EFFECT OF A TRAINING PROGRAMME ON KNOWLEDGE AND PRACTICE OF LIFESTYLE MODIFICATION AMONG HYPERTENSIVE PATIENTS ATTENDING OUT-PATIENT CLINICS IN LAGOS

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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

  1. LASUTH
  2. LUTH
  3. 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