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Original Article

A Pilot Study of APN-led Self-management Program to Improve Cardiovascular Health Status among Korean Women with Risk Factors

Nah-Mee Shin1, Nah-Mee Shin1, Ji-Won Yoon2, Jiwon Choi3, Younghee Park4, Songi Jeon1
Korean Journal of Adult Nursing 2016;28(2):237-245.
Published online: April 30, 2016

1College of Nursing, Korea University, Seoul

2College of Nursing, Shinhan University, Dongducheon

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Corresponding author: Shin, Nah-Mee College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea. Tel: +82-3290-4924, Fax: +82-927-4676, E-mail: nshin@korea.ac.kr
• Received: March 16, 2016   • Accepted: April 18, 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The aim of this study was to examine the effects of an Advanced Practice Nurse (APN)-led self-management program on cardiovascular health status among Korean women at risk of developing or progressing cardiovascular disease.
  • Methods
    This pilot study used one-group pre- and post- test experimental design. At health fairs in a community, 30 women who had one or more risk factors for metabolic syndrome were recruited and agreed to participate in the study. A total of 25 women completed the study. The intervention consisted of weekly follow-up calls and self-monitoring diary after an hour of individual counseling regarding risk factors, fast walking, and healthy diet tailored to the participants’ needs. Physical activity was assessed with the World Health Organization International Physical Activity Questionnaire and a pedometer.
  • Results
    Participants showed statistically significant improvements in blood pressure, body mass index, levels of triglyceride, total cholesterol and low density lipoprotein, numbers of metabolic syndrome factors, and the 10-year CV risk estimate after one month of concentrated intervention. In addition, their physical activity behavior significantly improved after the intervention.
  • Conclusion
    This APN-led self-management program targeting modifiable risk factors by offering tailored counseling and concentrated support during the transition might be effective in preventing progression to the cardiovascular disease.
  • Key Words: Cardiovascular disease; Diet; Physical activity; APN; Metabolic syndrome
Table 1.
Participants’ Characteristics (N=25)
Characteristics Categories n(%)
Age (year) 41~50 1 (4.0)
51~60 7 (28.0)
61~70 11 (44.0)
71~80 6 (24.0)
Marital status Married 16 (64.0)
Widowed Divorced or separated 6 3 (24.0) (12.0)
Job Full time homemaker Retired 16 2 (64.0) (8.0)
Part time (hourly) 3 (12.0)
Part time or full time 4 (16.0)
Highest education completed Elementary 6 (24.0)
Junior high 6 (24.0)
High school 7 (28.0)
≥Community college 6 (24.0)
Monthly household income (10,000 won) ＜200 (＜$1,700.00) ≥200 (≥$1,700.00) 18 7 (72.0) (28.0)
Post-menopause Yes No 21 4 (84.0) (16.0)
Family history of CVD Yes No 9 16 (36.0) (64.0)
Past medical history Hypertension 6 (24.0)
Hypercholesterolemia 9 (36.0)
Diabetes Mellitus 1 (4.0)
Smoking Yes 3 (12.0)
Never 22 (88.0)
Regular exercise Yes (3 days/week) 5 (20.0)
Irregular (1~2 days/week) 6 (24.0)
No 14 (56.0)

CVD=cardiovascular disease.

Table 2.
Cardiovascular Health Status, Physical Activity, and Diet at Time 1 and Time 2 (N=25)
Variables Categories (normal range) Time 1 Time 2 t p
M±SD M±SD
Blood pressure (mmHg) Systolic (＜140) 126.76±17.16 118.76±13.14 2.52 .019
Diastolic (＜90) 75.20±11.54 69.80±6.34 2.82 .009
Obesity indicators Body mass index (＜25 kg/m²) 25.14±3.52† 24.85±3.44† 3.63 .001
Waist circumference (＜85 cm) 82.12±7.66 81.54±7.70 1.61 .120
Blood cholesterol profile (mg/dL) Total cholesterol (＜200) 212.10±34.01† 201.35±36.09† 2.51 .021
High-density lipoprotein (＞50) 54.40±13.67 54.96±12.05 0.35 .727
Low-density lipoprotein (＜130) 108.25±24.93 101.20±24.39 2.22 .039
Triglycerides (＜150) 171.68±71.85† 138.92±60.02 2.45 .022
Fasting blood glucose (＜100 mg/dL) 101.44±18.56† 100.84±15.21† 0.17 .870
Number of metabolic syndrome factors (＜3) 2.20±1.35 1.32±1.11 3.38 .002
Probability of 10-year risk estimate (%) 3.84±2.82 2.80±2.08 2.36 .027
Dietary habit Level of fat intake 2.15±0.54 2.11±0.47 0.32 .750
Level of sodium intake 2.17±0.37 2.07±0.39 2.22 .036
Physical activity (WHO IPAQ) Days of walking for≥10 minutes 4.33±2.33 6.17±1.40 -3.73 .001
Minutes of walking per day 62.86±39.17 100.00±134.56 -1.31 .205
Minutes of physical inactivity per day 327.67±190.10 229.60±150.40 2.09 .048

†Means higher than normal range.

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    A Pilot Study of APN-led Self-management Program to Improve Cardiovascular Health Status among Korean Women with Risk Factors
    Korean J Adult Nurs. 2016;28(2):237-245.   Published online April 30, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.2.237
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    A Pilot Study of APN-led Self-management Program to Improve Cardiovascular Health Status among Korean Women with Risk Factors
    Korean J Adult Nurs. 2016;28(2):237-245.   Published online April 30, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.2.237
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    A Pilot Study of APN-led Self-management Program to Improve Cardiovascular Health Status among Korean Women with Risk Factors
    A Pilot Study of APN-led Self-management Program to Improve Cardiovascular Health Status among Korean Women with Risk Factors

    Participants’ Characteristics (N=25)

    Characteristics Categories n(%)
    Age (year) 41~50 1 (4.0)
    51~60 7 (28.0)
    61~70 11 (44.0)
    71~80 6 (24.0)
    Marital status Married 16 (64.0)
    Widowed Divorced or separated 6 3 (24.0) (12.0)
    Job Full time homemaker Retired 16 2 (64.0) (8.0)
    Part time (hourly) 3 (12.0)
    Part time or full time 4 (16.0)
    Highest education completed Elementary 6 (24.0)
    Junior high 6 (24.0)
    High school 7 (28.0)
    ≥Community college 6 (24.0)
    Monthly household income (10,000 won) ＜200 (＜$1,700.00) ≥200 (≥$1,700.00) 18 7 (72.0) (28.0)
    Post-menopause Yes No 21 4 (84.0) (16.0)
    Family history of CVD Yes No 9 16 (36.0) (64.0)
    Past medical history Hypertension 6 (24.0)
    Hypercholesterolemia 9 (36.0)
    Diabetes Mellitus 1 (4.0)
    Smoking Yes 3 (12.0)
    Never 22 (88.0)
    Regular exercise Yes (3 days/week) 5 (20.0)
    Irregular (1~2 days/week) 6 (24.0)
    No 14 (56.0)

    CVD=cardiovascular disease.

    Cardiovascular Health Status, Physical Activity, and Diet at Time 1 and Time 2 (N=25)

    Variables Categories (normal range) Time 1 Time 2 t p
    M±SD M±SD
    Blood pressure (mmHg) Systolic (＜140) 126.76±17.16 118.76±13.14 2.52 .019
    Diastolic (＜90) 75.20±11.54 69.80±6.34 2.82 .009
    Obesity indicators Body mass index (＜25 kg/m²) 25.14±3.52† 24.85±3.44† 3.63 .001
    Waist circumference (＜85 cm) 82.12±7.66 81.54±7.70 1.61 .120
    Blood cholesterol profile (mg/dL) Total cholesterol (＜200) 212.10±34.01† 201.35±36.09† 2.51 .021
    High-density lipoprotein (＞50) 54.40±13.67 54.96±12.05 0.35 .727
    Low-density lipoprotein (＜130) 108.25±24.93 101.20±24.39 2.22 .039
    Triglycerides (＜150) 171.68±71.85† 138.92±60.02 2.45 .022
    Fasting blood glucose (＜100 mg/dL) 101.44±18.56† 100.84±15.21† 0.17 .870
    Number of metabolic syndrome factors (＜3) 2.20±1.35 1.32±1.11 3.38 .002
    Probability of 10-year risk estimate (%) 3.84±2.82 2.80±2.08 2.36 .027
    Dietary habit Level of fat intake 2.15±0.54 2.11±0.47 0.32 .750
    Level of sodium intake 2.17±0.37 2.07±0.39 2.22 .036
    Physical activity (WHO IPAQ) Days of walking for≥10 minutes 4.33±2.33 6.17±1.40 -3.73 .001
    Minutes of walking per day 62.86±39.17 100.00±134.56 -1.31 .205
    Minutes of physical inactivity per day 327.67±190.10 229.60±150.40 2.09 .048

    †Means higher than normal range.
    Table 1. Participants’ Characteristics (N=25)

    CVD=cardiovascular disease.

    Table 2. Cardiovascular Health Status, Physical Activity, and Diet at Time 1 and Time 2 (N=25)

    Means higher than normal range.

    Table 1.

    Table 2.

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