Hypertension Self-Care Activity Level Effects Research Articles

Translation, adaptation, and validation of a Chinese version of the Hypertension Self-Care Activity Level effects (H-SCALE) for patients with hypertension.

Lifestyle modification is an essential component of prevention and management of hypertension. Existing instruments in Taiwan focus on assessing lifestyle modifications by evaluating medication adherence or confidence in controlling blood pressure. However, other self-care activities, such as diet, physical activity, weight management, smoking, and alcohol consumption are also important. The Hypertension Self-Care Activity Level Effects (H-SCALE) is one such instrument, but there are no similar tools available in Taiwan. This study aimed to translate the H-SCALE into Chinese and test its validity, and reliability in a sample of adults with hypertension. The English version of the 31-item H-SCALE was translated into Chinese using the forward-backward method. The content validity index (CVI) of the translated scale was determined by five experts in hypertension. Item analysis was conducted with a pilot sample of 20 patients with hypertension. Cronbach's α was used to establish the internal consistency reliability for the Chinese version of the H-SCALE (H-SCALE-C). Exploratory factor analysis (EFA) explored the structure of the H-SCALE-C. Additionally, construct validity was examined with confirmatory factor analysis (CFA). Patients with hypertension were recruited by convenience sampling from a cardiovascular outpatient clinic of a medical center in northern Taiwan. A total of 318 patients met the inclusion criteria and participated in factor analysis in the study. Pilot testing of the scale items indicated most patients could not accurately estimate the number of days of alcohol consumption for the previous week. Therefore, three alcohol-related items were removed. The adaptation resulted in a 28-item H-SCALE-C. EFA revealed a 4-factor solution with 13 items that explained 63.93% of the total variance. CFA indicated a good fit for a 4-factor model and construct validity was acceptable. Internal consistency reliability was acceptable (Cronbach's alpha for the four subscales ranged from 0.65 to 0.94). Convergent validity was acceptable, and discriminant validity was significant. The H-SCALE-C is a valid, reliable tool for promptly assessing life-style activities for patients with hypertension in Taiwan. The instrument is suitable for assisting healthcare providers in evaluating self-care activities, which could be used to facilitate lifestyle modifications for patients with hypertension.

Health coaching for hypertension control in primary care patients with uncontrolled hypertension in Egypt.

Health coaching effectively improves hypertension self-care activities and the control of blood pressure (BP) in hypertensive patients. Studies on the effects of health coaching on patients in primary care with uncontrolled hypertension in developing countries are limited. In this study, the effectiveness of health coaching on hypertension self-care and BP control was assessed in patients who have uncontrolled hypertension compared to standard care in Egypt. Our quasi-experimental study included control and intervention groups. The intervention group included 70 participants who received health coaching sessions (face-to-face and by telephone) besides the standard care, whereas the control group included 71 participants who only received the standard care. The study was conducted between July 2020 and November 2021. The participants were recruited from three primary healthcare settings in the Port Said Governorate. Personal and medical history, BP measurements, and hypertension self-care activity level effects (H-SCALE) were obtained. Paired-t-test was used to assess the changes in BP measurement, and H-SCALE score before and after receiving the health coaching. McNemar's test was used to assess changes in controlled BP and optimal hypertension self-care activities between control and health coached groups. Multiple logistic regression analysis assessed the predictors of better BP control. Health coaching resulted in more controlled BP (51.4%, P < 0.001) compared to the delivery of only usual care (11.3%, P = 0.008). The intervention showed a significant promotion in hypertension self-care activities, including medication usage (P < 0.001), low-salt diet (P < 0.001), and weight management (P < 0.001). The H-SCALE score mean change was the only predictor for BP control (odds ratio 1.057, P = 0.048) in the intervention group after 6 months. Intervention including traditional health coaching and phone calls is a beneficial modality for the promotion of hypertension self-care and improvement of BP control in primary care patients with uncontrolled hypertension.

Personal factors related to self-care management among people with hypertension at primary health care: A cross-sectional study

Background: Hypertension requires long-term treatment and can last a lifetime. Recommendations for hypertensive patients, where it is necessary to change behavior related to self-care, consist of increasing a healthy diet, limiting sodium intake, increasing physical activity, reducing smoking, and reducing alcohol consumption. Objective: The purpose of this study was to identify the self-care model of patients with hypertension in primary healthcare in Kota Malang. Methods: This study's design was descriptive analytic with a cross-sectional methodology. Using G Power, 321 hypertension patients were used as samples. Purposive sampling was used in this study. The instruments used H-SCALE, also known as the Hypertension Self-Care Activity Level Effects. Pearson Chi-squared test was used to examine correlations among variables. Results: Factors of gender (p=0.001) and education (p=0.020) are related to self-care in hypertensive patients. Majority of respondents were women, 223 people (69.5%), Most of the respondents had elementary school education, 136 people (41.4%), the majority of the 321 respondents (216, 67.3%) have moderate self-care category. Gender and age were significant factors associated with self-care among hypertensive patients (p&lt;0.05) Conclusion: Gender and education level have significant correlation with self-care management of hypertension. Providing self-management intervention by considering gender and education level needs improvement. Other factors need to be explored in further research.

Translation and evaluation of psychometric properties of the Persian version of the Hypertension Self-Care Activity Level Effects (H-SCALE)

Background & ObjectivesHypertension is a major cause of cardiovascular disease and premature death worldwide. Managing hypertension through self-care practices is considered one of the most effective strategies. However, to accurately assess the self-care status of individuals with hypertension, a valid and reliable tool is necessary. This study aimed to evaluate the psychometric properties of the Persian version of the Hypertension Self-Care Activity Level Effects Questionnaire.MethodsPresent methodological study was conducted on 218 patients with hypertension visiting the Clinic of Qom educational and medical centers. Subjects were selected with convenience sampling. Data were collected using the H-SCALE, and a demographic questionnaire. The translation was done from the recommended backward-forward method according to the WHO protocol. After that, face and content validity were applied, along with construct validity involving a comparison of known groups and confirmatory factor analysis. To test reliability, Cronbach's alpha was used. Data analysis was performed by SPSS and smart-PLS software.ResultsThe factor loadings of the self-care behaviors questionnaire were significant in all constructs, and were higher than 0.5 except for three items. The known-groups method showed that the self-care score of patients with controlled blood pressure was significantly higher than those with uncontrolled blood pressure. The extent of average variance extracted (AVE) of the majority of the constructs in the questionnaire was greater than 0.5 and, the composite reliability was greater than the AVE, indicating a good convergent validity. The divergent validity of the questionnaire was confirmed using the Fornell-Larcker criterion and the heterotrait-monotrait ratio (HTMT). Cronbach's alpha coefficient, combined reliability, and communalities index were optimal.ConclusionAccording to research findings, the Persian version of the questionnaire has good validity and reliability that can be used as a tool to measure the level of self-care of hypertension by health care providers.

Factors associated with self-care behaviours among people with hypertension residing in Kathmandu: a cross-sectional study

ObjectiveTo determine the prevalence and associated factors of self-care behaviours among people with hypertension in the Kathmandu district of Nepal.DesignCross-sectional study.SettingMunicipalities of Kathmandu district, Nepal.ParticipantsWe enrolled 375 adults aged ≥18...

Self-care practices and associated factors among hypertension patients in public hospitals in Harari regional state and Dire Dawa City administration, Eastern Ethiopia: A multi-center cross-sectional study.

IntroductionHypertension is a silent killer that causes serious health issues in all parts of the world. Hypertension is a risk factor for cardiovascular disease, stroke, and kidney disease. Self-care practices have been identified as an important component of hypertension management. Despite the government's commitment and the interventions of various stakeholders, the burden of hypertension and its sequel remain unabated. A recent study showed that hypertension self-care practices play a vital role in controlling and managing high blood pressure, even though there is poor self-practice among hypertensive patients in Ethiopia. Therefore, this study assessed the level of self-care practices and associated factors among hypertension patients in public hospitals in Harari regional state and Dire Dawa City Administration, Eastern Ethiopia.MethodsHospital-based cross-sectional study was conducted from June 15 to July 15/2021 among 415 adult hypertensive patients on follow-up. The participants were selected using systematic sampling. Hypertension Self-Care Activity Level Effects (H-SCALE) was used to collect data through face-to-face interviews. The SPSS version 24 was used for analysis. Logistic regression analyses were done to determine the association between the outcome and independent variables. For multivariate logistic regression models, variables having a P < 0.25 during bivariate analysis were candidates. The strength of the association was estimated using AOR and 95% CI. The level of statistical significance was declared at a p < 0.05.ResultsThis study revealed that 52% (95% CI, 48.2–58%) had good level of self-care practices. Formal education (AOR = 3.45, 95% CI: 2.1–4.85), good knowledge about hypertension (AOR = 1.5, 95% CI: 1.17–2.1) 1.5, abstain from chewing khat (AOR = 2.01, 95% CI: 1.44–3.94), strong social support (AOR= 1.9, 95% CI: 1.16–3.1), and absence of depression (AOR = 2.03, 95% CI: 1.43–3.92) were statistically associated with a good level of self-care practices.ConclusionsThis study pointed out that about half of the participants had a good level of self-care practices. Formal education, good knowledge about hypertension, abstaining from khat chewing, good social support, and absence of depression showed associations with a good level of self-care practices. Therefore, public health interventions on hypertension self-care practices, and strengthening non-communicable diseases control programs are vital. Moreover, the provision of targeted education to patients can improve disease knowledge and self-care practices.

Adherence to Self-Care Behaviors in Hypertensive Patients During the COVID-19 Pandemic Using the Modified Version of the Hypertension Self-Care Activity Level Effects Questionnaire

Background and Aim: High blood pressure is an important global healthcare concern, and its prevalence is increasing worldwide. Self-care practice is a cost-effective method in controlling blood pressure. This study aims to assess the adherence to self-care behaviors among hypertensive patients during the COVID-19 pandemic in Qom, Iran. Materials and Methods: This is a descriptive-analytical study with a cross-sectional design that was conducted in 2021 on 218 hypertensive patients in Qom City who were selected using a convenience sampling method. The data collection tool was a two-part questionnaire; the first part surveyed demographic characteristics, while the second part was the modified version of the Hypertension Self-Care Activity Level Effects (H-SCALE) questionnaire. Data analysis was performed in SPSS software using independent t-test, ANOVA, Pearson's correlation test, and chi-square test. Results: The participants had a mean self-care score of 79.32. Among the self-care subscales, smoking exposure (90.1%), medication adherence (85.7%), healthy eating plan (42.8%), weight management (35.1%), and physical exercise (28.5%) showed the highest scores. Only patients with a university education demonstrated higher and more significant self-care scores. Conclusion: The COVID-19 pandemic has had an impact on hypertensive patients’ adherence to self-care behaviors in Qom. Considering the results, particularly in weight management and physical activity with the lowest scores, it is important to implement educational programs to inform hypertensive patients about the seriousness of the complications of the disease and encourage them to adhere to self-care behaviors.

Illness perception and concordance between prostate cancer survivors and caregivers and adherence to self-management behaviors.

e24002 Background: Illness beliefs are important determinants of self-management behaviors (SMBs). Spousal or informal caregiver involvement improves clinical outcomes in non-cancer survivors with chronic diseases. However, very little is known about the influence that caregivers have on comorbid disease SMBs in cancer survivors. In this study, we aim to understand and identify concordance in illness beliefs and perceptions between caregivers and prostate cancer survivors and to determine their impact on hypertension (HTN) SMBs. Methods: Survivors and their caregivers completed surveys assessing their beliefs and perceptions and SMBs regarding survivors’ HTN. Both survivors and caregivers answered the Brief Illness Perception Questionnaire (BIPQ) to assess beliefs and perceptions of survivors’ HTN. The BIPQ score is a sum of eight questions with a higher sum score indicating a more threatening view of the illness. Survivors reported adherence to SMBs using the Medication Adherence Report Scale (MARS) and Hypertension Self-Care Activity Level Effects (HSCALE). MARS scores &gt;4.5 were considered adherent. The HSCALE isdivided into five sub-scores – diet, physical activity, smoking behavior, weight management and alcohol intake and each was score was dichotomized. Cohen’s Kappa statistic assessed concordance between survivor and caregiver dyad responses to the BIPQ. Logistic regression assessed associations between survivor and caregiver BIPQ scores and odds of SMB adherence. Results: This analysis included 55 dyads. Mean age of survivors was 70.4 years ± 9.6; 12 (22%) were Black, 36 (65%) were White, 2 (4%) were Asian and 3 (5%) were other race. Mean age of caregivers was 64.4 years ± 10.5, 9 (16%) self-identified as Black, 35 (64%) White, 2 (4%) Asian and 3 (5%) other race. Survivors and caregivers had fair agreements about how much HTN affected survivors’ lives (k = 0.147, p = 0.008), how concerned survivors are about their HTN k = 0.130, p = 0.014), and HTN’s emotional impact on survivors (k = 0.185, p = 0.002). However, survivor-caregiver concordance about HTN had no significant impact on survivors’ SMBs. In contrast, caregivers’ beliefs about HTN was associated with survivors’ SMB such that a 1-point increase in caregiver’s BIPQ score was associated with 8% increase in the odds of survivors’ self-reported weight adherence (p = 0.0314). Survivors’ HTN beliefs were not associated with adherence to SMBs. Conclusions: Caregivers have a significant influence on prostate cancer survivors’ adherence to weight-related SMB, demonstrating that it is important to also educate caregivers who support cancer survivors with chronic comorbidities. Future analysis will include a larger cohort to better understand the interrelationship between caregivers’ illness beliefs and survivors’ SMBs and may help clinicians better direct interventions to improve survivorship outcomes.

Association between Knowledge and Self-care Adherence among Elderly Hypertensive Patient in Dwelling Community

BACKGROUND: Hypertension contributes significantly to the increase in cardiovascular disease cases, especially in the elderly. Knowledge and self-care compliance are needed, but in reality, awareness and regularity of control are still lacking in hypertensive patients in urban communities. AIM: The aim of the study was to determine the relationship of knowledge with self-care and get an overview of existing knowledge and self-care in the elderly with hypertension. METHODS: This is a quantitative and cross-sectional design recruited 383 hypertensive patients in three community health centers. Sampling with proportional random sampling from three health centers that have the highest cases of hypertension in the city of Padang. Knowledge instrument using hypertension knowledge-level scale. Moreover, hypertension self-care adherence using hypertension self-care activity level effects. Analysis using Chi-square test RESULTS: The sample of this study was 383 respondents. About 66.3% are women, 88.3% have low education, and 86.9% do not work. 51.2% had duration of hypertension 0–5 years and the average age was 60.89 ± 8.072 years. About 94.8% of respondents have poor knowledge. Self-care practice showed 64% non-adherence to medication, 88.5% non-adherence to the DASH diet, and 82.5% non-adherence to weight management. However, 78.6% indicated non-smoking adherence and 100% alcohol avoidance adherence. There was a relationship between knowledge and adherence to weight management (p=0.000; odds ratio [OR] 6.7 (95% confidence interval [CI] for Exp B; 2.65–16.91)) and physical activity (p=0.000; OR 14.99 (95% CI for Exp B; 5.65–39.79)). CONCLUSION: Providing comprehensive and repeated health education for the elderly with hypertension can increase their knowledge. The involvement of patients and families is needed to improve self-care behavior.

Correlation of Hypertension Self-Care Activity Level Effects Factors with Perceived Stress in Uncontrolled Hypertensive Patients

BACKGROUND: Stress is associated with hypertension self-care behavior activity. Low self-care can cause hypertension and make hypertension uncontrolled. Patients with uncontrolled hypertension are very susceptible to experiencing stress through self-care activities that they must do. AIM: This study aims to identify the role of perceived stress on the self-care behavior of patients with uncontrolled hypertension. This study aims to assess the correlation of hypertension self-care activity level effect factors with perceived stress in patients with uncontrolled hypertension. METHODS: This quantitative study with a cross-sectional design recruited 383 patients with uncontrolled hypertension at a community health center. The sampling technique is consecutive sampling. Perceived stress was assessed using Perceived Stress Sclae (PSS) and hypertension self-care activities were assessed using Hypertension Self-Care Activity Level Effect (H-SCALE). Data were analyzed using chi-square and multivariate test. RESULTS: All respondents experienced stress, where 55.6% severed perceived stress and 44.4% moderate perceived stress. Severe stress occurs 60% in middle age, 54.2% in the elderly, 56.6% of male respondents, and 55.1% of female respondents. About 71.9% of respondents do not go to school, 69.2% are highly educated, and 56.6% of respondents do not work. Medication non-adherence (p = 0.000; OR = 0.941; 95% CI = 0.911–0.973) and weight management non-adherence (p = 0.006; OR = 0.956; 95% CI = 0.927–0.987) were positively correlated with the level of perceived stress in patients uncontrolled hypertension. CONCLUSION: Improving coping strategies for stress by designing educational provisions about medication and weight management (diet and physical activity) are easily understood by people who do not experience education. Continuity and comprehensive education are needed.

A web-based self-management program to improve lifestyle and blood pressure control in patients with primary hypertension: a randomized controlled trial

Abstract Background Hypertension contributes to the main risk factor of the high incidence of cardiovascular diseases and mortality. Successful control of blood pressure requires behavioral changes; therefore, it is of considerable importance to develop a web-based self-management program that assist patients to tailor their lifestyle and empower them manage their disease. Objective Our primary aims were to evaluate the effects of a web-based self-management program for improving blood pressure and blood lipids control in patients with primary hypertension. Our secondary aims were to evaluate the effects of the web-based self-management program on enhancing patients' lifestyle, medication adherence and self-efficacy. Methods This randomized controlled trial used permuted block randomization design and randomly divided the 222 patients into the intervention group (n=111) and control group (n=111). Patients in the intervention group received the web-based self-management program, and the control group received standard care. Lifestyle and medication adherence were assessed by using the Hypertension Self-Care Activity Level Effects Scale (H-SCALE). Self-efficacy was measured through using the Chinese version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C). The data of blood pressure and serum lipids were collected through web-based self-report and chart review. We used the generalized estimating equations to evaluate the effects of the intervention. Results There were no statistically significant differences of the baseline demographic characteristics and antihypertensive dosages from both groups. The intervention group received the web-based self-management program and showed a decrease in systolic blood pressures (−19.82 mmHg vs 7.99 mmHg, p&amp;lt;0.001) and diastolic blood pressures at 6 months (−9.17 mmHg vs 0.48 mmHg, p&amp;lt;0.001) compared to the control group. Regarding the H-SCALE scores measured at 6 months, the intervention group achieved a higher Medication Adherence Subscale scores (p&amp;lt;0.001), Diet Subscale scores (p&amp;lt;0.001), and Weight Management Subscale scores (p&amp;lt;0.001) than those of the control group. The intervention group achieved a higher SES6C scores than that of the control group (p&amp;lt;0.001) at 6 months. Finally, the intervention group had significantly lower serum levels of triglycerides and low-density lipoproteins than the control group at 6 months (−11.38 mg/dL vs 16.31 mg/dL, −9.93 mg/dL vs 3.12 mg/dL, respectively, p&amp;lt;0.001). Conclusion The greatest benefit of this program was allowing participants to consult dietary issues with us immediately. Since lifestyles vary among different individuals, we considered the individuality of each participant when providing feedback and involving them in the devising of interventions to increase their confidence in hypertension self-care and ultimately achieve the optimal control of blood pressure and blood lipid levels. Funding Acknowledgement Type of funding sources: None.

The Effects of Home-Based Self-Care Education on Blood Pressure and Self-Care Behaviors among Middle-Aged Patients with Primary Hypertension in Iran: A Randomized Clinical Controlled Trial

Self-care education (SCE) through home visit is one of the methods with potential effects on self-care. This study aimed to evaluate the effects of home-based SCE on blood pressure and self-care behaviors among middle-aged patients with primary hypertension in Iran. This randomized controlled trial was conducted on 110 middle-aged patients with hypertension recruited from public healthcare centers in the south of Tehran, Iran in September 2019. After convenience sampling, Participants were simple randomly allocated to control and intervention groups. Intervention group received a 2-month home-based SCE while control group received routine care services. Before and 2 months after the intervention, self-care behaviors were assessed using the Hypertension Self-Care Activity Level Effects (H-SCALE). Data were analyzed using the SPSS software (v. 16.0) at a significance level of less than .05. After 2 months, the posttest mean scores of self-care behaviors in medication adherence (17.42 ± 1.03 vs 14.49 ± 1.01, p = .04), physical activity (8.16 ± 0.39 vs 6.47 ± 0.52, p = .01), low-salt diet (52.51 ± 3.8 vs 35.36 ± 3.47, p = .001), and blood pressure control (3.47 ± 0.22 vs 2.42 ± 1.89, p = .001), in the intervention group were significantly greater than the control group. However, there were no significant between-group differences respecting the posttest mean scores of the weight management ( p = .06) and smoking cessation ( p = .2). Also, the mean blood pressure between the 2 groups changed after the intervention, but this difference was not statistically significant. This study suggests the effectiveness of home-based SCE in significantly improving self-care behaviors among patients with hypertension. But more studies are needed to measure the effectiveness of intervention on blood pressure. IRCT code: IRCT20190623043985N1. Registered 06/30/2019, https://fa.irct.ir/trial/40351 .

EFFECT OF A PHARMACIST INTERVENTION ON SELF MANAGEMENT PRACTICES AMONG HYPERTENSIVE-DIABETIC PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL

Objective: The objective of this study was to evaluate the effect of a pharmacist-led intervention on self-management practices among hypertensive-diabetic patients receiving care in a Nigeria tertiary hospital.&#x0D; Methods: The study adopted a prospective, longitudinal; single-blind, two-arm randomised controlled trial to implement a pharmacist-led educational intervention on hypertension management among patients in Federal Medical Centre Lokoja, Kogi State. All the patients who met the eligibility criteria and gave their written consent to participate in the study were recruited into the study randomized in the intervention group (IG) and Control (CG). Data was collected using Hypertension Self Care Activity Level Effects (H-SCALE) questionnaire. The retrieved questionnaires were first coded into Microsoft Excel (2014) for cleaning of errors, after which the data was exported into the Statistical Product and Services Solutions (SPSS for windows, Version 16.0. SPSS Inc. 2007, Chicago, USA) software. Descriptive statistics such as frequencies, percentages and mean scores were used to summarise the data. All responses were first presented as frequencies and percentages. Chi-square was used to determine the correlation between socio-demographic and patients’ clinical characteristics. Independent sample t-test and paired sample t-test were used to compare differences between and within groups.&#x0D; Results: At baseline, more patients in the control group were adherent to their medications 16 (11.5) and had low salt diets 47 (33.8) than patients in the intervention group. However, more patients in the intervention group were non-smokers 127 (88.8) and engaged more in physical activity 38 (26.6) than patients in the control group. However, more of the patients in the control group were adherent to weight management practices 38 (27.3) than patients in the intervention group 36 (25.2), at baseline. All the patients in both study groups reported to have taken alcohol in the past seven days. It can be seen that, patients in the intervention group at endpoint, differed positively from the control group at baseline in adherence to medication, physical activity, reducing alcohol consumption and smoking cessation. It can also be observed that the baseline intervention group differed positively from the endpoint in medication adherence (t=-26.045, p&lt;0.001); physical activity (t=-15.081, p&lt;0.001); weight management practices (t=-5.479, p&lt;0.0010, and alcohol consumption 9t=-11.550, p&lt;0.001).&#x0D; Conclusion: A pharmacist led educational intervention had a positive impact on the self-management practices of hypertensive-diabetes patients.

The effects of Orem's self-care theory on self-care behaviors among older women with hypertension: A randomized controlled trial

Background: Lifestyle modification and self-care have potential effects on hypertension management among older women. Objectives: The aim of this study was to assess the effects of using Orem's Self-Care Deficit (OSCD) theory on self-care behaviors among older women with hypertension. Methods: This clinical trial was conducted in 2018–2019. A 70-year-old woman with hypertension were conveniently recruited from healthcare centers in Ramsar, Iran, and randomly allocated to a control and an intervention group. Participants in the intervention group received self-care education based on the OSCD theory. The control group received no intervention. Data were collected using a personal characteristics questionnaire, a researcher-made self-care need assessment checklist, and the Hypertension Self-Care Activity Level Effects questionnaire. The Wilcoxon and the Mann–Whitney U-tests were used to analyze the data. Results: There were no significant differences between the groups respecting the pretest mean scores of medication adherence, weight control, physical activity, and nutrition-related self-care behaviors (P > 0.05). However, after the intervention, the between-group difference respecting the mean scores of these behaviors were statistically significant (P < 0.001). Conclusion: The OSCD theory is effective in promoting self-care behaviors among women with hypertension. Therefore, its use is recommended to improve hypertension management and quality of life and reduce treatment-related costs in these patients.

Role of family support and self-care practices in blood pressure control in individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala

Background: Despite the availability of effective drugs, blood pressure (BP) control rate is sub-optimal in individuals with hypertension in low- and middle-income countries (LMICs). The role of self-care in the management of BP is less studied in LMIC settings. Methods: We conducted a community-based, cross-sectional study in individuals with hypertension in Kollam district, Kerala. A multistage cluster sampling method was used for the selection of study participants. We measured self-care by using an adapted Hypertension Self-Care Activity Level Effects (H-SCALE) scale. Descriptive statistics were used to summarise the data and logistic regression analysis was conducted to identify factors associated with BP control. Results: In total, 690 individuals with hypertension (women=60%) and a mean age of 57±8 years participated in the study. More than half (54%) of the participants were adherent to anti-hypertensive medications. However, the adherence rate was much lower for the dietary approach to stop hypertension (DASH) diet (12.8%), recommended level of physical activity (24%) and weight management (11.4%). Overall BP control was achieved in two of five individuals (38.4%, 95% CI: 34.7-42.0%). Among self-care activities, adherence to medications (AOR: 1.8, 95% CI: 1.3-2.5), DASH diet (AOR: 1.5, 95% CI: 1.0-2.4), and non-smoking status (AOR: 3.3, 95% CI: 1.7-6.4) were associated with control of BP. Additionally, good family support to self-care (AOR: 1.9, 95% CI: 1.1-3.1) was associated with better control of BP. Conclusion: In individuals with hypertension, the BP control rate is achieved in two of five individuals. Adoption of self-care activities are sub-optimal. Both family support and adherence to self-care activities are associated with BP control. Family based interventions to improve adherence to self-care activities could have a significant public health impact in achieving better population-level BP control rates in Kerala, India.

A-039 Adherence and Executive Functioning in an Elderly Population with Type 2 Diabetes in México

Abstract Objective Diabetes is a prevalent chronic illness that can impact Executive Functioning (EF). Adherence to treatment is an important aspect in diabetes management however little published research addresses the relationship between adherence and EF in individuals with Type 2 Diabetes Mellitus (T2DM). The objectives of this study are: compare the levels of adherence and EF between T2DM and a control group. Analyze the relationship between adherence and EF in individuals with T2DM. Method The present study included 10 participants with T2DM and 10 control participants with Hypertension (HTN) all between the ages of 61–76. Participants were recruited through “Casa del Abue” a public center offering medical/social services to geriatric populations in Puebla, México. Neuropsychological Battery of Executive Functions and Frontal Lobes was administered to all participants, along with adherence measures specific to diagnosis: Summary of Diabetes Self-Care Activities or Hypertension Self-Care Activity Level Effects. Informed consent was obtained prior to participation. Results Results show significant differences in adherence between T2DM and HTN U = 1.0 p = &amp;lt; 0.001 and also between groups in EF measures related to medial Orbitofrontal cortex (OFC) U = 21.0 p = &amp;lt; 0.05. The relationship between adherence and EF in T2DM participants was moderately correlated r(10) = 0.32, p = 0.36. Descriptive statistics found in Table 1. Conclusion T2DM participants demonstrate significantly lower adherence levels and deficits in EF compared to the control group as expected. Given only a moderate correlation between adherence and EF was found, further research including a larger sample and more precise adherence measures such as HbA1c is suggested to further understand this relationship.

Role of family support and self-care practices in blood pressure control in individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala.

Background: Despite the availability of effective drugs, blood pressure (BP) control rate is sub-optimal in individuals with hypertension in low- and middle-income countries (LMICs). The role of self-care in the management of BP is less studied in LMIC settings. Methods: We conducted a community-based, cross-sectional study in individuals with hypertension in Kollam district, Kerala. A multistage cluster sampling method was used for the selection of study participants. We measured self-care by using an adapted Hypertension Self-Care Activity Level Effects (H-SCALE) scale. Descriptive statistics were used to summarise the data and logistic regression analysis was conducted to identify factors associated with BP control. Results: In total, 690 individuals with hypertension (women=60%) and a mean age of 57±8 years participated in the study. More than half (54%) of the participants were adherent to anti-hypertensive medications. However, the adherence rate was much lower for the dietary approach to stop hypertension (DASH) diet (12.8%), recommended level of physical activity (24%) and weight management (11.4%). Overall BP control was achieved in two of five individuals (38.4%, 95% CI: 34.7-42.0%). Among self-care activities, adherence to medications (AOR: 1.8, 95% CI: 1.3-2.5), DASH diet (AOR: 1.5, 95% CI: 1.0-2.4), and non-smoking status (AOR: 3.3, 95% CI: 1.7-6.4) were associated with control of BP. Additionally, good family support to self-care (AOR: 1.9, 95% CI: 1.1-3.1) was associated with better control of BP. Conclusion: In individuals with hypertension, the BP control rate is achieved in two of five individuals. Adoption of self-care activities are sub-optimal. Both family support and adherence to self-care activities are associated with BP control. Family based interventions to improve adherence to self-care activities could have a significant public health impact in achieving better population-level BP control rates in Kerala, India.

Self-Care Behaviour Practices and Associated Factors Among Adult Hypertensive Patient in Padang

Introduction: Hypertension self-care practice is essential for blood pressure control and reduction of hypertension complications. An Assessment of an individual hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to control hypertension. Objective: The purpose of this study was to assess Hypertension self-care practice and associated factors among patients in public health facilities in Padang. Method: In this cross-sectional study design with proportional random sampling. 260 hypertensive patients. Self-care activities were measured using hypertension self-care activity level effects (H-Scale). Results: The mean age was 60 years old, women (65.8%), unemployed (88.1%), senior high school (47.7%), duration had hypertension for 5-10 years (49.6%). 67.3% normal body mass index, 83.5% nonsmoking, 72.3% had’ not central obesity. There were four components of self-care that had a low level. They were physical activity adherence, using a low salt diet, weight management, and medication adherence. 100% abstinence from alcohol, 73.8% nonsmoking. The results of Chi-square indicated that BMI (p=0.002), central obesity (p = 0,000) were significantly associated with treatment adherence; there were also a significant association between education (p=0.005), BMI (p=0.002) and central obesity (p=0,000) with diet adherence; the age (p = 0.008), education (p = 0.014) and central obesity (p = 0,000) with adherence to physical activity; sex (p = 0,000), work (p=0,000) and education (p=0.025) with nonsmoking. Discussion: It is crucial to implement a well- designed program to improve hypertension self-care behaviors.

Practice and predictors of self-care behaviors among ambulatory patients with hypertension in Ethiopia.

BackgroundDespite the benefits of evidence-based self-care behaviors in the management of hypertension, hypertensive patients have low rate of adherence to the recommended self-care behaviors. Studies related to self-care behaviors among hypertensive patients are limited in Ethiopia.ObjectiveTo assess the rate of adherence to self-care behaviors and associated factors among hypertensive patients.MethodA cross-sectional study was conducted at the cardiac clinic of Ayder comprehensive specialized hospital among ambulatory hypertensive patients. Self-care behaviors were assessed using an adopted Hypertension Self-Care Activity Level Effects (H–SCALE). Data were collected through patient interview and review of medical records. Binary logistic regression analysis was performed to identify predictors of self-care behaviors.ResultA total of 276 patients were included in the study. The majority of the participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than half of the participants were adherent to the prescribed antihypertensive medications (48.2%) and recommended physical activity level (44.9%). Moreover, only 21.45% and 29% were adherent to weight management and low salt diet recommendations, respectively. Our finding indicated that rural resident (adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21–0.97), comorbidity (AOR: 0.16, 95% CI: 0.08–0.31), and negative medication belief (AOR: 0.25, 95% CI: 0.14–0.46) were significantly associated with medication adherence. Female sex (AOR: 0.46, 95% CI: 0.23–0.92), old age (AOR: 0.19, 95% CI: 0.06–0.60) and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03–0.57) were significantly associated with adherence to weight management. Female sex (AOR: 1.97, 95% CI: 1.03–3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI: 0.03–0.16) were significantly associated with adherence to alcohol abstinence. Female sex (AOR: 6.33, 95% CI: 1.80–22.31) and khat chewing (AOR: 0.08, 95% CI: 0.03–0.24) were significantly associated with non-smoking behavior. There was also a significant association between female sex and physical activity (AOR: 0.22, 95% CI: 0.12–0.40).ConclusionThe rate of adherence to self-care behaviors particularly weight management, low salt intake, physical exercise, and medication intake was low in our study. Elders, females, khat chewers, rural residents, and patients with negative medication belief, comorbidity, and inadequate knowledge of SCBs were less adherent to self-care behaviors compared to their counterparts. Therefore, health care providers should pay more emphasis to patients at risk of having low self-care behaviors.

Relative and Cumulative Effects of Hypertension Self-Care Behaviors on Blood Pressure.

New recommendations for hypertension (HTN) diagnosis and treatment highlight the role of self-care activities in managing blood pressure (BP). This cross-sectional study investigated the predictive validity of the Hypertension Self-Care Activity Level Effects (H-SCALE) measure and examined the relative and cumulative effects of HTN self-care adherence on BP. We pooled baseline data from three studies (N = 79), resulting in a gender and racially balanced sample. Partial correlations determined the relative effects of individual self-care behaviors on BP. We modeled the relationship between adherence to self-care behaviors and BP control using logistic regression. Physical activity had the greatest correlation with systolic BP. Adherence to each additional self-care behavior increased the odds of systolic BP control by 88% (95% confidence interval (CI) = [1.20, 2.96]) and diastolic BP control by 74% (95% CI = [1.10, 2.75]). Results provide further evidence that the H-SCALE is a valid assessment tool and should be adopted by clinicians to aid in improving BP management.