ASSESSMENT OF DIETARY COMPLIANCE AND PHYSICAL EXERCISE AMONG HYPERTENSIVE PATIENTS ATTENDING MEDICAL OUTPATIENT CLINIC IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL ITUKU-OZALLA

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TABLE OF CONTENTS                                         PAGE

Title Page                                                                                                                    i

Certification                                                                                                                ii

Approval Page                                                                                              iii

Dedication                                                                                                                  iv

Acknowledgement                                                                                                      v

Table of Contents                                                                                                       vi

List of Tables                                                                                                              ix

List of Figures                                                                                                             x

Abstract                                                                                                                      xi

CHAPTER ONE:     INTRODUCTION   

Background to the Study                                                                                           1

Statement of the Problem                                                                            3

Purpose of the Study                                                                                                  4

Objectives of the Study                                                                                              4

Research Questions                                                                                                     5

Hypotheses

Significance of the Study                                                       5

Scope of the Study                                                                                                     6

Operational Definition of Terms                                                        6

CHAPTER TWO:   REVIEW OF RELATED LITERATURE

Conceptual Review                                                                                                     7

Pathophysiology                                                                                                         7

Diagnosis                                                                                                                    9

Prevention                                                                                                                   12

Management of Hypertension                                                                       12

Lifestyle Modifications                                                            15
Resistant Hypertension                                                                15
Epidemiology                                                                                         16

Exploring Alternative Ideas: Shifting Focus to Elements with Greatest      

Impact on Public Health                                                 18                                                             

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Hypertensive Patients Who Exercise Have Lower Death Risk                                  19
Implications of hypertensive disease in surgical patients                                           20
Observation period                                                                           23
Causes of high blood pressure (hypertension)                                  24
How Common High Blood Pressure (Hypertension) is       24
Having blood pressure check                                        25
Cardiovascular Diseases                                                                25
Risk Factors for Cardiovascular Diseases                                   25
Assessing (calculating) your cardiovascular health risk              26
Lowering Blood Pressure                                                                        27
Lifestyle Treatments to Lower High Blood Pressure (Hypertension)                        27

National Institute of Health Guide to Lowering Blood Pressure with              29

Dietary Approaches to Stop Hypertension DASH (2014).

The DASH Eating Plan                                                                                              30

DASH Tips for Gradual Change                                                           31

Lifestyle – in Summary                                                                                               32

DRI Estimations                                                                             32
Calculating the RDA                                                                      33
Dieting as a cure to Hypertension                                            33

Dieting as a Solution to Overweight and Hypertension                    34

Types of Diets                                                                             35
Nutrition                                                                                    37
How the Body Eliminates Fat                                                            37
Weight Loss Groups                                                                           37
Food Diary                                                                                    37
Diuretics                                                                                                        37
Possible weight Loss Effects of Drinking Water Prior to Meals               38
Fasting                                                                               38

Dietary Compliance                                                                                                   

Dietary Self-Efficacy: Determinant of Compliance Behaviours and

Biochemical Outcomes in Haemodialysis Patients                                 39

Spike in Blood and Hypertensive Crisis                                               40

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Theoretical Review                                                                              41

Empirical Review                                                                                      43

Summary of Literature Review                                                                   52

CHAPTER THREE:    RESEARCH METHOD

Research Design                                                                                                         53

Area of Study                                                                                                             53

Population of Study                                                                                 53

Sample                                                                                                                                    54
Sampling Procedure
Inclusion Criteria                                                                     54
Instrument for Data Collection                                                          54
Validity of Instrument                                                                           55
Reliability of Instrument                                                                   55
Ethical Considerations                                                                       55
Procedure for Data Collection                                                            55
Method of Data Analysis                                                                56

CHAPTER FOUR:  PRESENTATION OF RESULTS                                      57

Research Question One: What are the eating practices adopted by hypertensive

patients attending UNTH Clinic?                               `                       58

Research Question Two: What is extent of Compliance with dietary 59

modification among hypertensive patients attending UNTH Clinic?

Research Question Three: What is the  extent of compliance with physical

exercises activities among hypertensive patients in UNTH?                                      60

Research Question Four: What is the relationship between demographic

factors and                                                                                                                  62

compliance to modification to dietary practices and physical

exercise activities among hypertensive patients in UNTH?

Summary of Findings                                                                         63

Testing of Hypotheses

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CHAPTER FIVE:  DISCUSSION

Discussion of  Major Findings                                                                   64

Conclusion                                                                                                                  66

Implication to Nursing                                                              67

Limitations of Study                                                                                       67

Suggestion for Further Studies                                                                   67

Summary                                                                                                                     67

Recommendations                                                                                      68

References                                                                                            69
Appendices

Appendix I:     Questionnaire                                                                                     

Appendix II:   Informed Consent Form        

Appendix III:  Letter of Introduction

Appendix IV:  Ethical Approval        

Appendix V:   Calculation  of  Sample Size                          

LIST OF TABLES                                                       PAGE

Table 1: Demographic characteristics of respondents                                                 57

Table 2: Distribution of respondents’ dietary practices                                              58

Table 3: Distribution of respondents who complied to dietary modification             59

Table 4: Distribution of respondents based on their compliance with

               specific dietary modification                                                                       59

Table 5: Distribution of respondents who engaged in physical exercises                   60       

Table 6: Distribution of respondents based on their compliance with specific

physical exercise                                                                                             60

Table 7:  Distribution of respondents based on their compliance with specific

areas of physical exercise                                                                                 61

Table 8: Relationship between demographic factors and compliance with

Lifestyle  modifications among the study participants                                    62

LIST OF FIGURES                                                 PAGE

Fig. 1: Classification of  Blood Pressure for Adult (JNC7)                           10

Fig. 2. The Health Belief Model (HBM)                                                        43

ABSTRACT

The management of hypertension is tripartite in nature: medication, physical exercise and dietary modification. While medication is curative, physical exercise and dietary modification are both preventive and curative. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of health complications, although treatment with medication is still often necessary in people for whom lifestyle changes are not enough. Physical exercise regimes which are shown to reduce blood pressure include isometric resistance exercises, aerobic exercise, resistance exercise etc.  However, substantial literature and research have shown that hypertensive patients rarely comply with these lifestyle changes with the resultant effect that even the medication does not seem to have effect in the long run. Hence the purpose of the study is to assess compliance with dietary modification and physical exercise among hypertensive patients attending Medical Out-Patient Clinic in UNTH. The objectives were to: identify dietary practices adopted by hypertensive patients in the study area; 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, and establish the relationship between demographic factors and compliance to modifications in dietary practices and physical exercise activities. A cross-sectional descriptive survey research design was employed and a sample of 240