Title

A project report submitted in partial fulfilment of the requirement of the clinical

pharmacy course.

Final Professional (Pharm. D)

By

NAME

Roll No.

(SESSION 2017-2022)

Akhtar Saeed College of Pharmaceutical Sciences,

Lahore, Lahore.
 DEDICATION

“Feeling honourable and proud to dedicate my work to my family

especially my beloved parents and dearest siblings”
 TABLE OF CONTENTS

Acknowledgement………………….………………………………………. Ⅰ
Abstract……………………………………….……………………………. Ⅱ
INTRODUCTION…………………………………….…………………….1
METHODOLOGY…………………………………………….……………4
Study Design……………………….……………………………….…………….….…….4

Study Population………….……….…………………………………….…….……….…4

Ethical Consideration…………....………………………………………….….…….…4

Inclusion Criteria……………………………………………………………. ….…….…4

Exclusion Criteria………….………………………………………….……...…….…….5

Procedure…………………………………………………………………….…...….…….5

Sample size………………………...……………………………………….……….……...5

Questionnaire Development……….….…………………………………………….…….6

Method of data collection……….…….…………………………………………….…….6

Validation and Reliability……….…….……………………………………………...…....7

Statistical Analysis Tool………….…………………………………………………….……7

RESULTS……….………………………………………………….………8
Socio-demographic characteristics of Participants……………………….……….…9

Table 1. Socio-demographic characteristics of Participants…………………….…10

Awareness and Preferences towards E-learning………………………….…………11

Table 2. Awareness and Preferences towards E-learning……………………….…12

Attitudes of Study participants towards E-learning………………………………...13

Table 3. Attitudes of Study participants towards E-learning……………………...14

Perceived barriers to E-learning………………………………………………….….15

Table 4. Perceived barriers to E-learning………………………………………….16

DISCUSSION…………………………………….………………………….17
CONCLUSION………………………………………………………………….….19

LIMITATIONS OF THE STUDY………………………………………………….20

QUESTIONNAIRE…………………………………………………………………21

REFERENCES………………………………………………………….……….….25
 STUDENT’S DECLARATION

I, [Name] D/O [Father’s Name] Final prof. (Doctor of Pharmacy) student of Akhtar Saeed
College of Pharmaceutical Sciences, Lahore, hereby declare that the research work entitled
“Title Name” is done by me. I also clarify that nothing has been incorporated in this research
work without acknowledgement and that to the best of my knowledge and belief it does not
contain any material previously published or written by any other person or any material
previously submitted for a degree in any university where due reference is not made in the
text.

SEHRISH ZEHRA
 SUPERVISOR’S DECLARATION

It is hereby certified that work presented by [Name] in the project titled “Title of the
Project” is based on the research study conducted by the candidate under my supervision.
No portion of this work has been formerly been offered for a higher degree in this university
or any other institute of learning and to the best of the author’s knowledge, no material has
been used in this thesis which is not his work, except where due acknowledgement has been
made. She has fulfilled all the requirements and is qualified to submit this report in partial
fulfilment for the requirement of clinical pharmacy course (Final Professional, Pharm.D) in
Akhtar Saeed College of Pharmaceutical Sciences, Lahore.

Supervisors

Ms. Muzna Suhail

Pharm. D, M.Phil. (Pharmacy Practice)
Punjab University College of Pharmacy,
University of the Punjab.
Lecturer
Akhtar Saeed College of Pharmaceutical Sciences, Lahore.
 CERTIFICATE

It is hereby certified that work presented by SEHRISH ZEHRA D/O HAIDER RAZA the
project “Medical Education and E-learning During Covid-19 Pandemic: Awareness,
Attitudes and Barriers Among Pharmacy Students in Lahore: A Cross-Sectional Study
in Lahore” has been fully successfully presented/defended and is accepted in its present
form as satisfying the requirement for the clinical pharmacy course (Final professional,
Pharm.D) in Akhtar Saeed College of Pharmaceutical Sciences, Lahore.

Candidate’s Name and Signature

Supervisor’s Name and Signature Ms. Muzna Suhail

Head of the Department, ACPS Mr. Kashif Mehmood

Vice-Principal, ACPS Dr. Qurat-ul-Ain

Principal, ACPS Prof. Dr. Tahir Javed Khan

Date _____________________
 Student Supervisor Agreement

Project Title “Title Name”

This research project is the intellectual property of the supervisor. All material of this
research project belongs to the supervisor. No part of this report could be used or submitted
for any type of publication anywhere other than the supervisor. If I’ll contribute till the date
manuscript published then I’ll be the Co-author otherwise my name must be excluded from
the submitted manuscript.

I agree, to the best of my ability, to act in accordance with the above agreement.

Student Signature: _________________________ Date: __________________

Supervisor(s) Signature: _____________________ Date: __________________

Witness: 1. _________________________

2. _________________________
 ACKNOWLEDGEMENTS

In the name of ALLAH, the Most Beneficial and the Most Merciful.

ALHAMDULI LLAH, all praises to ALLAH, WHO conferred me with His

countless blessings and empowered me to complete my Clinical Pharmacy

research work successfully. Countless salutations to the HOLY PROPHET

HAZRAT MUHAMMAD (P.B.U.H) symbol of humanity, perfection, and a

book of guidance for the whole universe.

I pay my sincere gratitude to my research supervisor Ms. Muzna Suhail

Lecturer, Akhtar Saeed College of Pharmaceutical Sciences, Lahore, for her
valuable guidance, deep wisdom, way of motivation, extended support and
assistance throughout the study.

I am highly indebted to Prof. Dr. M. Tahir Javed (Principal, ACPS) and Dr

Qurat-ul-Ain (Vice-Principal, ACPS) for their full co-operation in the course
of my research work.

[Insert your name here]

 Abstract

Introduction:

Ischemic heart disease (IHD) is a cardiovascular illness that affects heart

and blood vessels. This study was designed to evaluate the patient’s
perceptions about illness, patient’s beliefs about the reasons that produced
the illness, impact of illness perception on medication adherence among
persons with ischemic heart disease (IHD) in a community setting.

Methodology:

A cross-sectional study was conducted at various hospitals in Lahore. A

sample of 385 patients with IHD, who visited the cardiac clinic for routine
review, took part in the study. The participants completed a self-developed
Questionnaire which was split into 4 sections as follows: 1) Title,
Description and Purpose of the study, 2) Socio Demographic data of the
participants, 3) To examine the impact of illness perception on a
continuous scale, 4) To check the medication adherence using a Morisky
Green Levine scale. The data were analysed using SPSS Statistics.
Descriptive statistics was used to calculate the frequencies and
percentages.

Result:

Patients reported high levels of disease understanding and they were

convinced that they were able to control their condition by themselves and
with appropriate treatment. With reference to level of illness perception,
patients who were married (56.1%), had no schooling to primary
education (61.8%), were unemployed (51.9%) and those suffering from
myocardial infarction (57.7%) depicted a higher level of threatening illness
perception level. With reference to level of adherence, females were non-
adherent to therapy than males (p = 0.046). Also, unmarried patients were
more non-adherent to therapy than married ones (p <.001). Educational
status also played an important part with level of adherence (p = 0.021).
The relationship between medication adherence and illness perception was
found significant (p = 0.019).

Conclusion:

Health care professionals should raise the awareness of illness perception

and medication adherence in community. More the people are adhered to
medication more chances are there to achieve standard treatment
protocols. Illness perception also plays vital role in this regard.
Keywords
Illness perception; Medication adherence; Ischemic heart disease
CHAPTER 1

INTRODUCTION
The World Health Organization (WHO) estimates that 17.5 million people died 

from 

Cardiovascular disease globally in 2012, with IHD accounting for 7.4 millions o

f these deaths

(Nur, 2018). IHD is a cardiovascular illness that affects the heart and blood

vessels. It is an abnormal condition defined by heart and blood vessel

dysfunction caused by constriction of the interior layer of blood vessels and a

decrease in blood flow to the heart.(Kholid Rosyidi Muhammad Nur, 2017).

The highest burden of IHD occurs in developing countries including Pakistan as

a result of epidemiological transition: greater lifespan of individuals,

urbanisation, and lifestyle changes.(Roos, Myezwa, & Aswegen, 2015).

Recent advancements in the medicinal and surgical care of coronary artery

disease (CAD) have significantly lowered cardiac death rates; nonetheless,

individuals with established disease remain at greater risk for cardiac event

recurrences.(Stafford, 2008).

In general, patients' perceptions of pharmacological prophylaxis, including their

expectations of treatment efficacy and perceived risk associated with their

illness, account for around 20% of the variance in medication adherence.

(Boesgaard Graversen, 2022)

 According to research, people's perceptions of illness are frequently different

from their real medical condition.(Kholid Rosyidi Muhammad Nur, 2017).

Elderly individuals are more susceptible to many illnesses and have a larger

chance of non-adherence to medicine than the younger population(Shahab Papi,

2022). Physicians often fail to realize medication non adherence in their

patients, but they can also make a significant contribution by prescribing

complex drug regimens, failing to effectively explain the benefits and adverse

effects of a medication, and failing to consider the patient's financial burden.

(Marie T.Brown)
Patient’s beliefs about the reasons that produced the sickness are also important

in how they understand and live with their illness. Chronic stress and lifestyle

variables were the most often mentioned causes in a survey of attributions for

heart disease (HD). Some generally held assumptions about CHD have also

been found to be harmful to cardiac health, according to research. The phrase

cardiac invalidism is used to describe situations in which, although having

healed physically, individuals maintain an exaggerated sense of impairment and

concern about their symptoms, fearing that overexertion could induce another

MI.(Shashivadan P Hirani, 2015) . Beliefs in invalidism have been connected to

not just psychological distress, but also an increased chance of subsequent

cardiac difficulties (Figueiras, Maroco, Caeiro, Monteiro, & Trigo, 2015).

According to a 2003 report published by the WHO, adherence rates in

developed countries average only about 50%(Marie T.Brown). Medication

adherence is essential for the treatment of chronic illnesses. According to

studies, better adherence to treatment can enhance the effectiveness of health

treatments, resulting in lower healthcare costs (Mingming Yu, 2021).

CHAPTER 2

Methodology
Ethical Consideration

This study was approved by the ethical committee of Akhtar Saeed College of

Pharmaceutical Sciences. Before conducting the research, an informed consent

was also obtained from each and every participant. Research ethics were also

taken into account, as no deception or misleading information was employed as

the basis for the study.

Study Design

A cross-sectional survey was carried out from February 2022 to June 2022. The
study's target population was Ischemic Heart Disease patients from multiple
hospitals in Lahore, for whom the impact of illness perception on medication
adherence for IHD was evaluated. All the hospitals provide clinical (in-patient
& out-patient), diagnostic and emergency services.

Study Population

The research included a total of 377 participants (n=377). All ischemic heart

disease patients were enrolled in the study from outpatient cardiology

department of different hospitals. Incomplete forms were excluded while

evaluating results.

Inclusion criteria

Patients older than or younger than 65 years were enrolled in the study. People

more than 18 years of age were included. Patients with Ischemic heart disease
(acute or chronic).

Exclusion criteria

People less than 18 years of age were excluded .Cancer patients in remission

were not eligible for the research Also patients who were terminally ill, had

mental health problems affecting cognitive functions and who failed to give the

informed consent and women who were pregnant were excluded from the

study . Patients with other cardiac diseases including valvular heart disease were

excluded from the study.

Procedure

Participants were drawn randomly from various hospitals of Lahore, both

private and public, who have IHD patients. Before the initiation of the survey,

the participants were given a full explanation regarding the purpose of this

research, and their consent to participate in the study was obtained. The

questions, which were written in both English and Urdu, were created using a

Google form and then printed out in hard copy for distribution to the study

participants who were participating in face-to-face interviews. The filled

questionnaires were collected at the moment. In some cases, patients were not

keen to participate in the study because they are not interested .

Sample Size
A total of 385 people (n=385) took part in the study. The majority of the people

came from various cities' urban and rural areas. This data has been collected

from IHD patients in different hospitals.

Raosoft Calculator® was used to calculate the sample size with a 95%

confidence level, 5% margin of error and population size of 5000000, yielding a

sample size of 385 participants for the study that was estimated to be

representative of the population of IHD patients in Lahore. Considering a 10%

dropout in mind, in order to get an optimal response ratio, a total of 410 sample

size was the final number of responses required for data collection. Different

participants were approached via various social media platforms available

online or on web.

Questionnaire Development

After reviewing already published literature and going through different

publications on Impact of illness perception on medication adherence in IHD

patients, we developed a pre-tested and refined self-developed questionnaire for

the purpose of research. The developed questionnaire was initially tested by

sending it to the supervisor in order to ensure its legitimacy, authenticity and

typography for consistency, significance and appropriateness and once it was

approved it was shared with the participants. This survey comprised of 20

questions which required not more than 4 to 5 minutes to complete. This brief

questionnaire was split into 4 sections/categories. The first section was designed
to give a brief introduction to the participant and included the title of the survey,

description of the research and the purpose of the study. The second section

assessed the respondents’ socio demographic attributes (8 Questions), while the

third section was meant to examine the impact of illness perception (8

Questions) on a continuous scale ranging from 0 (less threatening level of

illness) to 10 (high threatening level of illness)(Nur, 2018).

The fourth and final section was designed to check the medication adherence (4

Questions). In the last section, Morisky Green Levine scale is used.

Method of Data Collection

Patients from various hospitals in Lahore were approached randomly to

participate in the study. After giving an introduction regarding the topic and

purpose of research and taking consent from the respondent, the questionnaire

was given to them. Field administrator, a pharmacy student at the undergraduate

level, conducted the questionnaire by handing out the forms to the educated

patient who can grasp the questions and collecting them later or by having

elderly who could not read or write fill it out during a face-to-face interview

The filled questionnaires were collected at the moment or later at a suitable time

indicated by respondents. In some cases, the patients were not keen to

participate in the study because they were uninterested. Patients were able to

read the aim of the research study, the research title, its purpose, its objective

and their permission to participate in the study once the questionnaire was
provided to them. For ease of comprehension, the study questions were stated in

clear, simple, and well-defined words. The research coordinators were

accessible to answer any questions at any time to provide ease to the

respondents. The results were calculated by using SPSS Statistics.

Validation and Reliability

In order to make sure that the developed questionnaire was authentic and

trustworthy enough a pilot test was initially conducted on 15 participants. The

first 15 participants who responded were not included in the research when

evaluating the data collected. Once the data from these 15 participants was

collected a primary statistical analysis was run on it. Cronbach's alpha was

applied in order to measure the internal consistency and to measure the scale of

reliability of our self-developed questionnaire. It was calculated to be 0.6 that is

acceptable in the range.

Statistical Analysis Tools

Data analysis was accompanied using Statistical tools. Statistical Package for

Social Sciences (IBM SPSS, version 28.0), has been used for analysis of the

collected data. Then descriptive statistics were applied for calculation of

frequencies and percentages.

Results
A total of 385 patients were approached. After evaluating the results of the

filled questionnaires, it was found that most of the participants were females

(50.1%), were below 65 years of age (37.66%), living in urban areas (61.7%)

and were married (68.0%). even though majority had a higher education

(59.2%), majority were unemployed (56.1%) and belonged to middle class

economic status (76.6%). With regards to level of illness perception, patients

who were married (56.1%), had no schooling to primary education (61.8%),

were unemployed (51.9%) and those suffering from myocardial infarction

(57.7%) depicted a higher level of threatening illness perception level (Table 1).

Table 1. Frequency distribution of sociodemographic variables with

regards to Level of Illness Perception