ABSTRACT
Hypertension is the most common non-communicable disease and the
leading causeof cardiovascular disease in the world. Many
people with hypertension are unaware of their condition making treatment
infrequent and inadequate. According
to Seven Joint National Committee Criteria (JNC7), the precise rule for the
treatment of hypertension begins with lifestyle modifications and ends with
medication. Unfortunately, many patients diagnosed to be hypertensive don’t
usually have proper education about lifestyle modification. Lifestyle modification is advised for all
patients with hypertension, in respective of pharmacological treatment, because
it may reduce or even abolish the need for medications.
The
objective of the study was to determine the effect of a training programme on
knowledge about hypertension, lifestyle modification and practice .Quasi
experimental method was used for this study to determine the effect of a
training programme on knowledge and practice of lifestyle modification. Sample size of 60 participants diagnosed to
be hypertensive and registered at the general out-patients and medical
out-patients clinics were used. (Control group n=30, intervention group n=30).
Two research settings were selected randomly from the three tertiary hospitals
in Lagos state. One of the hospitals was randomly selected to be the control
group and the other the experimental group. Purposive sampling was used to
select the participant from each setting. Data were collected through
administered questionnaire using a modified structured questionnaire from World
health organization for hypertensive patients and hypertension knowledge-level
scale (HK-LS). Data obtained were coded and analysed using SPSS version 21.0
statistical software. Variables and research questions were analysed using
descriptive analysis e.g. percentage, mean, and standard deviation and to show
relationship between dependent and independent variables. Hypotheses were
tested using inferential t-test at 0.05 level of significance.
Demographic data showed that female were more prevalent in the study,
level of literacy was fair in both groups. Above ninety three percent were
Yoruba in the control group and above 44% in the experimental group. This is
because this study was carried out in South-west Nigeria which is mainly
dominated by the Yoruba. Results suggested that pre-test general knowledge of
hypertension was low in both groups (t=2.836, p=0.065). Knowledge about
lifestyle modification was also low in both groups (t=0.256, p=0.7989). Practice of lifestyle modification as reported
by the participant was also inadequate (t=1.390, 0.1705). Intervention was
given and there was significant increase in the level of knowledge about
hypertension and lifestyle modification (t=2.665, p=0.010) and (t=4.741,
p=0.001) and improvement on their practice ((t=5.599, p=0.001)) after
intervention.
The study concluded that, there is relationship between knowledge and
practice, hence, it is pertinent that health care providers especially the
nurses should help provide continuous and focused health education and training
for the hypertensive in order to improve their knowledge and practice of
lifestyle modification therefore controlling their blood pressure and reducing
the risk for cardiovascular diseases. It is therefore recommended that health sector
should intensify efforts on health educating the populace on the type of
lifestyle that put them at risk of developing hypertension.
Hypertension is the most common non-communicable
disease and the leading cause of cardiovascular disease in the world. Many people with hypertension are unaware of their condition making
treatment infrequent and inadequate, which is responsible for it poor control and
not always taken seriously (Neutel & Campbell, 2008). Majority who are
suffering from hypertension have a type of hypertension called essential
hypertension or type one hypertension. Heredity and unhealthy lifestyle have
been widely acceptable has being responsible for this type of hypertension.
This has become a menace especially in Africa because of the adoption of
western lifestyle, coupled with its challenges of unhealthy environment,
poverty, lack of health seeking behaviour, lack of health insurance and
sedentary life lived by many.
According to Seven Joint National Committee Criteria
(JNC7), the precise rule for the treatment of hypertension begins with
lifestyle modifications and ends with medication. Unfortunately, many patients
diagnosed to be hypertensive don’t usually have proper knowledge about
lifestyle modification. Studies on lifestyle modifications have revealed that
modifications such as weight loss, taking Dietary Approaches to Stop
Hypertension (DASH) diet, exercising and reducing salt consumption would be
effective in lowering blood pressure and reducing its
complications especially the rate of morbidity and mortality of
cardiovascular diseases (Jafari, Shahriari, Sabouhi, Farsani & Babadi,
2016).
Lifestyle modification is advised for all
hypertensive, in respective of pharmacological treatment, because it may
abolish or even reduce the need for medications. The goal of prescribed
lifestyle changes is to lower blood pressure. This lifestyle changes also
offers a lot of health benefits and better outcomes for common chronic diseases
(Huang, Duggan & Harman, 2008). Yet studies have showed that ignorance and
lack of knowledge and awareness are some of the barriers to having a healthy
lifestyle and not controlling and preventing high blood pressure. It is
assumed that increased knowledge about the role of lifestyle in the occurrence
of high blood pressure would cause people to start modifying their lifestyles
and enhance their preventive behaviours as supported by the results of a study
which says `when the score of knowledge in high blood pressure patients
increases by one, their score of practice would increase by 0.12. (Jafari,
Shahriari, Sabouhi, Farsani & Babadi, 2016).
However, studies have shown that improving knowledge
and awareness alone could not be enough to control the effects of diseases by
itself but by increasing the score of attitude toward high blood pressure
through reinforcement, systolic and diastolic blood pressures would decrease
significantly. There are a lot of other barriers that can prevent individual to
modifying their lifestyle but studies have showed that increased knowledge,
attitudinal and change of perceptions will all lead to practice of lifestyle
modification (Jafari, Shahriari, Sabouhi, Farsani & Babadi, 2016).
The recommended lifestyle modification such as,
moderate alcohol intake, weight loss of 3% to 9% of body weight, the DASH diet,
regular aerobic exercise, and reduced dietary salt are lifestyle modification
that controls blood pressure. Depending on the type of intervention, blood
pressure reduction of 3 to 11 mm Hg systolic and 2.5 to 5.5 mm Hg diastolic,
are believed to have great influence on blood pressure reduction and ability to
potentiate antihypertensive drugs. The recommended diet called DASH diet is low
in total and saturated fat, sugar, sugary drinks, refined carbohydrates, and
red meat but high in vegetables, fruits,
whole grains, poultry, fish and low-fat dairy products. This DASH diet has long
been documented to lower weight, risk of type 2 diabetes, heart rate,
apolipoprotein B, homocysteine, C-reactive protein, and is accompanying by a
lower incidence of stroke, heart failure, and all-cause mortality (Lochner,
Rugge & Judkins, 2006).
In a premier trial, it was also documented that a
reduction of 14.2/7.4 mmHg in blood pressure is attained when DASH diet is
accompany by salt reduction and alcohol, aerobic exercise and weight loss,
which also reduces the prevalence of hypertension from 38% to 12% over the
period of six months. Reduce salt consumption by hypertensive patents,
possibly the single most important
hypotensive measure, entails regularly checking food labels for salt content,
staying away from processed foods, and using spices and herbs for flavour. It
is generally acceptable that personal efforts from the patients and reinforcing
and enabling environment from health personnel will lead to a great success in
diet and behavioural modification (Nicoll & Henein 2010).
Knowledge and practice of lifestyle modification among
patients with high blood pressure has however been showed to be inadequate in
some studies. In UK, Nicoll and Henein (2010) in their study revealed that many
hypertensive patients are unwilling to accept that their lifestyle practices or
choices have made a worthwhile contributed to their condition and may refuse
advice to change, this may be true of other hypertensive patients. Therefore,
health education about hypertension, its consequences and lifestyle
modification is been advocated to begin as early as possible in population
identified to be at risk (American Heart Association, 2010).
1.1 Statement of the problem
Despite the treatment guideline and numerous drugs
available for the treatment of hypertension, having patients bringing their
blood pressure under control has always been a mirage. Part of the guidelines
for the treatment of hypertension is lifestyle modification. In terms of
economic burden, morbidity, mortality, poorly controlled blood pressure is a
considerable important public health concern among older adult in the world.
High blood pressure is the leading and most significant modifiable risk factor
for, stroke, heart diseases, renal diseases and retinopathy. Recent
recommendations for the prevention and treatment of hypertension has placed
importance on modifying lifestyle. It has been proven that lifestyle
modifications that is capable of lowering hypertension include increased
physical activity, weight loss, reduced sodium intake. This include, a diet
rich in fruit, vegetables, and low-fat dairy products reduced in total and
saturated fat (Al-wehedy, Abd
Elhameed, & Abd El-Hammed, 2015).
Despite the above fact, it’s been documented in
several studies that most hypertensive patients don’t have enough knowledge
about lifestyle modification. In a study carried out among 101 participants on
perception and practice of lifestyle modification in South-East Nigeria, it was
revealed that about 87.1% of the participant were not aware that exercising
regularly is part of lifestyle modification while 60% were not aware that
alcohol intake should be of moderate consumption. The roles of unsaturated oil
and reduction in diary food intake, vegetables, and fruits in the control of
blood pressure were not aware by 80% and above. A little above 60% practiced
salt restriction among 88% that has some knowledge of salt restriction. This is
also applicable to the few with knowledge of weight reduction, regular
exercise, fruit intake, cigarette smoking and alcohol moderation,
respectively. The study shows there was
a negative relationship between diastolic and systolic blood pressures and the
level of practice. This typifies that knowledge level and practice of lifestyle
modifications were poor among the studied participants. (Okwuonu, Emmanuel & Ojimadu, 2014).
This is
in congruence with the researchers experience with patients, colleagues and
family members who are diagnosed to be hypertensive, and are far away from
modifying their lifestyle. This may be due to lack of adequate knowledge,
belief and lack of reinforcement and enabling environment motivating them to
modifying their lifestyle as documented. Jafari, Shahriari, Sabouhi, Farsani
& Babadi, (2016), postulated that having knowledge or a partial knowledge and
awareness alone will not lead to a change in health behaviours and practical
application of knowledge but enhancement of awareness through appropriate
educational programs. Therefore, this study is aimed at bridging the gap in
knowledge and practice of lifestyle modification through a training programme.
1.2 Objective of the Study
The main objective of this study, is to determine the effect of a
training programme on the knowledge and practice of lifestyle modification
programme among hypertensive patients attending out-patient clinics in Lagos.
The specific objectives are to:
- determine the
existing knowledge level of high blood pressure and lifestyle modification
among hypertensive patients in both groups;
- determine the
level of reported practice of lifestyle modification among hypertensive
patients in both groups;
- Implement a
lifestyle modification programme among hypertensive patients and
- determine the
effect of a training programme on knowledge and reported practice of
lifestyle modification among hypertensive patients in experimental group.
- What is the existing knowledge level
about hypertension and lifestyle modification among hypertensive patients in
control and experimental group?
- What are the
reported lifestyle modification practices among hypertensive patients in
both groups?
- What is the
effect of a training programme on post intervention knowledge of
hypertension, lifestyle modification and self-reported practice among
hypertensive patients in experimental group?
The hypotheses were
tested at 0.05 level of significance
H1: Patients who attend the training programme will demonstrate
high knowledge of hypertension and
lifestyle modification than those who did not
H1: Patients who attend the training programme will report improved
practice of lifestyle modification
than those who did not
1.5 Scope of the Study
This study was
carried out on hypertensive patients attending general and medical outpatient
clinic in Lagos University Teaching Hospital and Lagos State University
Teaching Hospital. The pre-test reliability of instrument was carried out on
patients with the same inclusion characteristics attending hypertension clinic
in Crystal Specialist Hospital Akowonjo, Lagos.
1.6 Significance of the Study
Having established a correlativity between knowledge
of hypertension, knowledge of lifestyle modification and its practice, this
study therefore has helped to support this claim and its effectiveness, by
increasing participants’ knowledge, thereby preventing the eminent
complications of unhealthy lifestyle and increase the number of patients
practising positive lifestyle modification. Hence, this study gave a focus
training on lifestyle modifications, having acquired knowledge on hypertension and its treatment as a
registered nurse with many years of experience and a master’s student
undergoing a training as an advanced nurse practitioner in adult health.
This study is also appropriate and significant because
it has added to the body of knowledge in healthcare system by emphasising to
the physicians and nurse clinicians the need to focus more on lifestyle
modification than sole dependence on antihypertensive. This study is also beneficial to patients by
bringing to their awareness the magical role lifestyle modification can play in
the management of their blood pressure thereby preventing life threatening
complications. In precise terms, this study is without doubt, a useful tool in
projecting the contributions of nurses to the body of knowledge on
non-pharmacological treatment of hypertension through their skill of health
education.
1.7 Justification for the Study
Nigeria is gradually
shifting from treating communicable diseases to non-communicable diseases. High
blood pressure is one of the non-infectious diseases whose prevalence and
complication has become an increasing problem, with a lot of Nigerians
suffering from strokes and other coronary artery disease. Globally, hypertension
is implicated to be responsible for 45% deaths from heart disease and 51% of
deaths due to strokes (WHO, 2013).
African region out of the six other regions also has
the highest occurrence of high blood pressure estimated at 46% of adult from
age 25 and above of which Nigeria contributes significantly to the increase,
this is according to WHOs Global status report on non- communicable diseases in
2012, (JCN, 2013). This is so in spite of the accessibility to safe and potent
drugs for hypertension and the availability of treatment guidelines,
hypertension is still grossly not controlled in a large proportion of patients
worldwide. Lack of awareness of lifestyle modifications, and inability to
practice these were one of the identified patient- related barriers to
hypertension control (Shibiru, Bayeta, Selamu, & Eliyas, 2016).
This study might help
the non-hypertensive to avoid hypertension through lifestyle modification, as
the number of people diagnosed with hypertension is on the increase on a daily
basis, thereby reducing its level of prevalence. Therefore this study is needed
in order to increase the number of hypertensive patients who will meet the
target goal blood pressure of less than 140/80mmHg according to Joint national
committee on the prevention of hypertension (JNC, 2013).
1.8 Operational Definition of Terms
Effect: these are the
outcome of the training programme on lifestyle modification.
Hypertension: hypertension is
defined as a systolic blood pressure (sbp) of 140 mmHg or more, or a diastolic
blood pressure (dbp) of 90 mmHg or more, or taking antihypertensive medication.
Adult patient: anyone aged 21 and
above diagnosed with high blood pressure of above 140/90mmhg who is on
antihypertensive medication or not, attending the out-patient clinics.
Lifestyle modification: are the health
promoting lifestyle such as physical activity, nutrition, quitting smoking,
reduced alcohol reduction which when practiced bring about reduction in blood
pressure.
Programme: are strategies or
interventions put in place to help client have a better understanding of
lifestyle modification and management of hypertension.
Knowledge: this is the
understanding of what lifestyle modification is before and after the
intervention programme.
Practice: these are the
lifestyles behaviour of the participants reported before and after the
lifestyle modification programme as assessed by their responses in pre and
post-test results using questionnaire.
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