Use this URL to cite or link to this record in EThOS:
Title: Exploring the provision of secondary prevention services for coronary heart disease in public hospitals in Jordan
Author: Ashour, Ala Fawzi
ISNI:       0000 0004 5362 129X
Awarding Body: Ulster University
Current Institution: Ulster University
Date of Award: 2014
Availability of Full Text:
Access from EThOS:
Purpose: Coronary heart disease (CHD) is a major health problem in Jordan and the leading cause of death. It is a progressive condition but effective secondary prevention (SP) that includes behavioural change and medication reduces risk. Little is known about the current provision of SP for patients with CHD in Jordan. This study was designed to explore the current provision of SP from perspective of professionals and to evaluate patients' risk factors, SP interventions received and associated outcomes. Method: A mixed methods, parallel, repeated measures research design was used with a purposive sample from three interventional hospitals. A questionnaire was completed by 16 key staff, 20 Jordanian health care professionals (JHCP) were interviewed and 180 patients were evaluated in hospital and after 6 months. All patients had either had an acute myocardial infarction (AMI) treated medically, a Percutaneous Coronary Intervention (PCI) or a coronary artery bypass graft (CASG). The quantitative data was collected using self-reported questionnaires and a medical record review during hospitalisation and six months later. The qualitative data was collected using semi-structured interviews with JHCP. The European guidelines on CHD prevention (2012) were used to define recommended targets. Results: Provision of SP services in Jordan was poor compared to Guideline recommendations. There was no cardiac rehabilitation, smoking cessation or SP available post-discharge. Interviews established that while health professionals expressed the importance of SP, multiple barriers existed. They were generally dissatisfied with current SP provision and wanted to improve it, but identified training and other issues that needed to be addressed in order to achieve this. The prevalence of risk factors in patients was high during hospitalisation and also at follow-up, but some small improvements at 6 months were observed. Obesity and overweight reduced from 77% to 75%, smoking reduced from 59% to 47% and physical inactivity reduced from 59% to 41%. Quality of life was low and anxiety and depression were high at both baseline and 6 months, but significant improvements over time were observed. Risk factors such as hypertension and blood sugar control deteriorated over time and patients' knowledge regarding their condition remained deficient at 6 months. Conclusion: Despite an extremely high prevalence of risk factors in this population, the provision of SP is poor and obstacles to its development are widespread. There was much greater focus on medical treatment arid medication rather than on lifestyle modifications. Secondary prevention of CHD in Jordan requires urgent improvement and the potential role of nurses in SP should be enhanced.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available