Study design
This cross-sectional study was reviewed and approved by the hospital ethics committee (K202410-20). Throughout the entire research process, the ethical guidelines of the Declaration of Helsinki were adhered to. All participants provided written informed consent, the questionnaires were uniformly stored by the researchers, and the research methods strictly complied with relevant guidelines.
Participants and procedure
The study adopted the convenience sampling method to recruit patients who underwent PCI at a Class A tertiary hospital from April 2024 to July 2024. The inclusion criteria were as follows: (1) patients who met the diagnostic criteria outlined in the Chinese Guidelines for Percutaneous Coronary Intervention (2016)13, underwent percutaneous coronary intervention, and were successfully treated; (2) aged 18 years or older; have normal comprehension ability and be able to complete the questionnaire independently or with the help of the researcher; and (3) provided informed consent and voluntarily participated in this study. The exclusion criteria included: (1) patients with cognitive and mental disorders or functional impairments in vision or hearing; (2) patients with functional impairments in vital organs or serious chronic comorbidities; and (3) patients with language dysfunctions that impede effective communication.
Methods
Instruments
General information questionnaire
The questionnaire was developed by the researcher to collect the following information: (1) General demographic data, including each patient’s admission number, sex, age, ethnicity, education level, marital status, monthly household income, employment status, smoking status, and alcohol consumption; (2) Disease-related information, such as each patient’s height, weight, overweight status, whether it was their first diagnosis of CHD, the time of diagnosis, duration of the disease, presence of comorbidities, and the grading of their cardiac function.
Health-promoting lifestyle scale
The Health-Promoting Lifestyle Profile-II (HPLP-II), developed by Walker et al14., was utilised to assess the level of health-promoting behaviours (HPBs) of the participants. It has been translated from English to Chinese with cultural validations. It has a good internal consistency (Cronbach’s alpha 0.91)15. The Chinese version HPLP-II consists of the same 52 items, covering six dimensions: health responsibility (with 9 items, such as reporting my abnormal signs or symptoms to healthcare providers, watching TV programs about promoting health, and asking questions when having difficulties in understanding the suggestions from healthcare providers, etc.), exercise (with 8 items, such as doing exercises according to the planned program, doing stretching exercises at least three times a week, and reaching the target heart rate during exercise, etc.), Nutrition (with 9 items, such as choosing a diet low in fat, saturated fat and cholesterol, limiting the intake of sugar and sugary foods, having breakfast, and reading the labels on food packages to confirm the nutritional content, fat and sodium levels, etc.), self-actualisation (with 9 items, such as feeling that I am growing and changing in a positive way, believing that my life has a purpose, and being full of hope for the future, etc.), interpersonal support (with 9 items, such as discussing my difficulties and concerns with relatives and friends, easily praising others for their achievements, and spending time with good friends), and stress management (with 8 items, such as having sufficient sleep, taking time to relax myself every day, and thinking of some pleasant things before going to bed, etc.). In the current study, the scale adopted the Likert 4-point scoring method, ranging from 1 (never) to 4 (always). The total score ranges from 52 to 208 points. The scores of the Physical Activity and Stress Management dimensions are between 8 and 32, while those of the other four dimensions are between 9 and 36.It uses a 4-point Likert scale, ranging from 52 to 208, where higher scores indicate higher levels of HPBs. The overall Cronbach’s alpha for the scale was 0.95, with dimensional values ranging from 0.70 to 0.86.
Data collection
Data were collected using a questionnaire method. The researcher explained the study’s purpose and significance to the participants and obtained their informed consent before administering the questionnaire. The researcher asked the 52 items in the HPLP-II to the participants one by one. During the questioning process, the researcher did not interrupt the participants casually, listened carefully to their statements, and refrained from giving any hints or guidance. The researcher assigned scores according to the participants’ answers to avoid errors that might arise if the participants filled out the questionnaire by themselves, thus completing the questionnaire administration.
The sample size was calculated to be 5–10 times the number of independent variables in the questionnaire.In this study, the general information included 20 variables, and the HPLP-II had a total of 6 dimensions, resulting in a total of 26 independent variables. Therefore, the required sample size was 130 to 260, accounting for a potential 10% attrition rate the sample size was adjusted to 143 to 286. Finally, the sample size was expanded to 300 cases.
Statistical analysis
Data were entered twice into Excel to create a database. Statistical analyses were performed using SPSS 26.0. Descriptive statistics summarised the general information, while measurement data were presented as mean and standard deviation (\({\overline{\text{x}}}\) ± s) and enumeration data as numbers and percentages (%). Two independent samples t-tests, one-way ANOVA, and multiple linear regression were used to analyse factors influencing the health-promoting lifestyle, with a significance threshold set at P = 0.05.