467
JOURNAL OF SCIENCE, Hue University, N
0
61, 2010 ASSESSMENT OF HEALTH EDUCATION OUTCOMES ABOUT
DYSLIPIDEMIA, USING A NETWORK OF COMMUNITY HEALTH
WORKERS IN HUE CITY
Doan Phuoc Thuoc
College of Medicine and Pharmacy, Hue University
Nguyen Thi Kim Tien
Vietnam's Ministry of Health
SUMMARY
Dyslipidemia is very common in the community and is an important risk factor of
atherosclerosis and coronary artery disease with high mortality. A community intervention of
health education is designed to progressively reduce dietary intake of satuprevalenced fats,
cholesterol, total calories and increase physical activities to decrease dyslipidemia. The
intervention was conducted by a network of medical staffs in wards and intergprevalence with
other health programmes. After 12 months of intervention, the prevalence of dyslipidemia
decreased 11.6% (from 39.3% to 27.7%). The prevalence of high serum total cholesterol (TC)
levels reduced from 20.4% to 11.1%, LDL-C levels reduced from 15.7% to 6%, triglicerides
levels did not change. Average values of serum HDL-C levels increased (from 53.6 mg / dL to
63.9 mg / dL) and LDL-C levels reduced (from 119.4 mg / dL to 100.6 mg / dL) (p <0.05);
average values of TC and TG did not change. Dietary and physical activity habits reduced
intake of satuprevalenced fats and alcohol, higher intake of vegetables, and fish. Higher
prevalence of exercise and sports. Excessive intake of alcohol per day reduced from 37.1% to
6.6%. Knowledge of dyslipidemia, dietary and physical activity also improved. There was an
increase in the prevalence of people who came clinic to test blood lipid by themselves (from

2. Methodology
- The subjects of the study were adults aged 20 years or older in Hue city
- Study design: A community intervention of health education is designed to
progressively reduce dietary intake of saturated fats, cholesterol, total calories and
increase physical activities to decrease dyslipidemia; the intervention was conducted for
12 months from 3/2008 to 5/2009 by a network of medical staffs in wards and intergrate
with other health programmes.
- Sample size: 350 adults aged 20 and older, calculated by following
formula
2
)1(2
d
Fpp
n



▪ F = 7,9; d: difference between dyslipidemia prevalence before (pA) and after
(pB) health education; pA : 35.08 % and pB : 25 % (expectantly)
- Sample: Choose two wards of Hue city randomly, randomly select five groups
(administrative units of ward) per ward, and 35 people aged 20 years and older per
group selected according to a list
- Methods of data collection:
+ A community survey to collect data before the community health education on
dyslipidemia 469
+ Implement health education programs based on a network of community
health workers for 12 months

video tapes for households.
Communication in ward health centers, pharmacies, and private clinics
- The concept of research variables
+ Blood lipid disorders classification: 470
Table 2.1. Blood lipid disorders classification: according to NCEP ATPIII 2002
LDL-
C (mg/dL)
<100 Optimal
100-129 Near Optimal
130-159 Borderline high
160-189 High
 190 Very high
CT (mg/dL)
<200 Desirable
200-239 Borderline high
 240 High
HDL-
C (mg/dL)
<40 Low
 60 High
TG (mg/dL)
<150 Desirable
150-199 Borderline high
200-499 High
 500 Very high
Source: Third Report of the National Cholesterol Education Program, 2002
+ Physical activity level


Before health education
(n= 350)
After health
education
(n= 350)
P
(Chi-
square)
Lifestyle habits % %
Eating
High fat diet 35.6 16.6 <0.05
Much vegetables, fish 43.5 69.7 <0.05
Sweet and starch 9.7 7.4 >0.05
Undefined 11.1 6.3 <0.05
Physical activity
No exercise 58.8 19.1 <0.05
Walk 33.3 71.1 <0.05
Badminton 6.9 5.4 >0.05
Running 0.5 2.8 <0.05
Others 0.5 1.5 <0.05 472
Level of physical
activity/day

Sedentary 26.9 2.9 <0.05
Low active 14.4 25.7 <0.05
Active 14.8 26.9 <0.05


Good 14.4 44.3 <0.05
Average 8.8 7.7 >0.05
Bad 76.8 48.0 <0.05
Preventive and
473
treatment
Good 14.8 54.6 <0.05
Average 40.3 11.4 <0.05
Bad 44.9 34.0 <0.05
Good level of knowledge on the causes, prevention, treatment and consequences
of dyslipidemia increased and bad level reduced after health education on lipids.
3.3. Comparing prevalences of testing and treatment of dyslipidemia on
sample before and after education
Table 3.3. The prevalence of testing and treatment of dyslipidemia before and after education
Testing and treatment
Before health
education (n= 350)
After health
Education (n=
350)
P
(Chi-
square)
% %
No testing, undefine 84.7 70.9 <0.05
Test 15.3 29.1 <0.05

(n= 350)
P
(Chi-square)IE
% % (%)
Desirable 60.7 72.3 <0.05
Dyslipidemia 39.3 27.7 <0.05 29.5
Including
- Simple dyslipidemia 17.6 20.5 >0.05
High blood TC 3.2 6.0 >0.05
High blood LDL-C 1.4 1.1 >0.05 21.4
High blood TG 3.7 9.7 <0.05
Low blood HDL-C 9.3 3.7 <0.05 60.2
- Complex dyslipidemia 21.7 7.1 <0.05 67.3
Two components 13.4 5.1 <0.05 61.9
More than two components 8.3 2.0 <0.05 75.9
After education, the prevalence of dyslipidemia reduced from 39.3% to 27.7%;
Intervention Effectiveness (IE) is 29.5%), including low blood HDL-C level decreased
from 9.3% to 3.7%, (60.2% IE), high blood LDL-C level decreased from 1.4% to 1.1%
(21.4% IE). High blood TG level increased. Comlex dyslipidemia (2.3 or 4 components)
decreased from 21.7% to 7.1% (67.3% IE).
Table 3.5. Dyslipidemia classification by levels of blood lipid components
Components
of lipide
Classification
Before health
education
(n= 350)


Before health education
(n= 350)
%
After health
Education
(n= 350)
%
P
(F test)
Mean
(mg/dL)
SD
(mg/dL)
M
(mg/dL)
SD
(mg/dL)

TC 196.9 50.3 191.4 43.3 >0.05
TG 129.3 86.5 136.8 75.2 >0.05
HDL-C 53.7 17.1 63.9 17.3 <0.05
LDL-C 119.4 48.2 100.6 45.4 <0.05
The mean of blood HDL-C levels increased (from 53.6 mg/dL to 63.9 mg/dL)
and blood LDL-C levels reduced (from 119.4 mg / dL to 100.6 mg / dL) after lipid
education. The mean of blood TC and TG levels did not change after lipid education (p
>0.05). 476

Some studies compared the benefits of physical activity and diet in the treatment
of lipid disorders, some studies have shown lifestyle intervention with moderate diet
combine with regularly physical activity less affect blood lipid levels than the more
powerful lifestyle intervention (diet and physical activity more powerful than), improve
better blood lipid levels and other risk. In concurrence to reducing the prevalence of
lipid disorders, the difference in the mean value of increasing blood HDL-C level and
reduction of LDL-C compared with before the intervention was statistically significant.
This result is the main target in the treatment of lipid disorders, reducing CHD risk 477
factors.
Important factor which reduce the prevalence of dyslipidemia is improvement of
the level of knowledge of lipid such as good knowledge of dyslipidemia, risks, causes,
prvention, and proper treatment increase after intervention;
. Improving the knowledge base to change life habits. The intervention program
in the U.S. has increased prevalences of physical activity among adults in the U.S. from
2001 to 2005. Research results in some developed countries, although intervention
programes impact but still have some barriers affecting knowledge and awareness of
dyslipidemia. Although knowledge of cholesterol in the U.S. has improved in recent
years, the involvement of cholesterol treatment is still low in this case.
The aforementioned study was conducted on seven groups in the UK, and
showed that all participants realize that high cholesterol levels adversely affect health,
but few people know their cholesterol levels, some doctors also do not mention
tcholesterol problems. The study concluded that knowledge about cholesterol and the
risk of CHD is not enough to change behavior.
Lipid education in the city of Hue has changed the perception and behavior for
people, increasing of detection and treatment of dyslipidemia in the community; after
the intervention prevalence of self-lipid testing requirements, understand results of tests
and proper treatment increase. It's necessary to maintain and promote behavioral change

Community health education on dyslipidemia based on a network of medical
staff in wards improved the level of knowledge and behavior change surrounding the
prevention and treatment of dyslipidemia, and effectively reduced the dyslipidemia
prevalence in the community.
REFERENCES
1. American Heart Association, "Myfats translator- A calculator that translates our fat
recommendations into daily limits just for you", published by Clarkson
Potter/Publishers, (2002).
2. Tạ Văn Bình, Nguyễn Thanh Hà, Nghiên cứu ảnh hưởng của thói quen ăn uống và chế
độ ăn đối với bệnh đái tháo đường , Some scientific research project typical of the
national projects, implementation of Endocrinology Hospital in 1969-2003, the Medical
Publishing, Hanoi (2004), 249-259.
3. Hatzitolios AI., Athyros V.G., Karaziannis A., C.Savopoulos, C.Charalambous, G.
Kyriakidis, Th. Milidis, C. Papathanakis, A. Bitli, I. Vogiatsis, G. Ntaios, N. Katsiki, A.
Symeonidis, K. Tziomalos, D.P. Mikhailidis and Collaborative group, Implementation
of stprevalencegy for the management of overt dyslipidemia: The improve-dyslipidemia
study, ScienceDirect-International Journal of Cardiology, (2009).
4. Lyne Lalonde, Katherine Gray-Donald, Ilka Lowensteyn and collaborators, Comparing
the benefits of diet and exercise in the treatment of dyslipidemia, Preventive Medicine
35, (2002), 16-24.
5. National Center for Chronic Disease Prevention and Health Promotion, , Physical
activity and good nutrition: Essential elements to .prevent chronic diseases and obesity,
CDC (Centers for Disease Control and Prevention), At A. Glance, (2008).
6. National Cholesterol Education Program (NCEP), Third Report of the National
Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and
treatment of High Blood Cholesterol in Adults (Adult Treatment panel III), final report,
NIH (National Institutes of Health) No 02-, (2002), 5215 479