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Social support in the education of patients with cardiovascular diseases: the situation in the Czech Republic

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journal homepage: http://kont.zsf.jcu.cz
DOI: 10.32725/kont.2019.028
Social support in the education of patients with
cardiovascular diseases: the situation in the Czech Republic
Lenka Šedová 1 *, Valérie Tóthová 1, Věra Olišarová 1, Sylva Bártlová 1, Ivana Chloubová 1,
Helena Michálková 1, Marie Trešlová 1, Radka Prokešová 2, Kristýna Toumová 1, Věra Adámková 3
1 University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery, and Emergency Care,
České Budějovice, Czech Republic
2 University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences, Institute of the Humanities in Nursing Professions,
České Budějovice, Czech Republic
3 Institute for Clinical and Experimental Medicine, Preventive Cardiology Department, Prague, Czech Republic
Abstract
e incidence of cardiovascular disease is linked to the risk factors of lifestyle. Traditional inuences are smoking, diet, physical activity
and psychosocial factors. Psychosocial factors include low socio-economic status, lack of social support, work-related stress and the state
or type of family life, depression and anxiety, and hostility.
e aim of this study was to demonstrate the connection of the views on selected psychosocial factors of cardiovascular diseases with
selected sociodemographic characteristics. A quantitative method using quantitative interviews was used to achieve the objectives. In
total, 1,992 persons aged 40 years and older were addressed. e set was representative of age, gender, and residence. e information
obtained was subjected to statistical analysis and the rate of dependence was assessed by the chi-2 test, the t-test and the analysis of the
test.
e results show that in prevention the doctors are focused on obtaining information about the employment of their patients, the
patient’s lifestyle and how the diagnosed cardiovascular disease aects the normal life of patients. Less often, in practice, questions
on socio-economic factors are found. In most questions, there was a signicant link with age, employment and family status. Positive
questions were more often answered by respondents over the age of 60, widowed respondents and respondents in disability or retirement
age. is may be related to targeted interventions for these vulnerable groups of patients. For most respondents, the family is a foothold
of lifestyle change.
Keywords: Cardiovascular; Disease; Factors; Patient; Psychosocial; Support
* Author for correspondence: Lenka Šedová, University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences,
Institute of Nursing, Midwifery and Emergency Care, U Výstaviště 26, 370 05 České Budějovice, Czech Republic;
e-mail: lsedova@zsf.jcu.cz; http://doi.org/10.32725/kont.2019.028
Submitted: 2018-08-15 • Accepted: 2019-01-31 • Prepublished online: 2019-04-29
KONTAKT 21/x: xxx–xxx • EISSN 1804-7122 • ISSN 1212-4117
© 2019 The Authors. Published by University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences.
This is an open access article under the CC BY-NC-ND license.
Original research article
Introduction
Cardiovascular diseases (CVD) are included among the most
frequent diseases of civilization (Gielen et al., 2015). In Eu-
rope, the mortality due to cardiovascular diseases is dierent
in the EU and the countries outside of it (Wilkins et al., 2017).
In the Czech Republic, they are the main cause of death. e to-
tal standardized mortality was 42% in 2016 (ÚZIS ČR, 2016).
Despite the dierences in the clinical symptoms of these dis-
eases, they share the same cause, which is atherosclerosis. Ath-
erosclerosis is a degenerative illness of the arteries. e causes
of atherosclerosis are multifactorial and closely related to life-
style (Piepoli et al., 2016; Puska et al., 2011). Mortality due to
chronic cardiovascular diseases has decreased in the last ten
years but the prevalence is still high (Cífková et al., 2010). e
incidence of cardiovascular diseases is related to age but it can
be etiologically related to other diseases, such as obesity and
sleep apnoea syndrome etc. (Slouka et al., 2018a).
e statistics of the Institute of Health Information and
Statistics of the Czech Republic show that the number of sick
days due to diagnosed CVD increases from 40 years of age, and
most sick days are found in people between 60 and 64 and 65+
(ÚZIS ČR, 2016). Cardiovascular diseases and those patho-
physiologically related to them are a serious public health
problem and an economic burden for society and its healthcare
system (Piepoli et al., 2016).
Psychosocial factors became considered health aecting
after the relationship between stress and health was found
(Solgajová et al., 2015). Contemporarily, we do not question
the hypotheses on the relationship between health and low
socioeconomic status (SES). People with lower SES are more
frequently stressed, which is negatively reected on the health
condition (Callander and McDermott, 2017; Labarthe, 2010).
One example is the research of the authors Kajanová et al.
(2016), who learned that socially excluded people have a sig-
nicantly lower overall quality of life (as well as lower physical
and mental health). Another example is the study of Slouka
KONTAKT / Journal of nursing and social sciences related to health and illness
NURSING
Šedová et al. / KONTAKT
2
et al. (2018b), which conrms a more frequent incidence of
larynx cancer in people with lower socioeconomic status and
unsuitable life habits.
More than 50 years ago, the rst evidence of the signi-
cance of psychosocial risk factors appeared regarding the in-
cidence of cardiovascular diseases. e related factors speci-
cally include low socioeconomic status, lack of social support,
low health literacy, work stress and family life, depression
and anxiety, and hostility (Bruthans et al., 2016; Compare et
al., 2013; Slouka et al., 2018a). For example, according to the
study of Kabátová et al. (2014), depression and bad mood are
related to the incidence of chronic illnesses. e respondents
most frequently showed cardiovascular diseases.
ese factors contribute to the incidence of cardiac ischem-
ic disease and worsen the prognosis for patients with coronary
artery disease. ey are the factors that aect the incidence of
coronary cardiac diseases and can be an obstacle in managing
and following the treatment of these diseases (de Mestral and
Stringhini, 2017; Töres et al., 2015).
e relationship between unfavourable work conditions
and the incidence of CVD has been studied for decades. e
mechanisms of the incidence are still unclear and the explan-
atory theories include direct activations of neuroendocrine
reactions to stressors; indirect factors include unhealthy be-
haviour – smoking, inactivity, obesity or the overconsumption
of alcohol (Kivimäki and Kawachi, 2015; Slouka et al., 2018a).
e psychosocial factors also include the level of social
support. Social support, which is received from other people,
groups and wider society, can aect the way patients manage
dicult situations such as illnesses. Social support can be di-
vided into emotional, evaluating, informational and instru-
mental (Albus, 2010).
e treatment of CVD is not only carried out with medica-
ments. e non-medicament part of the treatment also plays
an important and complex role (Doležal and Jarošová, 2015).
is complex treatment includes the bio-psycho-social view of
a patient. e anamnesis of psychosocial factors aecting car-
diovascular health should become a common part of clinical
practice. Learned information should be assessed consider-
ing the individual dierences of every patient (Slouka et al.,
2018b). An individualized approach in treatment oers mul-
timodal interventions which can include a number of other
experts, such as nutritional therapists, physiotherapists, psy-
chologists (Albus and Hermann-Lingen, 2015; Buford et al.,
2015; Schwarzer, 2008).
In this study, we focused on discovering patients’ opinions
on selected psychosocial factors which are related to the inci-
dence and development of CVD. We wanted to prove the rela-
tionship between the questions regarding psychosocial factors
and the selected sociodemographic factors of the sample group.
We focused on nding out about the patients’ socioeco-
nomic status as well as their employment. We also focused on
questions regarding the impact of lifestyle changes on the pa-
tient’s life and who supports the changes.
Materials and methods
We used the combination of a non-standardized questionnaire
and the standardized SF-36 questionnaire. e non-standard-
ized questionnaire was designed to assess education. We used
it to monitor the education from the point of view of people.
We also wanted to estimate how long the health education
lasted and to describe the extent and content of the education
including barriers.
e eld research was carried out using the technique of
standardized conducted interview between an interviewer and
a respondent (face-to-face). e nal form of the interview-
er’s sheet was based on the pre-research results. e research
was anonymous, the participation was voluntary and it did not
contain any controversial ethical questions.
e data collection was carried out in 2016. It was secured
by 582 professional interviewers from the Institute for the
Study of Health and Lifestyle in the Czech Republic.
e statistical processing of the data was carried out us-
ing the SASD 1.4.12 (Statistical Analysis of Social Data) pro-
gramme and SPSS. We processed the 1st classication degree
and the contingency tables of the selected indicators of the
2nd classication degree. In the 1st classication degree, cal-
culations of absolute and relative numbers were carried out,
as well as the modus, median, average, variance and standard
deviation. For every indicator, we carried out the calculation of
the variance, standard deviation, margin and interval estimate
of the average value 0.05 and the interval variance estimate
0.05. For the calculation of the level of dependence of selected
indicators, we calculated the Wallis–Spearman and correlation
coecient. We also applied the chi-2 of good concordance,
where we applied the Yates correction in case of an insucient
number of monitorings. We nally calculated the test of in-
dependence on the level of signicance α = 0.05; α = 0.01; α =
0.001.
We addressed 2,306 respondents, of which 314 (13.6%)
refused to be included in the study. 1,992 respondents aged
40 and above agreed to the interview. e parameters of the
sample group were based on the data from the Czech Statis-
tical Oce from the 31st December 2014. e sample group
consisted of people from the Czech Republic and its structure
responded to the following criteria: all regions, age and gender.
ese indicators were set as representative.
Results
e sample group included 937 men (47%) and 1,055 (53%)
women, which responds to the analogue structure of the peo-
ple in the Czech Republic over 40 years. e sample group in-
cluded the lowest number of respondents over 70 (Table 1).
Table 1. e structure of the sample group by gender and
age
Men Women
A%A%
40–49 years 284 14.3 275 13.8
50–59 years 242 12.1 245 12.3
60–69 years 237 11.9 270 13.6
70–79 years 126 6.3 167 8.4
80 years and above 48 2.4 98 4.9
Total 937 47 1,055 53.0
162 (8.1%) respondents had basic education, 735 (36.9%)
had apprenticeship certicate, 680 (34.1%) had secondary
education, 103 (5.2%) had higher vocational education and
312 (15.7%) had a university education. e majority of the
respondents were married (1,167; 60.1%), 129 (6.5%) were
single, 256 (12.9%) were divorced, 101 (5.1%) respondents
lived in a partnership and 309 (15.5%) respondents were wid-
Šedová et al. / KONTAKT
3
owed. e majority of the respondents were employees (965;
48.4%), 211 (10.6%) ran a business, 674 (33.8%) were retired,
92 (4.6%) drew an disability pension and 38 (1.9%) were un-
employed for more than 6 months. 12 (0.6%) chose the option
“other employment”.
47.1% were treated for cardiovascular disease. Most fre-
quently, they were 50 years old with hypertension, vascular
diseases of lower limbs or the condition after heart attack.
e respondents were asked who they saw as the greatest
support in the change of their lifestyle. ey were oered 6 op-
tions – doctor; nurse; friends; family; other patients and somebody
else. e respondents gave numbers to every option: 1 = the
largest support, and 6 = the smallest support.
e comparison of average values shows that the largest
support is family. A doctor is in second place, friends are in
third place, and a nurse is in fourth place. Other patients had
the smallest inuence. Regarding doctors, there was a greater
variability of responses. e smallest was related to other pa-
tients (who were in fth place) (Table2).
Regarding the assessment of the signicance of individual
subjects as a support in the change of lifestyle, doctors were in
the 1st (29.3%) and 3rd place (24.5%).
50.0% of the respondents put family in 1st place. 21.8%
put it in 2nd place and 15.3% put it in 3rd place. is fact and
the comparison of the average values enable the conclusion that the
respondents consider family to be the most important support re-
garding the change in their lifestyle (Table 2).
e assessment of family as the support for change in lifestyle
is signicantly related to education (P < 0.05). e respondents
with basic education and higher vocational education attached
signicantly lesser importance to the support in the change of
lifestyle. Statistically signicant connections to other sociode-
mographic indicators were not identied.
Another question was focused on the patients’ opinion
about their interest in selected psychosocial factors in medical
practice. e results are shown in Chart 1.
e results show that the respondents say that doctors are
interested in their patients’ employment and whether their
job is physically or psychologically demanding (67.5%). e
results of the statistical signicance show that doctors’ inter-
est in the eect of their patients’ job on their lifestyle is sig-
nicantly related to the patient’s gender, age, education and
job. Women more frequently chose a positive response to this
question (p < 0.01), the younger ones (40–59 years) more fre-
quently agreed with the statement (p < 0.01), and so did the
employed respondents (p < 0.001).
Table 2. Support in the lifestyle change – comparison of
average values; N = 1992 (in %)
Support Modus Median s2S
Doctor 1 2 2.591 1.890 1.375
Nurse 4 4 3.503 1.582 1.258
Friends 2 3 2.830 1.380 1.175
Family 1 1 1.977 1.528 1.236
Other patients 5 5 4.590 1.203 1.097
= arithmetic average; s2 = variance; S = standard deviation.
Doctors are less interested in their patients’ socioeconomic
situation. 53.7% of the respondents chose a negative response
to this question. is question showed a signicant relation-
ship with the respondents’ employment (p < 0.001). e em-
ployed respondents responded negatively; disabled pensioners
and the unemployed responded more positively.
e respondents positively assessed the interest of doctors
in their patients’ lifestyle (58.7%) and the way their illness
aected their life (58.8%). We identied a statistically signif-
icant relationship between the question of the interest in a
patient’s lifestyle and gender (p < 0.05), age (p < 0.001) and
employment (p < 0.01). Women and the respondents between
40 and 59 years more frequently chose the negative response.
Meanwhile, older respondents more frequently chose a posi-
tive response. We also identied a statistically signicant re-
lationship regarding employment. e employed respondents
more frequently responded negatively, in contrast to pension-
ers who more frequently responded positively. e analysis of
the question of how the illness aected the patient’s life is sig-
nicantly related to age (p < 0.001), employment (p < 0.001),
and education (p < 0.001). e relationship to age shows that
younger respondents (40–59 years) more frequently do not
agree with the statement, while older respondents agree with
it. e respondents with a lower level of education (basic, ap-
prenticeship) more frequently responded positively. Second-
ary school and university graduates mostly chose “I do not
know”. e result shows that a doctor is interested in their pa-
tients’ present lifestyle if they are familiar with their patient’s
job. e employed respondents more frequently chose a neg-
ative response, while pensioners agreed with the statement.
44.8% of the respondents chose a positive response to the
question of whether doctors had records on their progress in
Chart 1. Doctors’ interest in the factors that aect the changes in a lifestyle
Recording the progress
Interest in aecting the life of the ill
Interest in a patient’s lifestyle
Interest in a patient’s socioeconomic situation
Interest in a patient’s job
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%
Patients
Interest in
a patient’s
job
Interest in a patient’s
socioeconomic
situation
Interest in
a patient’s
lifestyle
Interest in
aecting the life
of the ill
Recording
the progress
67.5% 20.6% 58.7% 58.8% 44.8%
4
changing their lifestyle. More than 1/3 of the respondents did
not know of any records. Here as well, we identied the rela-
tionships to age (p < 0.001), education (p < 0.05) and employ-
ment (p < 0.001). Older respondents, along with those with a
lower level of education and pensioners were more frequently
positive regarding this question.
Discussion
e goal of this study was to analyze the level of the selected
psychosocial factors, which should be a part of the medical his-
tory of patients with cardiovascular diseases. We tried to nd
the relationship between the respondents’ opinions and the
selected sociodemographic characteristics.
Psychosocial factors aect the incidence and development
of CVD. e consideration of psychosocial factors enables an
individualized approach in a complex treatment. As stated by
Albus et al. (2015), one alternative for how to achieve a com-
plex treatment in a patient with ischemic cardiac disease is
oering multimodal interventions, which are based on the in-
uence of other experts, such as nutritional therapists, physi-
otherapists or psychologists.
ese days, there is a lot of evidence on the causality of
the incidence of cardiovascular diseases and inuenceable risk
factors. In common practice, the behavioural factors of these
diseases are not given sucient attention with regard to the
fact that these factors are not a part of common scoring sys-
tems for the estimation of cardiovascular diseases.
Psychosocial factors are a part of cardio-prevention despite
the fact that the causal eect of these factors on the incidence
of cardiovascular diseases has dierent methodological and
conceptual limitations. Psychosocial factors specically in-
clude a low socioeconomic status, insucient social support,
work stress and family life, depression and anxiety, and hostil-
ity (Albus, 2010; de Mestral and Stringhini, 2017).
We focused on the issue of a patient’s socioeconomic situ-
ation and employment, as well as on questions about the im-
pact of the change in the patient’s lifestyle on their life and
who supports them in achieving the change.
e evidence on the inuence of workload on the incidence
of CVD is shown by Kivimäki and Kawachi (2015). ey bring
evidence from 600,000 men and women from 27 cohort stud-
ies that were carried out in Europe, the USA and Japan. ese
studies show that work stress, such as a high level of physical
labour and long working hours are related to a medium risk of
CVD and stroke. Small dierences were recorded in the com-
parison of men and women, elderly and younger people and
employees with a dierent SES. Only a few studies dealt with
practical intervention regarding work stress and its positive
eect. Despite this fact, governments started campaigns for
health support at workplaces with the focus on the restriction
of work stress. e support of the awareness of the relationship
between work stress and CVD is an important part of health
support. In our research, 67.5% of the respondents stated that
their doctor was interested in their job. In this question, it is
interesting that we recorded a relationship to gender. Women
responded positively more frequently than men (p < 0.01). It is
necessary to mention that work anamnesis should be an oblig-
atory part of a patient’s total anamnesis. Employment regard-
ing cardiovascular diseases is very important because work in
a stressful environment may cause or worsen the condition
of CVD. A much worse prognosis is proven in unemployed
patients (Töres et al., 2015). In our sample group, the ma-
jority of the respondents were employed and only 1.9% were
unemployed for more than 6 months. e question regarding
employment is related to the doctor’s interest in the patient’s
socioeconomic situation. According to the respondents, their
doctors show little interest in their socioeconomic situation
(20.6%). Here, we can see the relationship between a positive
response and employment (p < 0.001). e respondents who
are employed often responded negatively, which is in contrast
to the invalid pensioners or unemployed respondents. Here, it
is shown that doctors are interested in the way their patients
with low income manage their situation. is question is very
important because an employed patient can also have a low
income and thus be in a complicated situation which can cause
daily stress. Other questions concerned the doctors’ interest in
the respondents’ lifestyle and how CVD aected their life. In
both questions, more than 50% of the respondents respond-
ed positively (Chart 1). We identied a relationship between
the doctors’ interest in their patients’ lifestyle and gender (p <
0.05), age (p < 0.001) and job (p < 0.01). Men more frequently
responded positively, as well as the unemployed respondents,
pensioners and older respondents. If we are to provide pa-
tients with recommendations regarding changes in their life-
style, we should know their contemporary lifestyle. 58.7% of
the respondents responded positively to the question regard-
ing their doctor’s interest in their current lifestyle, which is
not a satisfying result, so we can say that doctors are inclined
toward unied recommendations. Another question is related
to the doctors’ interest in the way CVD aects a patient’s life.
58.8% of the respondents responded positively. Here, we can
also say that it is not a high number. Older respondents, un-
employed respondents, pensioners or those with a lower level
of education more frequently responded positively. We can say
that doctors’ questions about this issue are directed toward
the threatened groups of patients. e question about the in-
uence of CVD on life is related to social support. Social sup-
port is one of the most studied factors that moderate the in-
uence of negative life events. A number of studies show that
the combination of low social support and long-term stress is
a predictor of the incidence of a number of diseases (Compare
et al., 2013). In this study, we dealt with the question of who
is the largest support in the process of changing the lifestyle
of patients with CVD. e results are shown in Table 2. It is
clear that in our sample group the largest support is provided
by families, then doctors, friends, nurses and other patients.
e analysis of the second classication degree shows that the
choice of a doctor, nurse or friends as social support is related
to age, employment or marital status. It is clear that doctors,
nurses and friends are more frequently considered as support
in this issue by the respondents over 60 years and the respond-
ents living alone, those who were widowed and pensioners.
Limitations of the study
e conclusions can be limited by the random selection of the
sample group.
Conclusions
e conclusions provide evidence of the fact that doctors are
focused on gaining information about their patients’ employ-
ment, lifestyle and the inuence of CVD on their life. It is inter-
esting that fewer respondents are interested in the socioeco-
nomic situation, which is related to employment and the eect
on lifestyle. Most questions showed a signicant relationship
between age, employment and marital status. Respondents
over 60 years more frequently answered positively, as well as
Šedová et al. / KONTAKT
5
those who were widowed and pensioners. is fact can be re-
lated to the targeted intervention regarding these threatened
groups of patients. Most respondents consider family as sup-
port regarding the change in their lifestyle.
Conict of interests
e authors have no conict of interests to declare.
Acknowledgements
Supported by the program project of the Czech Ministry of
Health, reg. No. 15-31000A. All rights are reserved according
to regulations for protection of intellectual property.
Sociální opora v edukaci pacientů s kardiovaskulárními chorobami: situace v České republice
Souhrn
Výskyt kardiovaskulárních chorob je vázán na rizikové faktory životního stylu. Tradičními ovlivnitelnými faktory jsou kouření,
výživa, fyzická aktivita a psychosociální faktory. Mezi psychosociální faktory konkrétně patří nízké socioekonomické postavení,
nedostatek sociální opory, pracovní stres a stav nebo způsob rodinného života, deprese a úzkost, nepřátelství.
Cílem předložené studie bylo prokázat souvislost názorů na sledování vybraných psychosociálních faktorů kardiovaskulár-
ních chorob s vybranými sociodemograckými charakteristikami. K naplnění cílů byla využita kvantitativní metoda s využitím
řízených rozhovorů. Celkem bylo osloveno 1992 osob ve věku 40 let. Soubor byl reprezentativní věkem, pohlavím i bydlištěm.
Zjištěné informace byly podrobeny statistické analýze a míra závislosti byla hodnocena pomocí chí-2 testu, t-testu a testu analýzy.
Z výsledků je patrné, že se lékaři v rámci prevence ve své praxi orientují na získání informací o zaměstnání svých pacientů,
oživotním stylu pacienta i o tom, jak diagnostikované kardiovaskulární onemocnění ovlivňuje běžný život pacientů. Méně čas-
to dochází v praxi ke zjištění otázek k socioekonomickým faktorům. Ve většině otázek byla zachycena signikantní souvislost
svěkem, zaměstnáním a rodinným stavem. Kladně na otázky častěji odpovídali respondenti nad 60 let, respondenti ovdovělí
arespondenti v invalidním nebo starobním důchodu. Tento fakt může souviset s cílenou intervencí u těchto ohrožených skupin
pacientů. Pro většinu respondentů je rodina oporou v úpravě životosprávy.
Klíčová slova: kardiovaskulární; faktory; choroby; pacient; psychosociální; opora
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