Effect of a Training Programme on Knowledge and Practice of Lifestyle Modification Among Hypertensive Patients Attending Out-patient Clinics in Lagos
CHAPTER ONE
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.
CHAPTER TWO
REVIEW OF LITERATURE
Introduction
This chapter discuss the following listed sub headings and the gap that exist.
Definition, types, causes and signs and symptoms
Prevalence of HTN
HTN morbidity and mortality
Management of hypertension
Existing programs/interventions for controlling HBP
Empirical studies on the effectiveness of lifestyle modification and knowledge
Theoretical Framework
Definition, types, causes and signs and symptoms
Hypertension is defined as systolic blood pressure of 140mmHg or greater or diastolic blood pressure of 90mmHg or greater or as taking hypertensive medications. A blood pressure record of less than 140/90mmHg is a well-controlled blood pressure. (Awobusuyi, Adebola, & Ajose, 2012). Hypertension is said to be a silent killer because it has no definitive symptoms hence an individual with hypertension is prone to its complication before diagnosis and treatment. The two types of hypertension are essential hypertension which is also called primary hypertension, this is responsible for 90-95% of hypertension and has no specific symptoms. Secondary hypertension whose cause is related to a medical condition (Ugorji, 2014).
The true and real causes of high blood pressure are not exactly known, however, some conditions and risk factors and several factors may be responsible in its development. These factors are, too much consumption of alcohol i.e. more than 1 or 2 drinks per day, old age, genetics, stress, smoking, overweight or obese, lack of exercise, high sodium consumption, family history, of hypertension, sleep apnoea, chronic kidney disease, adrenal and thyroid disorders (Klodas, 2014).
Prevalence of hypertension
The prevalence of hypertension is a worldwide menace, various health record and institutions has record supporting this from year to year. This prevalence varies according to age, gender, ethnicity, nationality and medical conditions
A yearly consensus conference with the responsibility of reviewing the world literature including the cochrane collaboration databases and JNC 7 program prescribed lifestyle changes as a key strategy for prevention and treatment of high blood pressure. Over 20% of Iranian adults are hypertensive. Recent studies suggest that approximately 23% of individuals aged 35-65 years in Isfahan have hypertension. The risk of cardiac accidents and stroke mortality rise with increasing levels of BP. It is believe that the most cost-effective strategies for reducing the global burden of premature cardiovascular disease and death is by preventing and controlling high blood pressure. Reducing morbidity and mortality is the goal of prevention and management of high blood pressure.
This goal may be achieved by lifestyle modification, alone or with pharmacological therapy. Reducing just 3 mmHg of systolic blood pressure (SBP) in the entire population has the ability to decrease the mortality of stroke by 8% and mortality of coronary artery disease by 5%. Several studies have demonstrated correlation between hypertension and lifestyle factors such as high salt intake, physical inactivity, overweight, and maladaptive coping with stress. For as long as it can be remembered, lifestyle modification has been recommended to reduce blood pressure. In fact, if people decreased their sodium intake, exercised more, and kept their weight at an optimal level, HTN would have been less prevalent. Countries differ in their ability to manage HTN and implement these interventions. According to World Health Organization (WHO), the most vital barriers for lifestyle modification programs in developing countries are low literacy levels and low income. WHO encourages countries to develop prevention programs based on their own resource and patients’ education levels (Hasandokht, Farajzadegan, Paknahad, & Rajati, 2014)
Globally, the prevalence of hypertension is on the increase.972 million people were diagnosed to be hypertensive in the year 2000 with a prevalence rate of 26.4%. By year 2025, its rate would have increased to 29.2 as projected. This prevalence vary in the world, with the highest in Poland with 68.9% in men and 72.5% in women, rural Indian has the lowest rate with 3.4 % in men and 6.8% in women. Depending on the gender, age, body size of the population studied and ethnicity, the incidence rate of hypertension is from 3% – 18% (Wilson, Vlack, Shchievink, Doak, Shane, & Deart, 2014).
High blood pressure is one of the commonly encountered diseases afflicting human race worldwide. Approximately, 75 million adults are affected in the United States. It is a greater risk factor for chronic kidney disease, myocardial infarction, stroke and vascular disease (Go, Bauman, King, Farrow, Lawrence, Williams’s eta al, 2013). Despite hypertension is the main risk factor for stroke and cardiovascular disease, most times it is not effectively controlled because it is symptomless and not taken serious. Lowering the Blood Pressure reduces the associated risk factors. Therefore putting strategy in place to effectively reduce high blood pressure is by increasing the number of patients who get their blood pressure controlled.
CHAPTER THREE
METHODOLOGY
Introduction
This chapter presents the research design, population, sample and sampling techniques, instrumentation, reliability and validity of the instrument, data collection procedure and method of data analysis.
Research Design
This study employs quasi experimental design to assess the effect of a lifestyle modification programme on knowledge and practice among adult hypertensive patients attending medical out-patients clinic in Lagos. The setting of this study were Lagos University teaching hospital, (LUTH) which was used as the experimental group and Lagos State University Teaching Hospital, Ikeja (LASUTH) as the control group. Lagos University Teaching Hospital is situated in Idi-Araba, Mushin Local Government Area of Lagos State. Lagos University Teaching Hospital, Idi-Araba was formerly Surulere Mainland Hospital, built on 92 acre field of bush and farmland. Admission of patients started around mid-August 1962 with 330 beds. Credit of establishment goes to Doctor Moses Majekodunmi who was the then Minister of Health and late Prime Minister Abubakar Tafawa Balewa who dedicated the hospital on the 3rd of October, 1962. Bed state of the hospital is now 761, with various departments of specialty. Each ward contains 27-32 patients. It has 11 surgical wards, 6 female surgical wards, 4 male surgical wards and 3 paediatrics wards. The clinic arm of the hospitals is classified to surgical, medical, paediatrics, oncology, dental, general out-patient, and staff clinic under which will have different specialties.
The Lagos State Government formally converted the Ikeja General Hospital to the Lagos State University Teaching Hospital in July 2001. The bed state of the hospital is 600. Each ward contain between 16 – 30 beds. The clinic arm of the hospital is classified into, medical, surgical, oncology, dental, paediatrics, general out-patient clinic and staff clinic with different specialties. The hospital also provides emergency services with helicopter tarmac area ready for unavoidable accident been a few kilometers away from the airport.
Population
The target population were male and female adult clients who have been diagnosed to be hypertensive and who were either on antihypertensive drugs or not, attending general and medical out-patient clinic in LUTH and LASUTH.
CHAPTER FOUR
DATA ANALYSIS, RESULTS AND DISCUSSION OF FINDINGS
Introduction
This chapter was organized according to the research questions raised and discussion of findings.
Source: Researcher’s Model, 2017
Table (1) shows that female were more prevalent in the study, level of literacy was fair in both groups. Majority, 93.3% were Yoruba in the control group and 44% in the experimental group. This is because this study was carried out in South-west Nigeria which is mainly dominated by the Yoruba.
Pre intervention
Research Question 1
What is the existing knowledge level about hypertension and lifestyle modification among hypertensive patients in control and experimental group? Tables 2 and 3 gave answer to this question.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary
This study investigated the effect of a training programme on knowledge and practice of lifestyle modification among hypertensive patients. The purpose of the study was to determine the effect of a training programme on knowledge about hypertension and it treatment, knowledge of lifestyle modification and practice of lifestyle modification. To answer this, three research questions were raised and two hypotheses formulated. A quasi experimental design was adopted for the study. The population of the study consist of 60 participants, 30 from Lagos university teaching hospital used for the experimental group and 30 from Lagos state teaching hospital for the control group.
Two instruments, a modified structured questionnaire from World health organization for hypertensive patients, hypertension knowledge-level scale (HK-LS) and institute de recherches cliniques de montreal were used to measure knowledge of hypertension, lifestyle and reported practice. The instrument for data collection were modified hypertension knowledge-scale (HK-LS). The reliability test was carried out at Crystal Specialist hospital Akowonjo, Lagos, using 11 questionnaires and the Alpha Chronbach score of 0.793 was obtained. The final instrument were personally administered through interview and collected. The data were analyzed and interpreted using percentages, and frequency distribution tables, and Chi-square was used to determine the level of knowledge and practice pre and post in the control and study groups. The findings showed there was fair knowledge about hypertension in both groups but low knowledge about lifestyle modification and inadequate practice of lifestyle modification. The findings also showed an increased in knowledge and practice after intervention.
Conclusion
This study was carried out to determine the effect of lifestyle modification programme on knowledge and practice of lifestyle modification among adult hypertensive patients. This was related to the fact that despite the availability of different drugs option for the control of hypertension and advice to modify lifestyle, millions of people are living with the disease and new diagnosis are made every day. It was showed that training was associated with improved knowledge and practice of lifestyle modification. Hence, this study has helped to validate that training on lifestyle modification is effective in increasing level of knowledge and improving practice as reported by the participants. This is clearly showed in Table 10 and 11.
It is therefore pertinent that health care providers especially the nurses must help provide continuous and focused health education and training for the hypertensive in order to empower them to practicing positive health behaviours that will in a long run help them control their blood pressure. This is also important because a reduction in blood pressure as low as 2mmHg is capable to reduce the risk of cardiovascular diseases by 15% ( Oza & Garcellano, 2015).
Recommendations
Based on the findings of this study, the following recommendations are made which call for the health sector to intensify effort on health educating the populace on the type of lifestyle that put them at risk of developing hypertension. Other recommendations are:
- There should be an advancement of the usual health talk at the medical out-patient clinics for the hypertensive to make it more focused and intentional towards promoting lifestyle modification. Also more time should be giving to health talk than the usual 10 to 15 minutes during the clinic2
- Increase awareness of hypertensive patients about risk factors of hypertension is important to motivate them to adopt healthy lifestyle to control the disease
- There should be regular jingle on the importance of lifestyle modification via mass media.
- Periodic training on lifestyle modification should be part of the treatment guideline for hypertensive patients.
- The relationship between health personnel and the patients should be based on trust which is important in motivating the patients to change their lifestyle behaviours.
- Encouraging hypertensive patients to sustain the practice of lifestyle modification such as regular exercise, maintaining healthy weight, consumption of DASH diet, quitting smoking and reduced alcohol consumption, salt restrictions and reducing stress.
- The findings of this study can help in developing health planning programmes to control hypertension, prevent complications in hypertensive and prevention for non-hypertensive individual.
Limitation of the study
Some limitations were encountered in the course of the study despite the research objectives were met. First, it was difficult randomizing the participants because the number of patients seen at the general out-patients clinic per day who met the inclusion criteria were few. Hence, purposive sampling method was use, which could limit the generalization of this study. Secondly, having all the patients in one session for the training progamme and for posttest was difficult, hence, the participants were taking in sessions. 25 participants in the experimental group and 20 in the control group were present for posttest as against 30 for the pretest.
Although lifestyle modifications focusing on knowledge and practice were the independent variables intended to be studied, there was an indication that other variables not included in this study could be effective in the control of blood pressure. Measurement of blood profile such as cholesterol level and triglycerides were not included because of financial constraints. In the same vein, limited time and financial resources made the study to take place only in LUTH and LASUTH. This challenges the generalizability of the study.
Suggestion for further studies
- This study was carried out within a short period of time, future researchers should consider giving more time for same study in order to follow up participant practice of lifestyle modification.
- For a wider generalization of the findings, future researchers in this area of study should enlarge the study setting in order to have a broader national outlook.
- This study is based on effect of a training programme on knowledge and practice of lifestyle modification, further studies should include the measurement of clinical parameters indicating effect of practice of lifestyle modification on blood pressure control. E.g. measurement of cholesterol level, triglycerin, body mass index etc.
- Further studies should also consider factors that may influence the practice of lifestyle modification among hypertensive patients.
REFERENCES
- Abd El-Hay, S.A, & Mezayen, S.E. (2015). Knowledge and Perceptions related to Hypertension Lifestyle behavior modification and Challenges that is facing Hypertensive Patients. IOSR Journal of Nursing Science (IOSR-JNHS), 4 (6), 15-26. doi: 10.9790/1959-04611526
- Al-wehedy, A., Abd Elhameed, S.H., & Abd El-Hammed, D. (2015). Effect of lifestyle program on controlling hypertension among older adults. Journal of Education and practice, 5, 5.
- Anowie, F., & Darkwa, S. (2015).The knowledge, attitude and lifestyle modification practices of hypertensive patients in the cape coast Meropolis- Ghana. Journal of scientific research, 8 (7), 1-15.
- Appel, L. J., Brands, M. W., Daniels, S. R., Karanja, N., Elmer, P.J., & Sacks, F.M. (2005). Dietary Approaches to prevent and Treat Hypertension. American Heart Association, 47(2), 296-308. Doi: 10.1161/01.HYP.0000202568.01167.B6
- Appel, L.J. (2003). Lifestyle modification as a Means to Prevent and Treat High blood pressure. American Society of Nephrology, 14: 599-5102. doi:10.1097/ol.ASN.0.0000 70141.69483.SAJ
