Knowledge, attitudes, and beliefs about acute coronary syndrome among patients with type 2 diabetes

Johnson, Camille Alardis Hunte; Pitta, Natássia Condilo; Dessotte, Carina Aparecida Marosti; Dantas, Rosana Aparecida Spadoti; Rossi, Lídia Aparecida

doi:10.1590/1518-8345.5435.3503

Camille Alardis Hunte Johnson

Charles Roza School of Nursing, Linden, Guyana.

http://orcid.org/0000-0002-0399-9249

Natássia Condilo Pitta

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0003-0098-3310

Carina Aparecida Marosti Dessotte

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0002-5521-8416

Rosana Aparecida Spadoti Dantas

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0002-3050-7000

Lídia Aparecida Rossi Corresponding author: Lídia Aparecida Rossi E-mail: rizzardo@eerp.usp.br https://orcid.org/0000-0002-4141-861X

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0002-4141-861X

Authors’ contribution:

Study concept and design: Camille Alardis Hunte Johnson, Lídia Aparecida Rossi. Obtaining data: Camille Alardis Hunte Johnson. Data analysis and interpretation: Camille Alardis Hunte Johnson, Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas, Lídia Aparecida Rossi. Statistical analysis: Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas. Obtaining financing: Camille Alardis Hunte Johnson. Drafting the manuscript: Camille Alardis Hunte Johnson, Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas, Lídia Aparecida Rossi. Critical review of the manuscript as to its relevant intellectual content: Camille Alardis Hunte Johnson, Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas, Lídia Aparecida Rossi.

All authors approved the final version of the text.

Conflict of interest: the authors have declared that there is no conflict of interest.

Associate Editor: Maria Lúcia Zanetti

Corresponding author: Lídia Aparecida Rossi E-mail: rizzardo@eerp.usp.br https://orcid.org/0000-0002-4141-861X

Variable	N (%)
Sex
Female	39 (65)
Male	21 (35)
Age (years) Mean=55; S.D.^ * S.D. = Standard Deviation =11.6*
Educational level
Primary	25 (41.7)
Secondary	26 (43.3)
University	6 (10.0)
Trade School	3 (5.0)
Time since diabetes diagnosis (months) Mean=23.2; S.D. = 9.5
Comorbidities (yes)	54 (90.0)
Hypertension	42 (70.0)
Coronary Artery Disease	4 (6.7)
Neuropathy	10 (16.7)
Nephropathy	3 (5.0)
Retinopathy	20 (33.3)
Body mass index (yes) Mean= 31.4; S.D. = 5.7 eutrophic
Eutrophic	6 (10.0)
Overweight	19 (31.7)
Obesity I	19 (31.7)
Obesity II	14 (23.3)
Obesity III	2 (3.3)
Physical activity (yes)	46 (76.7)
Walking	38 (63.3)
Running	4 (6.7)
Riding	3 (5.0)

ACS^* * ACS = Acute Coronary Syndrome; -Response Index Knowledge subscale	Total mean score (S.D.)^† † S.D. = Standard Deviation; 9.12 (3.4)
Correct answer for each item	Total median score (range) 9.0 (4-16)
Correct answer for each item	N (%)
1. Lower abdominal pain^‡ ‡ Reverse code (N=59)	43 (72.9)
2. Arm pain or shoulder pain (N=60)	27 (45.0)
3. Arm paralysis^‡ ‡ Reverse code (n=56)	43 (76.8)
4. Back pain (N=58)	25 (43.1)
5. Chest pain/pressure/tightness (N=58)	26 (44.1)
6. Chest discomfort (heaviness, burning, tenderness) (N=60)	23 (38.3)
7. Cough^‡ ‡ Reverse code (N=56)	40 (71.4)
8. Dizziness, light headedness (N=57)	19 (33.3)
9. Headache^‡ ‡ Reverse code (N=59)	31 (52.5)
10. Heartburn/indigestion/stomach problem (n=60)	29 (48.3)
11. Jaw pain (N=59)	16 (27.1)
12. Loss of consciousness/fainting (N=59)	21 (35.6)
13. Nausea/vomiting (N=59)	20 (33.9)
14. Neck pain (N=58)	26 (44.8)
15. Numbness/tingling in arm or hand^‡ ‡ Reverse code N=60	26 (43.3)
16. Pale, ashen, loss/change of color (N=59)	16 (27.1)
17. Palpitations/rapid heart rate (N=59)	29 (49.2)
18. Shortness of breath/difficulty breathing (N=60)	30 (50.0)
19. Slurred speech^‡ ‡ Reverse code (N=57)	37(64.9)
20. Sweating (N=60)	18 (30.0)
21. Weakness/fatigue (N=59)	12 (20.3)

ACS^* * ACS = Acute Coronary Syndrome; -Response Index - Attitudes subscale	Total median score (range) 11.5 (5-18)
Items	Total mean score (S.D.)^† † S.D. = Standard Deviation 11.2 (3.5)
22. How sure are you that you could recognize the signs and symptoms of a heart attack in someone else?	1.8 (0.9)
23. How sure are you that you could recognize the signs and symptoms of a heart attack in yourself?	2.0 (0.9)
24. How sure are you that you could tell the difference between the signs or symptoms of a heart attack and other medical problems?	2.0 (1.0)
25. How sure are you that you could get help for someone if you thought they were having a heart attack?	2.6 (0.9)
26. How sure are you that you could get help for yourself if you thought you were having a heart attack?	2.8 (0.8)

ACS^* * ACS = Acute Coronary Syndrome; -Response Index - Beliefs subscale	Total median score (range) 22 (7-28)
Items	Total mean score (S.D.)^† † S.D. = Standard Deviation, 21.3 (4.5)
27. If I have chest pain that doesn’t stop after 15 minutes, I should get to the hospital as soon as possible^‡ ‡ Reverse code (N=60)	2.1 (1.0)
28. I would be embarrassed to go to the hospital if I thought I was having a heart attack, but I wasn’t (N=59)	3.2 (0.9)
29. If I thought I was having a heart attack, I would wait until I was very sure before going to the hospital (N=59)	3.2 (0.9)
30. If I thought I was having a heart attack, I would rather have someone drive me to the hospital than have an ambulance come to my home (N=59)	2.6 (1.0)
31. If I’m having chest pain and I’m not very sure if it’s a heart attack, I should go to the hospital^‡ ‡ Reverse code (N=58)	2.1 (0.9)
32. Because of the cost of medical care, I would want to be absolutely sure I was having a heart attack before going to the hospital (N=58)	1.8 (0.9)
33. If I thought I was having a heart attack, I would go to the hospital right away^‡ ‡ Reverse code (N=59)	1.7 (1.0)

Variables	ACS^* * ACS = Acute Coronary Syndrome; -Response Index subscales
	Knowledge		Attitude		Beliefs
	Median (Range)	p-value	Median (Range)	p-value	Median (Range)	p-value
Sex		0.656^† † Mann-Whitney test;		0.846^† † Mann-Whitney test;		0.271^† † Mann-Whitney test;
Female (n=39)	9.5 (4.0-15.0)		11.0 (5.0-18.0)		22.0 (7.0 28.0)
Male (n=21)	8.00 (4.0-16.0)		12.0 (6.0 16.0)		23.0 (13.0-28.0)
Age (years)		0.573^† † Mann-Whitney test;		0.153^† † Mann-Whitney test;		0.001^† † Mann-Whitney test;
< 60 (n=41)	8.0 (4.0-16.0)		12.0 (5.0-18.0)		21.0 (7.0-28.0)
60+ (n=45)	9.0 (4.0-14.0)		9.0 (5.0-17.0)		23.0 (15.0-27.0)
PA ^‡ ‡ PA = physical activity;		0.677^† † Mann-Whitney test;		0.178^† † Mann-Whitney test;		0.335^† † Mann-Whitney test;
Yes (n=9)	8.0 (4.0-16.0)		11.0 (5.0-18.0)		22.0 (7.0-28.0)
No (n=51)	11.0 (5.0-12.0)		8.0 (6.0-15.0)		25.0 (13.0-27.0)
Time Diag. ^§ § Time Diag. = Time since diabetes diagnosis;		0.138^† † Mann-Whitney test;		0.049^† † Mann-Whitney test;		0.049^† † Mann-Whitney test;
Less than 12 months (n=27)	10.0 (4.0-16.0)		13.0 (5.0-17.0)		20.0 (13.0-28.0)
From 12 to 36 months (n=33)	8.0 (4.0-14.0)		10.0 (5.0-18.0)		23.0 (7.0-28.0)
BMI^\|\| \|\| BMI = Body mass index;		0.646^† † Mann-Whitney test;		0.405^† † Mann-Whitney test;		0.968^† † Mann-Whitney test;
Not overweight (n=6)	8.0 (5.0-1720)		8.5 (6.0-15.0)		21.5 (16.0-27.0)
Overweight (n=44)	9.0 (4.0-16.0)		12.0 (5.0-18.0)		22.0 (7.0-28.0)
Educational Level		0.008^¶ ¶ Kruskal-Wallis test		0.009^¶ ¶ Kruskal-Wallis test		0.109^¶ ¶ Kruskal-Wallis test
Primary (n=25)	7.5 (4.0 - 15.0)		9.0 (5.0 - 17.0)		23.0 (13.0 - 28.0)
Secondary (n=24)	9.0 (4.0 - 14.0)		12.0 (5.0 - 18.0)		22.0 (7.0 - 28.0)
Trade or university (n=9)	13.5 (7.0 - 16.0)		14.0 (11.0 - 15.0)		18.0 (16.0 - 27.0)

[1] Authors’ contribution:

Study concept and design: Camille Alardis Hunte Johnson, Lídia Aparecida Rossi. Obtaining data: Camille Alardis Hunte Johnson. Data analysis and interpretation: Camille Alardis Hunte Johnson, Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas, Lídia Aparecida Rossi. Statistical analysis: Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas. Obtaining financing: Camille Alardis Hunte Johnson. Drafting the manuscript: Camille Alardis Hunte Johnson, Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas, Lídia Aparecida Rossi. Critical review of the manuscript as to its relevant intellectual content: Camille Alardis Hunte Johnson, Natássia Condilo Pitta, Carina Aparecida Marosti Dessotte, Rosana Aparecida Spadoti Dantas, Lídia Aparecida Rossi.

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