Abstract P313: Poor Cardiovascular Health Knowledge despite the Rising Epidemic of Cardiovascular Diseases: findings from a peri-urban Nepalese community

Abstract

Nepal, a low-income South Asian country, is facing a growing epidemic of atherosclerotic cardiovascular diseases. Information on how well its population knows about the underlying risk factors and possible prevention and control strategies is an important determinant in tackling the epidemic. Studies indicate Nepalese people have poor knowledge regarding cardiovascular health, for example, about symptoms of heart attack or diabetes. We conducted a study on cardiovascular health literacy in a peri-urban area near Kathmandu and tested the hypothesis that better cardiovascular health knowledge is associated with superior cardiovascular health behaviour. For this cross-sectional study, we conducted face-to-face interviews with 777 consenting adults aged 25-59 years from six randomly sampled clusters of Duwakot and Jhaukhel communities between September and November 2011. We used WHO-STEPs questionnaire to gather information on demographic, behavioural and anthropometric variables. Additionally, we did a thorough literature search to construct questions on cardiovascular health knowledge and attitude. Scores were given to knowledge, attitude and behaviour/practice components which were then aggregated to calculate composite median percent scores. Five categories from highest to lowest quintiles of median percent scores were then generated. Seventy percent of the respondents were females- out of which two-thirds were housewives, and a third was without formal education. A fifth of the 229 male respondents were doing agriculture-based work. When asked to spontaneously name the risk factors, respondents showed low overall knowledge- ranging from 1% for diabetes and 29% for smoking. Sixty percent of them did not know any heart attack symptom. Chest pain as a heart attack sign was known only to 14% of the respondents. Nonetheless, 86% of them thought heart diseases could be prevented by improving lifestyles. However, 65% of men and 54% of women did not want to change their lifestyle as they did not consider themselves to be at risk. Further, among those with highest knowledge quintile score, only 14.7% had highest attitude quintile score, and only 13.4% had highest behaviour quintile score. Likewise, among those with lowest knowledge quintile score, 26% had lowest attitude quintile score, and 16.4% had lowest behaviour quintile score. In conclusion, despite the rising burden of cardiovascular epidemic in Nepal, population-level knowledge on cardiovascular health is still poor. Further, better knowledge did not necessarily translate into superior cardiovascular health behaviour. Therefore, community-based interventions that improve all the three components should be promoted rather than those which influence only the knowledge aspect.