Effect of an Educational Workshop on Heart Disease Prevention Knowledge of
Employees in Rural, Northeast Missouri: A Pilot Study

Megan Temme
Samantha Goode
Dierdra Fausto
Jonathan Jones
Truman State University, Kirksville, MO


Adult employees participated in an hour-long heart attack prevention workshop that covered the causes of heart attacks, prevention techniques including proper diet and exercise regimens, and symptoms and warning signs of a heart attack. Prior to and immediately following each workshop, the participants completed a heart attack prevention knowledge test. Results indicated that the mean knowledge post-test score for all participants was significantly higher than their mean knowledge pre-test score. It seems that a brief workplace heart attack prevention workshop could improve knowledge of employees in different types of work settings.

Keywords Heart Disease, Prevention, Workshop, Employees, Rural


Heart Disease and Risk Factors

Heart disease is the number one worldwide killer of men and women, and it kills more people than all forms of cancer combined (Mayo Clinic, 2009). Heart disease is a term used to describe a variety of specific heart conditions. Heart failure, heart arrhythmias, and coronary artery disease, including heart attacks and chest pain, are all types of heart disease (US Department of Health and Human Services [DHHS], 2009a). The most common form of heart disease is atherosclerosis. Atherosclerosis is most frequently caused by environmental factors such as unhealthy diet, lack of exercise, being overweight, and smoking (Mayo Clinic, 2009). Uncontrollable risk factors for heart disease include: heredity, age, and gender, specifically those of the male gender; persons of the Mexican, American Indian, Native Hawaiian, and Asian-American race; and persons aged 65 and over (American Heart Association, n.d.). Controllable risk factors for heart disease include tobacco smoke, both first and secondhand smoke, high blood cholesterol, high blood pressure, physical inactivity, being overweight or obese, consumption of a substantial amount of alcohol, and having uncontrolled diabetes mellitus (American Heart Association, n.d.).

African-Americans, followed closely by Caucasian, Hispanic, American Indian/Alaskan Natives, and Asian and Pacific Islanders are considered at-risk populations (Division for Heart Disease and Stroke Prevention, 2008). It was reported that 78 percent of African- American women, 73 percent of Hispanic-American women, and 58 percent of Caucasian women are overweight or obese, which is a major risk factor for developing heart disease and having a heart attack (National Coalition for Women with Heart Disease, 2009). In 2005, 322,841 men died from heart disease; and an additional 9.4 percent of all Caucasian men, 7.1 percent of African-American men, and 5.6 percent of Mexican-American men were living with coronary heart disease. For men, the average age of the first heart attack was 66 years old, and half who experienced a heart attack before age 65 died within the next eight years. Of all cardiac events in men, 70 to 89 percent are sudden (Lloyd-Jones et al., 2009). Additionally, women account for 51% of the total heart disease deaths (Lloyd-Jones et al., 2009). Heart disease is the leading cause of death for women 65 years of age and older, the second leading cause of death for women ages 45-64, and the third leading cause of death in women ages 25-44 (Centers for Disease Control and Prevention [CDC], 2009).

In 2002, in the state of Missouri, 16,708 deaths were attributed to heart disease, which was the leading cause of death in Missouri (CDC, 2004). In 2007, 29.4 percent of Missouri adults had high blood pressure (Missouri Department of Health and Senior Services, 2007). In 2008, 25 percent of Missourians smoked, 65.5 percent were overweight or obese, and 27.6 percent had not reported exercising in the past 30 days (Missouri Department of Health and Senior Services, 2009). According to the National Institute for Occupational Safety and Health (NIOSH), there is not enough research to report the specific occupational risk factors for heart disease in the state of Missouri. However, NIOSH does believe that there are certain toxins present in the work environment that may negatively affect the heart. These toxins include carbon disulfide, nitroglycerin, and carbon monoxide. Of these three toxins, carbon monoxide is the most commonly encountered toxin in the workplace. Other risk factors may include environmental tobacco smoke, extreme heat or cold, stress, noise level, and shift work (CDC, 2009).

Heart Disease Prevention

There are national initiatives to reduce heart disease prevalence that include basic implementation and capacity-building programs to support primary and secondary heart disease and stroke prevention. The CDC and the DHHS have created a toolkit for heart disease prevention in the workplace. In 2002, the Heart-Healthy and Smoke-Free at Work Project was created. The program goals are to improve health of employees, prevent heart disease, and save revenue (CDC, 2008b). Through planning, implementing, tracking, sustaining population-based interventions, and using strategies that include policy, environmental elements, and systems change; this program aimed to increase heart disease prevention awareness (DHHS, 2009b). In Missouri, the state’s heart disease prevention program uses population-based strategies to increase the public’s awareness of heart disease, the urgency of prevention, and the signs and symptoms of heart disease as well as to monitor prevention strategies and programs in health care sites, worksites, and communities (DHHS, 2007).

Missouri’s heart disease prevention programs are administered and evaluated by the Missouri Cardiovascular Health Program, the Missouri Diabetes Prevention and Control Program, and the Federally Qualified Health Centers. The programs’ overarching goals are to reduce the number of people with heart disease (DHHS, n.d.). Since December 2006, there has been a dramatic increase in the number of participants in the program (CDC, 2007). However, heart disease is still the leading cause of death in Missouri (Missouri Department of Health and Senior Services, n.d.).


The purpose of this project was to train and certify Health Science undergraduate students to teach heart disease prevention educational workshops to adult employees in rural, Northeast Missouri. The reasons for this project were (a) a state-wide goal for Missouri to increase knowledge and awareness of heart disease risk and (b) health promotion programs at the worksite have been demonstrated to be effective in reducing health risk factors in employees,



A convenience sample of 55 employees who worked in various work settings (office/administrative staff in a college setting, laborers at a college physical plant, and US Army Reserve officers and enlisted personnel) was contacted and asked to participate in the heart disease prevention educational workshop and study titled “Your Heart Matters.” After IRB approval of the study and participant informed consent were obtained, 50 employees volunteered to participate in “Your Heart Matters” for a response rate of 91 percent. The office/administrative employees (10 participants) worked in the offices of an undergraduate university. The physical plant employees (7 participants) were responsible for general upkeep of the grounds, building maintenance and repair, boiler plant operation, and cleaning at a college campus. The Army Reservists (33 participants) were members of a medical platoon and participated in monthly physical training and continuing education programs at a local base. The participants were all adults between the ages of 20-65 years who lived in rural, northeast Missouri. 


Instructor Training:

In spring 2009, student instructors for the workshops were trained by an American Red Cross-certified Instructor Trainer in the American Red Cross Workplace Training: “Your Heart Matters” Module to prepare them to teach workshops to the employee participants. The American Red Cross provides consistent and reliable education and training in injury and illness prevention and emergency care. They serve families and communities through blood services, disaster relief, preparedness education, services to family members in crisis, and health and safety education. The training provided student instructors with the background and knowledge needed to understand risk reduction strategies for coronary heart disease. Specifically, the training included a content overview as well as suggested instructional techniques for teaching adults about the topics of risk factors for coronary heart disease, development of a plan to reduce risk factors for coronary heart disease, and recognition of the signals of a heart attack.

Your Heart Matters Workshop Facilitation:

In fall 2009, the student instructors taught four workshops to accommodate the work shifts of the office/administrative staff, physical plant employees, and Army Reservists. The hour-long workshop for the participants covered the following topics: coronary heart disease knowledge pre-post tests, causes of coronary heart disease, risk factors, how to reduce the risks of heart disease, and coronary heart disease knowledge. Participants also received a Food Guide Pyramid, heart disease risk assessments, as well as additional resources. This educational intervention program, based on Social Cognitive Theory, demonstrated to the participants how their behavior, their work environment, and their personal factors were interrelated. By discussing the various heart disease risk factors that the participants had in their lives, they were able to understand how risk factors are related and have an overall affect on their health.

The teaching methods used a combination of adult learning and active learning strategies. Adult learners tend to be goal-oriented, relevancy-oriented, active participants, and self-directed (Knowles, 1975). To actively engage the adult learners, the workshop consisted of traditional lecture, group discussion, individual risk assessments, and modification/synthesis of individualized potential daily lifestyle routines. Using active-learning strategies, specifically “Examine-Prepare–Take Action,” the participants were challenged to analyze new information and then apply it to solve problems in their daily lives. Addressing the multiple components that influence a person’s ability to learn helped to also meet the cultural needs of the predominately rural, Caucasian, and lower socio-economic level participants. To address these needs, student instructors used appropriate literacy level handouts and made problem situations realistic to daily life in rural America. Before teaching the class, an analysis of the various needs of adult learners was completed. After assessing their needs, the American Red Cross “Your Heart Matters” lesson plan was modified by integrating participants’ life experiences and working environments into the lesson content.


A researcher-created, pre-post test (Appendix A), based on the instructional content presented in the American Red Cross “Your Heart Matters” module, was used. The quiz consisted of 20 multiple-choice questions about risk factors for heart disease, symptoms of heart attacks, and prevention techniques such as proper nutrition and exercise. Most questions were at depth of knowledge Level 2 (skills/concepts) or Level 3 (strategic thinking). A panel of three Certified Health Education Specialists was recruited to subjectively review the instrument for face and content validity. Modifications were made based on the panel’s suggestions. After IRB approval, the instrument was piloted with a similar sample population of employees. The instrument was then modified before being administered to the participants in this study. Cronbach’s Alpha was used to determine the internal reliability (a=.627). The low alpha score can be somewhat attributed to the small sample size. Prior to and immediately following each of the workshops, the participants completed the quiz.


With the workshop as the intervention, this study followed a repeated measure design. A paired-samples t-test was used to compare mean pre-test heart attack prevention knowledge scores to mean post-test knowledge scores of all of the participants.


A paired t-test was used to determine if there was a change between the mean pre-test and post-test scores. There was a statistically significant difference between mean pre-test scores (M = 12.32; SD = 3.159) and mean post-test scores (M = 15.86; SD = 2.688). (t(49) = -6.001, p = .001) among all participants.


Heart disease is the leading cause of death in the United States and over 80 million Americans have some form of heart disease (CDC, 2008a). Approximately 10 percent of Missouri adults reported surviving a heart attack or having coronary heart disease (Missouri Department of Health and Senior Services, 2009). However, according to the CDC (2008), only 27 percent of Americans know the warning signs of a heart attack and the importance of calling 911 immediately. Therefore, this workshop was designed to educate adults about heart disease prevention techniques and symptoms of a heart attack. Since adult learners are goal-oriented and want practical, applicable information, the workshop was structured to include both lecture and interactive activities such as writing personal goals and creating a balanced meal plan. Following the completion of the workshop, participants gained knowledge about heart attack prevention techniques.

Although the state of Missouri is making progress on achieving the goals of increasing heart disease prevention through diabetic and cardiovascular collaborative activities focusing on general public awareness about heart disease, this study’s participants’ knowledge about heart disease prevention could still be improved. Significant gains in knowledge among the study’s participants may have been attributed to the single, unified message that was presented at the workshop.

Because of small sample size and selection of participants from clerical and service job categories, it may be difficult to generalize these results. The reliability could be improved by developing three distinct constructs within the assessment instrument. Three dominant themes (nutrition, physical activity, and general prevention information) emerged from the assessment tool but were not divided into three separate constructs. Furthermore, the test-like assessment tool may not be the best representation of adult learners’ knowledge. Utilizing a pretest-posttest control group design may also improve program evaluation efforts.

A large percentage of Missourians are overweight or obese (Missouri Department of Health and Senior Services, 2009). Because heart disease is so prevalent, recommendations for healthy living and prevention strategies are essential. The participants possessed similar heart attack prevention knowledge as the general public before the workshop; following the workshop, participants had increased their heart attack prevention knowledge. Based on the results of this pilot study, it is recommended that a heart attack prevention workshop be provided to all administrative and clerical/service employees in order to teach and reinforce heart attack prevention techniques. If sound learning theories are applied, health education workshops can be an effective method to increase immediate knowledge among adult learners. Interactive teaching techniques and application-based, problem-solving strategies seem to engage the adult learner and aid in their understanding of the material.

Appendix A: Pre-Post Quiz - Your Heart Matters Heart Attack Prevention Knowledge

  1.  Which of the following is the leading cause of death in the United States
    1. Heart Disease
    2. Stroke
    3. Accidents
    4. Cancer 
  2.  On a Nutrition Food label, which of the following is considered “low”
    1. 2%
    2. 5%
    3. 10%
    4. 15%
  3. One benefit of physical activity is
    1. Increased blood pressure
    2. Decreased HDL
    3. Increased LDL
    4. Decreased stress
  4.  Heart Disease affects more than ____ Americans
    1. 10 million
    2. 15 million
    3. 20 million
    4. 25 million
  5. Plaque that builds up in the bloodstream and narrows the arteries limits the flow of oxygenated blood to the heart is known as
    1. Angina
    2. Heart Attack
    3. Heart Disease
    4. Atherosclerosis
  6.  If you think someone is having a heart attack, you should immediately
    1. Lay the person on their side
    2. Have the person take deep breaths
    3. Call 911
    4. Have the person drink water
  7.  Which of the following is a signal of a heart attack
    1. Pain spreading to the legs
    2. Flush, red colored skin
    3. Denial or feeling of impending doom
    4. Abdominal cramps
  8.  Women have a increased risk of a heart attack after
    1. Childbirth
    2. Breastfeeding
    3. Menopause
    4. Age 68
  9. When beginning an exercise plan, a person should
    1. Write a goal
    2. Exercise until it hurts
    3. Focus on at least two areas at a time
    4. Start just slightly below your last peak performance level
  10.  According to the American College of Sport Medicine, a person should exercise
    1.  30 minutes of moderate activity 3 times a week
    2.  30 minutes of moderate activity 5 times a week
    3.  30 minutes of vigorous activity 3 times a week
    4.  30 minutes of vigorous activity 5 times a week
  11.  According to the Center for Disease Control and Prevention (CDC), how many servings of fruit and vegetables should a person eat per day
    1.  3 servings
    2.  5 servings
    3.  7 servings
    4.  9 servings
  12.  Chest pains that persist and last longer than ____ minutes is a signal of a heart attack
    1. 1-2
    2. 3-5
    3. 6-7
    4. 8-10
  13. Controllable risk factors for heart disease include which of the following
    1. Gender
    2. Family History
    3. Smoking
    4. Age
  14.  On a Nutrition Fact label, ___ is considered “high”
    1. 20%
    2. 30%
    3. 40%
    4. 50%
  15.  Which of the following is a signal of a heart attack
    1. Shortness of breath
    2. Slurred speech
    3. Blurred vision
    4. Headache
  16.  When writing a “SMART” goal, the S stands for
    1. Specific
    2. Sustainable  
    3. Skill
    4. Simple
  17.  Which of the following is an uncontrollable risk factor for heart disease
    1.  Smoking
    2.  High Blood Pressure
    3.  Ethnicity
    4.  Diabetes
  18.  To lose weight, which of the follow must be true
    1. a person exercised for 45 minutes a day, five days a week
    2. caloric intake is less than caloric output
    3. a person has a gym membership
    4. a person ate a low-carb diet
  19.  Which of the following is considered the “good” cholesterol
    1. High Density Lipids
    2. Low Density Lipids
    3. Medium Density Lipids
    4. There is no “good” cholesterol
  20. Which of the following statements is true
    1. Men have an earlier heart disease onset than women
    2. Women have an earlier heart disease onset than men
    3. There is no difference between men and women onset age
    4. Onset age of heart disease has not been studied




American Heart Association. (n.d.) Risk Factors and Coronary Heart Disease. Retrieved January 19, 2010 from http://www.americanheart.org/presenter.jhtml?identifier=4726.

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Center for Disease Control and Prevention. (2007). State program: Missouri Basic Implementation. Retrieved February 25, 2010 from http://www.cdc.gov/DHDSP/state_program/mo.htm.

Center for Disease Control and Prevention (2008a). Preventing Chronic Diseases: Investing Wisely in Health Preventing Heart Disease and Stroke. U.S. Department of Health and Human Services. Retrieved October 7, 2009 from http://www.cdc.gov/chronicdisease/resources/publications/fact_sheets/pdf/dhdsp.pdf

Center for Disease Control and Prevention. (2008b). Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit. Retrieved February 25, 2010 from http://www.cdc.gov/dhdsp/library/toolkit/.

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Division for Heart Disease and Stroke Prevention (CDC). (2008). Heart Disease Fact Sheet. Retrieved April 20, 2009 from http://www.cdc.gov/DHDSP/library/fs_heart_disease.htm

Knowles, M. (1975). Self-Directed Learning. A Guide for Learners and Teachers. New York: New York. Association Press.

Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, B., Flegal, K., Ford, E., et al. (2009). Heart Disease and Stroke Statistics- 2009 Update: A report from the American Heart Association Statistics Committee and Stroke statistics Subcommittee. Circulation. Retrieved January 3, 2010 from http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.191261v1

Mayo Clinic Staff. (2009). Heart disease. Retrieved April 26, 2009 from htpp://www.mayoclinc.com/health/heart-disease/DS01120

Missouri Department of Health and Senior Services. (2007). Behavioral Risk Factor Surveillance Survey. Retrieved October 7, 2009 from http://www.dhss.mo.gov/brfss/index.php.

Missouri Department of Health and Senior Services (2009). Behavioral Risk Factor Surveillance System: 2008 Key Findings. Office of Epidemiology. Jefferson City, MO. Retrieved October 7, 2009 from http://www.dhss.mo.gov/brfss/2008_BRFSS_Key_Findings_Report.pdf.

Missouri Department of Health and Senior Services (n.d.). Missouri Heart Disease Data: DHSS Heart Disease Data Profile. Retrieved February 25, 2010 from http://www.dhss.mo.gov/HeartDisease/

National Coalition for Women with Heart Disease. (2009). Women & heart disease fact sheet. Retrieved September 28, 2009 from http://www.womenheart.org/resources/cvdfactsheet.cfm

US Department of Health and Human Services. (2007). State program: Missouri basic implementation. Retrieved April 27, 2009 from http://www.cdc.gov/DHDSP/state_program/mo.htm

US Department of Health and Human Services. (2009a, February 2). Heart Disease. Retrieved January 19, 2010 from http://www.womenshealth.gov/faq/heart-disease.

US Department of Health and Human Services. (2009b). National Heart Disease and Stroke Prevention Program. Retrieved April 14, 2009 from http://www.cdc.gov/DHDSP/state_program/index.htm

US Department of Health and Human Services (n.d.) Reducing the Burden of Disease. Retrieved February 25, 2010 from http://www.healthierus.gov/step/summit/prevportfolio/prgrams/heart_disease_stroke.htm#Missouri.


Acknowledgement: The training portion of this project was funded through a Project Grant from the National Office of Eta Sigma Gamma National Professional Health Education Honorary.


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