McKinley Sharon, Dracup Kathleen, Moser Debra K, Riegel Barbara, Doering Lynn V, Meischke Hendrika, Aitken Leanne M, Buckley Tom, Marshall Andrea, Pelter Michele
University of Technology Sydney and Northern Sydney Central Coast Health, Critical Care Nursing Professorial Unit, Level 6, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
Int J Nurs Stud. 2009 Aug;46(8):1037-46. doi: 10.1016/j.ijnurstu.2009.01.012. Epub 2009 Feb 24.
Coronary heart disease (CHD) and acute coronary syndrome (ACS) remain significant public health problems. The effect of ACS on mortality and morbidity is largely dependent on the time from symptom onset to the time of reperfusion, but patient delay in presenting for treatment is the main reason timely reperfusion is not received.
We tested the effect of an education and counseling intervention on knowledge, attitudes and beliefs about ACS symptoms and the appropriate response to symptoms, and identified patient characteristics associated with changes in knowledge, attitudes and beliefs over time.
We conducted a two-group randomized controlled trial in 3522 people with CHD. The intervention group received a 40 min, one-on-one education and counseling session. The control group received usual care. Knowledge, attitudes and beliefs were measured at baseline, 3 and 12 months using the ACS Response Index and analyzed with repeated measures analysis of variance.
Knowledge, attitudes and beliefs scores increased significantly from baseline in the intervention group compared to the control group at 3 months, and these differences were sustained at 12 months (p=.0005 for all). Higher perceived control over cardiac illness was associated with more positive attitudes (p<.0005) and higher state anxiety was associated with lower levels of knowledge (p<.05), attitudes (p<.05) and beliefs (p<.0005).
A relatively short education and counseling intervention increased knowledge, attitudes and beliefs about ACS and response to ACS symptoms in individuals with CHD. Higher perceived control over cardiac illness was associated with more positive attitudes and higher state anxiety was associated with lower levels of knowledge, attitudes and beliefs about responding to the health threat of possible ACS.
冠心病（CHD）和急性冠状动脉综合征（ACS）仍然是重大的公共卫生问题。ACS对死亡率和发病率的影响很大程度上取决于从症状发作到再灌注的时间，但患者延迟就诊是未能及时进行再灌注的主要原因。
我们测试了一项教育与咨询干预措施对关于ACS症状的知识、态度和信念以及对症状的适当反应的影响，并确定了随时间推移与知识、态度和信念变化相关的患者特征。
我们对3522名冠心病患者进行了两组随机对照试验。干预组接受了40分钟的一对一教育与咨询课程。对照组接受常规护理。使用ACS反应指数在基线、3个月和12个月时测量知识、态度和信念，并采用重复测量方差分析进行分析。
与对照组相比，干预组在3个月时知识、态度和信念得分从基线显著增加，且这些差异在12个月时持续存在（所有p值均为0.0005）。对心脏病更高的感知控制与更积极的态度相关（p<0.0005），更高的状态焦虑与更低的知识水平（p<0.05）、态度（p<0.05）和信念（p<0.0005）相关。
一项相对简短的教育与咨询干预提高了冠心病患者对ACS的知识、态度和信念以及对ACS症状的反应。对心脏病更高的感知控制与更积极的态度相关，更高的状态焦虑与对可能的ACS健康威胁反应的知识、态度和信念水平较低相关。
