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.
TABLE OF CONTENTS
Content
Page
Title Page
i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables ix
List of Figures x
List of appendices xi
CHAPTER ONE: INTRODUCTION
- Background to the Study 1
- Statement of the Problem 3
1.3 Objective of the Study 4
1.4 Research Questions 4
1.5 Hypotheses 5
1.6 Scope of the Study 5
1.7 Significance of the Study 5
1.8 Justification for the Study 6
1.9 Operational Definition of terms 6
CHAPTER TWO:
REVIEW OF LITERATURE
2.0 Introduction 8
Content Page
2.1 Definition, Types, Causes and Signs and Symptoms 8
2.2 Prevalence of Hypertension 9
2.3 Management of Hypertension 12
2.4 Hypertension Morbidity and Mortality 14
2.5 Existing Programs/Interventions for Controlling Hbp 15
2.6 Empirical Review 18
2.7 Theoretical Review 22
2.8 Conceptual Model 23
CHAPTER THREE: METHODOLOGY
3.0 Introduction 24
3.1 Research Design 24
3.2 Population 25
3.3 Sample size and sampling Technique 25
3.4Instrumentation 26
3.5 Validity of Instrument 27
3.6 Reliability of Instrument 27
3.7 Method of data Collection 27
3.8 Method of Data Analysis 29
3.9 Ethical Consideration 29
Content Page
CHAPTER
FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION
OF FINDINGS
4.0 Introduction 30
4.1 Socio-demographic data of the participants 30
4.2 Pre-intervention 31
4.3 Post intervention 42
4.4Hypotheses Testing 56
4.5 Discussion of Findings 57
4.6 Application of the conceptual model (precede procede theory) 60
CHAPTER FIVE: SUMMARY, CONCLUSION AND
RECOMMENDATIONS
5.1Summary 62
5.2 Conclusion 62
5.3 Recommendations 63
5.4 Limitation of the Study 64
5.5 Suggestion for Further Studies 64
REFERENCES
APPENDICES
LIST
OF TABLES
Table Page
4.1 Socio-demographic data
of the participants 30
4.2.1 Pre intervention
knowledge about hypertension 32
4.2.2 Summary of responses on
knowledge about hypertension 33
4.2.3 Significance of knowledge about hypertension pre intervention 33
4.2.4 Pre intervention
knowledge about lifestyle modification 34
4.2.5 Summary of responses on
knowledge about hypertension pre intervention 34
4.2.6
Significance of knowledge about lifestyle modification pre
intervention 35
4.2.7 Practice
of lifestyle modification pre intervention; Diet section 36
4.2.8 Summary of responses to
practice of lifestyle modification pre intervention 42
4.2.9 Significance
of practice of lifestyle modification pre intervention 42
4.3.1 Knowledge about
hypertension post intervention 43
4.3.2 Summary of responses on
knowledge about hypertension post intervention 44
4.3.3 Significance of knowledge about hypertension post intervention 44
4.3.4 Knowledge about
lifestyle modification post intervention 46
4.3.5 Summary of responses on knowledge about lifestyle modification post intervention 47
4.5.6 Significance of
knowledge about lifestyle modification post intervention 47
4.5.7
Practice of lifestyle modification post intervention: Diet section 48
4.5.8 Summary of responses on practice of lifestyle modification post
intervention 54
4.5.9 Significance of practice lifestyle modification post intervention 54
4.5.10
Effect of the training programme on
control group 55
4.5.11 Table Effect of the training programme on
Experimental group 55
4.6.1
Effect of the training programme on
knowledge about hypertension and lifestyle modification
in both control and experimental groups. (Post intervention). 56
4.6.2 Effect of the training
programme on practice post intervention in both groups 57
LIST OF FIGURES
Figure page
2.7
Application of Procede-Preced theory 22
2.8
Conceptual Model 23
APPENDICES
Inform consent
Questionnaire
Teaching plan
Notification for
ethical clearance
Ethical approval
- LASUTH
- LUTH
- BUHREC
LIST OF
ABBREVIATIONS
LASUTH – Lagos State
University Teaching Hospital
LUTH – Lagos University
Teaching Hospital
HIN – Hypertension
BP – Blood Pressure
SBP – Systolic blood
pressure
DBP – Diastolic Blood
Pressure
DASH – Dietary
Approaches to Stop Hypertension
DALYS – Disability
adjusted life years
US – United State
UK – United Kingdom
AHA – American Heart
Association
JNC7– Joint National
Committee on detection, Evaluation and Treatment of High Blood Pressure (JNC7)
ADA – American
Diabetics Association
CHAPTER ONE
INTRODUCTION
1.0 Background to the Study
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:
EFFECT OF A TRAINING PROGRAMME ON KNOWLEDGE AND PRACTICE OF LIFESTYLE MODIFICATION AMONG HYPERTENSIVE PATIENTS ATTENDING OUT-PATIENT CLINICS IN LAGOS
