Corresponding author: Elena Raevschi, Department of Social Medicine and Health Management, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Email:
Cardiovascular disease as the most common cause of death is considered the main global public health challenge of the 21st century.[
The promotion of responsible health behaviours constitutes a major effort of health care policies in Europe and the United States.[
The aim of the study was to assess the cardiovascular health from a forward-looking perspective on health responsibility in order to improve attitudes approaches.
The present study is a cross-sectional community survey conducted in the Republic of Moldova. The purpose of the study was to estimate the relationship between the cardiovascular health status (CVH) and the attitudes towards responsibility for health in adult population.
The sample size of 2,612 adult respondents was determined according to the requirements for a descriptive observational study, considering the nonresponse rate of 20%. The random sampling was performed in order to identify the districts to be included in the study from overall country. The participants were selected from identified districts within the Primary Care Units through convenience sampling by including the persons who visited the physicians during the study period, and agreed to participate.
The inclusion criteria were as follow: age 18+ years and residence in the Republic of Moldova.
The exclusion criteria included pregnancy, acute disease, and verbally not agreeing to participate.
Each participant signed an informed consent form before being entered into the study. The study was approved by the Research Ethics Committee of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova (No. 32/38/07.04.2015).
A validated questionnaire was used to collect data and filled up by the participating physicians. Socio-demographics characteristics (age, sex, education level, and occupation) were recorded. We used structured interviews and direct measurements of systolic and diastolic blood pressure, body mass index, total serum cholesterol, and fasting serum glucose.
The cardiovascular health was measured using cardiovascular health metrics categories (ideal, intermediate, and poor) according to the definition of the American Heart Association.[
As shown in
Methodology of cardiovascular health scoring based on defined categories
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Health behaviour subscale | |||
1. Smoking | Ideal | Never or quit >12 months | 1 |
Intermediate | Former ≤12 months | 1 | |
Poor | Current | 0 | |
2. Physical activity | Ideal | ≥150 minutes/week moderate or ≥75 min/week vigorous or ≥150 minutes/week moderate and vigorous | 1 |
Intermediate | 5-149 minutes/week moderate or 5-74 minutes/week vigorous | 0 | |
Poor | <5 minutes/week moderate | 0 | |
3. Healthy diet | Ideal | 4-5 components | 1 |
Intermediate | 2-3 components | 1 | |
Poor | 0-1 components | 0 | |
Health conditions subscale | |||
4. Body mass index, kg/m2 | Ideal | <25 | 1 |
Intermediate | 25-29 | 0 | |
Poor | ≥30 | 0 | |
5. Blood pressure, mmHg | Ideal | <120 /<80 | 1 |
Intermediate | SBP = 120-139 or DBP = 80-89 | 0 | |
Poor | SBP ≥140 or DBP ≥90 | 0 | |
6. Total serum cholesterol, mol/L | Ideal | <5.0 | 1 |
Intermediate | 5.0-6.19 | 0 | |
Poor | ≥6.2 | 0 | |
7. Fasting serum glucose, mmol/L | Ideal | <5.6 | 1 |
Intermediate | 5.6-6.09 | 0 | |
Poor | ≥6.1 | 0 |
SPB: systolic blood pressure; DBP: diastolic blood pressure
Responsibility for health was measured through the single choice item: “Who in your opinion is responsible for maintaining and improving your health?” Five response categories were given: (1) “Public authorities”, (2) “Health professionals”, (3) “Family”, (4) “Yourself” and (5) “Not sure”
We grouped the response categories into recoded variables as follows:
(1) to (3) – Social health responsibility attitudes approaches;
(4) – Personal health responsibility attitudes approaches;
(5) – Undecided.
Data were expressed as median and interquartile range (IQR). Normality checking was analysed by Kolmogorov-Smirnov and Shapiro-Wilk tests. The collected data were analysed by MAC PSPP (version 1.4.1) using independent samples Mann-Whitney U-test and Kruskal-Wallis test with pairwise comparisons at the significance level of 0.05.
Socio-demographic characteristics of study participants are shown in
The median (IQR) of total CVH scores and its subscales are shown in
The distribution of cardiovascular health and its subscales scores by socio-demographic variables taken into the study are reported in
As shown in
The respondents with social and undecided health responsibility attitudes approach achieved lower scores of cardiovascular health and its subscales.
Baseline characteristics
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Age groups, years | |
18-65 | 1955 (74.8%) |
>65 | 657 (25.2%) |
Sex | |
Male | 910 (34.8%) |
Female | 1702 (65.2%) |
Education level | |
Middle school | 821 (31.4%) |
High school | 1232 (47.2%) |
University | 559 (21.4%) |
Occupation | |
Cadre | 680 (26.0%) |
Worker | 654 (25.1%) |
Farmer | 180 (6.9%) |
Retired | 1025 (39.2%) |
Non response | 73 (2.8%) |
Cardiovascular disease diagnosed | |
Yes | 1539 (58.9%) |
No | 1073 (41.1%) |
Scores of cardiovascular health and its subscales of study participants
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Total CVH | 0 | 7 | 4.0 | 3.0 | 5.0 |
Health behaviours | 0 | 3 | 3.0 | 2.0 | 3.0 |
Health conditions | 0 | 4 | 2.0 | 1.0 | 2.0 |
CVH: cardiovascular health
Results of single factor analyses for cardiovascular health and its subscales scores among the participants
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Age | |||
18-65 | 4.0 (3-5) | 3.0 (2-3) | 2.0 (1-2) |
>65 | 4.0 (3-5) | 2.0 (2-3) | 1.0 (1-2) |
U † | −5.16 | −4.63 | −3.65 |
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<0.001 | <0.001 | <0.001 |
Sex | |||
Male | 4.0 (3-4) | 2.0 (2-3) | 1.0 (1-2) |
Female | 4.0 (3-5) | 3.0 (2-3) | 2.0 (1-2) |
U † | 8.921 | 12.906 | 2.113 |
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<0.001 | <0.001 | 0.035 |
Education level | |||
Middle school | 4.0 (3-5) | 2.0 (2-3) | 1.0 (1-2) |
High school | 4.0 (3-5) | 3.0 (2-3) | 1.0 (1-2) |
University | 4.0 (3-5) | 3.0 (2-3) | 2.0 (1-2) |
H ‡ | 11.254 | 6.388 | 7.709 |
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0.004 | 0.041 | 0.021 |
CVH: cardiovascular health; HB: health behaviours; HC: health conditions; †: independent sample Mann-Whitney U test; ‡: Kruskal-Wallis H test
Cardiovascular health status and attitudes approaches to responsibility for health
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CVH | 4.0 (3.0-4.0) | 4.0 (3.0-5.0) | 9.045 <0.001 | 4.0 (3.0-4.0) | 4.0 (3.0-5.0) | 3.0 (2.0-4.25) | 49.969 <0.001 |
HB | 2.0 (2.0-3.0) | 3.0 (2.0-3.0) | 0.098 0.922 | 2.0 (2.0-3.0) | 3.0 (2.0-3.0) | 2.0 (1.0-3.0) | 71.112 <0.001 |
HC | 1.0 (1.0-2.0) | 2.0 (1.0-2.0) | 12.570 <0.001 | 1.0 (1.0-2.0) | 2.0 (1.0-2.0) | 1.0 (1.0-2.0) | 8.155 0.021 |
CVH: cardiovascular health; HB: health behaviours; HC: health conditions; CVD: cardiovascular disease; †: independent sample Mann-Whitney U test; ‡: Kruskal-Wallis H test
In the present study, we found that meeting a greater score of cardiovascular health metrics and its subscales was related to personal health responsibility attitudes approaches. In addition, those diagnosed with cardiovascular disease appear willing to improve their behaviours when their health condition worsens. Taken together, our results suggest that increasing individual’s motivation for personal responsibility in addressing their own health would imply improvement of the community health. Acceptance of this leads to strengthen the strategies for health promotion focusing more on an individual’s motivation to assume personal responsibility for behaviours affecting their health.
It is evident from our results that male cardiovascular health total score was significantly lower than the female CVH score. These results are in line with well-known data that the cardiovascular mortality is higher for male than female suggesting that along with biological component, the behaviour component is implied in sex differences of cardiovascular disease impact.
In the content in which we are underlining the importance of health responsibility attitude approaches, the theme of this paper integrates into the current concerns of medical scientific research, which shows an increasing interest in the field of individual and community level health promotion based on health responsibility approaches.[6-8,10,11,13-16] There is greater awareness of the person-centred approach significance in order to improve the society health.[
The present study assessed the cardiovascular health measured by the American Health Association definition and health responsibility of individuals, representing a unique attempt of this kind, such approaches being absent in the literature.
A better cardiovascular health status was related to personal health responsibility attitude approaches. The population free of cardiovascular disease is not likely to engage in health behaviours to prevent the onset of the disease, appearing willing to improve their behaviours after acquiring the disease. Further studies are needed to account for efficacy interventions focusing on individual’s motivation to assume personal responsibility for behaviours affecting their health.