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Combination of factors that do not comply with non pharmacological recommendations in patients undergoing percutaneous coronary intervention

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https://www.eduzhai.net International Journal of Psychology and Behavioral Sciences 2017, 7(3): 67-71 DOI: 10.5923/j.ijpbs.20170703.01 Constellation of Factors for Non-Compliance with Non-Pharmacological Advices to Percutaneous Coronary Intervention Patients Mohiuddin Mohammad Alamgir1,*, M. Shafiqur Rahman2, Rukhsana Shaheen3 1Deputy Commandant, Combined Military Hospital Dhaka, Dhaka, Bangladesh 2Associate Professor (Community Medicine), Army Medical College Jessore, Jessore, Bangladesh 3Assistant Professor (Community Medicine), Shaheed Tajuddin Ahmed Medical College, Gazipur, Bangladesh Abstract This study was an attempt to find out the constellation of factors interplaying for non-compliance with non-pharmacological advices to percutaneous coronary intervention patients attending Combined Military Hospital Dhaka, Bangladesh. This was a qualitative, obtrusive (reactive), descriptive socio-medical research using face to face in-depth interview with conveniently selected eighty-two ‘peer reviewed’ samples of percutaneous coronary intervention patients. Data were analyzed using limited descriptive statistics as well as Rothman’s concept of causal constellation, which were interpreted through both etic and emic approaches to draw conclusion. All ethical issues including avoiding plagiarism have been taken care of. The findings of the study show that necessary factors responsible for non-compliance of non-pharmacological management advices making web of constellation were ‘lack of self-control’, ‘addiction’, ‘ignorance’, ‘laziness’, ‘health problem’, and ‘time constrain work’. The study concluded with the suggestions for strengthening health literacy among percutaneous coronary intervention patients in Combined Military Hospital Dhaka. The study hinted for further probing of constellation factors among such patients in general population. Keywords Non-compliance, Non-pharmacological advice, Percutaneous coronary intervention patient 1. Introduction Evolution of life in earth, not just a geologic second ago, led to the appearance of human life. Each human follows a life course which ends with death [1]. Death is preceded by certain diseases that have two types of dimensions: communicable disease and non-communicable disease (NCD). Non-communicable diseases currently cause more deaths than all other causes combined, and NCD deaths are projected to increase from 38 million in 2012 to 52 million by 2030 [2]. Death of a human being before age of seventy years is considered as premature [3]. At present there appears an unprecedented opportunity to alter the course of NCDs which can prevent the majority of premature deaths. One pattern of NCD is coronary artery disease (CAD), which is one of the leading causes of mortality and morbidity in developed world, as well as developing countries like Bangladesh [4]. Moreover, it continues to be a major public health problem. Treatment of CAD is essential and coronary artery bypass grafting (CABG) was the only alternative to * Corresponding author: mm.alamgir@yahoo.com (Mohiuddin Mohammad Alamgir) Published online at https://www.eduzhai.net Copyright © 2017 Scientific & Academic Publishing. All Rights Reserved pharmacotherapy for the treatment of CAD till 1977. After that gradually, another modality of treatment, that is, percutaneous coronary intervention (PCI) has surpassed CABG as the most common means for treating CAD because of improvement of materials used, the use of stents, and pharmacotherapy. Percutaneous coronary intervention is safe due to reduced radiation exposure, quick mobilization of patient and no procedural complication [5]. Persons having established CAD and undergone PCI are already at very high risk of development of further events of cardiovascular disease (CVD) and need compliance with life-long follow-up of medical advices. Patients’ compliance to medical advices is crucial for better prognosis, which involves many factors, and makes it difficult to comply life-long. The post-PCI management of CAD patients involves both pharmacological (i.e., medicines) and non-pharmacological (i.e., lifestyle advices) management for restoration of normal functional coronary artery and/ or treatment of co-morbid medical condition(s) [6]. The estimations of World Health Organization (WHO) indicate that in developed countries compliance to long term medical advices for NCDs in the general population is around 50.0 percent, which is much lower in developing countries [7]. This study aims to look into the constellation of factors and find out the necessary causes that influence non-compliance with 68 Mohiuddin Mohammad Alamgir et al.: Constellation of Factors for Non-Compliance with Non-Pharmacological Advices to Percutaneous Coronary Intervention Patients non-pharmacological management advices after discharge age of the patients ranged between 31 and 74 years. The among PCI patients attending Combined Military Hospital standard deviation (SD) was ± 9.4. (CMH) Dhaka, Bangladesh. 1.1. Research Theme Just as statistical significance establishes causal relationship in quantitative studies, Rothman’s causal constellation pies point to causal association in qualitative studies [8]. Compliance of treatment follow-up, where many different component causes have been identified for each of its types in relation to ‘universal variables’, this study delved into identification of a final common pathway representing a web of causation comprising of only necessary causes for non-compliance with non-pharmacological management advices. 7.3% 92.7% Male Female Illustration 1. Pie Chart Showing sex Distribution of PCI Patients 2. Methods and Materials The study was approved by the Ethical Committee of the Armed Forces Medical Institute, Dhaka, Bangladesh. The purpose of the research was explained to participants, who thereafter gave verbal informed consent. This qualitative obtrusive (reactive) descriptive socio-medical study was conducted in the naturalistic setting of CMH Dhaka. The study population were patients with PCI who attended CMH Dhaka for follow-up advice. No specific time interval between follow-up advice and interview was considered. Convenient variety of non-probability sampling technique was applied during January and February 2016 to pick up total 82 sample units, which was agreed on peer review and considering data collection time in hand, PCI patients flow per day, and the time allocated for each interview through ‘grand tour neutral probing’. Coherent PCI patients aged 18 years or more of both sexes were included. Those, not entitled to get treatment from CMH Dhaka, denying consent, or unable to communicate were excluded. Interviews were continued until content saturation was reached, or no new themes emerged. Some interviews were audio-taped and transcribed to facilitate analysis. 3. Result Sex and Age Distribution of PCI Patients The study revealed that out of total eighty-two PCI patients 92.7 percent of the patients were male and the rest 7.3 percent were female as shown in Illustration 1. It was found that majority 35.4 percent of PCI patients were in the age group of 50 – 60 years and next 32.9 percent were in the age group of 60 – 70 years. Some 23.2 percent patients were in the age group of 40 – 50 years and the remaining 4.9 and 3.7 percent were in two extreme age group of 70 years or above and 30 – 40 years respectively, as shown in Table 1. The mean age of the patients were 55.6 years, median and mode being 56 and 65 years respectively. The Table 1. Age Distribution of PCI Patients Age group (in complete year) f 30 - 40 3 40 - 50 19 50 - 60 29 60 - 70 27 ≥ 70 4 Total 82 % 3.7 23.2 35.4 32.9 4.9 100.0 Mean = 55.6 years, Median = 56 years, Mode = 65 years, SD = ± 9.4, Range = 31 – 74 Non-Pharmacological Management Advice Non-pharmacological management advices prescribed by the physician to the individual PCI patient are considered here as lifestyle modification advice that need to be followed for the rest of life to prevent further consequences. Table 2. Distribution of Lifestyle Modification Advices to PCI Patients* Advice Avoid tobacco use Avoid physical inactivity Avoid unhealthy diet Avoid harmful use of alcohol Regular follow-up F % 76 92.7 72 87.8 60 73.2 5 6.1 15 18.3 *Multiple responses Table 2 shows that majority 92.7 percent PCI patients were advised with ‘avoid tobacco use’, followed by 87.8 and 73.2 percent advised with ‘avoid physical inactivity’, and ‘avoid unhealthy diet’ respectively. Some 18.3 percent patients were advised with ‘regular follow-up’, and the least 6.1 percent patients were advised with ‘avoid harmful use of alcohol’. International Journal of Psychology and Behavioral Sciences 2017, 7(3): 67-71 69 Non-Compliance with Non-Pharmacological Management Advice Non-compliance of non-pharmacological management advices by individual PCI patients are depicted here as coding for the concerned data generated by in-depth interview. The list has eleven codes and presented as factors for non-compliance of non-pharmacological advices. The study revealed that majority 28.0 percent PCI patients disclosed non-compliance with non-pharmacological advices because of ‘lack of self-control’, followed by 24.3 percent of non-compliance due to ‘health problem’. Some 14.6 percent PCI patients divulged non-compliance owing to each factor, either ‘time constrain work’ or ‘laziness’. ‘Ignorance’ was responsible for 13.4 percent of non-compliance. Some 2.4 percent non-compliance was found responsible for each factor, either ‘perceived wellbeing’ or ‘far-flung from CMH’ or ‘lack of environmental support’. ‘Addiction’, and ‘lack of family support’ were separately responsible for 4.8 percent of non-compliance, and a few 1.2 percent of non-compliance was responsible for ‘loss of memory’ as depicted in table 3. Table 3. Distribution of Factors for Non-compliance with Non-pharmacological Management Advice by PCI Patients* Factor f % Ignorance 11 13.4 Lack of self-control 23 28.0 Health problem 20 24.3 Time constrain work 12 14.6 Laziness 12 14.6 Perceived wellbeing 2 2.4 Addiction 4 4.8 Far-flung from CMH 2 2.4 Lack of family support 4 4.8 Loss of memory 1 1.2 Lack of environmental support 2 2.4 *Multiple responses Constellation of Factors for Non-Compliance with Non-Pharmacological Management Advices Illustration 2 shows sufficient cause for non-compliance with non-pharmacological management among male PCI patients that comprises of ‘perceived wellbeing’, ‘time constrain work’, ‘ignorance’, ‘lack of self-control’, ‘health problem’, ‘laziness’, ‘addiction’, ‘far-flung from CMH’, ‘lack of family support’, and ‘lack of environmental support’. Each of these factors is component of sufficient cause. In female PCI patients, components of sufficient cause are ‘time constrain work’, ‘ignorance’, ‘lack of self-control’, ‘health problem’, and ‘addiction’. Irrespective of sex, ‘time constrain work’, ‘ignorance’, ‘lack of self-control’, ‘health problem’, and ‘addiction’ are the necessary cause for non-compliance with non-pharmacological management among PCI patients. Male Female MORS TUVW XY ORST V Legend M = Perceived wellbeing O = Time constrain work R = Ignorance S = Lack of self-control T = Health problem U = Laziness V = Addiction W = Far-flung from CMH X = Lack of family support Y = Lack of environmental support Illustration 2. Rothman’s Causal Pies Showing Constellation of Factors for Non-compliance with Non- pharmacological Management Advice by Sex Illustration 3 shows the components of sufficient cause for non-compliance with non-pharmacological management advices among different age groups. It is found that irrespective of age groups, no necessary factor is responsible for non-compliance with non-pharmacological management advices among PCI patients. 30–40 Years O U 40–50 Years O RS TV X 50–60 Years O RS TU W 60–70 Years RS TU X Y ≥70 Years M ST X Legend M = Perceived wellbeing O = Time constrain work R = Ignorance S = Lack of self-control T = Health problem U = Laziness V = Addiction W = Far-flung from CMH X = Lack of family support Y= Lack of environmental support Illustration 3. Rothman’s Causal Pies Showing Constellation of Factors for Non-compliance of Non- pharmacological Management Advice by Age Illustration 4 shows the components of sufficient cause for non-compliance with non-pharmacological management advices among different educational qualification groups. It is found that irrespective of educational qualification, ‘lack of self-control’, ‘health problem’, and ‘laziness’ are the necessary causes for non-compliance with non-pharmacological management advices among PCI patients. Illustration 5 shows components of sufficient cause for non-compliance with non-pharmacological management advice in different occupation groups among PCI patients. It is revealed from the study that irrespective of occupation groups, ‘health problem’ is the necessary cause for 70 Mohiuddin Mohammad Alamgir et al.: Constellation of Factors for Non-Compliance with Non-Pharmacological Advices to Percutaneous Coronary Intervention Patients non-compliance with non-pharmacological management advice among PCI patients. ≤7 Years Of Schooling ompleted RS TU VX 8–9 10–11 ≥12 Years of Years of Years of Schooling Schooling Schooling Completed Completed ompleted M OR OS OR ST STU WX TU UV WX Y Legend M = Perceived wellbeing O = Time constrain work R = Ignorance S = Lack of self-control T = Health problem U = Laziness V = Addiction W = Far-flung from CMH X = Lack of family support Y = Lack of environmental support Illustration 4. Rothman’s Causal Pies Showing Constellation of Factors for Non-compliance with Non-pharmacological Management Advice by Educational Qualification Govern Private ment Service Service O O RS RS TU T X X Retirement Business Home Making MRS TUV WXY T O U R S T V W Legend M = Perceived wellbeing O = Time constrain work R = Ignorance S = Lack of self-control T = Health problem U = Laziness V = Addiction W = Far-flung from CMH X = Lack of family support Y = Lack of environmental support illustration 8. Among all the PCI patients, the necessary causes for non-compliance were non-pharmacological management were ‘health problem’, ‘ignorance’, ‘time constrain work’ ‘lack of self-control’, ‘addiction’, and ‘laziness’. Married Widow or Living with Widower Spouse MOR RST STU UV VW XY Unmarried O Legend M = Perceived wellbeing O =Time constrain work R = Ignorance S = Lack of self-control T = Health problem U = Laziness V = Addiction W = Far-flung from CMH X = Lack of Family support Y = Lack of environmental support Illustration 6. Rothman’s Causal Pies Showing Constellation of Factors for Non-compliance of Non-pharmacological Management Advice by Marital Status

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