Assessment of Dietary Compliance and Physical Exercise Among Hypertensive Patients Attending Medical Outpatient Clinic in University of Nigeria Teaching Hospital, Ituku-Ozalla
Chapter One
Purpose of the Study
The purpose of the study is to assess compliance with dietary modification and physical exercise among hypertensive patients attending the Medical Outpatient Clinic in UNTH Ituku-Ozalla.
Objectives of the Study
Specific objectives are to:
- identify dietary practices adopted by hypertensive patients in the study population
- determine the extent of compliance with dietary modification among hypertensive patients that attend UNTH Medical Outpatient Clinic
- determine the extent of compliance with physical exercises among hypertensive patients in UNTH Medical OutpatientClinic
- establish the relationship between demographic factors and compliance with dietary practices and physical exercise activities in the study
CHAPTER TWO
REVIEW OF RELATED LITERATURE
This research was reviewed under the following headings: Conceptual Review; Theoretical Review; Empirical Review and Summary of Literature Reviewed.
Conceptual Review Concept of Hypertension
Hypertension results from a complex interaction of genes and environmental factors. Numerous common genetic variants with small effects on blood pressure have been identified as well as some rare genetic variants with large effects on blood pressure, but the genetic basis of hypertension is still poorly understood. Blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable. Several environmental factors influence blood pressure. High salt intake raises the blood pressure in salt sensitive individuals; lack of exercise, obesity, stress, and depression can play a role in individual cases. The possible role of other factors such as caffeine consumption, and vitamin D deficiency are less clear. Insulin resistance, which is common in obesity and is a component of syndrome X (or the metabolic syndrome), is also thought to contribute to hypertension. Events in early life, such as low birth weight, maternal smoking, and lack of breast feeding may be risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain unclear (Coca, 2008).
Secondary hypertension results from an identifiable cause. Kidney disease according to Daniels, and Gidding, (2013), is the most common secondary cause of hypertension. Hypertension can also be caused by endocrine conditions, such as Cushing’s syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn’s syndrome or hyperaldosteronism, hyperparathyroidism and pheochromocytoma. Other causes of secondary hypertension says Daskalopoulou, Stella, (2015) include obesity, sleep apnea, pregnancy, coarctation of the aorta, excessive liquorice consumption and certain prescription medicines, herbal remedies and illegal drugs. Arsenic exposure through drinking water has been shown to correlate with elevated blood pressure.
Pathophysiology
This shows illustration depicting the effects of high blood pressure.
In most people with established essential hypertension, observe Rodriguez, Maria Alexandra; Kumar, Siva, De Caro, & Matthew (2010), increased resistance to blood flow (total peripheral resistance) accounts for the high pressure while cardiac output remains normal. There is evidence that some younger people with prehypertension or ‘borderline hypertension’ have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.
These individuals develop the typical features of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age. Whether this pattern is typical of all people who ultimately develop hypertension is disputed. The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and arterioles, although a reduction in the number or density of capillaries may also contribute. Whether increased active arteriolar vasoconstriction plays a role in established essential hypertension is unclear. Hypertension according to Diao, Wright, Cundiff, & Gueyffier, (2012), is also associated with decreased peripheral venous compliance which may increase venous return, increase cardiac preload and, ultimately, cause diastolic dysfunction.
CHAPTER THREE
RESEARCH METHOD
This chapter presents the research design, area of study, population of study, sample, sampling procedure, instrument for data collection, validity of instrument, reliability of instrument, ethical consideration, procedure for data collection and method of data analysis.
Research Design
This is a cross sectional descriptive study which used a survey design. The descriptive survey design was based on ongoing events. The cross sectional approach involves data collection at one point in time (Polit & Beck, 2006). It also aimed at collection and analysis of responses of people who represent the population designed to elicit their opinion about a specific topic (Chinwuba, Iheanacho & Agbapuonwu, 2013).
Area of Study
This study was conducted in Medical Outpatient Clinic of University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla. U.N.T.H is a tertiary health institution which serves as a referral centre in the Nkanu West Local Government Area, Enugu State of Nigeria. It is located 21 kilometers from Enugu metropolis along Enugu-Port Harcourt Express way, bounded in the east by Ozalla Town, West by Ituku Community and in the North by the extension of the Udi hills. The hospital covers about 200 acres of land.
It has forty one main departments with three out posts (comprehensive health centres) at Obukpa near Nsukka, Enugu State, Abagana, Anambra State and Isuochi, Abia State. There are twenty four wards, seventeen clinics and ten units. The bed capacity of the hospital is five hundred. The hypertensive patients attend MOP clinic of UNTH every day. There is no specific clinic day for hypertensive patients. UNTH serves as a training centre for medicine, nursing and other health care personnel. It is also a research centre.
Population of Study
The target population for the study was hypertensive patients attending Medical Out Patients Clinic in UNTH Ituku-Ozalla. The accessible population was all hypertensive patients that met the inclusion criteria of the study. The population was estimated at 1089 representing the average monthly attendance in the clinic. (Source: attendance register in the clinic).
CHAPTER FOUR
PRESENTATION OF RESULTS
This chapter focused on the presentation of results from data analysis. Out of a total number of 293 questionnaires administered, 240 were correctly completed and returned giving a total return rate of 82%.
CHAPTER FIVE
DISCUSSION
This chapter discussed the major findings of the study. It also presented conclusions, recommendations, limitations of the study, summary and suggestions for further studies.
Discussion of major findings
Relationship between demographic factors and compliance to dietary modifications and physical exercise activities among the study population
The relationship between demographic factors and dietary compliance and physical exercises were examined. This study showed that compliance to dietary modifications was higher in males than females, though the relationship was not statistically significant. This finding is however at odds with that of Dionne et al (2012) who found a significantly higher compliance among females compared to males. Significant dietary modification and physical exercise compliance levels were found for respondents aged 50 years and above at P value of 0.005. This could be due to socio-environmental and cultural reasons that subtly compel people within this age bracket to make lifestyle modifications due to the incidence of illnesses associated with age group. The findings also showed that the employment of respondents had a significant relationship with dietary compliance level for only civil servants. The knowledge level and proclivity to share information coupled with the strong support structure in the civil service may have contributed to this outcome. Besides the significant relationship between age (≥50years) and compliance to physical exercise and activities, duration of illness (>16years) also had a statistically significant relationship with compliance P value of.001. The long duration of the illness may have increased the involvement of respondents within this age bracket in physical exercises and hence they benefited from improved outcomes. Thus it reinforced their willingness to continue physical exercise routines.
Conclusion
Based on the findings of this study, the following conclusions were made.
- There was poor dietary practices 142(59.20%) adopted by hypertensive
- There was poor compliance with dietary modification as only 56 (23.3%) respondents complied with requisite dietary
- There was also poor compliance with physical exercise activities as only 184(76.7%) respondents complied with physical
- Respondents aged 50 years and above showed significant levels of compliance with both dietary and physical exercise requirements than otherage
- Age, employment and duration of illness are the only demographic factors that had statistically significant relationships with compliance to lifestyle modifications at p<0.05 level of
Implication to Nursing
The study brought out areas of concentration for everybody and particularly people above 50 years who are more likely to be hypertensive. The study also explained implications of certain foods either carelessly taken or taken without moderation. The relevance of moderate physical exercises to physical fitness and by extension prevention of hypertension was clearly brought out by the study. The study brought out clearly the methods of management of HTN by the Nursing Personnel. So nurses should channel health education to the appropriate areas mentioned above when in contact with hypertensive patients especially during clinic visits or community out reach programmes.
Limitations of the Study
The researcher encountered certain difficulties in the course of this research and they include:
- Some of the responses given by the respondentsmay have been made estimations or even exaggerations. This has also been reported in similar
- Despite the effort of the researcher and her assistants to explain the questionnaire, some respondents may have understood the questions differently. However, these limitations were taken care of through the analysis of data in a way that ensured validity and reliability of the
- Huge financial expenses in carrying out this
Suggestion for further Studies
Since the study reported poor compliance with dietary modifications and physical exercise requirements, there is a need to investigate health professionals’ contribution to this poor status as well as explore more effective ways of improving patients’ lifestyle modifications from the healthcare providers’ perspective. This, it is hoped, will significantly improve the outcomes in the management of hypertension in the Nigeria.
The researcher would suggest that any further research on this topic should be directed at: Effects of sodium and alcohol on the health of Hypertensive patients.
Summary
This study assessed compliance with dietary modifications and physical exercise among hypertensive patients attending Medical Out Patient Clinic in UNTH. The study was designed to:
- Identify dietary practices of hypertensive
- Determine the extent of compliance with dietarymodification among hypertensive patients in
- Determine the extent of compliance with physical exercises among hypertensive patients in
- Establish the relationship between demographic factors and compliance to lifestyle modifications in dietary practices and physical exercise
Literature was reviewed under conceptual review and empirical studies which were based on the objectives and research questions raised. Descriptive survey research design was employed and a sample of 240 respondents was drawn from the study population. Validated questionnaire was administered to the respondents and their responses were analyzed using descriptive and inferential statistics. The study revealed that there was poor compliance with dietary modifications 16(6.25%) and physical exercise requirements 15(6.50%) among the study participants, which has made the hypertensive patient of MOP of UNTH spend more time than is necessary in the hospital which has also implied inefficacy of the therapies administered which in effect are not necessarily so.
Recommendations
Based on the findings, the following recommendations are made.
- There is a need for increased focus on lifestyle modifications in primary care strategies to control blood pressure and reduce the risk of cardiovascular events alongside blood pressure control with antihypertensive medications. This will invariably guide the patients into improvement in their quality of
- Non-governmental Organizations (NGOs) and Faith-Based Organizations (FBOs) can through their programmes for improved health outcomes for hypertensives emphasize the importance of lifestyle modifications alongside their drug distribution
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