INTRODUCTION:

According to WHO estimates in 2003, 16.7 million people around the globe die of coronary heart disease each year. This is over 29 percent of all deaths globally. Today men, women and children all are at risk and 80 percent of the burden is in low and middle income countries .Coronary heart disease is affecting among Indian men and women 5-10 years earlier than other communities. Indians also show higher incidence of hospitalization, morbidity and mortality than other ethnic groups.¹

Coronary Heart Disease (CHD) is one of the cruel diseases that could either take the life away or disable person for life at any time without warning. Primarily, women were believed to have less risk in exposing to some modifiable risk factors such as alcohol, tobacco and high lipid food consumption. Oestrogen was also believed to have protective effects amongst younger women since the incidence of CHD increased in women at older age, From World Health Organization’s (2007) report it is found that CHD is the most common cardiovascular disorder and is responsible for almost 50% of cardiovascular deaths globally.²

Repressive coping is the tendency to avoid/repress negative emotions. It protects against psychiatric disorder, but is also associated with less accurate detection of sadness/fear, less eye movements toward threatening stimuli, increased blood pressure, decreased heart rate variability, cortisol dysregulation and poor adherence to health recommendations. Hence, repressive individuals may show overt behavioural and physiological signs of distress despite their claims of low distress.⁴

Anxiety management training was a brief, three-stage cognitive-behavioural programme to provide subjects with stress management skills that can be easily applied to tension-producing situations.The programme including practice in imagery, in increasing awareness of physical sensations, and in deep relaxation techniques. A special offshoot of the therapy, which emphasizes the modulation of responses to stressors and designed for cardiac rehabilitation programmes. Anxiety management training showed some promising results in controlling high blood pressure. Anger management training, or stress inoculation therapy was effort to modify anger and hostility by teaching effective coping skills.⁵

NEED FOR THE STUDY:

The present study attempted to assess the current that whether there are certain specific personality pattern of coronary heart disease patients and the coping strategies they use to deal with these stressful situations.

OBJECTIVES OF THE STUDY:

1 To determine the personality profile and coping strategies among patients who are diagnosed to have coronary artery disease by using Catter’s 16 personality Factor and Coping brief scale.

2 To determine the personality profile and coping strategies among non-patients group Catter’s 16 personality Factor and Coping brief scale.

3 To compare the difference in the personality profile and coping strategies among coronary heart disease patients and non-patients groups

METHODOLOGY:

A descriptive comparative study consisting of 25patients those are diagnosed to have coronary heart disease and 25 healthy class 4 workers age group of 35-60 years in OPDs, in A. J. Institute of Medical Sciences and Research Centre and Omega Hospital, Mangalore selected by using purposive sampling technique.

INCLUSION CRITERIA:

· CHD patients (in/outpatients) after 1 week of initial diagnosis of CHD.

· Non professionals class 4 worker age group of 35-60 years.

· Are willing to participate in the study.

· Aged more than 35 years.

· Who can read and understand Kannada or English.

DESCRIPTION OF THE TOOLS:

Tool I: Demographic Proforma:

Demographic proforma was used to collect sample characteristics which include age, gender, religion, marital status, education, income, occupation, type of work, dietary pattern and healthy habits, specific life style practice, family history of cardiovascular disease, duration of illness, number of hospitalization within previous six months and treatment undertaken.

Tool II: PGI Health Questionnaire:

PGI health questionnaire is used to select non-patients group who are scoring less than 12.⁶

Tool III: Brief coping scale:

Brief coping scale (English version) self reporting questionnaire by Carver C. S. (1997). It includes like self- distraction, denial, active coping, substance use, use of emotional support, use of instrumental support, behavioural disengagement, venting, positive framing, planning, humour, acceptance, religion, and self-blame.⁷

Tool IV: Cattell’s 16 F Personality Traits Scale:

Cattell’s 16 F Personality Traits Scale, in this exploration of personality, British psychologist Raymond Cattell found that human personality could be best explained by a model that has sixteen variables (personality traits).It is a standardized tool which comprises 164 statements , for each indicate how accurate it is on the scale of (1) disagree (2)slightly disagree (3) neither agree nor disagree
(4) slightly agree (5) agree.⁸

Validity and Reliability:

The content validity of the tool was established in consultation with the research guide and five nursing experts.

The internal consistency of English version of the Cattell’s 16 personality factors was supported by Cronbach’s alphas ranging from .73-.99 ⁸ and internal consistency of English version of the Brief COPE scale was supported by Cronbach’s alphas ranging 0.25 to 1.00.⁷

The reliability of the Kannada version of the tool was established by administering the tools to 10 patients who are diagnosed with coronary heart disease and 10 non patients. The internal consistency of the tools was checked by using Karl Pearson Correlation Coefficient. Reliability of the instruments was established by internal consistency, coping brief scale among patient (r=.821), and non patients (r=.859), Cattell’s 16 personality scale among patients (r=.954) and non patients (r=.845) and PGI scale reliability among non patients (r=.816). Hence the tools were found to be reliable.

Data Collection Procedures:

Prior to the data collection, permission was obtained from the hospital authority for conducting the study. Ethical clearance was obtained through the Institutional Ethics Committee. Non-patients were selected through PGI scale. Personality factors assessment was done using Cattell’s 16 F Personality Traits Questionnaire and Coping strategies assessment done using copying brief scale by CHD patients and non patients group.

Plan for data analysis:

Demographic proforma was analysed using frequency and percentage. Unpaired ‘t’ test was used to compare the difference in personality profile scores between coronary heart disease patients and non-patients group

RESULTS:

The result is presented in three parts

Section A: Description of the sample characteristics

Table 1: Frequency and percentage distribution of subjects according to their sample characteristics N= 25+25

No.	Demographic variables	Patient group		Non-patient group
No.		f	%	f	%
1.	Age in years
a)	34-45	7	28	13	52
b)	46-55	9	36	10	40
c)	56-65	6	24	2	80
d)	66and above	3	12	-
2.	Gender
a)	Male	15	60	14	56
b)	Female	10	40	11	44
3.	Religion
a)	Hindu	9	36	9	36
b)	Muslim	10	40	9	36
c)	Christian	6	24	7	28
4.	Marital status
a)	Single	11	44	13	52
b)	Married	11	44	8	32
c)	Divorced	-	-	-	-
d)	Widow/widower	3	12	4	16
5.	Educational status
a)	No formal schooling	3	12	9	36
b)	Primary	7	28	10	40
c)	High school	11	44	6	24
d)	College education	4	16	-	-
6.	Monthly Income
a)	Less than 5000	6	24	11	44
b)	5000-10000	5	20	12	48
c)	10000-15000	-	-	2	8
d)	Above1500	14	56	-	-
7.	Occupation
a)	Skilled worker	6	24	11	44
b)	Semiskilled worker	7	28	11	44
c)	Govt-employee	9	36	-	-
d)	Private –employee	3	12	3	12
8.	Dietary practices
a)	Vegetarian	15	60	4	16
b)	Non vegetarian	10	40	21	84
9.	Unhealthy habits
a)	Chewing betel leaves/pan parag	4	16	11	44
b)	Smoking	12	48	14	56
c)	Alcoholism	8	32	-
d)	Drug abuse	1	4	-

10.	Specific life style practice
a)	Regular excises/walking	11	44	13	52
b)	Regular check up	10	40	10	40
c)	Relaxation technique	3	12	2	8
d)	Other	1	4	-	-
11.	Family history of cardiovascular disease
a)	Yes	13	52	-	-
b)	No	12	48	-	-
12.	Duration of illness
a)	<6 month	10	40	-	-
b)	6-12 month	6	24	-	-
c)	1-5 years	9	36	-	-
13.	Number of hospitalization with in previous 6 month
a)	Zero	16	64	-	-
b)	Once	3	12	-	-
c)	Twice	6	24	-	-
14.	Treatment undertaken
a)	Medical management	14	56	-	-
b)	Percutaneous coronary intervention procedure	10	40	-	-
c)	Surgical management	1	4	-	-

Data presented in table 1 show that majority (80%) of sample in the non-patient group were in 56-65 years and patients (36%) were in the age group of 46-55 years. The least percentage in the patients (12%) were in the age group of above 66 years. Majority of patients (60%) and non-patients (56%) were males. Highest percentage of subjects in the patient (40%) and non-patient group (36%) were Muslims. Highest percentage of patients (44%) and majority of non-patients (52%) were single. The highest percentage of the subjects had high school education (44%) and non-patients had primary education (40%). Highest percentages of the subjects (36%) were govt employee and non-patients (44%) were skilled and semiskilled workers. Majority of subjects (60%) were vegetarians and non-patients (84%) were non vegetarians. Highest percentage of subjects in the patients (48%) and non-patients (56%) were smoking. The highest percentage of the subjects in the patients (44%) and non-patients (52%) were performing regular excises/walking. The highest percentages of patients (52%) were having family history of cardiovascular disease. The highest percentage (40%) had <6 month duration of illness. Majority of subjects (56%) were hospitalized with in the previous 6 months. Majority of patients (64%) had undergone medical treatment.

Section B: Description of personality profile and coping strategy among coronary heart disease patients and non-patients group

Figure 1: Range, Mean, Standard Deviation, Mean percentage scores of coping strategy among patients and non-patients N=25

Figure 1: Bar diagram representing the percentage distribution of coping strategies among coronary heart disease patients and non-patients group

Figure 1 show that mean score of coping strategy in non-patients (97.32±2.135) was greater than patients (78.12±4.497). The data also depicts the range of score in patients was higher (19) where as in non-patients it was less (9).

Figure 2: Range, Mean, Standard Deviation, Mean percentage of personality profile among patients and non-patients N=25+25

Figure 2: Bar diagram representing the percentage distribution of personality profile among coronary heart disease patients and non-patients group

Figure 2 show that mean score of personality profile in non-patients (588.72±15.931) was greater than patients (587.6±42.571). The data also depicts the range of score in patients was higher (154) where as in non-patients it was less (66).

Section D: compare the difference in the personality profile and coping strategies among coronary heart disease patients and non-patients groups

H0₁: There is no significant difference in personality profile scores between coronary heart disease patients and non-patients group.

Table 4: Unpaired ‘t’ test showing difference in personality profile scores between coronary heart disease patients and non-patients group N=25+25

	Group		Mean score± SD	t		p
Patients		587.6±42.572		0.123	0.902
Non-patients		588.72±15.931

t₄₈=1.96, p< 0.05 *=significant

According to data depicted in Table 4, Unpaired ‘t’ test show that there was no significant difference in the personality profile scores (t=0.123, p<0.05) between coronary heart disease patients and non-patients group. Hence the null hypothesis H0₁was accepted

H0₂: There is no significant difference in coping strategies scores between coronary heart disease patients and non-patients group

Table 5: Unpaired ‘t’ test showing difference in coping strategies scores between coronary heart disease patients and non-patients group N= 25+25

Group	Mean score± SD	t	p
Patients	78.12±4.494	19.295	<0.001***
Non-patients	97.32±2.135	19.295

t₄₈=1.96,p< 0.05

***=Very highly significant

According to data depicted in Table 5, Unpaired ‘t’ test show that there was a significant difference in the coping strategies (t= 19.295, p<0.05) between coronary heart disease patients and non-patient group. Hence H0₂null hypothesis was rejected.

DISCUSSION:

Sample characteristics:

In the present study the majority (80%) of sample in the non-patient group were 56-65 year of age and highest percentage of patients group (36%) were in the age group of 46-55 years. Majority of subjects in the patients (60%) and non-patients (56%) were males. Majority subjects (56%) had income <5000 rupees.

These findings were supported by a similar study conducted regarding Coronary artery disease and depression showed that majority of subjects were in the age group above 40 years.⁹Another study conducted regarding personality profile and coping skills among coronary heart disease among patients and non-patient group conducted at New Delhi also showed that all selected subjects were males¹⁰. And a similar study conducted regarding personality, type a behaviour and coronary heart disease showed that coronary heart disease group had slightly lower average income level.⁵

Description of personality profile and coping strategies among coronary artery disease patients and non-patients group:

In the present study no significant difference was found in personality profile between coronary heart disease patients and non-patients group. Whereas in the another study regarding personality profile and coping skills among coronary heart disease among patients and non-patient group conducted at New Delhi showed that coronary heart disease patients had certain specific personality traits.¹⁰

In the present study there was significant difference in coping strategies (t=19.295, p≤0.05) among coronary heart disease patients and non-patients group. The present study finding were supported by study regarding personality profile and coping skills among coronary heart disease among patients and non-patient group conducted at New Delhi showed that there was significant difference in coping strategies among coronary heart disease patients and non-patients group (t=3.89, p≤0.05).⁹Similar findings were found in a study regarding differences in stress, burn out and coping strategies between women with coronary heart disease and healthy matched women showed that women with coronary heart disease reported a higher level of burn out and lesser coping ability compared to healthy women.¹¹Another study on relationship between stress and coping style with coronary heart disease showed that coronary heart disease have higher stress rates in comparison with control group, and use emotion oriented coping strategies in general.¹²

NURSING IMPLICATION:

Nursing education:

To meet the challenging needs of the society, more qualified nurses are essential. The nursing curriculum should give more emphasize on health programmes. Nursing students need to be cooperate in patients care and to give health education to coronary heart disease patients on personality profile and coping strategies in the clinical settings. As nurse educators, there is opportunity to the nursing personnel to educate the coronary heart disease patients regarding personality profile and coping strategies. Nurse educators should encourage and support students to conduct campaigns to educate the public regarding the risk factors of coronary heart disease and health promotion behaviours to modify the risk factors in order to prevent the occurrence and recurrence of coronary heart diseases.

Nursing practice:

Professional obligation of nursing is the provision of caring services to human beings. Health personnel can serve as the foundation for motivating patient and general population to understand personality profile and coping strategies among coronary heart disease patients as a major issue that may arise when not adhere with the treatment facilities.

Nursing administration:

Nursing administration plays a pivotal role in the supervision and management of nursing professionals. They should develop clear-cut policy guidelines to give relevant information, education and training to the nursing personnel. Communication through media can play a very important role in disbursing information to the public with the preparation of simple messages in news papers, pamphlets, magazines and television in local language .also should arrange for proper infrastructure, comfort measures, proper staffing and economical benefits to the Coronary heart disease patients.

Nursing research:

The study helps the nurse researcher to develop insight into the development of teaching module and materials for patients with coronary heart disease towards personality profile and coping strategies and prevention recurrence of coronary heart disease. Research regarding coping strategies for coronary heart disease patients helps to identify the needs of educational programmes in common population. Nurses should be encouraged to identify problems which could be study scientifically to create new evidences for further research.

RECOMMENDATIONS:

Keeping in view the present research study findings, the following recommendations have been made.

· A similar study can be undertaken on a larger sample of cardiac patients.

· A similar study can be undertaken to compare personality profile and coping strategies among coronary heart patients between males and females.

· A similar study can be undertaken to compare personality profile and coping strategies among coronary heart patients and other patients.

CONCLUSION:

From the findings of the present study, it can be concluded that there was no significant difference in the personality profile scores between coronary heart disease patients and non-patients group and also showed that there was a significant difference in the coping strategies between coronary heart disease patients and non-patient group. Studies of this kind should be an ongoing process to make awareness on personality profile and coping strategies among coronary heart disease. Such type of study will add to the body of knowledge of the nursing practice.

REFERENCE:

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2. Wilasinee Chaiyasit. Personality traits of coronary heart disease patients: a study of female young adults. International Journal of Behavioral Science 2013, vol. 8,1906-4675.

3. Stone AA, Neal JM. New measures of daily coping: development and preliminary results. J Person Soc Psychol 1984; 46 : 892-906

4. Johan Denollet Elisabeth J. Martens and Ivan Nyklı´cˇek Viviane M. Conraads Beatrice de Gelde Clinical Events in Coronary Patients Who Report Low Distress: Adverse Effect of Repressive Coping Health Psychology Copyright 2008 by the American Psychological Association 2008, Vol. 27, No. 3, 302–308

5. Mohammed K. Ali, K.M. Venkat Narayan and Nikhil Tandon. Diabetes and coronary heart disease: Current perspectives. Indian J Med Res 132, November 2010, pp 584-597.

6. Verma SK, Wig NN.PGI Health Questionnaire: Construction and initial tryouts. Indian Journal of Clinical Psychology Sep 1976 ;3 (2):135-42.

7. Carver CS, Scheier MF, Weinteraub JK. Assessing copying strategies: A theoretically based approach. Journal of Personality and Social Psychology 1989:56:267-83.

8. Heather EP, Cattell, Alan DM. The Sixteen Personality Factor Questionnaire (16 PF).The Sage Handbook and Personality Theory and Assessment. Sage Publications Ltd 2008 Volume 1:135-59.

9. Michael J. Zellwegera, Remo H. Osterwaldera, Coronary artery disease and depression Indian J Med Res 132, November 2010, pp 584-597.

10. Ajaz Ahmad Khan, Mudassir Hassan, Pradeep Kumar,Deapti Mishra, Ranjeet Kumar. Personality profile and coping skills among coronary heart disease patients and non-patient groups. Delhi psychiatry journal October 2012; 15(2 )

11. S Howard, Personality ,type A behaviour and coronary heart disease, Journal of Personality and Social Psychology,Vol:53,page 783-792.

12. Tina H, Helene T, Differences in stress ,burn out and coping strategies between women with coronary heart disease and healthy matched women, Journal of health psychology, Vol 8(4),page:433-445.

Received on 15.07.2015 Modified on 27.07.2015

Int. J. Nur. Edu. and Research 3(4): Oct.-Dec., 2015; Page 400-405

DOI: 10.5958/2454-2660.2015.00030.7