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

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