Knowledge of Myocardial Infarction and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka - A Cross-Sectional Study

Knowledge of Myocardial Infarction and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka - A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge of Myocardial Infarction and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka - A Cross-Sectional Study Pathum Perera, Sampatha Goonewardena This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7826783/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Myocardial infarction (MI) is a major global health concern and one of the leading causes of morbidity and mortality. This study aimed to describe knowledge of MI and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka. Methods: A descriptive cross-sectional study method was conducted in cardiology clinic at a selected tertiary care hospital of Colombo district, Sri Lanka using systematic random sampling. A pretested interviewer administered questionnaire was used for data collection. Logistic regression models were used to determine the association between knowledge and relevant factors. Results: The mean age of the patients was 52.56 years (SD=12.96); range 18 to 89). Good knowledge of MI was observed in 46.8% (n= 117) of participants. The knowledge mean score was lowest for signs and symptoms (0.46, SD= 0.499) and preventive measures (0.47, SD=0.50), while knowledge of risk factors and complications (both 0.50, SD= 0.501) were comparatively higher. Only (30%, n=75) correctly identified MI as the death of heart muscle. Stress (42.4%, n=106) avoidance was less recognized preventive measure. Knowledge was significantly associated with factors such as younger age, nuclear family type, higher educational and receiving information about MI. Conclusions – Overall, less than half of the participants demonstrated good knowledge of MI. Targeted public educational programs are needed to improve knowledge of MI. Future research should include diverse populations and assess the long-term impact of educational interventions. Awareness Myocardial Infarction Primary Prevention Risk Factors Signs and Symptoms Sri Lanka 1. Introduction Cardiovascular diseases are foremost community-based health challenge across the worldwide( 1 ). Of these, Ischemic heart disease (IHD) making up the largest proportion of the burden and contributing to 32% of worldwide mortality in 2019( 2 ). One significant complication of IHD is MI ( 3 ). MI colloquially known as a heart attack( 4 ). Cardiovascular diseases (CVDs) remain the leading cause of death globally, posing a major public health burden( 5 ). In 2021 alone, an estimated 20.5 million people died from CVDs, representing one in every three deaths globally. Among these IHD like MI has emerged as the primary cause of premature mortality, ranking first in 146 countries for men and 98 countries for women( 6 ). Alarmingly, over three-quarters of CVD-related deaths occur in low- and middle-income countries, reflecting significant disparities in healthcare access and prevention strategies. Among the 17 million premature deaths (under age 70) caused by noncommunicable diseases in 2019, 38% were attributable to CVDs ( 7 ). According to recent Annual Health Bulletin of Sri Lanka, nearly 50% of the total deaths in government hospitals were attributed to major non-communicable diseases, including CVDs. Among these, the relative mortality burden from IHD was 12.6%. Additionally, out of the 419,934 hospital admissions due to CVDs, 18,715 deaths were directly linked to these conditions, underscoring the significant impact of CVDs such as MI. In the 2022 and 2023 there were 66,498 and 67,355 recorded government hospital death in Sri Lanka. Out of them, IHD accounted for 13% of the hospital morality( 8 ). Moreover, awareness of MI symptoms and risk factors is essential for timely intervention( 9 ) ( 10 ). Research conducted among post-MI patients in Sri Lanka revealed that a significant percentage do not fully comprehend the severity of their condition or the importance of lifestyle changes necessary to prevent subsequent episodes( 2 ). This gap of health literacy is particularly concerning, given that effective secondary preventive strategies can significantly enhance patients' quality of life and reduce the risk of recurrent MI. Many countries have conducted studies to assess knowledge of MI among patients in different settings, as a result of the increasing morbidity and mortality linked to MI. Several studies have been conducted in South Asian nations like Nepal, West Bengal and India( 4 , 11 – 13 ). In addition, East Asian countries such as Korea and China, West Asian countries such as Saudi Arabia( 3 , 14 , 15 ), North American counties such as Canada( 5 ) and United States( 16 ), African countries such as Tanzania( 17 , 18 ) have undertaken extensive studies to explored this area. However, in Sri Lanka, only a limited number of studies have been conducted focusing on Knowledge of MI. These studies have also highlighted the importance of understanding the patients’ knowledge regarding MI. In Sri Lanka, Sooriyagoda et al investigated delayed hospital presentation among ST-elevation MI patients, finding that atypical chest pain was a significant reason for delayed hospital presentation ( 19 ). Another study conducted with post MI patients to assess knowledge of MI highlighting the need of future researches and community awareness programmes( 2 ). Despite advancements in medical treatment, poor knowledge and awareness of MI symptoms and risk factors continue to hinder early detection and timely medical intervention. This study aimed to describe knowledge of MI and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka. 2. Methodology 2.1 Study design and setting This cross-sectional descriptive study was conducted in a cardiology clinic of a selected tertiary care hospital in Colombo district, Sri Lanka from December 2024 to June 2025 to describe knowledge of MI and associated factors among patients. The selected tertiary care hospital serves a varied population from areas of Colombo representing a wide range of cultural and educational background. The cardiology clinic of the tertiary care hospital caters to large number of patients, allowing our study to describe knowledge related to MI that is highly representative of health literacy among this population. 2.2 Inclusion and exclusion criteria Inclusion criteria were participants aged ≥ 18 years and should have a confirmed diagnosis of MI or attending the clinic for the management of conditions associated, such as diabetes, hypertension and dyslipidaemia at least 6 months prior to the study. We excluded those who had difficulty in communicating and those with a prior medical diagnosis of a psychiatric disorder. These disorders were identified using clinical records. The data collection was done during April to May 2025. 2.3 Ethical consideration The study was approved by the Research Ethics Committee (REC), Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. as well as Director’s permission of relevant selected tertiary care hospital, Colombo, Sri Lanka. In addition, permission from relevant consultants and nursing in-charges of hospital were obtained prior to data collection. The study was conducted in accordance with the relevant regulations of the REC in respect of information, consent and other laws and regulations relating to the protection of the rights and welfare of human subjects participating in biomedical research. All the participants were informed about the study and informed written consent was obtained prior to the data collection. 2.4 Study population and sample size Based on previous research by Dutta et al( 4 ), which determined knowledge regarding MI among adults, 81% of participants had adequate knowledge, the required sample size was calculated using Lwanga and Lemeshow1991 formulation for a single proportion. With a 0.05 margin of error and expected non-responsive rate of 10%, a sample of 267 was determined. Actual non-responsive rate was 6.3%, a total of 250 participants were recruited. 2.5 Data collection The patients were selected using systematic sampling method. An interviewer-administered questionnaire was adapted and developed after an extensive and intensive literature review. The questionnaire was designed to obtain relevant socio-demographic characteristics, health profile, lifestyle and knowledge of MI including sources of information, symptoms, risk factors, preventive measures and potential complications. After that the questionnaire was translated into Sinhala and Tamil by two bilingual translators to ensure conceptual equivalence. Then, it was pre-tested for clarity with 10 patients in the cardiology clinic of Colombo East Base Hospital. The face and content validation were conducted by a Professor with subject expertise. Primary outcome variables were level of knowledge regarding MI while secondary outcome measure included associations between knowledge level and independent variables. 2.6 Data analysis Data were coded and analysed using IBM SPSS statistical software version 26.0. Descriptive statistics were used to describe demographics, socio-economics, health profile and life style information as frequencies and percentages and/or means and standard deviations as appropriate. Knowledge was categorized into good and poor knowledge based on the mean scores. Knowledge was analysed based on 38 knowledge questions related to MI. For each correct answer “1” mark was given and “0” mark for incorrect and don’t know responses so that the maximum score that one can obtain is 38 and the minimum is zero. The mean knowledge score of study participants was 23.68 (SD ± 8.277). Then depending on the mean value, overall knowledge was divided in to two categories. Above the mean value it is considered as good knowledge and below the mean value it considered as poor knowledge. Chi square analysis was used to test the associations between level of knowledge and other independent variables. Variables from the bivariate analysis were further analysed using logistic regression models and reported using odds ratios (ORs) and 95% confidence intervals (CIs) to determine strength and direction of association. Significance was taken as p-value of less than 0.05. 3. Results Table 1 presents basic characteristics of patients including socio-demographics, socio-economics, life style, health profile. The total of 250 (responsive rate = 93.63%) participated in this study with a mean age was 52.56 years (SD=12.96). Table 1 Basic characteristics of the study participants (N=250) Variable number % Age (in years) < 60 ≥ 60 172 78 68.8 31.2 Gender Male Female 96 154 38.4 61.6 Ethnicity Sinhala Tamil Moor 219 24 7 87.6 9.6 2.8 Current marital status Single Currently married Widowed Divorced /Legally separated 47 187 12 4 18.8 74.8 4.8 1.6 Highest educational level No schooling Below Grade 5 (primary school) Grade 5-11 (secondary school) G.C.E. O/L † passed Up to G.C.E. A/L G.C.E. A/L † passed Diploma/Degree 22 28 64 31 21 26 58 8.8 11.2 25.6 12.4 8.4 10.4 23.3 Family type Nuclear Extended 175 75 70 30 Current employment status Employed Unemployed 103 147 41.2 58.8 Average Monthly Income < LKR 60,000 ≥ LKR 60,000 186 64 15.2 84.8 Health Profile of the study participants Hypertension Diabetes Mellitus Dyslipidaemia Previous experienced MI Family History of MI 204 197 173 136 150 81.6 78.8 69.2 54.4 60 † General Certificate of Education – Ordinary Level (national examination held after 11 years of school education) ± General Certificate of Education – Advanced Level (national examination held after 13 years of school education The majority (68.8%) were aged below 60 years. More than half were female (61.6%). Most of the participants were of Sinhala ethnicity (87.6%), while Tamil and Moor participants represented (9.6%) and (2.8%) respectively. The majority were married (74.8%) and belonged to nuclear families (70%). Regarding the educational level (25.6%) had schooling up to Ordinary level examination and (23.2%) had a diploma/degree. Most participants were not employed (58.8%). More than half of the participants reported a monthly income below LKR 60,000. The majority of participants had hypertension (81.6%) and diabetes mellitus (78.8%). More than half reported a previous history of MI (54.4%). Table 2 shows life style and information receiving status of participants regarding MI. Alcohol consumption and smoking reported by (19.2%) and (15.2%) respectively, while (27.6%) reported engaging in regular exercise. Respondents had received information about MI from different sources. Table 2: Life style and source of information status (N= 250) Characteristic number % Smoking status Yes No 38 212 15.2 84.8 Alcohol Consumption Yes No 48 202 19.2 80.8 Regular Exercise Yes No 69 181 27.6 72.4 Source of information regarding MI Medical Officers / Nurses Family Members Media (TV/Radio) Internet 151 42 124 75 60.4 16.8 49.6 30 More than half of participants (60.4%) had received information regarding MI from Medical officers/nurses and (49.6%) had received from media. Table 3 summarizes participants correct responses to MI knowledge on signs & symptoms, risk factors, preventive measures and complications. Regarding the nature of MI, (35%) of respondents gave the right answer that MI is a death of heart muscle. Table 3; Distribution of correctly identified MI knowledge (N= 250) Characteristic number % Meaning of MI Death of heart muscle 70 35 Signs & Symptoms Chest pain 248 99.2 Difficulty in breathing 167 66.8 Nausea or vomiting 79 31.6 Excessive sweating 150 60 Dizziness 71 28.4 Chest pain can radiate to the jaw 94 37.6 Chest pain can radiate to the arms and shoulder 193 77.2 Fainting (syncope) 55 22 Indigestion 76 30.4 Risk Factors Smoking 220 88 High blood pressure 240 96 High cholesterol (law density lipoprotein) 242 96.8 Diabetes 167 66.8 Having a family history of heart diseases 117 46.8 Obesity 107 42.8 Stress 93 37.2 Processed foods high in cholesterol 148 59.2 High sugar foods and beverages 107 42.8 High intake of salt 158 63.2 Preventive measures Maintaining a healthy weight 150 60 Avoiding stress 106 42.4 Controlling blood pressure 225 90 Quitting smoking 208 83.2 Controlling diabetes 182 72.8 Regular exercise 156 62.4 Low fat and cholesterol diet 211 84.4 Taking prescribed medications (blood pressure medications, DM medications, statin) 247 98.8 Complications Heart failure 119 47.6 Arrythmia (irregular heartbeat) 66 26.4 Stroke 98 39.2 Sudden cardiac arrest 152 60.8 Sudden death 236 94.4 While, concerning about sign and symptoms of MI, (99.2%) % of respondents identified chest pain followed by difficulty in breathing (66.8%), excessive sweating (60%), nausea & vomiting (31.6%), pain radiation to jaw (37.6%), pain radiation to arms and shoulder (77.2%), indigestion (30.4%) and fainting (22%) as a sign and symptoms of MI. Regarding the risk factors of MI, participants had answered that high blood pressure (96%) followed by diabetes (66.8%), High cholesterol (law density lipoprotein) (96.8%), stress (37.2%), having family history(46.8%), smoking (88%) and obesity (42.8%) are the risk factors of MI. Concerning the diet, (63.25)% of respondents answered that high intake of salt increases the risk of MI and only (42.8%) of respondents told that High sugar foods and beverages is a risk factor. Regarding preventive measures, (60%) respondents told that maintaining healthy weight followed by consuming low fat and cholesterol diet (84.4%), avoiding stress (42.4%), controlling blood pressure (90%), controlling diabetes (72.8%), quitting smoking (83.2%) and engaging regular exercise (62.4%) are the preventive measures of MI. Regarding complications, almost all participants said that sudden death (94.4%) is a complication of MI, while sudden cardiac arrest (60.8%). Only (47.6%) answered that heart failure is a complication of MI. Table 4 shows knowledge distribution of MI components to identify specific areas contributing to overall knowledge. The mean scores and standard deviations of four key knowledge components were described. Signs & symptoms, preventive measures, risk factors, and complications. Table 4; Knowledge distribution of MI Components Component Mean Std. Deviation (SD) Signs & Symptoms 0.46 0.499 Risk Factors 0.50 0.501 Preventive measures 0.47 0.500 Complications 0.50 0.501 Among these, the lowest mean score was observed for knowledge of signs and symptoms (mean = 0.46, SD= 0.499). This was followed closely by preventive measures (mean = 0.47, SD=0.50), while slightly higher mean scores were noted for knowledge of risk factors and complications (both at 0.50, SD= 0.501). Table 5 presents the associated factors of MI. Knowledge was significantly associated with factors such as younger age (OR= 3.2; CI 1.5,7.1) Table 5: Factors associated with Knowledge of MI among patients Characteristic Good Knowledge (N=332) Poor Knowledge (N=88) Unadjusted OR (95% CI) P value Adjusted OR (95% CI) P value Age ≤60 years >60 years 99 (57.6) 18 (23.1) 57 (22.9) 31 (18.1) 0.2(01,0.4) <0.001 3.2 (1.5,7.1) 0.002 * Gender Male Female 52(54.2) 65 (42.2) 73 (42.2) 60 (76.9) 0.6 (0.3,1.0) 0.065 1.2 (0.5,2.7) 0.534 Ethnicity Sinhala Others 101 (46.1) 16 (51.6) 44 (45.8) 89 (57.8) 0.8 (0.3,1.7) 0.566 0.6 (0.8,5.5) 0.715 Type of family Nuclear Extended 96 (54.9) 21 (28) 79 (45.1) 54 (72) 0.3 (0.1,0.5) < 0.001 4.0(1.9,8.4) <0.001 * Education level O/L and below AL and above 89 (65.4) 28 (24.6) 47 (34.6) 86 (75.4) 5.8 (3.3,10.1) < 0.001 0.2 (0.1,0.5) <0.001 * Employment status Employed Others 68 (66) 49 (33.3) 35 (34) 98 (66.7) 3.8(2.2,6.6) < 0.001 0.7 (0.3,1.6) 0.535 Monthly income < LKR 60,000 ≥ LKR 60,000 67(36%) 50(78.1%) 119(64%) 14(21.9%) 6.3 (3.2,12.3) < 0.001 0.4 (0.1,1.0) 0.054 Regular exercises Yes No 43(62.3%) 74(40.9%) 26(37.7%) 107(59.1%) 0.4 (0.2,0.7) 0.002 1.5 (0.7,3.3) 0.223 Received information Yes No 105(55%) 12(20.3%) 86(45%) 47(79.7%) 0.7 (0.1,0.4) < 0.001 2.3 (1.0,5.2) 0.036 * nuclear family type (OR= 4.0 CI 1.9,8.4), higher educational level (OR=0.2; CI 0.1,0.5) and receiving information about MI (OR=2.35; CI 1.0,5.2). 4. Discussion In our study, the majority of participants were aged between 41 and 60 years, constituting 54% (n = 135) of the sample. This finding is consistent with a study conducted in Kathmandu, Nepal, where more than half (54.0%) of the respondents belonged to the 40–59 age group ( 12 ). Similarly, a Sri Lankan study also reported that nearly (85%) of participants were with the 45–50 age group being the most represented( 2 ). A study conducted in West Bengal showed that majority age group was (46.11%, n = 83) belong to the age group 51–60 years( 4 ). These findings collectively suggest that middle-aged and older adults constitute the predominant group affected by MI. The findings of our study indicated that the most common source of information about MI was healthcare professionals, with (60.4%) of participants received information from doctors and nurses. This shows that the dissemination of knowledge that provides information to many participants occurs through doctors and nurses. Media sources such as television and radio were (49.6%), followed by internet (30%). Notably, only (16.8%) responded reported receiving information from family members. In comparatively, a study conducted in Nepal, the majority participants reported family members (72.2%) as their primary source of information, followed by healthcare workers (69.6%) and television (51.9%). This indicates a stronger role of familial communication in Nepal context ( 12 ). In contrast a study conducted in Saudi Arabia showed a different patten. Television was reported as a source by only (13.9%) of participants, while internet use (28%) and healthcare professionals (21%) were less prominent compared to our study ( 20 ). In the present study, more than half of the participants were unable to correctly define MI, only (30.0%) accurately identified MI as the death of cardiac muscles due to inadequate blood supply. Additionally, (16.4%) incorrectly associated MI with heart failure, and (1.2%) mistook it for a stroke. Comparatively, in a study conducted in Nepal, (32.9%) correctly identified MI as heart muscle death, (16.5%) associated it with heart failure, (10.5%) confused it with stroke, and (40.5%) responded with “Don’t know”( 12 ). These findings indicate a generally low level of understanding regarding nature of MI in both populations, emphasizing the need for improved public education to enhance awareness and recognition of MI. This study also highlights the need to improve public knowledge of MI signs and symptoms ( 12 ). Also, a study conducted in West Sumatra found that (90.1%) participants knew that chest pain is a common symptom of MI. However, knowledge was limited in case of discomfort in the arm/shoulder as a symptom( 21 ). The Kashmir study showed moderate awareness of chest pain (40%), chest pain radiating to the jaw (44.7%) and arms (54%), and higher recognition of nausea (60.7%), indigestion (60.3%), and shortness of breath (62%). ( 13 ). These findings highlight the need to improve public knowledge of MI symptoms across different populations. The study conducted in Riyadh Saudi Arabia found high awareness of symptoms such as jaw pain (90%), chest pain (85.9%), and fatigue (85.8%). The study also revealed strong awareness of major risk factors (91.6%) recognized smoking and obesity, and (85.3%) acknowledged the role of family history in increasing MI risk ( 22 ). Similarly, a study conducted in Afghanistan, reported that only( 39.8%) were aware of obesity, (38.5%) recognized physical inactivity (33.8%) identified family history as risk factors of MI( 23 ) Our study found that high awareness of major MI risk factors. However, knowledge was notably lower for lifestyle-related, with only (48.8%) recognizing a sedentary lifestyle, (42.8%) identifying obesity, (37.2%) acknowledging stress, and (46.8%) aware of family history as risks. Dietary risk awareness was moderated with (63.2%) were aware of the risks associated with high salt consumption. In contrast, a study reported generally high awareness of risk factors such as high blood pressure and obesity (91.1%), high cholesterol (77.2%), stress (88.6%), diabetes (84.8%), smoking and alcohol consumption (84.8%), and sedentary lifestyle (73.4%) ( 12 ). These differences highlight gaps in knowledge about lifestyle and familial risks in the current population, emphasizing the need for targeted education to address these areas( 12 ). Also, a research conducted in Mogadishu, Somalia, presented that only less than half of respondents identified hypertension (48.9%), diabetes (45%), dyslipidaemia (45%) and obesity (43.8%) as risk factors and awareness of lifestyle related risks such as being physical inactivity (41.2%), excessive salt consumption (43.8%) was low( 24 ). This contrast with the findings of our study. In our study, (46.8%) of participants demonstrated good knowledge about MI, while (53.2%) had poor knowledge. Compared to a study conducted among adults in West Bengal, where (25%) had good knowledge, (56.11%) had average knowledge, and (18.89%) had poor knowledge, the proportion of poor knowledge in the current study is notably higher. This suggests a concerning gap in awareness, particularly in recognizing risk factors, early symptoms, and preventive measures of MI ( 4 ). The present study revealed that several significant factors influencing the level of knowledge regarding MI. Age, educational attainment, family type, employment status, and income were all significantly associated with participants' knowledge levels. Age (< 60 years), those with education beyond Ordinary level, employed participants, individuals from nuclear families, and those earning a monthly income above LKR 60,000 exhibited higher levels of MI awareness. These findings align with Saudi Arabia study, who reported that higher education and income were significantly associated with MI awareness ( 25 ). Although their study found that males had lower awareness than females, our study found no statistically significant gender difference. Similarly, another study conducted with Saudi Arabia population found that the age group 35–44 showed higher awareness compared to younger and older groups, with significant associations also found for marital status and income level paralleling our findings( 3 ). South Korea further supports this, emphasizing the role of demographic factors such as age, education, and income in influencing awareness and adherence to MI preventive behaviours, including lifestyle modifications and medication compliance ( 5 ). Furthermore, a recent study in Riyadh, Saudi Arabia found that significant associations between MI knowledge and gender, age, education, and marital status ( 22 ). The strength of our study was that we used a structured, pre-tested, face and content validated questionnaire to ensure consistency in data collection, data was collected through an interviewer-administered questionnaire that translated to local languages (Sinhala/Tamil), reduces the risk of incomplete responses. Also, the selected tertiary care hospital that serves a large and diverse patient population, representing a wide range of cultural and educational backgrounds was a key strength of our study. Our study limitations included its’ cross-sectional study design of this study which precluded confirmation of any causal associations and the study was conducted at a selected tertiary care hospital, which might limit the generalizability of the findings to other settings. 5. Conclusion Our findings suggest the knowledge was comparatively low on certain risk factors such as family history, obesity, stress, and high sugar consumption as risk factors. Half of participants demonstrated good knowledge regarding preventive measures. However, knowledge of the importance of stress avoidance as a preventive measure was low. Most participants were aware of serious complications like sudden death and cardiac arrest, recognizing their life-threatening nature. This highlights the need for targeted health education on the current preventive measures to be taken including family-oriented sessions to improve early recognition MI. Future studies should be conducted over the long-term including other regions of Sri Lanka to evaluate the impact of educational interventions and support services on patient outcomes. Declarations Ethics approval and consent to participate All participants provided written informed consent before participation. The study adhered to ethical guidelines for research involving human subjects. This study was conducted following ethical principles and approved by the REC of the Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. (Ethical Approval No. REC/NSG 033) Consent for publication Not applicable. Competing interests The authors declare no competing interests. Clinical trial number Not applicable. Funding No funding was received for this manuscript. Author Contribution P.P Significant contributed to the conception and design of the study, performing the literature review, data collection, data analysis, results interpretation, reviewing successive write of the manuscript. S.G Significant contributed to the supervise the study and design of the study, results interpretation, data cleaning and data analysis, writing successive revisions of the manuscript, and approving the final manuscript. All authors reviewed, edited, and approved the final version of the manuscript. Acknowledgement The authors would like to thank the Administration and healthcare staff of the selected tertiary care hospital for their support during the data collection. We are also grateful to the patients who generously gave their time to participate the study. Data Availability Data available on the request from the authors. References Abed MA, Khalil AA, Moser DK. 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Awareness regarding Myocardial Infarction among diabetic patients attending in a tertiary level hospital. Acta Sci Med Sci. 2019;3(8):131–6. https://doi.org/10.31080%2FASMS.2019.03.0359. Bano Z, Bano MZ, Annu S, Akhter M, Yaqoob I, Bashir A et al. Assessment of prevalent risk factors and warning signs and symptoms among myocardial infarction patients attending cardiology department, Skims. Int J Res Educ Sci Methods 2022;10(09). Alanazi A, Alghanim MH, Alamer AJ, Alshaqaqiq MA, Al Busaeed MM, Alahmed AH, et al. Acute myocardial infarction patients’ knowledge regarding the modifiable risk factors of heart disease. Int J Pharm Res Allied Sci. 2020;9(2):210–6. Al Harbi KM, Alluhidan WA, Almatroudi MI, Almuhanna NI, Alotaibi NM. Knowledge and Attitude of general people towards symptoms of heart attack and the impact of delay time in Riyadh, Saudi Arabia. Cureus. 2022https://doi.org/10.7759%2Fcureus.32758. Tran P, Tran L. Influence of rurality on the awareness of myocardial infarction symptoms in the US. Ther Adv Cardiovasc Dis. 2019;13:1753944719891691. https://doi.org/10.1177/1753944719891691 . Hertz JT, Madut DB, Tesha RA, William G, Simmons RA, Galson SW, et al. Knowledge of myocardial infarction symptoms and perceptions of self-risk in Tanzania. Am Heart J. 2019;210:69–74. https://doi.org/10.1016/j.ahj.2019.01.003 . Pallangyo P, Mkojera ZS, Komba M, Mfanga L, Kamtoi S, Mmari J, et al. Public knowledge of risk factors and warning signs of heart attack and stroke. Egypt J Neurol Psychiatry Neurosurg. 2024;60(1):12. https://doi.org/10.1186%2Fs41983-023-00780-x. Sooriyagoda SKGPHK, Amarasinghe RMMK, Kumara HSR, Jayawickreme SR, Abeysinghe AHMTB. Factors contributing to delayed presentation in ST-Elevation myocardial infarction and implication for in-patient outcomes. Sri Lanka J Med. 2024;33(1):32–8. https://doi.org/10.4038/sljm.v33i1.428 . Bohamad AH, Buali HH, Aljasem JM, Alhussain AH, Alamer MA, Elsheikh E. Comparing Gerd and Non-GERD patients regarding knowledge level of acute myocardial infarction symptoms, risk factors and immediate action must be taken in Eastern province, Saudi Arabia. Cureus. 2023https://doi.org/10.7759%2Fcureus.35309. Haq A, Yeffi Masnarivan M, Yenti N, Fadhilla. Assessment of public knowledge of heart attack and stroke in West Sumatra Province. Malays J Public Health Med. 2022;22(3):124–9. Syed W, Samarkandi O, Alanazi AA, Alotaibi N, Al-Rawi MBA. Assessment of myocardial infarctions knowledge, attitudes and beliefs among adults living in Riyadh Saudi Arabia – insights from cross-sectional study. Sci Rep. 2024;14(1):31457. https://doi.org/10.1038/s41598-024-83169-x . Akmal S, Ikramullah I, Hayatullah A. Awareness of Myocardial Infarction in Nangarhar Residents: A Community Based Study. J Cardiol Cardiovasc Med. 2024;9(2):130–4. https://dx.doi.org/10.29328/journal.jccm.1001193 . Hassan M, Ahmed S, Hassan M, Mohamud M, Abdi A. Exploring myocardial infarction knowledge, attitudes, and practice among Mogadishu’s Somali Residents. Vasc Health Risk Manag 2024; Volume 20:13–20. https://doi.org/10.2147/VHRM.S448220 Alsaab SM, Almutairi AM, Alsaadi GK, Altokhais ZA, Alabdulqader SH, Alnofal WY, et al. Awareness of myocardial infarction symptoms and risk factors in Saudi Arabia: A Cross-Sectional Study. Cureus. 2023https://doi.org/10.7759%2Fcureus.50092. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7826783","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542128874,"identity":"c365268a-5213-4628-ab28-2821125a18aa","order_by":0,"name":"Pathum Perera","email":"","orcid":"","institution":"University of Sri Jayewardenepura","correspondingAuthor":false,"prefix":"","firstName":"Pathum","middleName":"","lastName":"Perera","suffix":""},{"id":542128875,"identity":"4ebe0147-1299-4c87-90fc-f6a38bdd46e4","order_by":1,"name":"Sampatha Goonewardena","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYPCCAwz8DAwJYCYfD1E6Eg4wSDZAtbARrcXgAJRNUIt8++m0Bz9/3JE3Pn/g2QOGGjuglgP4tRicyd1u2JPwzHDbjYR0A4ZjyQxsvA0EtDDkbpPgSTjMuO0GQ5oEA9sBBjZ+Qg7rf7tN8k/CYfvN/QeAWv4RoYXhRu42aaAtiRsYEtIkGNsOEOGwG2+3G8ukHU6eAfJLYl8yD0Hvy/fnbnv4xuawbX//mbQHH77ZyfHzJBByGQMblOZJA0UmUREJ08J+jBjVo2AUjIJRMAIBAIYJRCqujAmoAAAAAElFTkSuQmCC","orcid":"","institution":"University of Sri Jayewardenepura","correspondingAuthor":true,"prefix":"","firstName":"Sampatha","middleName":"","lastName":"Goonewardena","suffix":""}],"badges":[],"createdAt":"2025-10-10 12:21:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7826783/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7826783/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95529028,"identity":"88cd5db7-c694-4085-addb-b07ab26e7851","added_by":"auto","created_at":"2025-11-10 10:16:42","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86797,"visible":true,"origin":"","legend":"","description":"","filename":"PathumPereraMIKnowledgeDiscoverpublichealthmanuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7826783/v1/223622166ce1e134b67a86c2.docx"},{"id":95504708,"identity":"bf60a9c8-4a92-427f-946e-c417758bb436","added_by":"auto","created_at":"2025-11-10 05:52:54","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5070,"visible":true,"origin":"","legend":"","description":"","filename":"7e66cf1c895848be8cfc43f580f6486e.json","url":"https://assets-eu.researchsquare.com/files/rs-7826783/v1/924064aeeb49ec37181a3ca7.json"},{"id":95504709,"identity":"995b358c-d628-433f-9c7a-09734421e384","added_by":"auto","created_at":"2025-11-10 05:52:54","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101108,"visible":true,"origin":"","legend":"","description":"","filename":"7e66cf1c895848be8cfc43f580f6486e1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7826783/v1/8c6d606f2d1487fa63187180.xml"},{"id":95528679,"identity":"234a46e6-2291-494c-8180-76b1c9c53350","added_by":"auto","created_at":"2025-11-10 10:16:23","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98440,"visible":true,"origin":"","legend":"","description":"","filename":"7e66cf1c895848be8cfc43f580f6486e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7826783/v1/36b529087830733f669c4a28.xml"},{"id":95504711,"identity":"f5da927e-b213-428c-af86-8bcd5f14f661","added_by":"auto","created_at":"2025-11-10 05:52:54","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107693,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7826783/v1/de0325e6b7a17620c3db0b71.html"},{"id":100235506,"identity":"3f4b0e1e-02d6-443f-815f-1fa84dc8d4d7","added_by":"auto","created_at":"2026-01-14 12:25:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":831203,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7826783/v1/6e76a9cf-aa9d-410f-8e64-7f6a20a8e111.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge of Myocardial Infarction and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka - A Cross-Sectional Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCardiovascular diseases are foremost community-based health challenge across the worldwide(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Of these, Ischemic heart disease (IHD) making up the largest proportion of the burden and contributing to 32% of worldwide mortality in 2019(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). One significant complication of IHD is MI (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). MI colloquially known as a heart attack(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Cardiovascular diseases (CVDs) remain the leading cause of death globally, posing a major public health burden(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In 2021 alone, an estimated 20.5\u0026nbsp;million people died from CVDs, representing one in every three deaths globally. Among these IHD like MI has emerged as the primary cause of premature mortality, ranking first in 146 countries for men and 98 countries for women(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Alarmingly, over three-quarters of CVD-related deaths occur in low- and middle-income countries, reflecting significant disparities in healthcare access and prevention strategies. Among the 17\u0026nbsp;million premature deaths (under age 70) caused by noncommunicable diseases in 2019, 38% were attributable to CVDs (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to recent Annual Health Bulletin of Sri Lanka, nearly 50% of the total deaths in government hospitals were attributed to major non-communicable diseases, including CVDs. Among these, the relative mortality burden from IHD was 12.6%. Additionally, out of the 419,934 hospital admissions due to CVDs, 18,715 deaths were directly linked to these conditions, underscoring the significant impact of CVDs such as MI. In the 2022 and 2023 there were 66,498 and 67,355 recorded government hospital death in Sri Lanka. Out of them, IHD accounted for 13% of the hospital morality(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Moreover, awareness of MI symptoms and risk factors is essential for timely intervention(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Research conducted among post-MI patients in Sri Lanka revealed that a significant percentage do not fully comprehend the severity of their condition or the importance of lifestyle changes necessary to prevent subsequent episodes(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis gap of health literacy is particularly concerning, given that effective secondary preventive strategies can significantly enhance patients' quality of life and reduce the risk of recurrent MI. Many countries have conducted studies to assess knowledge of MI among patients in different settings, as a result of the increasing morbidity and mortality linked to MI. Several studies have been conducted in South Asian nations like Nepal, West Bengal and India(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In addition, East Asian countries such as Korea and China, West Asian countries such as Saudi Arabia(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), North American counties such as Canada(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and United States(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), African countries such as Tanzania(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) have undertaken extensive studies to explored this area. However, in Sri Lanka, only a limited number of studies have been conducted focusing on Knowledge of MI. These studies have also highlighted the importance of understanding the patients\u0026rsquo; knowledge regarding MI.\u003c/p\u003e\u003cp\u003eIn Sri Lanka, Sooriyagoda et al investigated delayed hospital presentation among ST-elevation MI patients, finding that atypical chest pain was a significant reason for delayed hospital presentation (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Another study conducted with post MI patients to assess knowledge of MI highlighting the need of future researches and community awareness programmes(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite advancements in medical treatment, poor knowledge and awareness of MI symptoms and risk factors continue to hinder early detection and timely medical intervention.\u003c/p\u003e\u003cp\u003eThis study aimed to describe knowledge of MI and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design and setting\u003c/h2\u003e\u003cp\u003e This cross-sectional descriptive study was conducted in a cardiology clinic of a selected tertiary care hospital in Colombo district, Sri Lanka from December 2024 to June 2025 to describe knowledge of MI and associated factors among patients. The selected tertiary care hospital serves a varied population from areas of Colombo representing a wide range of cultural and educational background. The cardiology clinic of the tertiary care hospital caters to large number of patients, allowing our study to describe knowledge related to MI that is highly representative of health literacy among this population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Inclusion and exclusion criteria\u003c/h2\u003e\u003cp\u003eInclusion criteria were participants aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years and should have a confirmed diagnosis of MI or attending the clinic for the management of conditions associated, such as diabetes, hypertension and dyslipidaemia at least 6 months prior to the study. We excluded those who had difficulty in communicating and those with a prior medical diagnosis of a psychiatric disorder. These disorders were identified using clinical records. The data collection was done during April to May 2025.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Ethical consideration\u003c/h2\u003e\u003cp\u003e The study was approved by the Research Ethics Committee (REC), Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. as well as Director\u0026rsquo;s permission of relevant selected tertiary care hospital, Colombo, Sri Lanka. In addition, permission from relevant consultants and nursing in-charges of hospital were obtained prior to data collection. The study was conducted in accordance with the relevant regulations of the REC in respect of information, consent and other laws and regulations relating to the protection of the rights and welfare of human subjects participating in biomedical research. All the participants were informed about the study and informed written consent was obtained prior to the data collection.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Study population and sample size\u003c/h2\u003e\u003cp\u003eBased on previous research by Dutta et al(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), which determined knowledge regarding MI among adults, 81% of participants had adequate knowledge, the required sample size was calculated using Lwanga and Lemeshow1991 formulation for a single proportion. With a 0.05 margin of error and expected non-responsive rate of 10%, a sample of 267 was determined. Actual non-responsive rate was 6.3%, a total of 250 participants were recruited.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data collection\u003c/h2\u003e\u003cp\u003eThe patients were selected using systematic sampling method. An interviewer-administered questionnaire was adapted and developed after an extensive and intensive literature review. The questionnaire was designed to obtain relevant socio-demographic characteristics, health profile, lifestyle and knowledge of MI including sources of information, symptoms, risk factors, preventive measures and potential complications. After that the questionnaire was translated into Sinhala and Tamil by two bilingual translators to ensure conceptual equivalence. Then, it was pre-tested for clarity with 10 patients in the cardiology clinic of Colombo East Base Hospital. The face and content validation were conducted by a Professor with subject expertise. Primary outcome variables were level of knowledge regarding MI while secondary outcome measure included associations between knowledge level and independent variables.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Data analysis\u003c/h2\u003e\u003cp\u003eData were coded and analysed using IBM SPSS statistical software version 26.0. Descriptive statistics were used to describe demographics, socio-economics, health profile and life style information as frequencies and percentages and/or means and standard deviations as appropriate. Knowledge was categorized into good and poor knowledge based on the mean scores. Knowledge was analysed based on 38 knowledge questions related to MI. For each correct answer \u0026ldquo;1\u0026rdquo; mark was given and \u0026ldquo;0\u0026rdquo; mark for incorrect and don\u0026rsquo;t know responses so that the maximum score that one can obtain is 38 and the minimum is zero. The mean knowledge score of study participants was 23.68 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;8.277). Then depending on the mean value, overall knowledge was divided in to two categories. Above the mean value it is considered as good knowledge and below the mean value it considered as poor knowledge. Chi square analysis was used to test the associations between level of knowledge and other independent variables. Variables from the bivariate analysis were further analysed using logistic regression models and reported using odds ratios (ORs) and 95% confidence intervals (CIs) to determine strength and direction of association. Significance was taken as p-value of less than 0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable 1 presents basic characteristics of patients including socio-demographics, socio-economics, life style, health profile. The total of 250 (responsive rate = 93.63%) participated in this study with a mean age was 52.56 years (SD=12.96).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 Basic characteristics of the study participants (N=250)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u003cstrong\u003enumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eAge (in years)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 60\u003c/p\u003e\n \u003cp\u003e\u0026ge; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003cp\u003e61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003cp\u003eSinhala\u003c/p\u003e\n \u003cp\u003eTamil\u003c/p\u003e\n \u003cp\u003eMoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87.6\u003c/p\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eCurrent marital status\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eCurrently married\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003cp\u003eDivorced /Legally separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003cp\u003e74.8\u003c/p\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eHighest educational level\u003c/p\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003cp\u003eBelow Grade 5 (primary school)\u003c/p\u003e\n \u003cp\u003eGrade 5-11 (secondary school)\u003c/p\u003e\n \u003cp\u003eG.C.E. O/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e passed\u003c/p\u003e\n \u003cp\u003eUp to G.C.E. A/L\u003c/p\u003e\n \u003cp\u003eG.C.E. A/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e passed\u003c/p\u003e\n \u003cp\u003eDiploma/Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eFamily type\u003c/p\u003e\n \u003cp\u003eNuclear\u003c/p\u003e\n \u003cp\u003eExtended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eCurrent employment status\u003c/p\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003cp\u003e58.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eAverage Monthly Income\u003c/p\u003e\n \u003cp\u003e\u0026lt; LKR 60,000\u003c/p\u003e\n \u003cp\u003e\u0026ge; LKR 60,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003cp\u003e84.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5966%;\"\u003e\n \u003cp\u003eHealth Profile of the study participants\u003c/p\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003cp\u003eDyslipidaemia\u003c/p\u003e\n \u003cp\u003ePrevious experienced MI\u003c/p\u003e\n \u003cp\u003eFamily History of MI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6387%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7647%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003cp\u003e78.8\u003c/p\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003cp\u003e54.4\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp; \u0026nbsp; \u0026dagger;\u003c/sup\u003eGeneral Certificate of Education \u0026ndash; Ordinary Level (national examination held after 11 years of school education)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026plusmn;\u003c/sup\u003eGeneral Certificate of Education \u0026ndash; Advanced Level (national examination held after 13 years of school education\u003c/p\u003e\n\u003cp\u003eThe majority (68.8%) were aged below 60 years. More than half were female (61.6%). Most of the participants were of Sinhala ethnicity (87.6%), while Tamil and Moor participants represented (9.6%) and (2.8%) respectively. The majority were married (74.8%) and belonged to nuclear families (70%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the educational level (25.6%) had schooling up to Ordinary level examination and (23.2%) had a diploma/degree. Most participants were not employed (58.8%). More than half of the participants reported a monthly income below LKR 60,000. The majority of participants had hypertension (81.6%) and diabetes mellitus (78.8%). More than half reported a previous history of MI (54.4%).\u003c/p\u003e\n\u003cp\u003eTable 2 shows life style and information receiving status of participants regarding MI. Alcohol consumption and smoking reported by (19.2%) and (15.2%) respectively, while (27.6%) reported engaging in regular exercise. Respondents had received information about MI from different sources.\u003c/p\u003e\n\u003cp\u003eTable 2: Life style and source of information status (N= 250)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.4538%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e\u003cstrong\u003enumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2605%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.4538%;\"\u003e\n \u003cp\u003eSmoking status\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2605%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003cp\u003e84.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.4538%;\"\u003e\n \u003cp\u003eAlcohol Consumption\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2605%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003cp\u003e80.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.4538%;\"\u003e\n \u003cp\u003eRegular Exercise\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2605%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27.6\u003c/p\u003e\n \u003cp\u003e72.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.4538%;\"\u003e\n \u003cp\u003eSource of information regarding MI\u003c/p\u003e\n \u003cp\u003eMedical Officers / Nurses\u003c/p\u003e\n \u003cp\u003eFamily Members\u003c/p\u003e\n \u003cp\u003eMedia (TV/Radio)\u003c/p\u003e\n \u003cp\u003eInternet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2605%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMore than half of participants (60.4%) had received information regarding MI from Medical officers/nurses and (49.6%) had received from media.\u003c/p\u003e\n\u003cp\u003eTable 3 summarizes participants correct responses to MI knowledge on signs \u0026amp; symptoms, risk factors, preventive measures and complications. Regarding the nature of MI, (35%) of respondents gave the right answer that MI is a death of heart muscle.\u003c/p\u003e\n\u003cp\u003eTable 3; Distribution of correctly identified MI knowledge (N= 250)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003enumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eMeaning of MI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eDeath of heart muscle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eSigns \u0026amp; Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eChest pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eDifficulty in breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e66.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eNausea or vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eExcessive sweating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eDizziness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eChest pain can radiate to the jaw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eChest pain can radiate to the arms and shoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e77.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eFainting (syncope)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eIndigestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eRisk Factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eSmoking\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eHigh blood pressure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eHigh cholesterol (law density lipoprotein)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e96.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eDiabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e66.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eHaving a family history of heart diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e46.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eObesity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eStress\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eProcessed foods high in cholesterol\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e59.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eHigh sugar foods and beverages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eHigh intake of salt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003ePreventive measures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eMaintaining a healthy weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eAvoiding stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eControlling blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eQuitting smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e83.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eControlling diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e72.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eRegular exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eLow fat and cholesterol diet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eTaking prescribed medications (blood pressure medications, DM medications, statin)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eArrythmia (irregular heartbeat)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eSudden cardiac arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71.4286%;\"\u003e\n \u003cp\u003eSudden death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2381%;\"\u003e\n \u003cp\u003e94.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhile, concerning about sign and symptoms of MI, (99.2%) % of respondents identified chest pain followed by difficulty in breathing (66.8%), excessive sweating (60%), nausea \u0026amp; vomiting (31.6%), pain radiation to jaw (37.6%), pain radiation to arms and shoulder (77.2%), indigestion (30.4%) and fainting (22%) as a sign and symptoms of MI.\u003c/p\u003e\n\u003cp\u003eRegarding the risk factors of MI, participants had answered that high blood pressure (96%) followed by diabetes (66.8%), High cholesterol (law density lipoprotein) (96.8%), stress (37.2%), having family history(46.8%), smoking (88%) and obesity (42.8%) are the risk factors of MI. Concerning the diet, (63.25)% of respondents answered that high intake of salt increases the risk of MI and only (42.8%) of respondents told that High sugar foods and beverages is a risk factor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Regarding preventive measures, (60%) respondents told that maintaining healthy weight followed by consuming low fat and cholesterol diet (84.4%), avoiding stress (42.4%), controlling blood pressure (90%), controlling diabetes (72.8%), quitting smoking (83.2%) and engaging regular exercise (62.4%) are the preventive measures of MI. Regarding complications, almost all participants said that sudden death (94.4%) is a complication of MI, while sudden cardiac arrest (60.8%). Only (47.6%) answered that heart failure is a complication of MI.\u003c/p\u003e\n\u003cp\u003eTable 4 shows knowledge distribution of MI components to identify specific areas contributing to overall knowledge. The mean scores and standard deviations of four key knowledge components were described. Signs \u0026amp; symptoms, preventive measures, risk factors, and complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4; Knowledge distribution of MI Components\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComponent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Std.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDeviation (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65%;\"\u003e\n \u003cp\u003eSigns \u0026amp; Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13%;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65%;\"\u003e\n \u003cp\u003eRisk Factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13%;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65%;\"\u003e\n \u003cp\u003ePreventive measures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13%;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65%;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13%;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong these, the lowest mean score was observed for knowledge of signs and symptoms (mean = 0.46, SD= 0.499). This was followed closely by preventive measures (mean = 0.47, SD=0.50), while slightly higher mean scores were noted for knowledge of risk factors and complications (both at 0.50, SD= 0.501).\u003c/p\u003e\n\u003cp\u003eTable 5 presents the associated factors of MI. Knowledge was significantly associated with factors such as younger age (OR= 3.2; CI 1.5,7.1)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5: Factors associated with Knowledge of MI among patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"912\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=332)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(N=88)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnadjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026le;60 years\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;60 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e99 (57.6)\u003c/p\u003e\n \u003cp\u003e18 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57 (22.9)\u003c/p\u003e\n \u003cp\u003e31 (18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2(01,0.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.2 (1.5,7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.002\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52(54.2)\u003c/p\u003e\n \u003cp\u003e65 (42.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e73 (42.2)\u003c/p\u003e\n \u003cp\u003e60 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.6 (0.3,1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.2 (0.5,2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003cp\u003eSinhala\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e101 (46.1)\u003c/p\u003e\n \u003cp\u003e16 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (45.8)\u003c/p\u003e\n \u003cp\u003e89 (57.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.8 (0.3,1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.6 (0.8,5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eType of family\u003c/p\u003e\n \u003cp\u003eNuclear\u003c/p\u003e\n \u003cp\u003eExtended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e96 (54.9)\u003c/p\u003e\n \u003cp\u003e21 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e79 (45.1)\u003c/p\u003e\n \u003cp\u003e54 (72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.3 (0.1,0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.0(1.9,8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003cp\u003eO/L and below\u003c/p\u003e\n \u003cp\u003eAL and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89 (65.4)\u003c/p\u003e\n \u003cp\u003e28 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47 (34.6)\u003c/p\u003e\n \u003cp\u003e86 (75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.8 (3.3,10.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2 (0.1,0.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (66)\u003c/p\u003e\n \u003cp\u003e49 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35 (34)\u003c/p\u003e\n \u003cp\u003e98 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.8(2.2,6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.7 (0.3,1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eMonthly income\u003c/p\u003e\n \u003cp\u003e\u0026lt; LKR 60,000\u003c/p\u003e\n \u003cp\u003e\u0026ge; LKR 60,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e67(36%)\u003c/p\u003e\n \u003cp\u003e50(78.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119(64%)\u003c/p\u003e\n \u003cp\u003e14(21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.3 (3.2,12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4 (0.1,1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eRegular exercises\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43(62.3%)\u003c/p\u003e\n \u003cp\u003e74(40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26(37.7%)\u003c/p\u003e\n \u003cp\u003e107(59.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4 (0.2,0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.5 (0.7,3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4211%;\"\u003e\n \u003cp\u003eReceived information\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1053%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105(55%)\u003c/p\u003e\n \u003cp\u003e12(20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7895%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e86(45%)\u003c/p\u003e\n \u003cp\u003e47(79.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.7 (0.1,0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.3 (1.0,5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.89474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.036\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003enuclear family type (OR= 4.0 CI 1.9,8.4), higher educational level (OR=0.2; CI 0.1,0.5) and receiving information about MI (OR=2.35; CI 1.0,5.2).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn our study, the majority of participants were aged between 41 and 60 years, constituting 54% (n\u0026thinsp;=\u0026thinsp;135) of the sample. This finding is consistent with a study conducted in Kathmandu, Nepal, where more than half (54.0%) of the respondents belonged to the 40\u0026ndash;59 age group (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Similarly, a Sri Lankan study also reported that nearly (85%) of participants were with the 45\u0026ndash;50 age group being the most represented(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A study conducted in West Bengal showed that majority age group was (46.11%, n\u0026thinsp;=\u0026thinsp;83) belong to the age group 51\u0026ndash;60 years(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These findings collectively suggest that middle-aged and older adults constitute the predominant group affected by MI.\u003c/p\u003e\u003cp\u003eThe findings of our study indicated that the most common source of information about MI was healthcare professionals, with (60.4%) of participants received information from doctors and nurses. This shows that the dissemination of knowledge that provides information to many participants occurs through doctors and nurses. Media sources such as television and radio were (49.6%), followed by internet (30%). Notably, only (16.8%) responded reported receiving information from family members. In comparatively, a study conducted in Nepal, the majority participants reported family members (72.2%) as their primary source of information, followed by healthcare workers (69.6%) and television (51.9%). This indicates a stronger role of familial communication in Nepal context (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In contrast a study conducted in Saudi Arabia showed a different patten. Television was reported as a source by only (13.9%) of participants, while internet use (28%) and healthcare professionals (21%) were less prominent compared to our study (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the present study, more than half of the participants were unable to correctly define MI, only (30.0%) accurately identified MI as the death of cardiac muscles due to inadequate blood supply.\u003c/p\u003e\u003cp\u003eAdditionally, (16.4%) incorrectly associated MI with heart failure, and (1.2%) mistook it for a stroke. Comparatively, in a study conducted in Nepal, (32.9%) correctly identified MI as heart muscle death, (16.5%) associated it with heart failure, (10.5%) confused it with stroke, and (40.5%) responded with \u0026ldquo;Don\u0026rsquo;t know\u0026rdquo;(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These findings indicate a generally low level of understanding regarding nature of MI in both populations, emphasizing the need for improved public education to enhance awareness and recognition of MI. This study also highlights the need to improve public knowledge of MI signs and symptoms (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlso, a study conducted in West Sumatra found that (90.1%) participants knew that chest pain is a common symptom of MI. However, knowledge was limited in case of discomfort in the arm/shoulder as a symptom(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The Kashmir study showed moderate awareness of chest pain (40%), chest pain radiating to the jaw (44.7%) and arms (54%), and higher recognition of nausea (60.7%), indigestion (60.3%), and shortness of breath (62%). (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These findings highlight the need to improve public knowledge of MI symptoms across different populations. The study conducted in Riyadh Saudi Arabia found high awareness of symptoms such as jaw pain (90%), chest pain (85.9%), and fatigue (85.8%). The study also revealed strong awareness of major risk factors (91.6%) recognized smoking and obesity, and (85.3%) acknowledged the role of family history in increasing MI risk (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Similarly, a study conducted in Afghanistan, reported that only( 39.8%) were aware of obesity, (38.5%) recognized physical inactivity (33.8%) identified family history as risk factors of MI(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eOur study found that high awareness of major MI risk factors. However, knowledge was notably lower for lifestyle-related, with only (48.8%) recognizing a sedentary lifestyle, (42.8%) identifying obesity, (37.2%) acknowledging stress, and (46.8%) aware of family history as risks. Dietary risk awareness was moderated with (63.2%) were aware of the risks associated with high salt consumption. In contrast, a study reported generally high awareness of risk factors such as high blood pressure and obesity (91.1%), high cholesterol (77.2%), stress (88.6%), diabetes (84.8%), smoking and alcohol consumption (84.8%), and sedentary lifestyle (73.4%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These differences highlight gaps in knowledge about lifestyle and familial risks in the current population, emphasizing the need for targeted education to address these areas(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlso, a research conducted in Mogadishu, Somalia, presented that only less than half of respondents identified hypertension (48.9%), diabetes (45%), dyslipidaemia (45%) and obesity (43.8%) as risk factors and awareness of lifestyle related risks such as being physical inactivity (41.2%), excessive salt consumption (43.8%) was low(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This contrast with the findings of our study.\u003c/p\u003e\u003cp\u003eIn our study, (46.8%) of participants demonstrated good knowledge about MI, while (53.2%) had poor knowledge. Compared to a study conducted among adults in West Bengal, where (25%) had good knowledge, (56.11%) had average knowledge, and (18.89%) had poor knowledge, the proportion of poor knowledge in the current study is notably higher. This suggests a concerning gap in awareness, particularly in recognizing risk factors, early symptoms, and preventive measures of MI (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe present study revealed that several significant factors influencing the level of knowledge regarding MI. Age, educational attainment, family type, employment status, and income were all significantly associated with participants' knowledge levels. Age (\u0026lt;\u0026thinsp;60 years), those with education beyond Ordinary level, employed participants, individuals from nuclear families, and those earning a monthly income above LKR 60,000 exhibited higher levels of MI awareness. These findings align with Saudi Arabia study, who reported that higher education and income were significantly associated with MI awareness (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Although their study found that males had lower awareness than females, our study found no statistically significant gender difference. Similarly, another study conducted with Saudi Arabia population found that the age group 35\u0026ndash;44 showed higher awareness compared to younger and older groups, with significant associations also found for marital status and income level paralleling our findings(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). South Korea further supports this, emphasizing the role of demographic factors such as age, education, and income in influencing awareness and adherence to MI preventive behaviours, including lifestyle modifications and medication compliance (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Furthermore, a recent study in Riyadh, Saudi Arabia found that significant associations between MI knowledge and gender, age, education, and marital status (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe strength of our study was that we used a structured, pre-tested, face and content validated questionnaire to ensure consistency in data collection, data was collected through an interviewer-administered questionnaire that translated to local languages (Sinhala/Tamil), reduces the risk of incomplete responses. Also, the selected tertiary care hospital that serves a large and diverse patient population, representing a wide range of cultural and educational backgrounds was a key strength of our study.\u003c/p\u003e\u003cp\u003e Our study limitations included its\u0026rsquo; cross-sectional study design of this study which precluded confirmation of any causal associations and the study was conducted at a selected tertiary care hospital, which might limit the generalizability of the findings to other settings.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur findings suggest the knowledge was comparatively low on certain risk factors such as family history, obesity, stress, and high sugar consumption as risk factors. Half of participants demonstrated good knowledge regarding preventive measures. However, knowledge of the importance of stress avoidance as a preventive measure was low. Most participants were aware of serious complications like sudden death and cardiac arrest, recognizing their life-threatening nature. This highlights the need for targeted health education on the current preventive measures to be taken including family-oriented sessions to improve early recognition MI. Future studies should be conducted over the long-term including other regions of Sri Lanka to evaluate the impact of educational interventions and support services on patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e All participants provided written informed consent before participation. The study adhered to ethical guidelines for research involving human subjects. This study was conducted following ethical principles and approved by the REC of the Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. (Ethical Approval No. REC/NSG 033)\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding was received for this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eP.P Significant contributed to the conception and design of the study, performing the literature review, data collection, data analysis, results interpretation, reviewing successive write of the manuscript. S.G Significant contributed to the supervise the study and design of the study, results interpretation, data cleaning and data analysis, writing successive revisions of the manuscript, and approving the final manuscript. All authors reviewed, edited, and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the Administration and healthcare staff of the selected tertiary care hospital for their support during the data collection. We are also grateful to the patients who generously gave their time to participate the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData available on the request from the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbed MA, Khalil AA, Moser DK. 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Vasc Health Risk Manag 2024; Volume 20:13\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/VHRM.S448220\u003c/span\u003e\u003cspan address=\"10.2147/VHRM.S448220\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlsaab SM, Almutairi AM, Alsaadi GK, Altokhais ZA, Alabdulqader SH, Alnofal WY, et al. Awareness of myocardial infarction symptoms and risk factors in Saudi Arabia: A Cross-Sectional Study. Cureus. 2023https://doi.org/10.7759%2Fcureus.50092.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Awareness, Myocardial Infarction, Primary Prevention, Risk Factors, Signs and Symptoms, Sri Lanka","lastPublishedDoi":"10.21203/rs.3.rs-7826783/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7826783/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMyocardial infarction (MI) is a major global health concern and one of the leading causes of morbidity and mortality. This study aimed to describe knowledge of MI and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA descriptive cross-sectional study method was conducted in cardiology clinic at a selected tertiary care hospital of Colombo district, Sri Lanka using systematic random sampling. A pretested interviewer administered questionnaire was used for data collection. Logistic regression models were used to determine the association between knowledge and relevant factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean age of the patients was 52.56 years (SD=12.96); range 18 to 89). Good knowledge of MI was observed in 46.8% (n= 117) of participants. The knowledge mean score was lowest for signs and symptoms (0.46, SD= 0.499) and preventive measures (0.47, SD=0.50), while knowledge of risk factors and complications (both 0.50, SD= 0.501) were comparatively higher. Only (30%, n=75) correctly identified MI as the death of heart muscle. Stress (42.4%, n=106) avoidance was less recognized preventive measure. Knowledge was significantly associated with factors such as younger age, nuclear family type, higher educational and receiving information about MI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003e– Overall, less than half of the participants demonstrated good knowledge of MI. Targeted public educational programs are needed to improve knowledge of MI. Future research should include diverse populations and assess the long-term impact of educational interventions.\u003c/p\u003e","manuscriptTitle":"Knowledge of Myocardial Infarction and associated factors among patients attending a selected tertiary care hospital in Colombo district, Sri Lanka - A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 05:52:50","doi":"10.21203/rs.3.rs-7826783/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ebb47c3e-374c-4705-b9f3-2813e461b8f2","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-14T12:24:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 05:52:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7826783","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7826783","identity":"rs-7826783","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}