Development and Effectiveness of Tailored Education and Counseling Program for Patients with Coronary Artery Disease undergoing Percutaneous Coronary Intervention

So-Yeon Kim; Min Young Kim

doi:10.7475/kjan.2017.29.5.547

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Kim and Kim: Development and Effectiveness of Tailored Education and Counseling Program for Patients with Coronary Artery Disease undergoing Percutaneous Coronary Intervention

Original Article

Korean J Adult Nurs 2017;29(5):547-559.

Published online: 9 October 2017

DOI: https://doi.org/10.7475/kjan.2017.29.5.547

Development and Effectiveness of Tailored Education and Counseling Program for Patients with Coronary Artery Disease undergoing Percutaneous Coronary Intervention

So-Yeon Kim, MSN, RN¹, Min Young Kim, Ph.D., APN^2,

¹Jeju Regional Cardiocerebrovascular Center, Jeju National University Hospital, Jeju, Korea

²College of Nursing, Jeju National University, Jeju, Korea

Corresponding author: Kim, Min Young College of Nursing, Jeju National University, 102 Jejudaehak-ro, Jeju 63243, Korea. Tel: +82-64-754-3750, Fax: +82-64-702-2686, E-mail: musemy2@jejunu.ac.kr

- This manuscript is a revision of the first author's master's thesis from Jeju National University.

Received 29 August 201729 September 2017 Accepted 15 October 2017

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.

Abstract

Purpose

This study was to develop the patient-tailored education and counseling program (PTECP) for patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), and to identify the effects of PTECP on awareness of risk factors, knowledge, self-efficacy, self-care behavior, and blood cholesterol profile (BCP).

Methods

A non-equivalent control group pre-post design was used. Sixty patients who were newly diagnosed with CAD and treated PCI were recruited and participated either in an intervention group or a control group, thirty each. The PTECP focused on managing their own risk factors consisted of two individual educations, two individual counselings, three telephone counselings, and two short message services for eight weeks. Data were collected two times at baseline and 8 weeks after beginning of the program.

Results

After eight weeks, the patients’ awareness of risk factor (p<.001), knowledge (p=.015), self-efficacy (p<.001), and self-care behavior (p<.001) in the intervention group were significantly different from those of the control group. However, no difference in BCP was found between the groups.

Conclusion

The PTECP was effective in improving the patients’ awareness of CAD risk factors, knowledge, self-efficacy, and self-care behavior. Successful PTECP might lead to better health outcome in patients with CAD through effective self-management.

Keywords: Percutaneous coronary intervention, Secondary prevention, Risk factors, Self efficacy, Self care

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Figure 1.

Flow chart of study process.

Table 1.

Description of Patient-tailored Education and Counseling Program

Date	Theme	Contents	Methods	Time
D-2	Identify risk factors and educational needs	Assess risk factors and perceived risk factors of patient	Individual counseling (face to face)	20 min
		Assess educational needs
		Assess smoking history
	Understand risk factors	Introduce the program
		Clarify individual risk factors
		Make a management plan for individual risk factors
D-1	Understand CAD	Understand CAD	Individual education (face to face)	40 min
		Understand individual risk factors	Individual education (face to face)
		Understand the precautions and emergencies after discharge	- PPT/Brochure (about disease)
		Measure CO concentration & write a non-smoking pledge (if smoking now)	- Medication card - Diet report
		Q&A	- Brochure (about measuring own pulse)
	Practice	How to write a meal diary	- Brochure (about measuring own pulse)
	Practice self-management skill	How to write a meal diary	- CO meter - A non-smoking pledge
	Practice self-management skill	How to measure my own pulse	- CO meter - A non-smoking pledge
1 wk	Manage risk factors	Check the previous education contents	Telephone counseling	10 min
		Counsel individual risk factors	- Telephone counseling guideline
		Q&A	- Telephone counseling guideline
2 wk	Identify the management status	Check the management status of the risk factors (if needed, re-education)	Individual education (face to face)	20 min
		Check a meal diary & educate individual diet	- Brochure (about
		Measure CO concentration (if smoking at the start) & encourage non-smoking	disease)
			- Diet model
		Q&A	- CO meter
3 wk	Encourage self-care	Send short message of individual risk factor management	Sending short message	2 min
4 wk	Manage risk factors	Check the previous education and short message contents	Telephone counseling	10 min
		Counsel individual risk factors	- Telephone counseling guideline
		Q&A
5 wk	Encourage self-care	Send short message of individual risk factor management	Sending short message	2 min
6 wk	Manage risk factors	Check the previous counseling and short message contents	Telephone counseling	10 min
		Counsel individual risk factors	- Telephone counseling guideline
		Q&A
8 wk	Identify the management status	Check the management status of the risk factors	Individual counseling (face to face)	20 min
		Measure CO concentration (if smoking at the start) & encourage non-smoking	Individual counseling (face to face)
			- CO meter
		Feedback & encourage ongoing management

D-2=2 days before discharge; D-1=1 day before discharge; wk=week; CAD=coronary artery disease; CO=carbon monoxide; PPT=powerpoint.

Table 2.

Participants' Characteristics and Homogeneity between Intervention and Control Groups (N=60)

Variables	Categories	Total	Intervention group (n=30)	Control group (n=30)	x² or t	p
Variables	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t	p
Gender	Male	45 (75.0)	23 (76.7)	22 (73.3)	0.08	.766
Gender	Female	15 (25.0)	7 (23.3)	8 (26.7)
Age (year)	＜50	7 (11.7)	3 (10.0)	4 (13.3)	1.14	.662^†
	50~64	27 (45.0)	12 (40.0)	15 (50.0)
	≥65	26 (43.3)	15 (50.0)	11 (36.7)
		61.61±9.81	62.30±8.19	60.91±11.29	0.56	.576
Education level	≤ Elementary school	11 (18.3)	5 (16.6)	6 (20.0)	0.74	.783^†
	Middle school	19 (31.7)	11 (36.7)	8 (26.7)
	≥ High school	30 (50.0)	14 (46.7)	16 (53.3)
Occupation	Yes	45 (75.0)	23 (76.7)	22 (73.3)	0.08	.766
Occupation	No	15 (25.0)	7 (23.3)	8 (26.7)
Diagnosis	STEMI	13 (21.6)	6 (20.0)	7 (23.3)	0.69	.707
	NSTEMI	19 (31.7)	11 (36.7)	8 (26.7)
	Unstable angina	28 (46.7)	13 (43.3)	15 (50.0)
Diagnosis of	Yes	21 (35.0)	9 (30.0)	12 (40.0)	0.65	.417
hyperlipidemia	No	39 (65.0)	21 (70.0)	18 (60.0)
Diagnosis of hypertension	Yes	32 (53.3)	16 (53.3)	16 (53.3)	0.00	＞.999
Diagnosis of hypertension	No	28 (46.7)	14 (46.7)	14 (46.7)
Diagnosis of diabetes	Yes	19 (31.7)	9 (30.0)	10 (33.3)	0.07	.781
Diagnosis of diabetes	No	41 (68.3)	21 (70.0)	20 (66.7)
BMI (Kg/m²)	18.5~22.9 (normal)	10 (16.7)	4 (13.3)	6 (20.0)	1.15	.647^†
	23.0~24.9 (overweight)	20 (33.3)	9 (30.0)	11 (36.7)
	≥25 (obesity)	30 (50.0)	17 (56.7)	13 (43.3)
		25.07±2.34	25.26±2.26	24.89±2.44	0.62	.538
Family history related to CVD	Yes	8 (13.3)	5 (16.7)	3 (10.0)	0.57	.706^†
Family history related to CVD	No	52 (86.7)	25 (83.3)	27 (90.0)
Smoking	Current smoker	14 (23.3)	8 (26.7)	6 (20.0)	4.57	.102
	None	28 (46.7)	10 (33.3)	18 (60.0)
	Ex-Smoker	18 (30.0)	12 (40.0)	6 (20.0)
Fat intake	Large	18 (30.0)	8 (26.7)	10 (33.3)	0.64	.726
	Moderate	25 (41.7)	14 (46.6)	11 (36.7)
	Small	17 (28.3)	8 (26.7)	9 (30.0)
Excercise	Regular	22 (36.6)	10 (33.3)	12 (40.0)	0.62	.743^†
	Irregular	10 (16.7)	6 (20.0)	4 (13.3)
	No	28 (46.7)	14 (46.7)	14 (46.7)
Lipid-lowering drug	Yes	60 (100.0)	30 (100.0)	30 (100.0)	-	-
Lipid-lowering drug	No	0 (0.0)	0 (0.0)	0 (0.0)
Awareness of risk factor (range: 0~9)		5.30±1.48	5.20±1.63	5.40±1.32	0.52	.604
Disease-related knowledge (range: 0~25)		9.66±8.10	9.33±8.10	10.00±8.23	0.31	.753
Self-efficacy (range: 20~100)		64.43±9.12	63.63±9.48	65.23±8.83	0.67	.502
Self-care behavior (range: 23~115)		58.08±4.86	57.83±4.92	58.33±4.88	0.39	.694
Blood cholesterol profile (normal range)
TC (mg/dL)	(＜200)	181.73±38.42	180.76±39.36	182.70±38.10	0.19	.847
TG (mg/dL)	(＜150)	176.31±51.82	173.80±46.96	178.83±56.96	0.37	.710
HDL (mg/dL)	(≥40)	43.98±10.76	43.03±10.96	44.93±10.67	0.68	.499
LDL (mg/dL)	(＜100)	108.81±34.80	113.26±34.98	104.36±34.63	-0.99	.326

STEMI=ST elevation myocardial infarction; NSTEMI=Non-ST elevation myocardial infarction; BMI=body mass index; CVD=cardio-cerebrovascular diseases; TC=total cholesterol; TG=triglycerides; HDL=high density lipoprotein; LDL=Low density lipoprotein;

^† Fisher's exact test was done.

Table 3.

Awareness of Risk Factors of the Participants (N=60)

Categories	Total	Intervention group (n=30)	Control group (n=30)	t	p
Categories	M± SD	M± SD	M± SD	t	p
Family history	0.95±0.22	0.93±0.25	0.97±0.18	0.58	.561
Smoking	0.82±0.39	0.80±0.41	0.83±0.40	0.33	.744
Age	0.68±0.47	0.70±0.47	0.67±0.48	-0.27	.786
Hypertension	0.67±0.48	0.70±0.47	0.63±0.49	-0.54	.591
Diabetes	0.65±0.48	0.63±0.49	0.67±0.48	0.27	.791
Obesity	0.57±0.50	0.53±0.51	0.60±0.50	0.51	.610
Lack of exercise	0.42±0.50	0.43±0.50	0.40±0.50	-0.26	.798
Hyperlipidemia	0.32±0.47	0.27±0.45	0.37±0.49	0.82	.414
Gender	0.23±0.43	0.20±0.41	0.27±0.45	0.60	.549

Table 4.

Effects of Patient-Tailored Education and Counseling Program on Awareness of Risk Factors, Disease-Related Knowledge, Self-Efficacy, Self-Care Behavior and Blood Cholesterol Profile (N=60)

Variables		Intervention group (n=30)	Control group ⁽n=30)	t	p
Variables		M± SD	M± SD	t	p
Awareness of risk factors (range: 0~9)		7.97±1.67	6.10±1.37	-4.73	＜.001
Disease-related knowledge (range: 0~25)		16.43±7.67	11.16±8.53	-2.51	.015
Self-efficacy (range: 20~100)		85.06±5.66	68.66±8.71	-8.64	＜.001
Self-care behavior (range: 23~115)		79.60±3.37	66.20±4.28	-13.44	＜.001
Blood cholesterol profile	(normal range)
TC (mg/dL)	(＜200)	164.53±39.59	169.33±31.00	0.52	.603
TG (mg/dL)	(＜150)	167.57±46.31	174.13±45.32	0.55	.581
HDL (mg/dL)	(≥40)	41.53±11.06	44.50±12.25	0.98	.329
LDL (mg/dL)	(＜100)	103.53±22.73	97.10±30.44	-0.92	.358

TC=total cholesterol; TG=triglycerides; HDL=high density lipoprotein; LDL=Low density lipoprotein.

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