CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 180 AFRICA Looking for novel methods to help cardiovascular patients adhere to their medication has tremendous potential to improve the quality of life of these patients as well as reduce the cost of healthcare. This narrative review of studies on patient knowledge and perception of CVDs (Table 1) reveals low to moderate levels of knowledge and awareness of CVDs and associated risk factors. This was seen across different populations globally and there appears to be an incongruity in knowledge across the globe (Fig. 1). The knowledge gap is also apparent in the low perception rate of CVD-related deaths. Observations revealed that knowledge and perceptions were not necessarily practiced upon. In the study conducted by Surka et al.,15 respondents were hesitant and unsure in providing a clear definition of CVD. Some respondents were able to identify hypertension and diabetes as specific conditions related to CVD. Most respondents were uninformed due to poor communication from their respective healthcare providers. Participants with a higher level of education and formal employment were found to be more knowledgeable about cardiovascular health, its risk factors andwarning signs compared to those with lower levels of education. Educated individuals have an increased capability to comprehend information such as health messages delivered through various media channels. Similarly, studies have shown a greater knowledge among individuals residing in urban areas as opposed to those in rural settings (Table 1).2,15-19 Although participants were familiar with the terms used to describe CVD, they were found to have limited insight on what these terms mean, as patient knowledge of CVD was dependant on specific terminology15 or limited to only one or two symptoms, such as shortness of breath as a symptom of a heart attack. Respondents from Cameroon, however, were found to be unaware of classical symptoms of myocardial infarction.17 The overall knowledge of CVD was low among both the Kuwaiti and Cameroonian populations with 40.7 and 48.4%, respectively, not recognising any symptoms. The most common CVD identified by Kuwaiti respondants was coronary heart disease (29%), followed by congenital heart disease, deep-vein thrombosis and pulmonary embolism.20 Young African Americans felt they were moderately well informed about CVD, however, knowledge of preventative behaviours and risk factors were variable and inconsistent.21 There appears to be a lack of understanding among African American participants that high blood cholestetol levels are associated with consumption of dietary saturated fats. Observations revealed that although 76.6% of participants were aware that a high level of cholesterol is a major cause of heart disease, only 37.4% knew that reduction in animal products in their diet is a preventative behaviour.21 Acknowledgement of predisposing factors such as unhealthy diet, obesity, smoking and alcohol consumption were recognised as risk factors for CVD by various studies (Table 1), with stress being the most recognised risk factor in Ga-Rankuwa, South Africa. However, diabetes, high cholesterol level, sedentary lifestyle and hereditary factors were not recognised as risk factors by participants in both the Western Cape and Gauteng, South Africa.15,22 Respondents in Buea, Cameroon recognised obesity and diabetes as risk factors for CVD, however up to 54.2% of participants thought that family history was unrelated to CVD,17 and more than 99% of Nigerian participants were unaware that excess weight around the waistline increases the risk for CVD.16 Females in Ga-Rankuwa, South Africa were more aware and knowledgeable about risk factors, compared to males.22 Similarly, CVD knowledge was significantly greater among females compared to males in Kuwait as well as in those aged 50 to 59 years.20 Higher CVD knowledge among females could be CVD – cardiovascular disease, RSA – Republic of South Africa, HIV – human immunodeficiency virus African Americans Australia Ghana Limpopo, RSA Nigeria Cameroon Kuwait Malaysia Tanzania Uganda Tshwane,2 RSA Western Cape,2 RSA Low levels of heart disease knowledge, especially specific risk factors and warning signs Medication knowledge was high; however, medication adherence was low. Interventions are required to improve medication adherence rather than solely focusing on medication knowledge Strokes are perceived as serious and preventable, however awareness of risk factors and warning signs is sub-optimal Although general knowledge on CVD was prevalent, the community felt that poverty limited their ability to address social determinants of health. A need for design of a healthy diet and lifestyle modifications fitting a low-income community Early detection and preventative practices were lacking due to gaps in CVD knowledge. Urgent need to design and implement culturally appropriate health educational programmes A significant gap in CVD awareness exists. Cost-effective health education interventions may be beneficial Deficiencies in CVD knowledge. This could turn into insufficient preventative behaviours leading to sub-optimal patient outcomes. Apparent need for educational interventions Awareness of heart attack risk factors appears to be poor. Programmes and strategies to raise awareness of modifiable risk factors are urgently needed Knowledge of CVD risk factors are low. It is critical to develop and implement interventions to combat the rising burden of CVD Stroke knowledge is poor in both rural and urban areas. Public health initiatives that improve knowledge and awareness are urgently needed Overall knowledge of CVD risk factors are low. Primary healthcare clinics only feature HIV, tuberculosis and malaria. Initiation of a health project to improve CVD knowledge is imperative Respondents are aware about CVD, however have a low knowledge of risk and predisposing factors Fig. 1. Gaps in patient knowledge, perception and practice with regard to CVD identified in various countries.
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