Tools for Data Collection

This section provides a detailed discussion of the research tools used in this study, including a demographic data sheet, a medical-record data sheet, a CSEQ, a body- worn activity monitor, and a daily diary for chest pain.

Sociodemographic Data Sheet

A sociodemographic data sheet is a single form designed by the researcher for this study (Appendix D). The recruited patients completed the document in order to obtain demographic information about their age, gender, marital status, educational level and employment status. These data helped the researcher to identify the participants’ characteristics. The researcher assessed the homogeneity of the sample in each group in the demographic variables. In addition, the research compared the difference of the sociodemographic data between the participants of the study and the patients with AMI who refused to participate in the study. The researcher collected this data once at baseline time only.

Medical-Record Data

The researcher recorded medical data, such as the patients’ diagnosis date and type of treatment, for example PCI, PPCI, and medical therapy from the patients’ files. The researcher upon arrival at the OPD obtained the patients’ BMI. The researcher calculated BMI manually. BMI = weight (kg) / [height (m)]2. The researcher calculates the BMI through dividing the individual’s weight in kilograms by the square of their height in metres. BMI is simple to obtain and has been shown to be a reliable tool for assessing overweight compared to other measurements (CDC, 2015 ). The researcher used the weight and height scales available in the outpatients’ cardiac clinic.

The Cardiac Self-Efficacy Questionnaire

Self-efficacy levels were measured by using a validated and reliable self-reporting CSEQ with Cronbach’s alpha scores of 0.90 for control symptoms and 0.87 for maintenance function themes (Sullivan et al., 1998). CSEQ is used widely in the

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literature for assessing self-efficacy patients with cardiac disease (Allahverdipour, Asgharijafarabadi, Heshmati, & Hashemiparast, 2013; Fors et al., 2015; O’Neil et al., 2013; Sarkar et al., 2009; Sol et al., 2011). In addition, CSEQ is a disease-specific self-efficacy questionnaire that can provide accurate information regarding patients with AMI ability when they have to accomplish disease-specific situations.

After obtaining permission from the Author (Appendix B), the researcher translated the self-efficacy questionnaire from the original English version into Arabic, in order to make it conceptually equivalent for the targeted sample. Before using the translated CSEQ, evaluation of reliability and validity tests showed that, the Arabic version of CSEQ is valid and reliable with Cronbach’s alpha scores of 0.85, (see section 3.6.5).

Daily Diary for Chest Pain

According to Bandura, physiological and affective states are one of the four sources of self-efficacy, as individuals usually rely on their somatic and emotional condition when judging their capabilities. The researcher interpreted patients experiencing symptoms such as chest pain as a sign of susceptibility to lower performance ability. Hence, the researcher developed and used a daily diary for chest pain, which made note of factors such as the duration of chest pain, frequency and intensity at Time 1 and Time 2, as a tool to measure physiological and affective states (Appendix E). The researcher asked all participants to complete this daily dairy, and in the event that they did not feel pain, to return the daily diary with a blank entry. The participants completed the daily diary for chest pain if they felt chest pain. They described the pain, such as the pain for 2 minutes, once per day and 2/10 intensity. In order to link these data with changes in PA of participants, the daily diary for chest pain was returned along with the activPAL3™ monitor and CSEQ.

Using the activPAL3™

The activPAL3™ monitor (PAL Technologies.Ltd. Glasgow. Scotland) is a single thigh-mounted accelerometer-based device, as shown in Figure 4.2. The activPAL3™ monitor measures bodily acceleration using a triaxial accelerometer, it also incorporates an integrated microprocessor, which performs data reduction and

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manages data storage. The activPAL3™ monitor is worn at the midpoint of the anterior aspect of the thigh; it is lightweight (15 g) and small (53×35×7 mm). The activPAL3™ monitor is attached to the skin using a PALstickie™. These are self- adhesive patented dual layer hydrogels that are recommended for the attachment of the activPAL3™ monitor. Participants also use an additional waterproof bag to cover the adhesive pad in the case of exposure to water. The activPAL3™ data outcome presents the data in different colours, such as red for walking, green for standing and yellow for sitting/lying positions across the measurement days and hours (Figure 4.3 and Figure 4.4).

Figure 4.2 activPAL3™ body-worn activity monitor downloaded from (Clarke-Moloney et al., 2007, p. 489)

When the monitor was first put on by the researcher, all participants were given written and verbal instructions about the fact that the monitor had to be removed temporarily during periods of showering, bathing, or swimming. In normal circumstances, the activPAL3™ monitor is small and very light and does not interfere with normal activity or work. However, occasionally a participant was uncomfortable

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or unhappy wearing the monitor. If this occurred, the researcher advised the participant to take off the monitor for a short period. The participant also had the option to take the device off and end data collection.

The activPAL3™ monitors were used to measure PA in this study. Each participant was provided with an activPAL3™ monitor and a detailed demonstration of how to wear and remove the device (Appendix F). Participants were instructed to attach the activPAL3™ monitor for a full seven days at two time points, two weeks and six weeks after hospital discharge, for 24 hours per day (including when sleeping), and only to remove the device before swimming or doing any other water-based activities. The activPAL3™ monitor instructions and guidelines were given to the participants when attaching the activPAL3™ monitor in the outpatient clinic at two weeks and six weeks.

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Figure 4.4 Example of downloaded activPAL3™ monitor data (daily)

Charging and Programming the activPAL3™

The activPAL3™ is able to record data for up to 14 consecutive days, powered by an internal rechargeable battery. A docking station recharges the device through connecting a docking cable from the docking station to a USB port on a computer. Then the activPAL3™ device is placed in the docking station, which has slots for programming, data transfer, and charging. Complete charging takes around 3 hours. An orange light on the device shows when the battery is charging and switches off to indicate that the device is fully charged.

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Prior to use on a participant, a fully charged activPAL3™ is programmed to start recording new data. Programming the device requires the use of the activPAL3™ software application. The researcher downloaded the activPAL3™ software application from the activPAL3™ company website and installed it on a personal computer. After installing the software, the programming of the device occurs through connecting the device to the computer via a USB port using the station docking cable. The researcher starts the activPAL3™ software application, selects “Communicate with activPAL3™” from the “File” menu, and presses the “reprogram and clear memory” button. After the clearing the memory, the reprogrammed device starts recording immediately. A series of rapid flashes indicates that the device is programmed and ready for use. The researcher could use the activPAL3™ software application to program the device in order to start recording later, according to the planned start date and time. Throughout the duration of the device’s recording of a participant, a green light flashes every three seconds to indicate that the device is active and recording.

The Placement of the activPAL3™

Once the activPAL3™ monitor is charged and programmed, the device is attached to the patients. The activPAL3™ is placed directly on to a patient’s skin on their mid- thigh. The researcher then secures the monitor in place with a small hypoallergenic adhesive gel patch (hydro gel) “PALstickie™”. The researcher further secured the device through applying a transparent sticky film (Tegaderm) over the top. The activPAL3™ monitor is then worn continuously for the required duration of monitoring. During monitoring, the patient can continue wearing the device while carrying on with normal free-living activities during the day and during periods of sleep overnight. However, the waterproof bag was not used in this study to protect the activPAL3™ monitor. Accordingly, the participants need to remove the monitor during any exposure to water-based activity.

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activPAL3™ Data Download

The device was then inserted into the docking station and connected via the USB cable to the computer on which the activPAL3™ Professional software was installed. From the “File” menu, the researcher selected “Communicate with activPAL3™”, and, once a connection had been established, pressed the “download stored data” button to save the recorded data on to the computer. The data download usually took a few seconds to complete. The saved raw activPAL3™ file for each patient was identified by an anonymous code for further analysis.

The activPAL3™ monitor provides step counts and posture classification. The activPAL3™ monitor output data classifies body posture as sitting/lying, standing and stepping, through determining the inclination of the thigh, whether the wearer’s thigh is horizontal, as in sitting or lying, or vertical, as in standing or walking, as shown in Figure 4.5. In addition, the activPAL3™ monitor provides an assessment of PA in terms of energy expenditure, based on default values of metabolic equivalent. At the end of data collection, the activPAL3™ monitor data can be downloaded, via a connector to a computer, in the form of daily and hourly activity, which is classified as time spent sitting/lying and standing and stepping. Then the data is stored, processed and retrieved by special activPAL3™ application software.

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Figure 4.5 Physical activity behaviour categories (Granat, 2012, p. 1787).