14 | pISSN: 1858-3598  eISSN: 2502-5791 

 

Jurnal Ners  
Vol. 15, No. 1, April 2020 
http://dx.doi.org/10.20473/jn.v15i1.17628 

This is an Open Access article distributed 
under the terms of the Creative Commons 

Attribution 4.0 International License  

Original Research 

Self-Efficacy and Health Status in Coronary Artery Disease Patients 

Wantiyah Wantiyah, Mochamad Riko Saputra, and Fitrio Deviantony 

Faculty of Nursing, Universitas Jember, East Java, Indonesia 

ABSTRACT 

Introduction: Coronary Artery Disease (CAD) impairs all aspects of the patient's 
life due to the decrease in physical function and lower quality of life, indicating an 
overall decreased health status. Self-efficacy as a psychological factor plays an 
important role in individuals maintaining a healthy lifestyle and improving their 
health status. The aim of this study was to analyze the correlation between self-

efficacy and the health status of coronary artery disease patients. 

Methods: This study used an observational analytic research design with a cross-
sectional approach. This study involved 112 respondents who were coronary 
artery disease patients in RSD Dr. Soebandi Jember obtained through the incidental 
sampling method. The data was collected using Cardiac Self-Efficacy (CSE) and 
Seattle Angina Questionnaire (SAQ). The data analysis used the Spearman rank test 
with a 95% CI. 

Results: The results showed that there was a significant relationship between self-
efficacy and health status (p = 0,001, r = 0.307, α = 0,05). Self-efficacy was in good 
category (71,41 points) while health status was also in the good category (79,56 
points). 

Conclusion: The low positive correlation between the two variables shows that 
the higher the value of self-efficacy, the higher the value of health status. Good self-
efficacy through healthy living behaviors can increase the health status of coronary 
heart disease patients. It is important for nurses to improve the psychological 
aspect of the patients including self-efficacy when optimizing their self-care and 
health status. 

ARTICLE HISTORY 

Received: January 21, 2020 
Accepted: February 24, 2020 

KEYWORDS 

coronary artery disease; 
self-efficacy; health status 

CONTACT 

Wantiyah Wantiyah 
 wantiyah.psik@unej.ac.id 
 Faculty of Nursing, 
Universitas Jember, East 
Java, Indonesia 

Cite this as:  Wantiyah, W., Saputra, M, R., & Deviantony, F. (2020). Self-Efficacy and Health Status in Coronary Artery 
Disease Patients. Jurnal Ners, 15(1), 14-18. doi:http://dx.doi.org/10.20473/jn.v14i1.17628 

INTRODUCTION  

Coronary artery disease (CAD) is one of the most 
prevalent killer diseases in the world. The most 
common manifestations of underlying coronary heart 
disease are the presence of angina and myocardial 
infarction. Patients often experience symptoms of 
distinctive pain in the chest that spreads to the neck, 
jaw, ears, arms, and wrists, and possibly to the 
shoulder blades, back or abdomen. In connection with 
the effects of pain that are felt to be subjective, this 
can lead to psychological limitations such as anxiety 
arising from the sudden onset of illness and a fear of 
sudden death (Beltrame, 2017). Due to the feeling of 
pain, the physical restrictions, social disability, 
anxiety and depression, CAD patients are very 
vulnerable to a decline in health status (De Smedt et 
al., 2015; Le, Dorstyn, Mpfou, Prior, & Tully, 2018). 

The symptom-based burden of CAD becomes the 
focus of attention because it is an impact that is felt 
directly by the patient (Stahle & Cider, 2018). The 
impact of the symptoms can cause physical 
limitations in terms of walking, climbing the stairs 
and other daily activities (Suputra, 2015). Healthy 
behavior must still be applied in order to maintain the 
stability of the health status of patients with heart 
disease (Nuraeni, 2016). Because CAD threatens the 
lives of sufferers in an ongoing manner, it needs there 
to be a good management of health continuously. CAD 
can be prevented through healthy lifestyle behaviors 
(Hendiarto, 2014). The psychosocial construct that 
plays a role in healthy behavior is self-efficacy. It is a 
strong predictor of the ability to adopt healthy 

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http://dx.doi.org/10.20473/jn.v14i1.17628


JURNAL NERS 

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lifestyle changes (Bailey, Kashani, Eliasson, & 
Vernalis, 2013). Cardiac self-efficacy in cardiac 
patients is a specific measure of a patient's confidence 
in his capacity to perform activities that may be 
affected by the symptoms and complications of 
cardiovascular disease (Barham, Ibraheem, & Zyoud, 
2019). Self-efficacy makes a difference in how 
individuals feel, think and act. The level of specific 
self-efficacy in cardiovascular health is related to 
important behavioral determinants of cardiovascular 
health such as a high-fat diet, physical activity, 
smoking cessation and high blood pressure control 
through active stress management (Wigger, 2011). In 
this case, self-efficacy can influence health behavior 
and chronic disease management in many chronic 
disease settings (Sarkar, Ali, & Whooley, 2007). 
Healthy behavior, as a major factor, can reduce the 
risk of disease from becoming more severe and 
increase the success of any treatment and surgery 
that is to be performed (Nuraeni, 2016) 

Research findings in the United States show that 
on average, CAD patients have less self-efficacy. This 
low level of self-efficacy is associated with the risk of 
poor health management (Sarkar, Ali, & Whooley, 
2009). Poor health management behavior is also 
indicated by poor dietary arrangements and irregular 
control after returning home following 
hospitalization (Wantiyah, 2010). CAD patients with 
lower initial self-efficacy are more likely to be 
hospitalized for heart failure. In fact, with each 
standard deviation (22%), the decrease in the 
participants' self-efficacy is 40% more likely to 
resulting in them being hospitalized with heart failure 
and they are 30% more likely to die (Sarkar et al., 
2009). In addition, low self-efficacy involves many of 
the risk factors for existing heart disease. This is 
indicated by the research involving 71 respondents; 
81.6% of the respondents (as many as 58) had low 
self-efficacy with many of the risk factors (Bailey et 
al., 2013) 

Coronary artery disease is a chronic disease that 
lasts for the duration of a patient's life that is able to 
cause fluctuations in their health status from optimal 
function through to dropping dramatically due to 
recurrence. This can be life threatening (Wantiyah, 
2010). This disease requires complex treatment 
management including not only medication 
adherence but also a healthy lifestyle. Self-efficacy is 
important in the management of CAD because it 
comes from the individual who feels the impact of the 
disease. This is improved through the motivation to 
change into having a good level of health management 
and decision making in reference to their care 
(Hendiarto, 2014; Riegel et al., 2017). The ability to 
manage their lifestyle as a form of good self-efficacy is 
needed, especially when managing their exposure to 
risk factors. People tend to ignore this and have 
unhealthy lifestyles such neglecting to lessen the 
sodium in their diet and eating high-lipid foods. These 
both have an impact on the development of 
cardiovascular disease. This study hypothesis is that 

self-efficacy has a correlation with perceived health 
status among patients with CAD. 

MATERIALS AND METHODS  

This study used an observational analytical design 
with a cross-sectional approach. The sample used in 
this study consisted of CAD patients post-outpatient 
treatment in the Heart Clinic of RSD Dr. Soebandi 
Jember. In total, 112 patients with CAD were selected 
as the research participants according to the criteria 
established by the researcher. The measurement of 
the sample size used the application of G * Power with 
a power analysis of 0.90. 

The sampling technique used in this research was 
incidental sampling. This sampling technique 
determined the sample based on coincidence, where 
anyone who incidentally meets the researcher and 
who fits the inclusion and exclusion criteria can be 
sampled (Nursalam, 2017; Sugiyono, 2016). The data 

Table 1. Characteristics of the Respondents (n=112) 
Characteristics of the Respondents n % 

Gender 
Men 
Women 

 
91 
21 

 
81.25 
18.75 

Age 
<45 years old 
45-54 years old 
55-64 years old 
65-74 years old 
> 74 years old 

 
4 

15 
61 
27 
5 

 
3.57 

13.39 
54.47 
24.11 
4.46 

Education 
No school 
Graduated from elementary school 
Graduated from middle school 
Graduated from high school 
College 

 
7 

17 
17 
45 
26 

 
6.25 

15.18 
15.18 
40.18 
23.21 

Occupational Status 
Does not work 
Labor 
Farmers 
General employees 
entrepreneur 
Civil servants 
Indonesian National Army/ 
Indonesian Republic Police 

 
53 
9 
8 

12 
17 
11 
2 

 
47.32 
8.04 
7.14 

10.71 
15.18 
9.82 
1.79 

Income 
<Rp 2,000,000 
≥ Rp 2,000,000 

 
49 
63 

 
43.75 
56.25 

Marital Status 
Single 
Married 
Widowed 

 
0 

104 
8 

 
0 

92.9 
7.1 

Smoking History 
Never 
Ever  

 
35 
77 

 
31.2 
68.8 

Disease History 
Do not have 
Hypertension (High Blood Pressure) 
Stroke 
Diabetes Mellitus (Sugar Disease) 
Have others 

 
48 
48 
0 

14 
2 

 
42.86 
42.86 

0 
12.5 
1.78 

History of Chest Pain (Angina) in the 
past month 

No Chest Pain 
There is Chest Pain 

 
 

81 
31 

 
 

72.3 
27.7 

 

 

 



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collection process was carried out in January 2020 in 
the Heart Outpatient ward of RSD Dr. Soebandi 
Jember. The process of taking the data used an 
instrument in the form of a demographic 
characteristic questionnaire. The self-efficacy 
measurement was done using the Cardiac Self-
Efficacy (CSE) questionnaire by Sullivan translated 
and adapted to Bahasa Indonesian. This was found to 
be valid and reliable with a Cronbach’s Alpha 
reliability of 0.77 (Wantiyah, 2010). The health status 
measurement was done using the Indonesian version 
of Seattle Angina Questionnaire (SAQ). The validity 
and reliability values in general for the SAQ 
questionnaire were in the range of 0.477-0.577 and 
the Cronbach’s Alpha value was 0.866 (Nurhalimah, 
2016). The data analyses used a Spearman rank test 
with a 95% CI by using SPSS 26 to determine the 
relationship between the two variables, namely self-
efficacy and health status in patients with CAD. 

This study was declared to have passed the ethical 
test conducted by the Health Research Commission of 
the Faculty of Dentistry at the University of Jember 
with Ethics committee approval number No. 
706/UN25.8/KEPK/DL/2019. All of the respondents 
in this study were given informed consent. The study 
respondents had the right to refuse to participate 
without penalty if they wished to do so. 

RESULTS  

The respondent’s demographic characteristics 
including age, gender, education, occupational status, 
income, marital status, history of disease and history 
of heart attack in the past month have collectively 
been displayed in Table 1. Based on Table 1, most of 
the respondents (81.25%) were men. The 
respondents were dominated by those in the age 
range of 55-64 years, totaling 61 respondents 

(54.47%). The most common educational history of 
the respondents was having graduated Senior high 
school, totaling 45 respondents (40.18%). Most 
respondents did not work, totaling 53 respondents 
(47.32%). In relation to this, 63 respondents 
(56.25%) earn more than Rp. 2,000,000.00. Almost all 
of the respondents are married (92.9%). The 
respondents' smoking history shows that 77 
respondents (68.8%) have a history of smoking and 
that 48 respondents (42.86%) have hypertension. 
Chest pain experienced by the respondents during the 
past month showed that as many as 81 respondents 
(72.3%) did not complain of a heart attack in the past 
month. 

In Table 2, the self-efficacy measurement by CSE 
shows an average value of 71.41 (SD: 5.45). In Table 
3, the health status measurement by SAQ shows an 
average value of 79.56, which indicates that the 
average health status of CAD patients is included in 
the good category because the criteria value ≥ 72.03 
is the natural cut-off point. The median value is 80.39 
with a minimum value of 49.06 and a maximum value 
of 95. It is known that the indicator with a high 
average score has a symptom load of 89.9 with a 
minimum value of 20 and a maximum value of 100. 
The indicator with the lowest average value was 
physical limitations, equal to 68.4 with a minimum 
value of 20 and a maximum value of 100. 

Table 4 shows that there is a correlation between 
self-efficacy and health status in CAD patients. The 
Spearman rank test correlation coefficient value of 
0.307 shows that the correlation category of the 
relationship between the two variables is low. The 
direction of the relationship shows there to be a 
positive value which means that the higher or better 
the self-efficacy, the higher or better the health status 
of the CAD patients. 

DISCUSSION 

This study found that there is a relationship between 
self-efficacy in reference to the ability to manage the 
changeable risk factors with health status. The study 
findings show that good self-efficacy has a positive 
effect on the perception of the health status of CAD 
patients. This can impact their condition and any 
improvements. The improvement is indicated by the 
low complaint of angina recurrence and other 
symptoms of a heart attack. The level of specific self-
efficacy on cardiovascular health is related to the 
important behavioral determinants of cardiovascular 
health such as a high-fat diet, physical activity, 
smoking cessation and high blood pressure control 
through active stress management (Wigger, 2011). 

The statistical analysis results show that there is a 
relationship between the self-efficacy variable with 
the variable of the health status of CAD patients. The 
correlation category shows that the relationship 
between the two variables has a low correlation. The 
relationship between the two variables has a positive 
relationship. The nature of the relationship shows 
that good self-efficacy associated with health 

Table 2. The Value of Self-Efficacy in CAD Patients in 
RSD Dr. Soebandi Jember (n = 112) 

Variable Mean SD 

Self-Efficacy 71.41 5.45 

Table 3. Health Status Value in CAD Patients in RSD 
Dr. Soebandi Jember (n = 112) 

Variable Mean Median Min-Max 

Physical 
Limitations 

68.44 67.78 20-100 

Symptoms 
burden 

89.94 96.67 20-100 

Treatment 
Satisfaction 

84.41 86.25 47.50-100 

Quality of Life 79.57 83.33 33.33-100 

Health Status 79.56 80.39 49.06-95 

Table 4. The Correlation between Self-Efficacy and 
Health Status in CAD Patients in RSD Dr. Soebandi 
Jember (n = 112) 

Variable p r 

Self-Efficacy 
0.001 0.307 

Health Status 

 

 



JURNAL NERS 

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management will have an impact on the better health 
status of the CAD patients. This is supported by the 
research by Ahn, Song, & Choi, (2016) which shows 
that there is a relationship between the variables, 
where self-efficacy, self-health behavior and the risk 
factors that can be changed have an important role in 
improving the quality of life of CAD patients through 
the better and effective management of 
cardiovascular risk factors. Research by Sarkar, Ali, & 
Whooley (2007) shows that among patients with 
CAD, low cardiac self-efficacy is associated with poor 
health status, independent of CAD severity and 
depressive symptoms. The lack of self-efficacy in 
cardiac patients is associated with good self-
acceptance. Individuals who have good self-
acceptance can mean that they can accept both their 
weaknesses and strengths with realistic expectations. 
They can respect themselves. Individuals claim to be 
able to accept their conditions in various aspects 
positively and be able to live life well (Puspita, 2018). 
According to Bandura (1994), good self-efficacy is 
able to bring in adaptive behaviors, especially in the 
prevention of a health problem. Preventive efforts 
that are intended are efforts to reduce or control the 
risk factors that are detrimental to health. These 
efforts include being physically active, maintaining 
blood pressure, and developing various ways to 
manage stress (Buchanan, 2016). 

The low correlation of the two variables as 
indicated by the findings of the study in some patients 
showed good self-efficacy but a poor level of health 
status. These results are irrelevant because the 
patient's self-efficacy began to be high after they were 
diagnosed with CAD, especially in new patients. It is 
known that CAD is a disease that is caused by a long 
period of exposure to the risk factors. A drastic 
change in self-efficacy when the patient changes his 
behavior in terms of health management and risk 
exposure does not show significant results in terms of 
improving their health status immediately. 

CONCLUSION 

Based on the research findings and discussion, it can 
be concluded that there is a relationship between self-
efficacy and health status in patients with coronary 
heart disease at a low correlation level. The results 
showed that the better the self-efficacy of the patients 
with coronary heart disease, the better their health 
status. 

Prospective studies can explore, using qualitative 
methods, matters related to self-efficacy and health 
status including the patient perceptions related to the 
symptoms and limitations in terms of CAD given how 
the opinions, ideas and assumptions will be broader 
than just the symptoms themselves. 

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https://unhealthywork.org/psychological-risk-factors/self-efficacy-and-heart-disease/