Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies.
The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA.
FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA.
A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants’ CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed.
Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates.
Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study.
family physicians; cardiovascular diseases; lifestyle counselling; sub-Saharan Africa; online survey; family medicine trainee.
Non-communicable diseases (NCDs) are on the rise globally.
The prevention and management of the increasing burden of NCDs must be regarded as a global priority. Family physicians (FPs) are essential in carrying out the individual or group prevention and treatment strategies necessary for CVD risk reduction, as they are frequently the first point of contact in health systems.
In line with the above, the World Health Organization (WHO) and the International Society for Hypertension (ISH) recommend that primary care workers use WHO or ISH risk prediction charts to screen and counsel for CVD risk factor reduction in low-resource regions such as SSA.
Currently, the best evidence available appears to support counselling for CVD prevention. A systematic review by the United States Preventive Services Task Force (USPSTF) in 2014 found that in patients with established CVD risk factors, combined intensive lifestyle counselling (diet and/or physical activity) reduced total cholesterol, low-density lipoprotein, fasting blood glucose, blood pressures, diabetes incidence and weight.
Primary care physicians (PCPs) play an important role in patient counselling for CVD prevention and can support patients as they initiate and adhere to lifestyle changes. However, some barriers to CVD risk assessment and counselling behaviour have been identified, as even in developed regions physicians frequently do not effectively implement counselling and CVD risk reduction behaviour.
Similar to the developed regions, some studies have been conducted among PCPs in SSA. A study in South Africa revealed that different lifestyle modification knowledge exists among physicians and students practising in primary healthcare centres and tertiary centres.
This was an online, cross-sectional analytical study.
This study focused on the SSA region, defined as all of Africa excluding North Africa.
This study comprised all FPs (i.e. doctors who had completed a residency training in FM) and FM trainees who were practising or training in Anglophone SSA. Their contact details were drawn from the Faculty of Family Medicine, West African College of Physicians (WACP) and the Society of Family Physicians of Nigeria (SOFPON), the online platforms of the South African Academy of Family Physicians, South African Family Medicine Registrars and the African Primary Care and Family Medicine Education Network (PRIMAFAMED), World Organisation of National Colleges, Academies and Academic Associations of Family Physicians/General Practitioners (WONCA) African Region and AfriWon Renaissance (the WONCA Young Doctor Movement for Africa). Survey links were also sent through volunteers to the group email addresses of FPs and FM trainees in East Africa.
Family physicians and FM trainees practising in SSA at the time of the study with Internet access were included in the study.
Family physicians and FM trainees who withdrew consent, had inconsistent online access or were not contacted for various reasons, for example, annual leave, were excluded from the study.
Based on the highest proportion obtained from a similar survey among general practitioners (GPs) in Germany,
A stratified random sampling technique was used for this study. The existing strata were Central, East, West and Southern Africa. For all participants that opted in to the study and met the inclusion criteria, an equal proportion of 82 trainees and specialists from each of the existing strata were to be recruited via simple random sampling technique to give a total sample of 328.
A self-designed web-based questionnaire was used and consisted of an introductory section, a consent form and the main questionnaire.
The section assessing physician knowledge of CVD prevention was also self-designed by the authors based on the 2007 WHO guidelines on prevention of CVD.
The sections on physician personal health-related lifestyle practice and CVD counselling practice were adapted from a similar study by Voltmer et al.
The section assessing baseline characteristics (including age of participants, sex, designation, etc.) was self-designed with face validity assured, following a literature review of unique characteristics of participants that may have a direct effect on CVD counselling practice. It consisted of 21 items consisting of multiple-choice and open-ended questions that required short answers. Combining this section with the sections on personal health-related lifestyle practice and CVD counselling practice would yield 43 items. The combined sections were also reviewed by nine different physicians (four FPs and five non-FM specialists) who worked in the same institutions with the authors and were also considered to be experts in the management of CVDs. The 43 items (reflecting baseline characteristics of participants, their personal health-related lifestyle practices and patient counselling practices) were retained and these had an I-CVI ranging from 0.7 to 1.0. S-CVI/Ave was 0.95 for relevance and 0.90 for clarity. Calculations were also based on the formula by Zamanzadeh et al.
The survey was administered using the SurveyMonkey© platform and survey links sent to the email groups of the Faculty of Family Medicine, WACP and the SOFPON, the online platforms of the PRIMAFAMED, WONCA African Region and AfriWon Renaissance. Survey links were also sent through volunteers to the group email addresses of FPs and FM trainees in East Africa. Once the study period elapsed, the link was closed and all data collated.
Primary outcome variables included: (1) frequency of participants with adequate CVD counselling practice scores, defined for the purposes of this study, as always or usually counselled items combined and (2) the CVD and counselling practice scores. Secondary outcome variables included CVD prevention knowledge scores, proportion of participants who got each question on CVD prevention correct, proportion of participants with optimal personal health-related lifestyle practices, physician personal health-related lifestyle scores, frequency distribution of participants by sex, marital status, job designation, the presence of CVD risk among participants and among their friends or family members, type of community served by respondent’s practice, region of practice, mean age, median time at work and median monthly income.
The Pearson’s test of correlation was used to test for association between CVD screening or counselling practice scores and secondary variables that were continuous, while χ2 test of independence was used to test for association between the proportion of participants with optimal CVD counselling practice and secondary outcome variables that were categorical. Logistic regression was then used to test for the relationship between the primary and secondary outcome variables that showed statistically significant association. Data collation, description and analyses were done using SPSS version 23 and Microsoft Excel software
Ethical clearance was granted by the Health Research Ethics Committee, Federal Medical Centre, Keffi, Nasarawa State (Ethical Clearance Reference Number FMC/KF/HREC/078/15, Registration Number /21/12/2012). Informed consent was sought from each participant on the SurveyMonkey© platform by having them complete the consent form (see
The total number of participants was 174 (yielding a response rate of 53%), most of whom were married (145/174, 83%), females (89/174, 51%) with a mean age of 39.2 years. The majority of the participants (64/174, 37%) were FM trainees who had been in the residency programme for more than 2 years, mostly practising in West Africa (103/174, 59%) and were urban based (71/174, 41%) (see
Demographic characteristics of participants.
Characteristic | Frequency |
Percentage |
---|---|---|
Sex ( |
||
Male | 75 | 43.1 |
Female | 89 | 51.1 |
Marital status ( |
||
Married | 145 | 83.3 |
Single | 18 | 10.3 |
Separated | 1 | 0.6 |
Region of practice or training ( |
||
West Africa | 103 | 59.2 |
Southern Africa | 33 | 19.0 |
East Africa | 28 | 16.1 |
Central Africa | 1 | 0.6 |
Community type served by practice ( |
||
Urban | 71 | 40.8 |
Both urban and rural | 43 | 24.7 |
Semi-urban | 26 | 14.9 |
Rural | 24 | 13.8 |
Designation ( |
||
FM resident (> 2 years in training) | 64 | 36.8 |
FM specialist (≤ 5 years since completing training) | 46 | 26.4 |
FM specialist (> 5 years since completing training) | 33 | 19.0 |
FM resident (≤ 2 years in training) | 21 | 12.1 |
FM, family medicine.
, Missing values not included in the frequency.
The most common self-reported CVD risk factor among the participants was hypertension, affecting 9.2% (16/174) of them, while 2.9% (5/174) had experienced either angina or a myocardial infarction. Most of the participants (106/174, 61%) had at least one family member with a cardiovascular risk factor and 35.0% (61/174) had family members with a history of a CVD (see
Characteristics of participant cardiovascular disease risk factors.
Characteristic | Frequency | Percentage |
---|---|---|
Respondent cardiovascular risk | ||
Hypertension | 16 | 9.2 |
Obesity | 13 | 7.5 |
Dyslipidaemia | 6 | 3.4 |
Diabetes | 5 | 2.9 |
Respondent cardiovascular disease | ||
Angina/MI | 5 | 2.9 |
Stroke | 1 | 0.6 |
PE/DVT | 1 | 0.6 |
PAD | 1 | 0.6 |
Relative with at least one CVD risk factor | 106 | 61 |
Relative with a history of cardiovascular disease | 61 | 35.1 |
CVD, cardiovascular disease; PE/DVT, Pulmonary Embolism/Deep Vein Thrombosis; PAD, Peripheral Arterial Disease; MI, Myocardial Infarction.
The median scores for respondent’s knowledge of CVD prevention, personal health-related lifestyle and CVD counselling practice were 10, 30 and 14.6 respectively. Comparing the 25 and 75 percentiles with the maximum scores obtainable for each of these outcomes, most of the participants showed appropriate CVD prevention knowledge and personal health-related lifestyle scores with less than optimal patient CVD counselling practice (see
Distribution of participants’ scores for personal health-related lifestyle, knowledge of cardiovascular disease prevention and patient counselling practice.
Questionnaire category | Maximum score obtainable | 25th Percentile | 75th Percentile | Median |
---|---|---|---|---|
Physician personal health-related lifestyle score | 49.0 | 27.0 | 32.0 | 30.0 |
Knowledge of CVD prevention score | 16.0 | 10.0 | 10.0 | 10.0 |
Patient counselling practice score | 35.0 | 12.5 | 17.0 | 14.6 |
CVD, cardiovascular disease.
Concerning knowledge of CVD prevention, the majority of the participants (118/174, 68%) had accurate responses for question 6 (management of obesity), a relatively similar proportion of participants (57% – 65%) had accurate responses for questions on physical activity (Q5), salt intake (Q3), hypertension or CVD risk (Q9, Q10), diabetes mellitus or CVD risk (Q15, Q13) and fat intake (Q2). A marked decline for accurate responses was observed for other questions with the least being proportions of participants with accurate responses for question 8 (smoking and CVD risk). This distribution was statistically significant (see
Knowledge of cardiovascular event prevention: Distribution of accuracy of responses from most accurate to least accurate.
For the distribution of personal health-related lifestyle practices, almost all of the participants (173/174, 99%) had optimal or near-optimal lifestyle practice for item L8 (smoking). Similar proportions, 96% and 92% were seen for items L1 (diet) and L9 (sleep duration), respectively. A progressive decline of proportions of participants with optimal lifestyle practices was seen for majority of the other items with the least being item L14 (having a personal doctor), 16% (28/174). This distribution was statistically significant (see
Distribution of personal lifestyle practices of study participants, from most optimal to least optimal.
Concerning frequency of patient CVD counselling practice, most of the participants (113/174, 65%) always or usually counselled their patients on nutrition, while the proportions of those who always or usually counselled their patients on smoking, alcohol abuse, weight management, diabetes and hypertension screening ranged from 2% to 6% with the least being counselling for exercise, 0.6% (1/174). This distribution was also statistically significant (see
Distribution of participants by frequency of counselling practice in various health domains.
A negative correlation was observed between patient CVD counselling practice and physician personal lifestyle scores,
Pearson’s correlation between total counselling score and total lifestyle score.
Imputation number | Total CVD counselling practice score |
Total physician personal lifestyle score |
||
---|---|---|---|---|
Pearson correlation | Sig. (two-tailed) | Pearson correlation | Sig. (two-tailed) | |
Total CVD counselling practice score | 1.00 | - | −0.31 |
< 0.01 |
Total physician personal lifestyle score | −0.31 |
< 0.01 | 1.00 | - |
CVD, cardiovascular disease; Sig., significance.
, Significance level α = 0.05.
Also, most of the participants (11/19, 58%) who practised or trained in a rural setting had an adequate frequency of CVD counselling practice, while those in urban settings had the least proportion (9/60, 15%) of participants with an adequate frequency of CVD counselling practice (see
Association between cardiovascular disease counselling practice and type of community served by the participants
Community type served | CVD counselling practice |
Total | ||||
---|---|---|---|---|---|---|
Adequate |
Inadequate |
|||||
% | % | |||||
Urban | 9 | 15.0 | 51 | 85.0 | 60 | 0.001 |
Rural | 11 | 57.9 | 8 | 42.1 | 19 | |
Semiurban | 4 | 16.7 | 20 | 83.1 | 24 | |
Both urban and rural | 7 | 18.9 | 30 | 81.1 | 37 | |
Original data: Listwise,
Adequate, always or usually; inadequate, rarely or never.
CVD, cardiovascular disease.
,
These distributions were statistically significant. Other baseline characteristics of the participants did not show statistically significant associations with CVD counselling practice. There was no difference in the distribution of counselling practice scores between the trainees and the specialists as most of the trainees (66/84, 78.6%) and specialists (70/90, 77.8%) had poor counselling scores (χ2 = 0.02, df = 1,
Association between sub-Saharan Africa region and cardiovascular disease counselling practice scores.
SSA region | CVD counselling practice scores |
Total | ||||
---|---|---|---|---|---|---|
Adequate |
Inadequate |
|||||
% | % | |||||
West Africa | 8 | 9.2 | 79 | 90.8 | 87 | < 0.01 |
East Africa | 7 | 33.3 | 14 | 66.7 | 21 | |
Southern Africa | 15 | 50.0 | 15 | 50.0 | 30 | |
Central Africa | 1 | - | 1 | - | 2 | |
Original data: Listwise,
Adequate, always or usually; inadequate, rarely or never.
CVD, cardiovascular disease; SSA, sub-Saharan Africa.
,
Logistic regression between grouped cardiovascular disease counselling practice, physician lifestyle, region and type of community type served by the participants.
Predictors | SE | Wald | df | Sig. |
Exp. ( |
95% CI for exp. ( |
||
---|---|---|---|---|---|---|---|---|
Lower | Upper | |||||||
Region | 1.08 | 0.27 | 16.77 | 1 | < 0.01 | 2.96 | 1.76 | 4.97 |
Community type served | −0.04 | 0.19 | 0.03 | 1 | 0.85 | −0.97 | 0.66 | 1.41 |
Total personal lifestyle score | −0.19 | 0.05 | 12.7 | 1 | < 0.01 | −0.83 | 0.74 | 0.92 |
Original data: Listwise,
, Significance level
In assessing knowledge of CVD prevention among FPs and FM trainees in SSA, we found that overall most of the participants had accurate responses for the CVD prevention knowledge items. This is similar to findings from the National Study of Physician Awareness and Adherence to Cardiovascular Disease Prevention Guidelines in the United States, which showed a significant level of PCP awareness (90%) on CVD prevention guidelines.
On the whole, the assessment of personal health-related lifestyle practices revealed that most of the participants had optimal or near-optimal lifestyle practices for the
Concerning CVD counselling, most of the participants (65%) always or usually counselled their patients on nutrition. The proportions of those who always or usually counselled their patients on smoking, alcohol abuse, weight management, diabetes and hypertension screening ranged from 2% to 6% with the least being counselled for exercise, 0.6%. This may be linked to the low proportion of participants with optimal exercise frequency. An audit on the AUSDRISK (Australian type 2 diabetes risk assessment tool) usage by GPs found that lifestyle counselling only occurred in 1.2% of general practice encounters in 2009.
Current evidence shows a positive relationship between physician lifestyle practice and counselling practice rates and is in contrast with our findings, which revealed more frequent counselling practices among those with poorer lifestyle habits.
Having explored factors associated with CVD counselling practice rates, we observed that only
As an equal proportion of responses could not be obtained from each sub-Saharan region, the results would have to be interpreted with caution. This lack of equivalent responses could be attributed to a disproportion in the number of FPs and FM trainees across the continent as well as the recruitment communication from the various regional organisations. This study did not account for non-English-speaking FPs and FM trainees and FPs and FM trainees without Internet access, therefore we may have missed out on a significant population of FPs and FM trainees. Also, while we assessed for frequency of counselling practice, we could not assess the quality of the counselling practice. In addition, we did not account for differences between public and private sector physician
Despite the drawbacks, this was, however, a multi-centre study with participants from various countries across the sub-Saharan region, thus lending to its external validity. Also, the responses of the participants were statistically significant even though the number of participants did not meet the target sample size. Finally, the use of a self-report instrument could introduce response bias; therefore, results would have to be interpreted with this in mind.
Although general awareness about CVD prevention was high, continuous medical education may be necessary to promote the knowledge regarding prioritisation of care according to a 10-year CVD risk. This, alongside regular audit of CVD guideline utilisation, and a brief behavioural change counselling training programme for PCPs in all the regions, may help improve lifestyle counselling rates. Even though positive physician lifestyle practices are a necessary part of promoting patient counselling rates, promoting a healthy self-awareness for lifestyle change among those with poor lifestyle practices may still increase the quality and rates of patient counselling for CVD prevention.
In assessing knowledge of CVD prevention among FPs and FM trainees in SSA, we found that most of the participants had accurate responses for the CVD prevention knowledge items. However, the awareness appears to be partial because fewer participants were aware of recommendations on prioritisation of care according to a 10-year CVD risk. The majority of the participants had optimal lifestyle practices and most of the participants always or usually counselled their patients on nutrition but were less likely to screen or counsel patients on smoking, alcohol abuse, weight management, diabetes hypertension and exercise. Region of practice or training and physician personal lifestyle score were predictive of CVD patient counselling practice.
The authors would like to thank all the family physicians and family medicine trainees for participating in this study.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
P.O.A. was the lead author, conceived the study, drafted the initial manuscript and contributed to the study design. K.Y. revised the manuscript for intellectual content, contributed to the study design and acquired, analysed and interpreted the data. M.M. contributed to the study design, contributed to the initial draft and revised the manuscript for intellectual content. O.P. contributed to the study design, contributed to the initial draft and revised the manuscript for intellectual content. G.M. contributed to the study design, contributed to the initial draft and revised the manuscript for intellectual content. K.B.v.P. contributed to data acquisition and revised the manuscript critically for intellectual content. All authors gave final approval for the version to be published and agreed to be accountable for all aspects of the study.
Statistical information for
Questionnaire item |
|||
---|---|---|---|
Q1 | 132.8 | 4 | 0.01 |
Q2 | 58.0 | 1 | 0.01 |
Q3 | 64.7 | 1 | 0.01 |
Q4 | 17.2 | 4 | 0.01 |
Q5 | 315.2 | 3 | 0.01 |
Q6 | 91.7 | 1 | 0.01 |
Q7 | 78.3 | 3 | 0.01 |
Q8 | 95.2 | 4 | 0.01 |
Q9 | 61.8 | 1 | 0.01 |
Q10 | 59.9 | 1 | 0.01 |
Q11 | 40.4 | 1 | 0.01 |
Q12 | 48.7 | 4 | 0.01 |
Q13 | 323.3 | 4 | 0.01 |
Q14 | 96.4 | 4 | 0.01 |
Q15 | 345.8 | 4 | 0.01 |
Q16 | 21.3 | 4 | 0.01 |
α = 0.05.
Q6 – obesity; Q7 – alcohol intake; Q8 – smoking and CVD risk; Q9–Q12 – hypertension and CVD risk; Q13–Q15 – diabetes mellitus and CVD risk; Q16 – antiplatelet medication use.
df, degree of freedom.
, Test statistic: χ2 goodness-of-fit test.
, Q1 – prioritisation of care; Q2 – fat intake; Q3 – salt intake; Q4 – vegetables intake; Q5 – physical activity.
Statistical information for
Questionnaire item | |||
---|---|---|---|
Nutrition | 69.3 | 3 | < 0.01 |
Exercise | 68.1 | 3 | < 0.01 |
Weight Mgt. | 76.2 | 3 | < 0.01 |
Smoking | 83.8 | 4 | < 0.01 |
Alcohol abuse | 40.8 | 3 | < 0.01 |
HTN | 113.8 | 4 | < 0.01 |
Diabetes mellitus | 103.6 | 4 | < 0.01 |
HTN, hypertension; Mgt., management;
, Test statistic:
Statistical information for
Questionnaire item |
|||
---|---|---|---|
L1 | 86.6 | 2 | 0.01 |
L2 | 148.9 | 4 | 0.01 |
L3 | 88.5 | 4 | 0.01 |
L4 | 100.1 | 1 | 0.01 |
L5 | 73.8 | 3 | 0.01 |
L6 | 33.2 | 3 | 0.01 |
L7 | 101.5 | 3 | 0.01 |
L8 | 296.5 | 2 | 0.01 |
L9 | 226.1 | 5 | 0.01 |
L10 | 155.1 | 3 | 0.01 |
L11 | 91.9 | 4 | 0.01 |
L12 | 105.6 | 4 | 0.01 |
L13 | 49.9 | 4 | 0.01 |
L14 | 202 | 2 | 0.01 |
, Test statistic:
, L1 – diet; L2 – exercise frequency; L3 – exercise duration; L4 – salt; L5 – water intake; L6 – coffee; L7 – alcohol; L8 – smoking; L9 – sleep duration; L10 – red meat; L11 – regular check-up; L12 – cholesterol check; L13 – blood glucose check; L14 – have a personal doctor.
Kindly state your age (in years): __________
Kindly indicate your gender: Male [ ] Female [ ]
What best describes your marital status?
Kindly indicate your nationality (drop-down list)
Indicate the country in which you are currently practicing or undergoing your training
What kind of population demographic does your practice/training centre serve?
What is your religion?
What is your average monthly income_______________ (Kindly state the currency as well)
How many hours do you work in a week?_______________ (Kindly state an absolute value in hours)
Which of the following describes your current status:
A Family Medicine Resident/Trainee [ ] A Family Physician (i.e. completed the PG training/Residency training in family medicine) [ ]
For how long have you been in the training programme?
Indicate number if in years_________________ If in months, indicate number here ____________________
If you are a Family Physician, how many years has it been post-qualification ________________?
Please indicate (i.e. tick against each option), if any of the following are readily available in your consulting room or within 10 m from your consulting room:
Blood pressure measurement [ ], Weighing scale and tape [ ], Glucometer [ ],
Blood cholesterol measurement or a point for sample collection [ ],
Urine glucose measurement (dipstick) [ ], Urine albumin measurement (albustix) [ ]
Could you indicate (i.e. tick against an option), some barriers you face in screening for cardiovascular disease in your practice?
Lack of Time [ ], Ineffective training [ ], No compensation [ ], Language barrier [ ]
Lack of screening equipments [ ], Facilities available but process of screening is stressful [ ],
The screening tests are expensive [ ], Other (please indicate…………………………………)
From the list of health conditions provided below, kindly tick those you currently suffer from:
Hypertension [ ], Diabetes [ ], Dyslipidaemia [ ], Obesity [ ]
Is any of members of your family suffering from at least one of the diseases listed in Q15 above?
Yes [ ] No [ ]
Have you suffered from any of the following diseases?
Cerebrovascular disease (Stroke)
Yes [ ] No [ ]
Coronary heart disease (Angina, MI, etc.)
Yes [ ] No [ ]
Pulmonary embolism/Deep venous thrombosis
Yes [ ] No [ ]
Peripheral arterial disease
Yes [ ] No [ ]
Have any of your family members suffered from any of the diseases listed in Q17? Yes [ ] No [ ]
How often do you eat salad/raw vegetables/fresh fruits?
≥ once a day ≥ once a week (but less than once every day) ≥ once a month (but less than once every week) Rarely/Never
How often do you exercise?
>5 days in a week 4–5 days in a week 2–3 days in a week 1 day in a week Not at all
What is your total exercise duration in a day (in minutes)?
>40 [ ] 30–40 [ ] 20–30 [ ] 10–20 [ ] <10 [ ]
Do you add raw salt to your meals? Yes [ ] No [ ]
How would you estimate your daily drinking water intake to be?
<500 mL [ ] 500–1000 mL [ ] 1000–1500 mL [ ] >1500 mL [ ]
How often do you take coffee/black tea?
≥ once a day ≥ once a week (but less than once every day) ≥ once a month (but less than once every week) Rarely/Never
How often do you drink alcohol?
≥ once a day ≥ once a week (but less than once every day) ≥ once a month (but less than once every week) Rarely/Never
Concerning the use of cigarettes, which best describes you?
I currently smoke I used to smoke I have never smoked
For how long do you sleep each day (hours)
<6 [ ] 6 [ ] 7 [ ] 8 [ ] >8 [ ]
In a typical week, how often do you eat red meat?
≥3 times a day Once a day Once in 2–3 days Rarely/Never
How often do you undergo a physical check-up?
<1 year 1 to <2 years 2 to <3 years 3 to <4 years 4 to <5 years ≥5 years Never
How often do you take your Cholesterol measurement?
<1 year 1 to <2 years 2 to <3 years 3 to <4 years 4 to <5 years ≥5 years Never
How often do you take a diabetes screening test?
<1 year 1 to <2 years 2 to <3 years 3 to <4 years 4 to <5 years ≥5 years Never
Do you have a Personal doctor? Yes/No
According to WHO/ISH guidelines, when resources are limited, individual counselling and provision of care may have to be prioritised according to a__________ risk of cardiovascular event.
5 years 10 years 15 years 20 years I do not know
Total fat intake should be reduced to about 30% of calories, saturated fat to less than 10% of calories and most dietary fat should be polyunsaturated or monounsaturated (10% – 15% of calories).
All individuals should be strongly encouraged to reduce daily salt intake by at least one third and if possible, to <5 g per day.
The recommended daily allowance of fruits and vegetables for all individuals is _____?
200 g 300 g 400 g 500 g 600 g
The recommended duration of moderate physical activity that all individuals are encouraged to take per day is ____?
At least 30 min At least 40 min At least 50 min At least 1 h
All individuals who are overweight or obese should be encouraged to lose weight through:
A combination of increased-energy diet and increased physical activity A combination of a reduced-energy diet and increased physical activity A reduced-energy diet alone Increased physical activity alone A combination of reduced-energy diet and reduced physical activity
A male bank executive on follow-up at your clinic for hypertension reports that he consumes alcohol. At what level of his consumption would you advise him to reduce alcohol intake?
More than 2 units of alcohol per day More than 3 units of alcohol per day More than 4 units of alcohol per day More than 5 units of alcohol per day
For smokers with a 10-year CVD risk of 20% – 30%, which will you consider the most appropriate, from the treatment options below:
Nicotine replacement therapy only Nortriptyline only Amfebutamone and Nortriptyline only Nicotine replacement, Nortriptiline or Amfebutamone I do not know.
All individuals with blood pressure at or above 160/100 mmHg, or lesser degree of raised blood pressure with target organ damage, should have drug treatment and specific lifestyle advice to lower their blood pressure and risk of cardiovascular disease.
Strongly agree Agree Unsure Disagree Strongly disagree
All individuals with blood pressure below 160/100 mmHg, or with no target organ damage need to be managed
According to the neurovascular risk According to a 10-year cardiovascular risk According to the renovascular risk According to the endocrine risk According to a case-by-case basis
For a 10-year risk of CVD event ≥30% in individuals with persistent blood pressure ≥130/80 mmHg; a low-dose thiazide-like diuretic, ACE inhibitor or calcium channel blocker is recommended as first-line therapy. True/False
For a 10-year CVD risk of ≥30% in individuals with persistent blood pressure ≥130/80 mmHg, tick the recommended first-line therapy from the options provided below:
a. Low-dose thiazide-like diuretic
[ ]
b. An ACE Inhibitor
[ ]
c. Calcium channel blocker
[ ]
d. All of the above
[ ]
e. None of the above
[ ]
Mr Abu is a 67-year old pensioner who is hypertensive and a diabetic. He presented with a result showing a total cholesterol of 12 mmol/L (464 mg/dL). What single best option below will you consider:
He should be counselled to follow a lipid-lowering diet only A prescription for statins to lower the risk of cardiovascular disease is preferable Lipid-lowering diet and statins should be included in the treatment option for Mr Abu The results provided above does not need a special diet or statins Focus should be on glycaemic and blood pressure control only
Concerning Mr Abu above, the treatment choice should be based on an estimated cardiovascular risk. This is______
Always true Sometimes true Not applicable for Africa Never true I do not know
Individuals with persistent fasting blood glucose >6 mmol/L despite diet control should be given
Metformin Glibenclamide Pioglitazone Arcabose I do not know
At what level of cardiovascular risk should low-dose Aspirin be prescribed?
<10% 10% – 20% 20% – 30% ³30% I do not know
How often do you counsel your patients on nutrition?
Always Usually Sometimes Rarely Never
How often do you counsel your patients about regular exercise?
Always Usually Sometimes Rarely Never
How often do you counsel your patients on weight management?
Always Usually Sometimes Rarely Never
How often do you provide counselling for patients who need to quit smoking?
Always Usually Sometimes Rarely Never
How often do you provide counselling for patients who abuse alcohol?
Always Usually Sometimes Rarely Never
How often do you counsel your patients on screening for high blood pressure?
Always Usually Sometimes Rarely Never
How often do you counsel your patients on cholesterol screening and management?
Always Usually Sometimes Rarely Never
How often do you counsel your patients on screening for diabetes?
Always Usually Sometimes Rarely Never
_____________________________________________________________________________________
Dear Sir/Madam,
I am a family physician with AfriWon which stands for the African Organization for Young and Future General Practitioners (GPs)/Family Physicians (FPs) under the aegis of the African Region of World Organization of Family Doctors (WONCA Africa).
I intend to find out about your knowledge, personal practices and counselling practices as regards lifestyle and cardiovascular disease.
You will be asked to provide information on your demographics, some health-related lifestyle habits, some personal preventive measures, your awareness of primary CVD prevention method and your CVD counselling practice. There are 56 questions in total. We estimate you may need up to 30 min or slightly more to complete the survey. Please try and answer all the questions if you can.
The results of this project will be reported in a reputable journal and may be presented in a WONCA- or WONCA-affiliated conference.
Your participation is entirely of your own free will and you can withdraw from this study at any time you like without explanation. You have the right to refuse to answer any question you do not want to respond to.
Any information collected will remain confidential. Your name will not be attached to any published results. Only I and the coauthors will have access to the data.
Whether you join or refuse to join will have no effect on your employment status/grade level/salary level/rights and privileges in your training institution or academic college.
Thank You.
I have read the foregoing information and I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. I consent voluntarily to join as a participant in this study.
Name of participant:
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