Effect of Intervention on Lifestyle Changes among Patients with Coronary Artery Disease in Nepal: A Randomized Controlled Trial

Pramila Gaudel

Research output: Book/ReportDoctoral thesisCollection of Articles


Coronary artery disease (CAD) is the leading cause of mortality and disability worldwide. Unhealthy lifestyles are responsible for the high prevalence of CAD, especially among the South Asian population. Existing knowledge on the prevention of CAD is mainly based on studies conducted among populations in high-income countries. It is important to assess the effectiveness of interventions to improve healthy lifestyles in populations in low-income settings such as Nepal. The main aim of the study is to gain insight into the prevalence of modifiable risk factors and to investigate the effect of a nurse-led lifestyle modification intervention among patients with CAD. This study investigates unhealthy diet, physical inactivity, perceived stress, overweight or obesity, nonadherence to medication, smoking, and alcohol consumption. The first objective of the study was to evaluate the prevalence of lifestyle-related risk factors among patients with CAD (Phase I). The second and third objectives were to evaluate the effect of a lifestyle modification intervention on CAD patients’ lifestyle changes at one-month (Phase II) and six-month after the intervention (Phase III).

A cross-sectional study was conducted to evaluate the prevalence of lifestyle-related risk factors among CAD patients (n=224). A pre-test post-test control group experimental research design was used to evaluate the effect of the lifestyle modification intervention on CAD patients’ adherence to lifestyle changes. Baseline data were collected from CAD patients at the National Heart Center, Kathmandu, Nepal. At baseline, individual face-to-face structured interviews were conducted between May 1 and July 31, 2018. Follow-up data were collected by telephone interview, one-month and six-month after the baseline data collection. Patients were randomly selected into the group and usual care group using a simple random sampling technique. Seven lifestyle-related risk factors were included in this study, and culturally validated instruments were used to collect data on each of the lifestyle risk habits. Group counseling was given to patients (n=112) and their family members. The content of the counseling intervention was developed based on an extensive literature search and recommendations issued by different heart associations. The theoretical basis of the intervention was Imogene King’s theory of goal attainment.

The findings of the study, based on self-reported data, showed a high prevalence of multiple lifestyle-related risk factors among the studied patients, with stress being the most prevalent and current alcohol consumption the least. Male patients and patients with a high income had higher odds of being in the medium- and high-risk groups respectively. Except for adherence to medication, there were no statistically significant differences between the study groups at baseline. However, at one-month follow-up, five of the seven lifestyle-related risk factors differed significantly between the study groups: diet, adherence to medication, perceived stress, smoking, and alcohol consumption. A general linear model repeated measure analysis showed a greater improvement in lifestyle-related risk factor habits in the intervention group compared with the usual care group, the effects of time*group interaction were statistically significant for dietary habits, physical activity, medication adherence, and perceived stress at one-month and six-month follow-ups. All seven lifestyle-related risk factors differed significantly between the study groups at the six-month follow-up.

The generalizability of the study’s results is limited because the study was performed in a single cardiac center in Nepal. Because there is an increased incidence of CAD and fewer preventive measures in low- and middle-income countries such as Nepal, secondary preventive measures in addition to pharmacological and surgical therapies are a must. Counseling interventions delivered successfully by a nurse may improve healthy lifestyles among underserved CAD patients. Counseling and reading materials promote meaningful changes in health habits, which may bring health benefits to patients and minimize complications. More counseling and educational efforts should be targeted toward CAD patients.
Original languageEnglish
Place of PublicationTampere
ISBN (Electronic) 978-952-03-2674-6
Publication statusPublished - 2022
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028


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