000.5)	396.00 (792.00)	0 (1,003.50)
Stress	Exp	24.50 (10.75)	14.00 (9.25)	−11.00 (14.75)	−3.53^†	<.001
	Cont	25.00 (7.25)	20.00 (7.25)	−2.00 (6.50)
Diet
Calorie (kcal)	Exp	2,030.12±372.43	2,046.24±304.68	16.12±444.80	1.02	.313
	Cont	2,084.62±393.32	1,965.89±267.96	−118.73±465.86
Lipid (g)	Exp	35.28 (22.17)	44.79 (18.29)	8.39 (21.55)	−0.17^†	.869
	Cont	37.07 (34.09)	45.66 (13.90)	9.91 (37.76)
Cholesterol (mg)	Exp	19.89 (26.17)	37.01 (31.39)	14.63 (38.43)	−1.66^†	.098
	Cont	27.96 (51.06)	19.13 (26.25)	1.30 (51.40)
Sodium (mg)	Exp	3,783.24±962.57	2,289.91±546.78	−1,493.32±883.01	−4.43	<.001
	Cont	3,907.63±1,275.16	3,912.00±1,098.29	4.37±1361.84
Quality of life
PCS	Exp	44.42±5.92	54.45±5.39	10.02±9.01	1.52	.139
	Cont	42.21±7.65	48.93±6.27	6.72±5.22
MCS	Exp	46.97±8.00	56.34±5.66	9.37±8.84	3.04	.004
	Cont	49.04±10.22	50.72±6.91	1.68±8.63

Exp=Experimental group; Cont=Control group; IQR=Interquartile range; MET=Metabolic Equivalent Task; PCS=Physical Components Score; MCS=Mental Components Score.

^†Mann-Whitney U Test.

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