Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site

Abstract

Objectives: This study determined the knowledge, attitude and practice/behaviour of cardiovascular health in residents of a semiurban community of Nepal.

Design: To increase the understanding of knowledge, attitude and practice/behaviour towards cardiovascular health, we conducted in-home interviews using a questionnaire based on the WHO STEPwise approach to surveillance and other resources, scoring all responses. We also recorded blood pressure and took anthropometric measurements.

Setting: Our study was conducted as part of the Heart-Health-Associated Research and Dissemination in the Community project in the Jhaukhel-Duwakot Health Demographic Surveillance Site in two urbanising villages near Kathmandu.

Participants: The study population included 777 respondents from six randomly selected clusters in both villages.

Results: Seventy per cent of all participants were women and 26.9% lacked formal education. The burden of cardiovascular risk factors was high; 20.1% were current smokers, 43.3% exhibited low physical activity and 21.6% were hypertensive. Participants showed only poor knowledge of heart disease causes; 29.7% identified hypertension and 11% identified overweight and physical activity as causes, whereas only 2.2% identified high blood sugar as causative. Around 60% of respondents did not know any heart attack symptoms compared with 20% who knew 2-4 symptoms. Median percentage scores for knowledge, attitude and practice/behaviour were 79.3, 74.3 and 48, respectively. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge. Among those with highly satisfactory knowledge, only 14.7% had a highly satisfactory attitude and 19.5% and 13.9% had satisfactory and highly satisfactory practices, respectively.

Conclusions: Our study demonstrates a gap between cardiovascular health knowledge, attitude and practice/behaviour in a semiurban community in a low-income nation, even among those already affected by cardiovascular disease.

Keywords: Epidemiology; Preventive Medicine; Public Health.

Figure 1

Sex-wise distribution of cardiovascular risk factor status in the study population. m, Number of males; f, number of females; # p<0.001, ## p<0.01 (χ² tests). Risk factor categories were based on the WHO-NCD Risk Factor STEPS Survey manual. Current smokers included those who responded ‘yes’ to ‘Do you smoke?’ Past smokers included those who replied ‘yes’ to ‘Did you ever smoke in the past?’. ‘Ever drinkers’ included respondents who had ‘consumed a drink that contained alcohol ever in lifetime,’ and current drinkers included respondents who had ‘consumed alcohol within the previous month.’ The percentage of drinking frequency represents current drinkers who consumed at least one standard drink per occasion. Blood pressure data exclude respondents who did not submit to all three readings. Likewise, data for BMI, waist circumference and waist-hip ratio exclude respondents whose weight, height and waist and/or hip measurements were not taken. Increased waist circumference includes waist measurements of ≥80 cm (women) and ≥90 cm (men); increased waist–hip ratio is ≥0.85 (women) and ≥0.90 (men).