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The Relationship of Perceived Basic Psychological Needs For THE RELATIONSHIP OF PERCEIVED BASIC PSYCHOLOGICAL NEEDS FOR HEALTH BEHAVIORS AND MEDICATION ADHERENCE IN SAUDI ARABIAN PATIENTS WITH CORONARY ARTERY DISEASE A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Abdulaziz Almarwani December 2019 THE RELATIONSHIP OF PERCEIVED BASIC PSYCHOLOGICAL NEEDS FOR HEALTH BEHAVIORS AND MEDICATION ADHERENCE IN SAUDI ARABIAN PATIENTS WITH CORONARY ARTERY DISEASE. Abdulaziz Almarwani Dissertation Approved: Accepted: ___________________________ ___________________________ Advisor Department Chair Dr. Linda Shanks Dr. Marlene Huff ___________________________ ___________________________ Committee Member Interim Dean of the College Dr. Sheau-Huey Chiu Dr. Elizabeth A. Kennedy ___________________________ ___________________________ Committee Member Dean of the Graduate School Dr. Marlene Huff Dr. Marnie Saunders ___________________________ ___________________________ Committee Member Date Dr. Patricia Vermeersch ______________________________ Committee Member Judith A. Juvancic-Heltzel ii ABSTRACT Coronary Artery Disease (CAD) is one of the major causes of morbidity and mortality in Saudi Arabia. Health behaviors contributing to CAD are inactivity, diet, smoking, and medication nonadherence. In Saudi Arabia, these health behaviors were not examined through the lens of the self-determination theory, which emphasizes on patients' perceived psychological needs (PPN) (autonomy, competence, and relatedness). Therefore, this study aimed to explore the levels of PPN for health behaviors and medication adherence as well as assess the relationships among these needs and medication adherence. A cross-sectional descriptive exploratory correlational design was conducted on 121 CAD patients at Madinah Cardiac Center. The majority of study participants were men with an average age of 58 years. The levels of perceived autonomy in physical activity (PA-PA), diet (PA-Diet), and smoking (PA-Smoking), were relatively high with the means ranging from 5.6 to 6.4 out of 7. The level of perceived competence in not smoking (PC-Smoking) was higher (� = 5.8) than both perceived competence in physical activity (PC-PA) (� = 3.9) and perceived competence in diet (PC-Diet) (�= 4.3). Level of perceived relatedness in physical activity was medium with a mean of 4.2. Nearly half of the study participants reported high medication adherence, while 52.9% reported medium medication and low medication adherence. The result of Spearman’s rho and Pearson’s r test showed weak positive correlations between medication adherence and PA-PA, PA- diet, PC-PA, and PC-Diet. Perceived autonomy and perceived competence in health iii behaviors did not explain the variance in the medication adherence using multiple regression. All translated study instruments were reliable with Cronbach’s alpha of 0.86 or higher except for the MGL (4 items), where Cronbach’s alpha was 0.58. This study is the first study to provide information about the levels of PPN as well as the level of medication adherence among Saudi patients with CAD. Despite the limitations, the results of this study provide a starting point for Saudi healthcare policymakers to learn about the relationship among PPN in health behaviors. This study may also serve as the basis for future researchers to study other populations with chronic illnesses. iv ACKNOWLEDGEMENTS There are many people who deserve to be thanked for their support throughout my educational journey. I would like to thank my dissertation advisors Dr. Linda Shanks and Dr. Sheau-Huey Chiu for their immense amount of support and direction throughout the entire process of writing this dissertation. Without their guidance and support, this would not have been possible, and I would not be where I am today. I would also like to express my appreciation to my committee members. Dr. Marlene Huff, Dr. Patricia Vermeersch, and Dr. Judith A. Juvancic-Heltzel for their guidance and support. Also, I would like to thank the nursing faculty at The University of Akron and Kent State University for the valuable education I have received. I would like to thank the Saudi Arabian Cultural Mission (SACM) in Washington D.C and Taibah University for the support and guidance they provided to me during this governmental scholarship. I would like to thank the research department at the Madinah Cardiac Center (MCC) for their immense amount of support and direction throughout the process of data collection. I would like to thank the research office coordinator Ms. Aisha Alharbai and the head of nursing education Ms. Amira Ibrahim for their support. I would also like to thank the nursing research assistant Mr. Fahad Mousa Almarwani for his assistance during the data collection phase A special thanks to my family, my mother Fatemah Al Johani who has been always encouraging me toward the best, my father Mofdy Almarwani, and my wife Dr. v Bayan Almarwani for their endless support and continuous encouragement to strive towards my goal of becoming a successful person. My appreciation also extends to Dr. Gibran Mancus who has been a true brother to me in the USA. Finally, I would like to thank all my friends, colleagues and people who helped me throughout my academic and personal life. ءاﺪا(ھ وﻰﺪي ـــﻟا ــﻟا ﻟﻲﻟاﺎﻐ وو ا ﻟ ـ ﺪ ﻲﺗ ــﻟاﺎﻐ ﺔﯿﻟ وزوﺟ ﺘ ـ ﻲـ ــﻟاﺎﻐ ﺔﯿﻟ او ﻔط ﺎ ﻲﻟ ﻟ ﻦﯿ ﻞﯿﺼﻓو ــﻟاﺎﻐ ﯿﻟ ﻦ) vi DEDICATION I'd like to dedicate this work to King Abdullah bin Abdulaziz Al Saud. ھأيﺪ اﺬھ ا ﻌﻟ ﻞﻤ ا ﻰﻟ ﷲﻋﻚﻤ ﺒﻠﻠﻟ ﺑﻋﻦﺪ ﺰﺪﺒ ﯾﺰﻌ آلﻟا ﻮﻌﺳ د “ ﻤﺣر ﮫ "ﷲ ﮫ ﻤﺣر vii TABLE OF CONTENTS Page LIST OF FIGURES ....................................................................................................... xiv LIST OF TABLES ........................................................................................................... xv CHAPTER I. INTRODUCTION ..........................................................................................................1 Background ..............................................................................................................1 Cardiovascular Disease .....................................................................................1 Coronary artery Disease ....................................................................................2 Coronary Artery Disease in Saudi Arabia ....................................................... 3 Health Behaviors Contributing to Coronary Artery Disease ...........................4 Medication Adherence .....................................................................................5 Health Behaviors and Medication Adherence ................................................7 Self-Determination Theory .................................................................................. 10 Application of Self-determination Theory to Study .........................................12 Significance to Nursing ........................................................................................ 15 Summary ................................................................................................................16 Research Purpose .............................................................................................17 Research Questions ..........................................................................................18 II. LITERATURE REVIEW .............................................................................................19 viii Cardiovascular Diseases .......................................................................................19 Worldwide Cardiovascular Disease ..........................................................19 Cardiovascular Disease in the United States ............................................20 Coronary Artery Disease in the United States ...........................................20 Cardiovascular Disease in Saudi Arabia ...................................................21 Coronary Artery Disease in Saudi Arabia ............................................... 22 Health Behaviors Contributing to Cardiovascular Disease ..................................23 Health Behaviors Contributing to Coronary Artery Disease ....................25 Health Behaviors and Coronary Artery Disease .......................................26 Coronary Artery Disease and Physical Inactivity .....................................26 Coronary Artery Disease and Diet/Obesity ..............................................27 Coronary Artery Disease and Smoking ....................................................29 Medication Adherence ..........................................................................................30 Health Behaviors and Medication Adherence ..........................................31 Physical Activity and Medication Adherence ...........................................32 Diet and Medication Adherence ..............................................................33 Smoking and Medication Adherence .......................................................34 Physical Activity, Diet, Smoking and Medication Adherence ................35 Self Determination Theory ..................................................................................36 Basic Psychological Needs and Behaviors Contributing to Coronary Artery ........................................................................................................38 ix Gaps ......................................................................................................................40
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