O R I G I NA L A R T I C L E

Correlates of Health Behaviors in Patients

With Coronary Artery Disease
Younhee Kang1*, RN, MSN-ANP, PhD, In-Suk Yang2, RN, MSN, Narae Kim3, RN, BSN
1
Associate Professor, Division of Nursing Science, College of Health Sciences,
Ewha Womans University, Seoul, Korea
2
Docotoral Student, Division of Nursing Science, College of Health Sciences,
Ewha Womans University, Seoul, Korea
3
Master’s Student, Division of Nursing Science, College of Health Sciences,
Ewha Womans University, Seoul, Korea

Purpose To investigate the effect of cardiac knowledge and cardiac self-efficacy on health behaviors
after controlling for influences from associating factors of health behaviors in patients with coronary artery
diseases (CADs).
Methods A descriptive correlational and cross-sectional design was used. Subjects with CADs were
recruited from outpatient clinics of three academic medical centers. The cardiac knowledge, cardiac self-
efficacy, and health behaviors were measured by Coronary Heart Disease Awareness and Knowledge
Questionnaire, Cardiac Self-Efficacy Scale, and Health-Promoting Lifestyle Profile II respectively. The data
collected were statistically analyzed by descriptive statistics, t test, Kruskal-Wallis test, analysis of vari-
ance, Pearson’s correlation analysis, and the hierarchical multiple regression analysis.
Results A total of 157 subjects were recruited for this study. The mean age of subjects was 59.38 ± 10.04
years, and three-fourths (75.2%) were male. Subjects showed relatively low cardiac knowledge, moderately high
cardiac self-efficacy, and moderate level of health behaviors. The overall model significantly explained
48% of variance in health behaviors (F = 14.52, p < .001). Among predictors, age, education, smoking status,
experience of receiving patient education, and cardiac self-efficacy significantly affected health behaviors,
and cardiac self-efficacy had the greatest effect on health behaviors (β = .39). However, cardiac knowledge
had no statistically significant influence on health behaviors after controlling for the other factors.
Conclusion The findings suggested that cardiac self-efficacy was shown to be the most influencing factor
on health behaviors but cardiac knowledge had no influence on health behaviors. The nursing interven-
tions tailored on the patient characteristics should be developed in order to improve the health behaviors
of patients with CADs. [Asian Nursing Research 2010;4(1):45–55]

Key Words coronary artery disease, knowledge, self-efficacy, health behaviors

*Correspondence to: Younhee Kang, RN, MSN-ANP, PhD, Associate Professor, Division of Nursing
Science, College of Health Sciences, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu,
Seoul, 120-750, Korea.
E-mail: [email protected]

Received: February 15, 2010 Revised: February 17, 2010 Accepted: March 9, 2010

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 Y. Kang et al.

BACKGROUND factors with the health behaviors in clinical popula-

tions with CAD (Fleury & Sedikides, 2007; Lau-
Coronary artery diseases (CADs) are caused by the Walker, 2007; McKinley et al., 2009; Sol, van der
incomplete or complete occlusion of coronary Graaf, van der Bijl, Goessens, & Visseren, 2008). Dis-
arteries, the arteries that supply oxygenated blood ease knowledge is composed of information on
to the heart itself and meet its metabolic needs. pathophysiology, risk factor, treatment modality, and
Clinically significant CADs are manifested by symp- prevention methods related to a certain disease. It
toms including chest pain, sweating, and dysrrhyth- contributes to patients’ precise understanding of
mias, and may lead to the death in the extreme their disease and facilitates the decision making on
cases. According to the report from American Heart the lifestyle modification and its compliance, which
Association (Lloyd-Jones et al., 2009), despite of the may help slow down the disease process (Kayaniyil
26.4% decrease in the number of deaths by CADs et al., 2009; Mosca et al., 2006). In addition, disease
in 2005 compared with that of 1995, the mortality knowledge was known as a key element for the
rate still remains high as one out of the five deaths reduction in treatment-seeking time as well as the
in the United States was caused by CADs. Following primary and secondary disease prevention (Buckley
economic growth and industrialization, prolonged et al., 2007; McKinley et al.). However, most indi-
average life span and a westernized diet and life style viduals with CADs have passive attitudes towards
may result in the steady increase in the occurrence gaining knowledge on risk factors, signs and symp-
of CADs. Furthermore, the death rate per 100,000 toms of disease. Moreover, in the present health care
capita in 2007 was increased by 54.9% in compari- system, there is the limited time for nurses to edu-
son to that of 1998, and CADs was ranked as the cate and counsel patients due to the shortened length
third leading cause of death in Korea (Statistics of hospital stay (Buckley et al.). Thus, patients hardly
Korea, 2007). Thus, CADs have become a significant realize the importance and necessity of knowledge on
cause of death and this has significant influences on disease and compliance to healthy lifestyle changes
health care and nursing practice in Korea. (Lauck et al., 2009). Therefore, empirical examina-
To this date, the risk factors for CADs had been tion of the relationship between disease knowledge
well identified and CADs have been known to be pre- and health behaviors is needed in the population of
ventable through healthy lifestyle modifications and CADs.
consistent maintenance of chronic diseases (Redfern, Self-efficacy is defined as one’s confidence and
Ellis, Briffa, & Freedman, 2006). Thus, health behav- will to control one’s own health and has been known
iors are essential for patients with CADs for prevent- as the main predictor for complying with health pro-
ing possible cardiac events as well as keeping their moting behaviors and one of the key determinants in
health. Unfortunately, clinically, most patients with choosing and maintaining health behaviors (Fleury &
CADs rarely recognize the importance of lifestyle Sedikides, 2007; Han, Lee, & Kim, 2007; Sheahan &
and behavior changes in preventing the reoccurrence Fields, 2008). Specifically, the CADs population with
of symptoms (Lauck, Johnson, & Ratner, 2009). To high levels of self-efficacy have led to compliance
facilitate health behaviors in patients with CADs, of health behaviors such as adhering to medication
understanding the various factors that may associate regimen, healthy diet, and regular exercise, which
with motivating, initiating, maintaining, and rein- might have significant influences on lowering the
forcing health behaviors is essential. Subsequently, rate of symptom occurrence and readmission, and
effective nursing intervention strategies could be improving quality of life (Nakahara et al., 2006;
developed based on this knowledge. Sheahan & Fields).
Based on previous studies performed in the west- Previous studies examining the bivariate relation of
ern countries, it has been posited that disease knowl- health behavior focused on only one factor, either dis-
edge and self-efficacy might be plausible associated ease knowledge or self-efficacy, rather than analyzing

46 Asian Nursing Research ❖ March 2010 ❖ Vol 4 ❖ No 1

 Correlates of Health Behaviors in Coronary Heart Diseases

the concomitant effects of associated factors on health selected as a subject of this study were reviewed
behaviors. In addition, they are mostly performed in from the electronic medical records using the fol-
western countries. Methodologically, most studies lowing criteria:
utilized a general scale in measuring disease knowl-
edge and self-efficacy. This fact may interfere with the (a) The patient had a diagnosis of angina pectoris
appropriate representation of the variables measured. or myocardial infarction;
Therefore, under the consideration of cultural char- (b) The patient did not have complication of severe
acteristic, the two factors (disease knowledge and arrhythmia or congestive heart failure;
self-efficacy) should be examined in terms of their (c) The patient was an adult over 20 years of age
association with health behaviors in CADs patients. and was able to communicate in Korean.
Additionally, in measuring disease knowledge and
self-efficacy, cardiac specific instruments should be Measures
employed such as cardiac knowledge and cardiac Coronary Heart Disease Awareness and Knowledge
self-efficacy. Questionnaire (Kayaniyil et al., 2009) was used to
In the present study, therefore, the correlates of measure the cardiac knowledge; it was revised from
health behaviors, cardiac knowledge and cardiac self- the Cardiac Knowledge Questionnaire (Maeland &
efficacy were investigated in a Korean population with Havik, 1987) and the Coronary Heart Disease Knowl-
CADs. Upon the exploration of correlates of health edge (Smith, Hicks, & Heyward, 1991). Originally,
behaviors, the development of deliberate nursing this instrument consisted of 23 items measuring
strategies might be possible for the Korean popula- knowledge on pathophysiology, causes, risk factors,
tion with CADs. symptoms and treatment of CADs, and main cause
The present study aimed to determine the cor- of death in the United States. For this study, 20 items
relates of health behaviors in patient with CADs. were utilized excluding the 3 items on the statistics
The specific aims of the study were to explore the of the main cause of death and experience on treat-
relationship between cardiac knowledge, cardiac self- ment modality, which were not congruent with the
efficacy, and health behaviors, to examine the dif- purpose of this study. Each correct answer scored one
ferences in health behaviors by demographic and point and each incorrect answer scored zero point.
disease-specific characteristics, and to determine the A higher score indicates greater cardiac knowledge.
effects of cardiac knowledge and cardiac self-efficacy The psychometric characteristics of this scale were
on health behaviors. established (Kayaniyil et al.).
Cardiac self-efficacy was measured by Cardiac
Self-Efficacy Scale (Sullivan, LaCroix, Russo, & Katon,
METHODS 1998). This instrument was developed to measure
self-efficacy associated with heart disease. It was a
Design 16-item scale with 2 sub-dimensions including the
The present study utilized a descriptive correlational control of symptoms (8 items) and the maintenance
and cross-sectional survey design using a face-to-face of function (5 items), and an additional 3 items mea-
method. suring obesity, smoking and dietary habit only for
applicable subjects. Items were scored on a Likert
Sample and setting scale ranging from 0 (strongly disagree) to 4 (strongly
Subjects were recruited among outpatients who agree). In this study, the scoring was conducted with
had CADs at three academic medical centers in the sum of items except for the 3 specific items
Seoul, Korea. The subjects were selected from out- (obesity, smoking, and dietary habit). Scores ranged
patients who understood and agreed to participate from 0 to 52 with higher score indicating a greater
in the study. The requirements for the patient to be level of cardiac self-efficacy. In the previous study,

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 Y. Kang et al.

Cronbach’s alpha of the Cardiac Self Efficacy Scale item was assigned to a weight from 1 to 6, and the
was .87–.90 (Sullivan et al.). In the present study, Charlson score is the sum of the weights for all
Cronbach’s alpha was .80. conditions. A higher score indicates greater disease
Health behaviors was measured by the Health- burden.
Promoting Lifestyle Profile II (HPLP II; Walker, Kerr,
Pender, & Sechrist, 1990; Walker, Sechrist, & Pender, Data collection procedures
1987; Walker, Volkan, Sechrist, & Pender, 1988). Subjects were recruited using a convenience sam-
The HPLP II instrument consists of 52 items on six pling method from the outpatient clinics at three
sub-dimensions: (a) Health responsibility, 9 items; academic medical centers, Seoul, Korea. Data were
(b) Physical activity, 8 items; (c) Nutrition, 9 items; collected from September, 2009 to February, 2010
(d) Spiritual growth, 9 items; (e) Interpersonal rela- by researcher and assistant registered nurses. After
tions, 9 items; (f) Stress management, 8 items. All informed consent was obtained, data were obtained
items were scored on a 4-point Likert scale (1—Not using face-to-face interview. Disease-specific char-
at all; 2—Sometimes; 3—Often; 4—Always). A score acteristics were gathered through medical records.
for overall health behaviors was used by calculating From a total of 180 subjects who were invited to
mean of the subject’s response to all 52 items. Simi- participate, 157 subjects agreed to participate in the
larly, mean scores of sub-dimensions were obtained by study with a response rate of 87.2%.
calculating the subject’s response. Therefore, health
behaviors and each of the six sub-dimensions score Ethical considerations
could range from 1 to 4. Higher score indicates a Ethical approval was obtained from the institutional
greater level of health behaviors. Cronbach’s alpha review boards of the affiliated medical centers and
for HPLP II was .94, and the range for six sub- institutions. All study subjects were given both ver-
dimensions were from .79 to .87 (Walker & Hill- bal information and written summary of the study,
Polerecky, 1996). Cronbach’s alpha was .94 in the where a voluntary participation, guarantee of ano-
present study. nymity, free will of withdrawal from the participa-
The parameters which were collected for the tion, and no disadvantage upon withdrawal were
demographic characteristics were age, gender, marital explained. Upon both verbal and written consents
status and education in year of the formal schooling. from the subjects, data was collected.
Disease-specific characteristics included the diagno-
sis, Canadian Cardiovascular Society Angina (CCSA) Statistical analysis
classification, and period since diagnosed, body mass Data were analyzed with SPSS 15.0 (SPSS Inc.,
index, smoking status, diabetic mellitus, hyperlipi- Chicago, IL, USA). Univariate descriptive statistics,
demia, comorbidity, and the experience of receiving including the frequency distribution, the central ten-
patient education. The CCSA measures the level of dency, and the dispersion of the scores were exam-
functional status according to the frequency and inten- ined to identify missing data, outliers and errors in
sity of angina (Karimi et al., 2008). CCSA ranges from data entry. In addition, t test, Kruskal-Wallis test,
class I for no symptoms, to Class IV for the worst analysis of variance, Schéffe test, Pearson’s correla-
symptoms (Class I—ordinary physical activity does tion and hierarchical multiple regression analysis
not cause angina; Class II—slight limitation of ordi- were performed. A p value ≤ .05 was considered sig-
nary activity; Class III—marked limitation or ordinary nificant. In the present study, 157 subjects provided
physical activity; Class IV—inability to carry on phys- a statistical power of .93 with a medium effect size
ical activity). of .15 and the level of alpha at .05 (Cohen, 1988).
Comorbidity was recorded with Charlson Comor- This level of power was high enough to detect the
bidity Index, which was composed of 19 items true relationships among variables and strongly sup-
(Charlson, Pompei, Ales, & MacKenzie, 1987). Each ported the results of the study.

48 Asian Nursing Research ❖ March 2010 ❖ Vol 4 ❖ No 1

 Correlates of Health Behaviors in Coronary Heart Diseases

RESULTS into the diagnoses of myocardial infarction (28.7%)

and unstable angina (24.2%). Seventy-three subjects
Demographic and disease-specific characteristics (46.5%) were graded into the class II by CCSA. The
of the subjects period since diagnosis ranged from 1 month to 324
The demographic characteristics and disease-specific months with a mean of 38.95 ± 48.84 months. At the
characteristics of the sample for the present study are time of data collection, 21 subjects (13.4%) smoked,
shown in Tables 1 and 2 respectively, including age, 47 subjects (29.9%) had diabetes mellitus, and 88
gender, marital status, education, diagnosis, CCSA, subjects (56.1%) were diagnosed with hyperlip-
period since diagnosed, body mass index, smoking idemia. Of the 157 subjects, 60.5% had the experi-
status, diabetic mellitus, hyperlipidemia, comorbidity, ence of receiving the patient education on disease
and the experience of receiving patient education. from health care providers.
A total of 157 subjects were recruited for this
study. Their mean age was 59.38 ± 10.04 years, and Cardiac knowledge, cardiac self-efficacy and
three-fourths (75.2%) were male. The majority of health behaviors
subjects (88.5%) was married and the average year As shown in Table 3, cardiac knowledge score ranged
of education of the sample was 11.61 ± 4.44. from 6 to 18, with a mean value of 12.68 (SD = 2.37),
About half of the sample (47.1%) was diagnosed signifying relatively low cardiac knowledge. The aver-
with stable angina, and the rest were distributed age score of cardiac self-efficacy was 38.78 (SD = 7.38)

Table 1
General Characteristics of Subjects (N = 157)

Characteristics n %a M ± SD Range

Age (yr) 59.38 ± 10.04 34–82

< 40 5 3.2
41–50 27 17.2
51–60 53 33.8
61–70 49 31.2
71–80 21 13.4
> 81 2 1.3
Gender
Male 118 75.2
Female 39 24.8
Marital status
Married 139 88.5
Widowed 15 9.6
Single/divorced 3 1.9
Education (yr) 11.61 ± 4.44 0–20
No schooling 4 2.6
Elementary school 26 16.7
Middle school 28 17.9
High school 41 26.3
Undergraduate school 50 32.1
Graduate school 7 4.5
a
Percentages do not add up to 100% due to rounding.

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 Y. Kang et al.

Table 2
Disease-specific Characteristics of Subjects (N = 157)

Characteristics n %a M ± SD

Diagnosis
Stable angina 74 47.1
Unstable angina 38 24.2
Myocardial infarction 45 28.7
CCSA classification
I 56 35.7
II 73 46.5
III 17 10.8
IV 11 7.0
Period since diagnosed (month) 38.95 ± 48.84
BMI (kg/m2) 24.71 ± 3.05
Underweight (≤ 18.4) 1 0.6
Normal (18.5–24.9) 83 52.9
Overweight (25–29.9) 66 42.0
Obese (≥ 30) 7 4.5
Smoking status
Smoker 21 13.4
Non-smoker 68 43.3
Ex-smoker 68 43.3
Diabetic mellitus
Yes 47 29.9
No 110 70.1
Hyperlipidemia
Yes 88 56.1
No 69 43.9
Comorbidity 1.27 ± 1.46
Experience of receiving patient education
Yes 95 60.5
No 62 39.5

Note. CCSA = Canadian cardiovascular society angina; BMI = body mass index. aPercentages do not add up to 100% due to rounding.

Table 3
Descriptive Statistics for Cardiac Knowledge, Cardiac Self-efficacy and Health Behaviors (N = 157)

Variables No. of items Possible range M SD

Cardiac knowledge 20 0–20 12.68 2.37

Cardiac self-efficacy 13 0–52 38.78 7.38
Health behaviors 52 1–4 2.68 0.49

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 Correlates of Health Behaviors in Coronary Heart Diseases

Table 4
Association of Health Behaviors With Demographic Characteristics (N = 157)

Variable M SD χ2/t/r p

Gender −1.23 .22

Male 2.66 0.50
Female 2.77 0.46
Age .25 < .001
Marital status .22 .90
Married 2.68 0.45
Widow 2.75 0.73
Others (divorced, single) 2.38 0.85
Education .19 .02

with a range from 15 to 52, signifying s moderately using hierarchical multiple regression (Table 6). The
high cardiac self-efficacy. Subjects had moderate overall model significantly explained 48% of variance
degree of health behaviors (2.68 ± 0.49). in health behaviors (F = 14.52, p < .001). Among all
the predictors, age, education, smoking status, expe-
Differences in health behaviors by demographic rience of receiving patient education and cardiac
characteristics and disease-specific characteristics self-efficacy significantly affected health behaviors,
Table 4 shows differences in health behaviors by while cardiac self-efficacy had the greatest effect on
demographic characteristics. Subjects who are older health behaviors (β = .39). However, cardiac knowl-
(r = .25, p < .001) and with higher level of education edge did not have a significant influence on health
(r = .19, p = .02) showed the greater health behaviors. behaviors after controlling for other factors.
As demonstrated in Table 5, there was significant
difference in health behaviors among the groups by
diagnosis (F = 6.12, p < .001), and the group with DISCUSSION
stable angina had the highest level of health behav-
iors. The non-smoker group had the highest level of From findings of the present study, health behaviors
health behaviors among groups by smoking status of patients with CADs were associated with the
(F = 7.36, p < .001). Additionally, the group that had subjects’ age and education status. That is, the older
received patient education showed significantly and the better-educated individuals reported better
greater level of health behaviors than the other health behaviors. This finding was only partially
group without the experience (t = 4.44, p < .001). congruent with the previous findingings where
younger subjects and better-educated subjects had
Effects of cardiac knowledge and cardiac better health behaviors (Coulson, Strang, Mariño, &
self-efficacy on health behaviors Minichiello, 2004; Mosca et al., 2006). Persons with
As shown in the above results, the statistically signif- higher education were more likely to have higher
icant differences in health behaviors found accord- cognitive function and better comprehension capa-
ing to age, education, diagnosis, smoking status, and bility so that they might understand the necessity of
experience of receiving patient education are all lifestyle changes, be more motivated, and perform
factors that should be controlled for in order to health behaviors more often. In terms of age, how-
examine effects of cardiac knowledge and cardiac ever, subjects’ mean age in this study was younger
self-efficacy on health behaviors. This was done than that of other studies, which might explain why

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 Y. Kang et al.

Table 5
Association of Health Behaviors With Disease-specific Characteristics (N = 157)

Variables M SD t/F/r p Post hoc

Diagnosis 6.12 < .001 Stable > unstable =

Stable angina 2.82 0.49 myocardial
Unstable angina 2.56 0.48
Myocardial infarction 2.55 0.45

CCSA classification 0.87 .46

I 2.72 0.50
II 2.71 0.47
III 2.54 0.52
IV 2.56 0.48

Period since diagnosed 0.01 .92

BMI −0.12 .13

Smoking status 7.36 < .001 Smoker < non-smoker

Smoker 2.39 0.48
Non-smoker 2.82 0.49
Ex-smoker 2.64 0.44

Diabetics 0.88 .38

Yes 2.74 0.46
No 2.66 0.50

Hyperlipidemia −0.32 .75

Yes 2.67 0.44
No 2.69 0.54

Comorbidity 0.041 .61

Experience of receiving 4.44 < .001

patient education
Yes 2.82 0.49
No 2.48 0.41

Note. CCSA = Canadian cardiovascular society angina; BMI = body mass index.

current findings were not consistent with previous study. Furthermore, cardiac knowledge was not
findings. significantly associated with health behaviors after
Additionally, non-smokers had higher scores in controlling for other factors including age, educa-
health behaviors than those of other groups includ- tion, diagnosis, smoking status, experience of receiv-
ing smokers and ex-smokers in this study. This ing the patient education, and cardiac self-efficacy.
result was expected because the non-smokers might According to findings from the previous studies,
be more likely to perform the good health behaviors. however, knowledge on disease itself showed a
Persons with the experience of receiving patient significant role in making patients change their
education showed higher levels of health behaviors health behaviors or lifestyle (Alm-Roijer, Stagmo,
regardless of the level of cardiac knowledge in this Udén, & Erhardt, 2004; Kayaniyil et al., 2009;

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 Correlates of Health Behaviors in Coronary Heart Diseases

Table 6
Effects of Cardiac Knowledge and Cardiac Self-efficacy on Health Behaviors (N = 157)

Predictors B SE β t p

Age .02 .00 .34 4.54 < .001

Education .03 .01 .24 3.33 < .001
Diagnosis (unstable angina) −.14 .09 −.12 −1.64 < .001
Diagnosis (myocardial infarction) −.06 .08 −.06 −0.71 .48
Smoking status (smoker) −.33 .11 −.23 −3.05 < .001
Smoking status (ex-smoker) −.13 .07 −.13 −1.72 .09
Experience of receiving .30 .07 .24 4.16 < .001
patient education
R2 .32
F (df = 7, 149) 9.63 < .001

Age .02 .00 .31 4.74 < .001

Education .02 .01 .17 2.63 .01
Diagnosis (unstable angina) −.10 .08 −.09 −1.23 .22
Diagnosis (myocardial infarction) −.06 .08 −.06 −0.84 .40
Smoking status (smoker) −.22 .10 −.16 −2.32 .02
Smoking status (ex-smoker) −.13 .06 −.13 −1.99 .05
Experience of receiving .22 .06 .22 3.35 < .001
patient education
Cardiac knowledge .02 .01 .10 1.54 .13
Cardiac self-efficacy .03 .00 .39 6.07 < .001
R2 .48
F (df = 2, 147) 14.52 < .001

Mosca et al., 2006). Although numerous previous This finding was consistent with that of previous
studies suggested that patients’ knowledge on the research (Beal, Stuifbergen, & Brown, 2009; Mosca
disease was a key factor in determining their health et al., 2006; Stewart, Abbey, Shnek, Irvine, & Grace,
behaviors, it was possible that those studies did not 2004). In order to increase health behaviors of pa-
consider the associated factors simultaneously, and tients with CADs, the specific nursing strategy for
simply considered the bivariate relationships among enhancing the cardiac self-efficacy should be con-
factors. Thus, regardless of the present level of cardiac sidered, including personalized counseling, regular
knowledge, the experience of receiving patient edu- follow-up calls, and so forth (Lau-Walker, 2007).
cation played an essential role in predicting the health Furthermore, nursing interventions that would aid
behaviors because after receiving patient education, in initiating and maintaining health behaviors for a
patients might become more determined to change longer period should be designed and implemented
their lifestyles as well as more motivated. The findings despite any unusual situations (Martin et al., 2008).
provided significant implications to clinical nursing
practice. Empirically, it might be very critical for nurse
to offer patient education, which might strongly CONCLUSION
impact patient motivation and their lifestyles.
Cardiac self-efficacy was shown to be the most in- The present study aimed to explore the correlates
fluential predictor of health behaviors in this study. of health behaviors in patients with CADs. Age,

Asian Nursing Research ❖ March 2010 ❖ Vol 4 ❖ No 1 53

 Y. Kang et al.

education, diagnosis, smoking status, and experience from the previous studies, cardiac self-efficacy was
of receiving patient education were all factors shown shown as the most influential factor, while cardiac
to influence health behaviors. Contrary to previous knowledge was not shown as a significant factor. In
studies, it was demonstrated that cardiac knowledge place of cardiac knowledge itself, the experience of
had no influence on health behaviors; the experi- having received patient education was significantly
ence of receiving patient education had a significant associated with health behaviors. Findings from the
impact on health behaviors in the present study. present study demonstrated the gap between patient
Additionally, in line with previous studies, cardiac education and knowledge in explaining the behavior
self-efficacy was the most significant factor that af- change.
fected on heath behaviors. Throughout the current
study, the significant influencing factors found in-
cluded demographic and disease specific character- ACKNOWLEDGMENTS
istics, and cardiac self-efficacy. Based on the findings
of the study, nursing interventions tailored to pa- This study was partially supported by the 2008
tient characteristics should be developed in order Research Funds from the Research Institute of Nurs-
to improve the health behaviors of patients with ing Science, Ewha Womans University, Seoul, Korea.
CADs. Practically, clinical nurses should recognize
the importance of providing patient education de-
signed to change their lifestyle. In future research, REFERENCES
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