Predictors of cardiac self-efficacy among patients diagnosed with coronary artery disease in tertiary hospitals in Nepal

  • Rabina Shrestha | Dhulikhel Hospital Kathmandu University Hospital, Kathmandu, Nepal.
  • Lal Rawal School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia.
  • Rashmita Bajracharya University of Maryland, Baltimore, MD, United States.
  • Anup Ghimire BP Koirala Institute of Health Sciences, Dharan, Nepal.


Background: Cardiac self-efficacy determines how people feel, think, motivate themselves and behave with regards to improving their cardiac health subsequently preventing complications of coronary artery disease (CAD). Given almost one-third of global death is contributed by CAD with 10% of disability adjusted life years lost in low- and middle-income countries (including Nepal), it is important to identify factors that can promote cardiac self-efficacy. There are no studies in Nepal focusing on predictors of self-efficacy. Therefore, we aim to determine the predictors of cardiac self-efficacy of CAD patients in Nepal.
Design and Methods: This is a cross-sectional study where we recruited 170 patients (≥30 years) diagnosed with CAD from two tertiary level hospitals. Multiple linear regression model was used to identify the predictors of cardiac self-efficacy.
Results: The mean age of the participants was 60.45±10.39 years (range, 31-83). Most of the participants were diagnosed as myocardial infarction (91.2%), rest with unstable angina (6.5%) and stable angina (2.4%). The multivariate analysis shows age (p<0.001), health behaviors (p<0.001) and knowledge of the disease (p<0.001) were statistically significant predictors to cardiac self-efficacy. Every 1-year increase in age was associated with 0.23 units increase in cardiac self-efficacy score. Similarly, every unit increase in health behavior score and knowledge of disease score was associated with 0.432 units and 0.475 units increase in cardiac self-efficacy score, respectively.
Conclusion: Age and health behaviors were the strongest predictors of cardiac self-efficacy followed by knowledge of the disease. We conclude that those with poor health behavior are at a greater risk of poorer cardiac self-efficacy compared to those with relatively good level of self-efficacy. Public health interventions such as awareness raising about cardiac disease and health behavior modification along with early screening, diagnosis and appropriate care are essential to improving self-efficacy and cardiac care outcomes.



PlumX Metrics


Download data is not yet available.


WHO. Cardiovascular Diseases 2020. Available from:

American Heart Association. Coronary Artery Disease - Coronary Heart Disease Jul 31, 2015. Available from:

Centers for Disease Control and Prevention (CDC) [Internet]. Heart disease facts. Updated 8/9/2020. Available from:,killing%20365%2C914%20people%20in%202017.&text=About%2018.2%20million%20adults%20age,have%20CAD%20(about%206.7%25).&text=About%202%20in%2010%20deaths,less%20than%2065%20years%20old

Dhungana RR, Pandey AR, Bista B, Joshi S, Devkota S. Prevalence and associated factors of hypertension: A community-based cross-sectional study in municipalities of Kathmandu, Nepal. Int J Hypertens 2016;2016:1656938. DOI:

Rawal LB, Kanda K, Mahumud RA, et al. Prevalence of underweight, overweight and obesity and their associated risk factors in Nepalese adults: Data from a Nationwide Survey, 2016. PLoS One 2018;13:e0205912. DOI:

Dhitali SM, Karkiii A. Dealing with the burden of hypertension in Nepal: current status, challenges and health system issues. Regional Health Forum; 2013.

Dhimal M, Karki KB, Sharma SK, et al. Prevalence of selected chronic non-communicable diseases in Nepal. J Nepal Health Res Counc 2019;17:394-401. DOI:

Gautam R. NCDs in Nepal: Burgeoning Burden amid low priority and the ways forward. Health Prospect: J Public Health 2013;11:4-5.

Bandura A. Self Efficacy. In: Ramachaudran VS, editor. Encyclopedia of Human behavior: New York: Academic Press; 1994. p. 71-81.

Fors A, Ulin K, Cliffordson C, et al. The cardiac self-efficacy scale, a useful tool with potential to evaluate person-centred care. Eur J Cardiovasc Nurs 2014;14:536-43. DOI:

Kang Y, Yang IS, Kim N. Correlates of health behaviors in patients with coronary artery disease. Asian Nurs Res (Korean Soc Nurs Sci) 2010;4:45-55. DOI:

Kang Y, Yang I-S. Cardiac self-efficacy and its predictors in patients with coronary artery diseases. J Clin Nurs 2013;22:2465-73. DOI:

O’Neil A, Berk M, Davis J, Stafford L. Cardiac-self efficacy predicts adverse outcomes in coronary artery disease (CAD) patients. Health 2013;05:6-14. DOI:

Hajar R. Risk factors for coronary artery disease: Historical perspectives. Heart Views 2017;18:109-14. DOI:

Ahn S, Song R, Choi SW. Effects of self-care health behaviors on quality of life mediated by cardiovascular risk factors among individuals with coronary artery disease: A structural equation modeling approach. Asian Nurs Res 2016;10:158-63. DOI:

Song R, Oh H, Ahn S, Moorhead S. Validation of the cardiac health behavior scale for Korean adults with cardiovascular risks or diseases. Appl Nurs Res 2018;39:252-8. DOI:

Kayaniyil S, Ardern CI, Winstanley J, et al. Degree and correlates of cardiac knowledge and awareness among cardiac inpatients. Patient Educ Couns 2009;75:99-107. DOI:

Salari A, Rouhi Balasi L, Moaddab F, et al. Patients’ cardiac self-efficacy after coronary artery angioplasty. Jundishapur J Chronic Dis Care 2016;5:e60308. DOI:

Carroll DL. The importance of self-efficacy expectations in elderly patients recovering from coronary artery bypass surgery. Heart Lung 1995;24:50-9. DOI:

Yehle KS, Plake KS. Self-efficacy and educational interventions in heart failure: a review of the literature. J Cardiovasc Nurs 2010;25:175-88. DOI:

Polsook R, Aungsuroch Y. A cross-sectional study of factors predicting readmission in Thais with coronary artery disease. J Res Nurs 2020. doi: 10.1177/1744987120946792. DOI:

Barham A, Ibraheem R, Zyoud SeH. Cardiac self-efficacy and quality of life in patients with coronary heart disease: a cross-sectional study from Palestine. BMC Cardiovasc Dis 2019;19:290. DOI:

Sarkar U, Ali S, Whooley MA. Self-efficacy and health status in patients with coronary heart disease: findings from the heart and soul study. Psychosom Med 2007;69:306-12. DOI:

Allahverdipour H, Asgharijafarabadi M, Heshmati R, Hashemiparast M. Functional status, anxiety, cardiac self-efficacy, and health beliefs of patients with coronary heart disease. Health Promot Perspect 2013;3:217-29.

Idyan Z, Thato R. Determinants of Preventive behaviors for coronary artery disease among adults in Aceh Province, Indonesia. J Health Res 2017;31:109-17.

Ebraheim MN, Khorais AM. Effect of educational guidelines on cardiac self efficacy, health complaints and anxiety level among patients with coronary artery disease. Egypt J Health Care 2016;7:406-31. DOI:

Original Articles
Cardiac self efficacy, coronary artery disease, knowledge, health behavior
  • Abstract views: 456

  • PDF: 166
  • HTML: 0
How to Cite
Shrestha, R., Rawal, L., Bajracharya, R., & Ghimire, A. (2020). Predictors of cardiac self-efficacy among patients diagnosed with coronary artery disease in tertiary hospitals in Nepal. Journal of Public Health Research, 9(4).