Knowledge and Attitudes of Medical and Paramedical Staff Regarding Cardiac Rehabilitation Program at Al-Najaf Center for Cardiac Surgery
and Trans Catheter Therapy
Ali Saleem Salim1, Assistant prof. Suhair Mohammed Hassoun2, Assistant prof. Dr. Maral f. thabit3
1,2 Middle Technical University/ College of Health & Medical Technology/ Baghdad, Iraq.
3 Middle Technical University/ Technical Medical Institute/ Baghdad, Iraq.
Abstract
Background: Cardiac rehabilitation is very essential for patients who suffer from cardiac diseases to improve their quality of life during pre and post hospitalization period.
Aim: This study aimed to assess the knowledgeand attitudes of medical and paramedical staff on cardiac rehabilitation program (CRP), and relate the relationship between socio- demographic characteristics, qualifications and years of experience with their knowledge and attitudes on CRP.
Subjects and Methods: A descriptive; cross sectional study conducted at Al-Najaf Center for Cardiac Surgery and Trans Catheter Therapy, included 200 participants (33 medical staff and 167 paramedical staff) from 6th December-2020 ending on 17th March-2021.
Study instrument: To collect information about Knowledge and Attitudes of Medical and Paramedical Staff, the researcher develops a structured questionnaire depends on the previous studies (Kellar,2019; Kumudah et.al.,2020) and modified after reviewing by the supervisors and the 14 experts. All observations of the supervisors and the experts to evaluate the questionnaire contents, clarity, and adequacy were taken into consideration to achieve the present goals of the study.The study instrument consists of a total of 45 questions under 3 sections; the first section has 5 questions to analyse the respondents’ socio- demographic details, second section has 16 questions to analyse the respondents’ knowledge on CRP and the last section consists of 24 questions to analyse the attitudes of respondents’
on CRP.
Results: The current study was conducted on 200 medical and paramedical staff with the mean ± SD of their ages was 32.7±8.07 years ranging from 21 to 54 years. The highest percentage (53.0%) were from the 20-31 years age group and most of them were males (65.5%) with their level of education of Baccalaureate (45.5%), and Years of experience 1-5 (39.5%), while the highest percentage of professional level was (46.0%) from Nurses.
Conclusions: The current study concluded that the knowledge of medical and paramedical staff about the cardiac rehabilitation program in this institution is weak, but the majority of them have a fair attitudes about CRP and they have bigger desire and more willing to apply this program at their organization.
Recommendation:Workshops and training courses regarding CRP should be planned, developed and implemented to increase the knowledge level of healthcare providers and to identify educational deficiencies among them.
Key words: Cardiac rehabilitation, knowledge, attitudes, medicaland paramedical staff Introduction:
Cardiovascular diseases (CVDs) are group of disorders that involve the heart or blood vessels or both, they include coronary heart disease (CHD), cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, and deep vein thrombosis and pulmonary embolism (Abdelmoneim Awad & Hala Al-Nafisi,2014). CVDs are the leading cause of deaths in both developed and developing countries, it was estimated
that 30% (17.5 million people) of global all-cause mortalities were from CVDs, of these, 6.2 and 7.3 million were due to stroke and CHD, respectively, and it is expected to increase to 23.3 million by 2030 (Zhao et.al.,2019).
In Iraq, the epidemiological data on the incidence and prevalence of CAD as evidence of awareness are limited due to the unavailability of evidence-based national guidelines for the management of cardiovascular disease and surveillance studies as compared to other Eastern Mediterranean countries (Traina et.al.,2017). Recently, cardiovascular disease mortality was estimated to account for 33% in Iraq, and a greater recognition of the CVD burden in this area and the related risk factors beside to increasing the public knowledge and awareness of CAD symptoms and its risk factors are highly urgent to control and prevent this disease (Amen et.al.,2020).
Cardiac rehabilitation is a comprehensive program that prepares the patient for a complete, vital, and active life within the restrictions placed on him or her by the cardiac condition, and it has been used less than half of the time in recent years (Pareek,2018). In other word, cardiac rehabilitation (CR) is a process whereby a person is restored to an optimal physical, psychological, social, emotional, and economic status, therefore, CRP consists of risk factor modifications, dietary interventions, psychological supports, exercisetraining, and education (Moradi et.al.,2011).
Aim
This study aimed to assess the knowledgeand attitudes of medical and paramedical staff on cardiac rehabilitation program (CRP), and relate the relationship between socio- demographic characteristics, qualifications and years of experience with their knowledge and attitudes on CRP.
Subjects and Methods
A descriptive; cross sectional study conducted at Al-Najaf Center for Cardiac Surgery and Trans Catheter Therapy, included 200 participants (33 medical staff and 167 paramedical staff).
Duration of Study
The data collection continued for more than two months starting on 6th December- 2020 ending on 17th March-2021.
Place of Study
This study was done at Al-Najaf Center for Cardiac Surgery and Trans Catheter Therapy in Al-Najaf Al-Ashraf governorate, which is one of the holiest cities in Iraq, located to the south of Baghdad by about 160 km. Its estimated population in 2018 was 1,471592 people (Ghufran & Suhair,2020).
Inclusion and Exclusion Criteria of Study
Inclusion criteria: Medical and paramedical staff from both genders who working in Al-Najaf Center for Cardiac Surgery and Trans Catheter Therapy.
Exclusion Criteria: Medical and paramedical staff who refuse to participate in the study and visiting or rotating physician from other departments.
Statistical data analysis
Analysis of data carried out using the available statistical package of SPSS-25 (Statistical Packages for Social Sciences- version 25). Data were presented in simple measures of frequency, percentage, mean, standard deviation, and range. The significance of difference
for different percentages (qualitative data) was tested using Pearson Chi-square test (2-test) with application of Yate's correction or Fisher Exact test whenever applicable. Statistical significance considered whenever the P value was equal or less than 0.05.
Results
Demographic Characteristics: The current study was conducted on 200 medical and paramedical staff with the mean ± SD of their ages was 32.7±8.07 years ranging from 21 to 54 years. The highest percentage (53.0%) were from the 20-31 years age group and most of them were males (65.5%) with their level of education of Baccalaureate (45.5%), and Years of experience 1-5 (39.5%), while the highest percentage of professional level was (46.0%) from Nurses. The total number of medical staff was (33), while of paramedical staff was (167) participants. Table 1
Table 1: The Distribution of medical and paramedical staff according to Demographic Characteristics.
Medical and Paramedical staff demographic characteristics No. %
Age (years)
21-30 106 53.0
31-40 60 30.0
41-50 26 13.0
>50 8 4.0
Total 200
Mean ± SD 32.7±8.07
Gender Male 131 65.5
Female 69 34.5
Years of experience
1-5 79 39.5
6-10 65 32.5
11-15 38 19.0
16-20 13 6.0
>20 5 3.0
Educational level
Middle school of nurse 13 6.5
Diploma 68 34.0
Baccalaureate 91 45.5
Masters 11 5.5
PhD 17 8.5
Profession
Physician 23 11.5
Pharmacist 10 5.0
Nurse 92 46.0
Laboratory scientist 22 11.0
Medical Technologists 40 20.0
Staff nurse 13 6.5
Knowledge of medical and paramedical staff about (CRP)
Regarding knowledge of medical and paramedical staff about cardiac rehabilitation program (CRP), the highest percentage 98 (49.0%) of all participants (Medical and Paramedical staff) had poor knowledge, 60 (30.0%) had fair knowledge and the lowest percentage 42 (21.0%) had good knowledge about this program (CRP). In other hand this table showed that the highest percent (75.0%) of all participants answered correctly for (Are you familiar with the risk factors of coronary diseases & methods of prevention), while the lowest percent (24.5%) of all participants answered correctly for (Do you know the types of cardiac rehabilitation). Table 2.
Table 2: Distribution of Studied Sample according to their Knowledge regarding cardiac rehabilitation program (CRP).
Knowledge of medical and paramedical staff Yes No Don't Know
Evaluation
Items No. % No. % No. %
1 Rehabilitation means restoration of normal
life 142 71.0 36 18.0 22 11.0 Good
2 Do you have adequate information about
goals of Cardiac rehabilitation 58 29.0 116 58.0 26 13.0 Poor 3 Are you aware of indication of Cardiac
rehabilitation 80 40.0 98 49.0 22 11.0 Poor
4 Do you have adequate information of
Contraindication for CR 58 29.0 116 58.0 26 13.0 Poor
5 Are you familiar with key elements of
cardiac rehabilitation 59 29.5 115 57.5 26 13.0 Poor
6 Do you know the types of cardiac
rehabilitation 49 24.5 129 64.5 22 11.0 Poor
7 Do you know the members of cardiac
rehabilitation team 57 28.5 126 63.0 17 8.5 Poor
8 Do you have information on areas of
cardiac rehabilitation 65 32.5 111 55.5 24 12.0 Poor
9 Do you have general idea on cardiac
rehabilitation program 101 50.5 79 39.5 20 10.0 Fair
10 Phase I : Performed during patient
hospitalization 121 60.5 41 20.5 38 19.0 Fair
11 Are you familiar with activities of CR
Phase 1 76 38.0 98 49.0 26 13.0 Poor
12 Do you know passive exercises done
during cardiac rehabilitation 94 47.0 88 44.0 18 9.0 Fair 13 Phase II : Performed after discharge from
hospital 121 60.5 33 16.5 46 23.0 Fair
14 Are you familiar with activities in the CR
Phase 2 63 31.5 105 52.5 32 16.0 Poor
15 Phase III : Stage of exercise and education 117 58.5 35 17.5 48 24.0 Fair 16 Are you familiar with the risk factors of
coronary diseases & methods of prevention 150 75.0 32 16.0 18 9.0 Good
Total 200 Poor
Attitudes of medical and paramedical staff about (CRP)
Regarding attitudes of medical and paramedical staff about cardiac rehabilitation program (CRP), the highest percentage 106 (53.0%) of all participants (Medical and Paramedical staff) had fair attitudes, 82 (41.0%) had good attitudes and the lowest percentage 12 (6.0%) had poor attitudes about this program (CRP). In other hand this table showed that the highest percent (96.5%) of all participants answered correctly for (Are you familiar with risk factors for coronary diseases), while the lowest percent (24.5%) of all participants answered correctly for (Do you know the types of cardiac rehabilitation). Table 3.
Table 3: Distribution of Studied Sample according to their attitudes regarding cardiac rehabilitation program (CRP).
Attitudes of medical and paramedical staff Agree Disagree Not sure Evaluation
Items No. % No. % No. %
1 I should be familiar with cardiac
rehabilitation program 186 93.0 7 3.5 7 3.5 Good
2 My organization should has specified
policies for CRP 186 93.0 9 4.5 5 2.5 Good
3 I think there is no enough time to refer
patient for cardiac rehabilitation 83 41.5 72 36.0 45 22.5 Poor 4
It is essential to provide sufficient leadership, support and resources to implement CRP
184 92.0 5 2.5 11 5.5 Good
5 In this organization, cardiac rehabilitation
program is important 180 90.0 5 2.5 15 7.5 Good
6 I am skeptical about the benefits of cardiac
rehabilitation program 49 24.5 126 63.0 25 12.5 Fair
7
I think there is a requirement to provide necessary information and proper facilities to refer patients to CRP
179 89.5 6 3.0 15 7.5 Good
8 Consistent referral to CRP will prevent
cardiovascular disease 148 74.0 27 13.5 25 12.5 Good
9 Referral to CRP will reduce readmissions 160 80.0 17 8.5 23 11.5 Good 10 Consistent strategies of CRP will effect
positively on patient outcomes 156 78.0 16 8.0 28 14 Good
11 My Organization should have specified
staff for conducting CRP 168 84.0 18 9.0 14 7 Good
12 I lack the time to make referrals or discuss
CR with my patients 105 52.5 56 28.0 39 19.5 Poor
13 It isn't essential to have knowledge on
cardiac rehabilitation program 45 22.5 139 69.5 16 8 Fair
14 I am unfamiliar with CR guidelines 111 55.5 73 36.5 16 8 Poor 15 I am unsure of which patients to refer 104 52.0 66 33.0 30 15 Poor 16 I am concerned about patients'
comorbidities hindering participation. 151 75.5 16 8.0 33 16.5 Good
17 I am less likely to refer older patients to
CRP. 54 27.0 100 50.0 46 23 Fair
18 I feel patients are unlikely to attend despite
referral. 71 35.5 78 39.0 51 25.5 Fair
19 Resources and legislations within facility
support to the establishment of CRPs 94 47.0 57 28.5 49 24.5 Fair 20 I am unfamiliar with referral processes to
CRP. 111 55.5 46 23.0 43 21.5 Fair
21 I think a cardiac rehabilitation nurse can
act as Counselor 140 70.0 25 12.5 35 17.5 Fair
22 I know the responsibility of nurses
regarding CR 95 47.5 74 37.0 31 15.5 Good
23 I am aware of the CRP policies of the
organization 60 30.0 101 50.5 39 19.5 Fair
24 I think staff can establish CRP 135 67.5 22 11.0 43 21.5 Poor Association between participant's Knowledge about CRP and their demographic data
Regarding the association between knowledgeof participants with their socio- demographic characteristics, it had been found that non-significant association with most variables, except with (Years of experience and Profession) (0.003 and 0.027) respectively where a significant association had been found. Table 4.
Medical and Paramedical staff demographic characteristics
Poor Fair Good Total P.Value
No % No % No %
Age (years)
21-30 55 51.89 31 29.25 20 18.87 106
0.175
31-40 27 45.00 23 38.33 10 16.67 60
41-50 13 50.00 5 19.23 8 30.77 26
>50 3 37.50 1 12.50 4 50.00 8
Total 98 49.00 60 30.00 42 21.00 200
Gender Male 63 48.09 39 29.77 29 22.14 131
0.859
Female 35 50.72 21 30.43 13 18.84 69
Total 98 49.00 60 30.00 42 21.00 200
Years of experience
1 to 5 46 58.23 20 25.32 13 16.46 79
0.003
6 to 10 27 41.54 27 41.54 11 16.92 65
11 to 15 21 55.26 9 23.68 8 21.05 38
16-20 4 30.77 3 23.08 6 46.15 13
>20 0 0.00 1 20.00 4 80.00 5
Total 98 49.00 60 30.00 42 21.00 200
Educationa l level
Middle school of nurse 6 46.15 6 46.15 1 7.69% 13
0.152
Diploma 35 51.47 20 29.41 13 19.12 68
Baccalaureate 47 51.65 27 29.67 17 18.68 91
Masters 4 36.36 3 27.27 4 36.36 11
PhD 6 35.29 4 23.53 7 41.18 17
Total 98 49.00 60 30.00 42 21.00 200
Profession Physician 8 34.78 5 21.74 10 43.48 23
0.027
Pharmacist 8 80.00 1 10.00 1 10.00 10
Nurse 39 42.39 33 35.87 20 21.74 92 Laboratory scientist 16 72.73 4 18.18 2 9.09% 22 Medical Technologists 21 52.50 11 27.50 8 20.00 40
Staff nurse 6 46.15 6 46.15 1 7.69 13
Total 98 49.00 60 30.00 42 21.00 200
*Significant difference between proportions using Pearson Chi-square test at 0.05 level.
Associationbetween participants' Attitudes about CRP and their demographic data Regarding association between attitudesof participants with their socio-demographic characteristics, it had been found that non-significant association with most variables, except with (Educational level and Profession) (0.003 and 0.001) respectively where a significant association had been found. Table 5
Medical and Paramedical staff demographic characteristics
Poor Fair Good Total P.
Value
No. % No. % No. %
Age (years)
21-30 6 5.66 55 51.89 45 42.45 106
0.873
31-40 4 6.67 35 58.33 21 35.00 60
41-50 2 7.69 12 46.15 12 46.15 26
>50 0 0.00 4 50.00 4 50.00 8
Total 12 6.00 106 53.00 82 41.00 200
Gender Male 8 6.11 67 51.15 56 42.75 131
0.765
Female 4 5.80 39 56.52 26 37.68 69
Total 12 6.00 106 53.00 82 41.00 200
Years of experience
1 to 5 4 5.06 43 54.43 32 40.51 79
0.284
6 to 10 4 6.15 33 50.77 28 43.08 65
11 to 15 4 10.53 24 63.16 10 26.32 38
16-20 0 0.00 4 30.77 9 69.23 13
>20 0 0.00 2 40.00 3 60.00 5
Total 12 6.00 106 53.00 82 41.00 200
Education al level
Middle school of nurse
3 23.08 8 61.54 2 15.38 13
0.003
Diploma 4 5.88 44 64.71 20 29.41 68
Baccalaureate 5 5.49 46 50.55 40 43.96 91
Masters 0 0.00 4 36.36 7 63.64 11
PhD 0 0.00 4 23.53 13 76.47 17
Total 12 6.00 106 53.00 82 41.00 200
Profession
Physician 0 0.00 5 21.74 18 78.26 23
0.001
Pharmacist 1 6.25 8 50.00 1 6.25 10
Nurse 2 2.17 49 53.26 41 44.57 92
Laboratory scientist 2 9.09 13 59.09 7 31.82 22
Medical Technologists 4 11.76 23 67.65 13 38.24 40
Staff nurse 3 23.08 8 61.54 2 15.38 13
Total 12 6.00 106 53.00 82 41.00 200
*Significant difference between proportions using Pearson Chi-square test at 0.05 level.
Discussion
Regarding knowledge, the current study showed that approximately half (49.0 %) of all study sample (48.5% of medical staff and 49.1% of paramedical staff) had poor knowledge about the Cardiac Rehabilitation Program (CRP), and the lowest percentage (21.0%) had good knowledge, while the rest (30.0%) had fair knowledge. The current findings can be interpreted as this program is not implemented in Iraq yet, lack of insurance coverage and unavailability of CR centers as well as lack of enough studies about CRPin our country. In addition, this program is not taught in colleges and there are no workshops or training courses about it. This result similar to what had been found in Iran by Moradi et.al.,2011, in Belgaum byDegavi & Bhupali,2015 and in India by Choure et.al.,2015 and by de Melo Ghisi et.al.,2018, in other hand our results disagree with Zhu et.al.,2020 in China and Kumudah et.al., 2020 in Malaysia who show that the medical and nurse staff have a good mastery of cardiac rehabilitation knowledge respectively.
Regarding attitudes, the present study showed that most of participant's had fair and good attitudes (53.0%, 41.0%) respectively toward Cardiac Rehabilitation Program (CRP), while the rest (6.0%) had poor attitudes.These findings may come back to their having better desire and more willing to apply this program at their organization.
Our results disagree with Liu et.al.,2015, Zhu et.al.,2020 in China, Moradi et.al.,2011 in Iranand Kumudah et.al., 2020in Malaysia who showed that most of study sample had poor attitudes may be due to the fact that the nurses'attitudes towards attending CRP was very less, and only less number of nurses were participated in the CRP and CNE training program.
Conclusions: The current study concluded that the knowledge of medical and paramedical staff about the cardiac rehabilitation program in this institution is weak, but the majority of them have a fair attitudes about CRP and they have bigger desire and more willing to apply this program at their organization.
Recommendation: Workshops and training courses regarding CRP should be planned, developed and implemented to increase the knowledge level of healthcare providers and to identify educational deficiencies among them.
References
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