Relationship of Poor Education and Understanding of Most Women to Heart Attack Causes
This paper discusses in detail the research proposal on the reasons and proofs on why more women die in heart attacks. In particular, the research will focus on the questions: “What are the related factors affecting the massive death of women in relation to their education and understanding?” In this research proposal, the background, context and theme of the study are presented; the objectives of the study and the research statements are formulated. Here, vital concepts, questions and assumptions are stated. Finally, the scope and limitation of the study, methodology to be used and the significance of the research are discussed. Further, this paper briefly reviews related literature.
PROBLEM TO BE INVESTIGATED
Purpose of the Study
Generally, the purpose of the research is to conduct an experimental study to determine the relationship of poor education and causes of heart attacks of women. The research will specifically identify the different factors related to the causes of heart attacks in most women. The research will also conduct a phenomenological method of open-ended interviews with subsequent thematic analysis of the transcripts from which the researcher could get information for an educational program. Moreover, this proposed study would review relevant literature on the same topic. Based on the preliminary review of literature, the researcher assumed that there is a relationship between poor education and causes of heart attacks in most women.
Research Question and Null Hypothesis
The focus of this problem statement is to establish and determine the impact of poor education and understanding of women to the causes of heart attacks. Currently, there are no studies that provide a definitive answer regarding the negative and positive influence of poor education to the causes of heart attacks to most women. The researcher is hopeful that the proposed research will yield a significant result in terms of both positive and negative impact of poor education to the health of women. Thus, the study will work on the following hypothesis: “There is a significant relationship between poor education and understanding of women and causes of heart attacks”
This study will attempt to answer the following questions:
1. What are the related factors affecting to the death of most women in connection to heart attacks and poor education?
2. What is the degree of impact of poor education and understanding of women to the causes of heart attack?
3. What is the degree of relationship of the causes of heart attack and poor education of women?
4. What are the possible steps and procedures to minimize the massive death of women due to heart attacks in connection to education?
Definition of Terms
Brief Overview of the Study
The proposed study will attempt to prove that there is a significant relationship between poor education and understanding of most women to heart attack causes. The researcher will use Orem’s health belief to provide health model. The population sample would be women who have had a myocardial infarction and are able to identify areas that need to be addressed in the study. Women could be recruited from local hospital ER. The sample size could be 300 or more subjects till the researcher get some conclusions to the phenomenological study. The study will be divided into five sections. The first section will introduce the topic and the background and nature of the problem. The second section will present a review of literature. The third section will discuss the methodologies that will be used for the study. The forth chapter will be presenting the results and findings. And the final section will present the conclusion.
BACKGROUND AND REVIEW OF RELATED LITERATURE
A heart attack is a colloquial term referring to a serious, sudden heart condition that presents as varying degrees of chest pain, weakness, sweating, nausea and vomiting, sometimes causing loss of consciousness. A heart attack is a medical emergency. (U.S. Department of Health and Human Services)
The medical term for a heart attack is acute myocardial infarction, often abbreviated as AMI or MI. “Acute” means sudden, “myo” refers to muscle, and “cardium” refers to the heart, i.e. to the heart muscle (myocardium). “Infarction” is a medical term describing tissue death (necrosis) caused by an obstruction of blood flow. (U.S. Department of Health and Human Services)
Diagnosis
U.S. Department of Health and Human Services cited that the classical symptom of a heart attack is chest pain. However it is present only in 65-69% of cases. Pain most characteristic of a heart attack is described as “intense pressure” (“like an elephant sitting on your chest”) but can also be a sharp or stabbing pain. The pain may radiate to the left arm, neck or the back and can be slight, moderate, or severe.
Some associated symptoms include dizziness, nausea, shortness of breath and diaphoresis (excessive sweating). In the absence of these symptoms, sharp chest pain which goes away promptly when the patient stops moving chest and arm muscles often is not associated with a heart attack; but a sharp chest pain that persists despite lack of movement is a strong indicator of a heart attack.
Heart attacks sometimes occur with atypical pain or in the absence of classical symptoms, particularly in women, who may experience simply chest discomfort, a sensation of uncomfortable chest pressure, cold sweats, nausea, or pain in the arm, back, jaw, or stomach (so called anginal equivalents). Women are just as likely to die of a heart attack as men.
The Disease Process
Despite a dramatic decline in the death rate for coronary heart disease (CHD) over the past three decades, it continues to be the leading cause of death and major cause of disability in the United States. Each year, over 14 million Americans will be diagnosed with coronary heart disease, including over 7 million who experienced a myocardial infarction and over 6 million with angina pectoris. (American Heart Association. Biostatistical Fact Sheets. 2000)
Certain segments of the population are disproportionately affected by CHD, including individuals living in Kentucky and most of its contiguous states. Recent estimates from the American Heart Association indicate that only three other states in the nation have a CHD mortality rate higher than that of Kentucky. Compared with national CHD-related mortality rates of 89.5/100,000, Kentucky sustained a CHD mortality rate of 113.5/ 100,000, about 27 percent higher than the national level. (American Heart Association. Heart and Stroke Statistical Update, 1998)
Because of this disproportionate burden from CHD, researchers in this region have created a nickname descriptive of the region’s vulnerability to CHD. Similar to the “stroke belt” of the southern states, scientists have labeled Kentucky and neighboring states “Coronary Valley.” While researchers have paid little attention to this clustering of CHD and minimal empirical evidence exists about factors that account for Coronary Valley, understanding lay perspectives on CHD risk factors may provide insights into this high prevalence of CHD and may guide prevention efforts.
The association between health knowledge and behaviors makes intuitive sense–knowing the potential of health risks involved in certain activities may influence that individual to avoid such risks in favor of other activities that are viewed as neutral or favorable to one’s health. While scholars continue to debate the relative influence of health knowledge on preventive health behavior, much of the existing literature has demonstrated some association between knowledge and behavior. (Wardle J, Steptoe, A, Bellisle, F, Davou, B., 1997) For example, to understand the association between knowledge of disease risk factors and exercise behaviors, Steptoe and colleagues (Wardle, J, Fuller R, Holte, A, Justo, J, Sanderman, R, Wichstrom, L.,1997) interviewed over 16,000 young adults in the European Health and Behaviour Study. Their results revealed an association between the beliefs in the benefits of exercise for preventing heart disease and participating in exercise itself. Similarly, in a study of older adults, (Ferrini R, Edelstein S, Barret-Connor E,1997) found that those who agreed that diet and exercise were important for optimal health were significantly more likely to engage in behavior change than those expressing confusion about health risks and benefits.
Research on the relationship between cardiovascular disease risk factors and health behavior often has confirmed the connection between health knowledge and behavior. (Mirotznik J, Speedling E, Stein R, Bronz C.,1985 , Popay J, Williams G., 1996 and Mirotznik J, Feldman L, Stein R.,1995) The preponderance of this research suggests that while far from the only predictor of health behavior, in the absence of certain health knowledge, behavioral change is unlikely (Kelly RB, Zyzanski S, Alemagno SA.,1991 and Avis NE, McKinlay JB, Smith KW.,1990). Therefore, a starting point for prevention and intervention programs, particularly those populations experiencing epidemics, is to illuminate lay explanations of disease risk factors. Determining lay perspectives of CHD has the potential to: American Heart Association. Biostatistical Fact Sheets. 2000 reveal knowledge deficits that have been linked to suboptimal health behavior and (American Heart Association. Heart and Stroke Statistical Update,1998) identify risk factors described by lay individuals that often fall outside of the purview of public health and health care professionals. Once identified, such knowledge deficits may be addressed through specific and appropriate prevention efforts. Thus, the aim of this article is to reveal Kentuckians’ explanations about factors that might account for the elevated risk of CHD in their region.
PROCEDURES
Description of the Research Design
There are three kinds of research methods, correlational, experimental and descriptive. (Walliman and Baiche, 2001) The correlational kind of research method is used due to ethical problems with experiments. It is also used due to practical problems with experiments. Moreover, inferring causality from correlation not actually impossible, but very difficult. This mode of study is widely applicable, cheap, and usually ethical. Nonetheless, there exist some “third variable” issues and measurement problems.
The correlational research refers to studies in which the purpose is to discover relationships between variables through the use of correlational statistics (r). The square of a correlation coefficient yields the explained variance (r-squared). A correlational relationship between two variables is occasionally the result of an outside source, so we have to be careful and remember that correlation does not necessarily tell us about cause and effect. If a strong relationship is found between two variables, using an experimental approach can test causality.
In the descriptive method, it is possible that the study will be cheap and quick. It can also suggest unanticipated hypotheses. Nonetheless, this method will be very hard to rule out alternative explanations and especially infer causations. This descriptive type of research utilizes observations in the study. To illustrate the descriptive type of research, Creswell (1994) states that the descriptive method of research is to gather information about the present existing condition.
In this study, the experimental method will be used; it is the only method that can be used to establish cause-and-effect relationships (Creswell, 1994). That is, it is the only one that can be used to explain the bases of behaviour and mental processes. In this method, the subjects are split into two (or more) groups. One group, called the experimental group gets the treatment that the researcher believes will cause something to happen (this treatment is formally called the independent variable). The experimental and control groups are compared on some variable that is presumed to reflect the effects of the treatment, or outcome. This is formally referred to as the dependent variable.
To come up with pertinent findings and to provide credible recommendations, this study will utilize two sources of research: primary and secondary. Primary research data will be obtained through this new research study. The secondary research data will be obtained from previous studies on the same topic.
This research will base its findings partially through quantitative research methods because this permits a flexible and iterative approach. During data gathering the choice and design of methods will be constantly modified, based on ongoing analysis. This will allow investigation of important new issues about single parenting and questions as they arise, and allow the researcher to drop unproductive areas of research from the original research plan.
This study will also employ qualitative research method because it intends to find and build theories that will explain the relationship of one variable with another variable through qualitative elements in research. Through this method, qualitative elements that do not have standard measures such as behavior, attitudes, opinions, and beliefs will be analyzed.
Furthermore qualitative research is multimethod in focus, involving an interpretative, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret phenomena in terms of the meanings people bring to them. Accordingly, qualitative researchers deploy a wide range of interconnected methods, hoping always to get a better fix on the subject matter at hand.
For this research design, the researcher will gather data, collate published studies from different local and foreign universities and articles from books and journals; and will make a content analysis of the collected documentary and verbal material. Afterwards, the researcher will summarize all the information and make a conclusion based on the hypotheses posited.
Description of the Sample
The population for this study will be investors, business organization leaders and consumers. Samples will compose of 30 Christians who have served more than 5 years at their church. Stratified random sampling from Christian community will be used to ensure a sample representative of all socioeconomic levels in the community. Ten (10) samples will be randomly selected from each different organization/ministry.
Description of the Instruments
To determine what perception of the respondents pertaining the impact of losing respect to the office of the pastorate, the researcher will prepare a questionnaire and a set of guide questions for the interview that will be asked to the intended respondents. Questionnaires will be of a non-threatening nature that can be completed within 30 minutes. The respondents will grade each statement in the survey-questionnaire using a Likert scale with a five-response scale wherein respondents will be given five response choices. The equivalent weights for the answers will be:
Range Interpretation
4.50 – 5.00 Strongly Agree
3.50 – 4.00 Agree
2.50 – 3.49 Uncertain
1.50 – 2.49 Disagree
0.00 – 1.49 Strongly Disagree
Moreover, the researcher will also conduct interview with the respondents. The interview shall be using a semi-structured interview. It shall consist of a list of specific questions and the interviewer, at times, does deviate from the list or inject any extra remarks into the interview process. The interviewer may encourage the interviewee to clarify vague statements or to further elaborate on brief comments. Otherwise, the interviewer attempts to be objective and tries not to influence the interviewer’s statements. The interviewer does not share his/her own beliefs and opinions. The structured interview is mostly a “question and answer” session.
For validation purposes, the researcher will initially submit a sample of the set of survey questionnaires and after approval; the survey will be conducted to five respondents. After the questions were answered, the researcher will ask the respondents for any suggestions or any necessary corrections to ensure further improvement and validity of the instrument. The researcher will again examine the content of the interview questions to find out the reliability of the instrument. The researchers will exclude irrelevant questions and will change words that would be deemed difficult by the respondents, too much simpler terms. The researcher will exclude the five respondents who will be initially used for the validation of the instrument.
Explanation of Procedures
The project procedure will be broken down into five key stages; problem definition, research design, data collection, analysis of results and presentation findings and recommendations.
The project owner develops the original idea for the research project. The idea is discussed with the supervisor and other students. The project supervisor then provided guidance on developing the hypotheses and key reference material that would be needed for the project. After the approval of this research proposal, the researcher will review literature pertaining to the topic.
Afterwards, significant issues and problems will be identified. The researcher will then start determining the population for the study, following the sampling. For this study, the researcher will focus on the causes of heart attacks and poor education of women. The researcher will ask the consent of the doctors, health professionals, women and even men. They will be ensured that their response to the survey and interview will be handled with high confidentiality. The procedures in data gathering will cover three months.
The researcher will collate, tally and tabulate the results. A preliminary analysis will be done before submitting the final draft to the supervisor.
Discussion of External Validity
The researcher will attempt to make the sample as representative to the population as possible. The population will be doctors, health professionals, women and men. The study will only cover the city/state of ____. Different organizations will be selected through stratified random sampling so as to have a representative sample in relation to socioeconomic backgrounds. In each organization, ten respondents will be selected through a systematic random sampling.
Discussion of Internal Validity
The researcher will make sure to rule out any threats to the internal validity of the study. The researcher will consider events that occur during the course of the program that might impact the final outcome. In the testing part, the researcher will make sure that the content of the testing instrument used in pretest does not duplicate the posttest. Instead, the researcher will make the content of the posttest reflective of the pretest. Moreover, the researcher is hoping that participants will not drop out from the program. In presenting the findings of the study, the researcher will ask the help of a statistician in interpreting the results of survey and tests.
References:
American Heart Association. Biostatistical Fact Sheets. 2000. Available from: URL: http://www. americanheart.org/statistics/biostats/index.html
American Heart Association (1998). Heart and Stroke Statistical Update. Dallas, TX:
Avis NE, McKinlay JB, Smith KW. (1990) Is cardiovascular risk factor knowledge sufficient to influence behavior? Am J Prey Med; 6:137-44.
Creswell, J.W. (1994) Research design. Qualitative and quantitative approaches. Thousand Oaks, California: Sage.
Ferrini R, Edelstein S, Barret-Connor E. (1994) The association between health beliefs and health behavior change in older adults. Prev Med; 23:1-5.
Kelly RB, Zyzanski S, Alemagno SA. (1991) Prediction of motivation and behavior change following health promotion: Role of health beliefs, social support, and self-efficacy. Soc Sci Med ; 32: 311-20.
Mirotznik J, Feldman L, Stein R. (1995) The health belief model and adherence with a community center-based supervised coronary heart disease exercise program. J Community Health; 20: 233-47.
Mirotznik J, Speedling E, Stein R, Bronz C.(1985),Cardiovascular fitness programs: Factors associated with participation and adherence. Public Health Report; 100:13-18.
Popay J, Williams G.(1996) Public health research and lay knowledge. Soc Sci Med ; 45:759-68.
Steptoe, A, Wardle, J, Fuller R, Holte, A, Justo, J, Sanderman, R, Wichstrom, L. (1997) Leisure time physical exercise: Prevalence, attitudinal correlates, and behavioral correlates among Europeans from 21 countries. Prev Med ; 26: 845-854.
U.S. Department of Health and Human Services
Walliman, Nicholas and Bousmaha Baiche. (2001) Your research project. SAGE Publications
Wardle J, Steptoe, A, Bellisle, F, Davou, B. (1997) Health dietary practices among European students. Health Psych; 16: 443-450.
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