Hypertension Self-care Behaviors Research Articles

Factors Contributing to Hypertension Self-Care Management Behavior in Elderly Rural Residents

The behavior of hypertension self-care management in the elderly is very important to be applied to reduce the prevalence of hypertension in rural areas. This study aims to analyze the factors associated with hypertension self-care management behavior in the elderly in rural areas based on the Protection Motivation Theory (PMT). The research design uses analytic observational with a cross-sectional approach. The sample in this study was 150 elderly people with hypertension who lived in rural areas. The independent variables are perceived vulnerability, perceived severity, perceived reward, response efficacy, self-efficacy, and intention. The dependent variable is hypertension self-care management behavior. Data collection uses the PMT and HSMBQ questionnaires. Bivariate analysis used the Spearman correlation test and multivariate analysis used linear regression with a significance level = 0.05. Bivariate test results found that perceived vulnerability (r=0.615 and p<0.05), perceived severity (r=0.497 and p<0.05), perceived reward (r=0.598 and p<0.05), efficacy response (r=0.510 and p<0.05), self-efficacy (r=0.477 and p<0.05), and intention (r=0.513 and p<0.05) related to hypertension self-care management behavior. Multivariate test results found that the PMT model associated with hypertension self-care management behavior includes perceived vulnerability (p<0.05), perceived severity (p<0.05), perceived reward (p<0.05), and self-efficacy (p<0.05). The value of R square = 0.519 indicates that the PMT model can predict 51.9% of self-care behavior. The dominant factor that can increase hypertension self-care management behavior is the perception of vulnerability. Nurses should be able to provide health education to improve hypertension self-care management behavior.

Abstract 051: Racial Differences In Hypertension Self-care Behaviors Among Adults With Hypertension In The Baltimore And Washington, D.C. Area

Introduction: Interventions utilizing comprehensive hypertension (HBP) self-care evaluation tools may reduce HBP disparities. However, studies examining racial differences in HBP self-care among people diagnosed with HBP are limited. Methods: We analyzed cross-sectional data from adults with HBP that receive care in the Baltimore and Washington D.C. area. Twenty self-care behaviors were examined via the Hypertension Self-Care Profile (HBP-SCP) tool and scored as 4-point Likert with total scores ranging between 20-80. Multinomial logistic regression models were used to assess the association between race categories (White, Black/African American, Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Other/Multi-racial) and HBP-SCP behaviors, adjusting for covariates. Results: The study included 4,391 adults diagnosed with HBP (mean age 62 ± 12 years; 55% female). The median HBP-SCP score was 47 and scores ≥ 47 or <47 were rated as good and poor, HBP self-care behavior, respectively. Compared to White adults, Asian and Black/African American adults were 29% less likely and 21% more likely, respectively, to have good HBP self-care behavior in the unadjusted model. Asian and Other/Multi-racial adults were 38% and 35%, respectively, less likely to have good HBP self-care behavior after adjusting for covariates compared to White adults (Table 1). Conclusion: Racial differences exist in HBP self-care behaviors among adults with HBP. These findings highlight the importance of practitioners assessing patients’ understanding of and adherence to self-care behaviors and developing culturally tailored approaches for improving adherence.

Hypertension Self-Care Behavior and Its Associated Factors among Patients with Hypertension

Background: Hypertension is a chronic medical condition that affects millions of people worldwide and can lead to severe health complications. Hypertension self-care behavior is important in managing their condition and reducing their risk of complication. This study aimed to to determine factors that associated with self-care behavior among patients with hypertension. Subjects and Method: This was cross-sectional study, conducted at Boyolali Regency, Central Java. A total of 122 participant are included in this study. The Independent variables were including age, sex, education level, income, and duration of hypertension. The dependent variable was Hypertension self-care behavior. The data of Hypertension self-care behavior were collected by Hypertension self-care behavior questionnaire (HSCBQ). Knowledge about hypertension was measured using a modified questionnaire of hypertension evaluation of lifestyle and management (HELM). The data were analyzed by multiple logistic regression. Results: Age ≥ 50 years (aOR=3.76; 95%CI=1.30 to 10.50; p=0.014), higher level of education (aOR=6.06; 95%CI=1.91 to 22.85; p=0.003) higher income (aOR=2.89; 95%CI=1.07 to 7.80; p=0.035), longer duration of hypertension (aOR=3.35; 95%CI=1.13 to 9.93; p=0.029) and good knowledge of hypertension (aOR=10.56; 95%CI=3.51 to 31.71; p<0.001) were associated and statistically significant with Hypertension self-care behavior. Conclusion: Older age, higher level of education, higher income, longer duration of hypertension and good knowledge had statistically significant association with good Hypertension self-care behavior. Keywords: age, duration of hypertension, hypertension self-care behavior, income, knowledge, level of education. Correspondence: Akhmad Azmiardi. School of Health Science Mamba’ul ‘Ulum Surakarta. Jln. Ringroad, Mojosongo, Jebres, Surakarta, Central Java, Indonesia. Email: aazmiardi@gmail.com. Mobile: +6285245412021.

Association of Perceived Neighborhood Health With Hypertension Self-care

Hypertension self-management is recommended for optimal blood pressure (BP) control, but self-identified residential contextual factors that hinder hypertension self-care are understudied. To quantify perceived neighborhood health and hypertension self-care and assess interactions with the area deprivation index (ADI) and healthy food availability at home. A cross-sectional study was conducted in Baltimore, Maryland, including primary care adults enrolled in the Achieving Blood Pressure Control Together trial between September 1, 2013, and June 30, 2014. Participants were Black and had at least 2 BP readings greater than or equal to 140/90 mm Hg in the 6 months before enrollment. Analyses were conducted from August 5, 2021, to January 28, 2022. Participants' perceived neighborhood health, defined as the mean standardized score across 4 subdomains of aesthetic quality, walkability, safety, and violence, with a higher score signifying better neighborhood health. Hypertension self-care behavior and self-efficacy. Multivariable generalized linear models were fit regressing each outcome on perceived neighborhood health (higher scores on each domain signify better perceived neighborhood health), adjusted for confounders, and interaction terms between neighborhood health and potential modifiers (ADI [higher percentiles correspond to more deprivation] and healthy food availability [higher scores indicate greater availability]) of the primary association were included. Among 159 participants (median [IQR] age, 57 [49-64] years; mean [SD] age, 57 (11) years; 117 women [74%]), median (IQR) hypertension self-care behavior was 50 (45-56) and self-efficacy was 64 (57-72). Better perceived neighborhood health was associated with greater hypertension self-care behavior (β, 2.48; 95% CI, 0.63-4.33) and self-efficacy (β, 4.42; 95% CI, 2.25-6.59); these associations persisted for all neighborhood health subdomains except aesthetic quality. There were no statistically significant interactions between perceived neighborhood health or its subdomains with ADI on self-care behavior (P = .74 for interaction) or self-efficacy (P = .85 for interaction). However, better perceived neighborhood aesthetic quality had associations with greater self-care behavior specifically at higher healthy food availability at home scores: β at -1 SD, -0.29; 95% CI, -2.89 to 2.30 vs β at 1 SD, 2.97; 95% CI, 0.46-5.47; P = .09 for interaction). Likewise, associations of perceived worse neighborhood violence with lower self-care behavior were attenuated at higher healthy food availability at home scores (β for -1 SD, 3.69; 95% CI, 1.31-6.08 vs β for 1 SD, 0.01; 95% CI, -2.53 to 2.54; P = .04 for interaction). In this cross-sectional study, better perceived neighborhood health was associated with greater hypertension self-care among Black individuals with hypertension, particularly among those with greater in-home food availability. Thus, optimizing hypertension self-management may require multifaceted interventions targeting both the patients' perceived contextual neighborhood barriers to self-care and availability of healthy food resources in the home.

Perceived Susceptibility to Chronic Kidney Disease and Hypertension Self-Management among Black and White Live Kidney Donors.

Despite the societal benefits of live kidney donation, Black donors may be more likely than White donors to develop hypertension (HTN) and chronic kidney disease after donation. Among live kidney donors diagnosed with post-donation HTN, little is known about potential racial/ethnic differences in HTN self-care behaviors and perceived susceptibility to developing kidney disease. We ascertained electronic medical records and phone survey data from live donors enrolled in the multi-center Wellness and Health Outcomes of LivE Donors (WHOLE-Donor) Hypertension Care Study between May 2013 and April 2020. Using multivariable logistic regression models performed January through June 2021, we examined potential associations of donor race/ethnicity with perceived susceptibility to kidney disease and self-care behaviors (ie, Behavioral Risk Factor Surveillance System measure assessing self-reported actions to control high blood pressure). The study included 318 US-based live kidney donors who developed post-donation HTN (57.6% female; 78.9% White; 18.6% Black; and mean age 46.7 years at donation). Black donors were equally as likely as White donors to report being moderately or strongly concerned about developing kidney disease (adjusted odds ratio, aOR: 1.27, 95%CI: .66, 2.14, P=.57). Donors with diabetes were more likely than those without diabetes (aOR: 2.43, 95%CI: 1.03, 5.01, P=.04), while donors aged >50 years were less likely than younger donors (aOR: .39, 95%CI: .18, .85, P=.02) to report being moderately or strongly concerned about kidney disease. Overall, 87% of donors reported taking at least one action to help control blood pressure, with no significant differences by sociodemographic factors. We found no substantial differences in perceived susceptibility to kidney disease among Black and White donors, despite published evidence that Black donors may experience greater risk of developing kidney disease than White donors. Behavioral interventions to enhance knowledge about future disease risk, attitudes, and self-care strategies among living kidney donors may be beneficial.

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.

Linking Health Literacy to Self-Care in Hypertensive Patients with Physical Disabilities: A Path Analysis Using a Multi-Mediation Model.

Hypertension has been identified as the most prevalent chronic disease, accounting for the majority of premature deaths in people with physical disability in South Korea. Self-care is vital in controlling high blood pressure. Health literacy has been implicated in self-care behaviors; however, the mechanisms behind this relationship remain unclear. Therefore, the present study aimed to test a hypothetical path model estimating the association between health literacy and hypertension self-care behaviors and to verify the mediating effects of access to healthcare, provider–patient interactions, hypertension knowledge, and hypertension control self-efficacy in hypertensive people with physical disability. In total, 211 hypertensive adults with physical disability completed an online survey. A path analysis using a multi-mediation model was performed using AMOS 17.0 (IBM SPSS Inc., Chicago, IL, USA), and indirect effects were estimated using phantom variables. As a result, the model fit indices were deemed excellent. Significant indirect pathways were determined from health literacy to hypertension self-care behavior via provider–patient interactions, knowledge, and self-efficacy, although no direct association was found between health literacy and self-care behaviors. The study findings supported the importance of provider–patient interactions, knowledge, and self-efficacy, which play a role in linking health literacy and self-care behavior in hypertensive patients with physical disability.

Assessment of Hypertension Self-Care Behaviors and Self-Efficacy Among Men in Saudi Arabia.

Hypertension is rapidly increasing in the Kingdom of Saudi Arabia (KSA), particularly among men. Assessment of hypertension self-care behaviors is a critical step to promoting blood pressure control. This study aimed to evaluate the Hypertension Self-Care Profile (HBP-SCP) among Saudi men in KSA. The HBP-SCP self-efficacy and behavior scales were translated into Arabic and tested on a convenience sample of 160 Saudi men with hypertension. Cronbach's alpha and factor analysis were conducted using SPSS. Internal consistency of the Arabic HBP self-care and self-efficacy scales was 0.84 and 0.90, respectively. Factor loading ranged from 0.25 to 0.70 for HBP self-care behaviors and from 0.28 to 0.77 for HBP self-efficacy. The Arabic HBP-SCP is acceptable in its reliability and validity for measuring HBP self-care behaviors and self-efficacy among Saudi men with hypertension.

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.

Self-Care Practices among Hypertensive Patients of all Aged Group in Tsum- Nubri Rural Municipality of Gorkha District


 
 
 
 Introduction: Hypertension is now becoming an increasingly important cause of morbidity and mortality in developing countries which leads to a major public health problem. It is necessary for an assessment of an individual’s hypertension self-care behavior and its associated factors in order to provide clinicians about important information regarding how to better control hypertension. Thus, the objective of this study was to assess the self-care practices among hypertensive patients of all age group and to understand the factors associate with it.
 Methods: A community-based cross-sectional study was conducted in Tsum-Nubri Rural Municipality of Gorkha district among 68 hypertensive patients. Self-care activities were measured using a semi-structured questionnaire with the H-hypertension self-care activity level effects (H-SCALE) and the data was entered and analyzed in SPSS version 16. Uni-variate analysis was done and was presented through frequency and percentage whereas, bivariate analysis was by using chi-square test where P value <0.05 was considered to be association between dependent and independent variables
 Results: Adherence to the recommended levels of medication was reported to 25%; only 8.8% followed the physical activity level guidelines. None of the participants showed adherence to weight management and low- salt diet recommendation. 51.5% of them were adherence to non-smoking and alcohol abstinence. Marital status (0.005), education level (0.003) and monthly household income (0.003) were significantly associated with adherence to non-smoking. Also, body mass index (0.001) was significantly associated with the physical activity.
 Conclusions: Based on study findings, life style modification and regular monitoring must be considered in order to increase good self-care practice
 
 
 

Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial.

Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others. We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans. Randomized comparative effectiveness trial. One hundred fifty-nine African Americans at an urban primary care clinic. Participants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving"). We assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy. BP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months. A context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control. ClinicalTrials.gov Identifier: NCT01902719.

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.

Design of a randomized controlled trial comparing a mobile phone-based hypertension health coaching application to home blood pressure monitoring alone: The Smart Hypertension Control Study

BackgroundHypertension is a major cause of morbidity and mortality but frequently remains uncontrolled. A smartphone application that provides coaching regarding home blood pressure monitoring and other aspects of hypertension self-care and related behavior change may be a scalable way to help manage hypertension. Methods/designThe Smart Hypertension Control Study is a prospective, randomized controlled trial to assess the effects of a hypertension personal control program (HPCP), which consists of an automated artificial intelligence smartphone application that provides individualized support and coaching to promote home monitoring and healthy behavior changes related to hypertension self-management. Enrolled adults with uncontrolled hypertension will be randomized in a 1:1 fashion to the HPCP with home blood pressure monitoring or to home monitoring alone. We plan to enroll 350 participants, with a target of 300 participants with complete six-month follow-up data. The primary study outcome will be systolic blood pressure at six months. Additional outcomes include measures of antihypertensive medication adherence, home blood pressure monitoring practices, self-management practices, weight, and self-reported health behaviors. ConclusionThe Smart Hypertension Control Study will evaluate blood pressure and hypertension self-management behavior outcomes in participants with uncontrolled hypertension exposed to a smartphone-based hypertension health coaching application in addition to home blood pressure monitoring compared to those exposed to home blood pressure monitoring alone.

Factors Predicting Self-Care Behaviors among Low Health Literacy Hypertensive Patients Based on Health Belief Model in Bushehr District, South of Iran.

The aim of this study was to determine the factors influencing adherence to self-care behaviors among low health literacy hypertensive patients based on health belief model. A cross-sectional study was conducted among 152 hypertensive patients with low health literacy. Patients with limited health literacy were identified by S-TOFHLA. The data were collected using H-scale for assessing self-care behaviors and, HK-LS for assessing knowledge of hypertension. A researcher-made questionnaire was applied for collecting data of health belief model constructs. Data were analyzed by SPSS version 22 with using multiple logistic regression analyses. Perceived self-efficacy was associated with all self-care behaviors except medication regimens. There was a significant association between perceived susceptibility and adherence to both low-salt diet (OR = 3.47) and nonsmoking behavior (OR = 1.10). Individuals who had more perceived severity (OR = 1.82) had significantly greater adherence to their medication regimens. Perceived benefits and barriers were not significantly associated with either type of hypertension self-care behaviors. It seems that designing and implementation of educational programs to increase self-efficacy of patients and promote their beliefs about perceived susceptibility and severity of complications may improve self-care behaviors among low health literacy hypertensive patients.

Psychometric Properties of the Hypertension Self-Care Behavior Scale for Elders with Hypertension in Korea

Psychometric Properties of the Hypertension Self-Care Behavior Scale for Elders with Hypertension in Korea

Self-Care Behaviors and Related Factors in Hypertensive Patients.

BackgroundAn assessment of an individual’s hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension.ObjectivesThe objective of this study was to investigate the self-care behaviors of hypertensive patients.Patients and MethodsThis cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects.ResultsThe mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435).ConclusionsBased on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors.

Correlates of Self-Care Behaviors among Low-Income Elderly Women with Hypertension in South Korea

To identify correlates of self-care behaviors among elderly, low-income Korean women with hypertension. A secondary analysis of data from a community-based intervention trial for hypertension control. Three community health posts in the Gangwon province, South Korea. Two hundred thirty-four (234) low-income elderly women (age 60-93) who had previously participated in a community-based intervention trial for hypertension control. The researchers collected data that included patient background characteristics, hypertension self-care behavior, self-efficacy of hypertension control, general knowledge of hypertension, and social support. The data were analyzed using descriptive and inferential statistics, including hierarchical regression analysis. The model explained 41.1% of the total variance in hypertension self-care behavior scores. Among elderly, low-income Korean women, the significant factors of their hypertension self-care behavior included: (a) self-efficacy of hypertension control (β = .62), (b) social support (β = .16), and (c) age (β = -.14). Hierarchical regression analysis showed that elderly Korean women that had higher self-efficacy of hypertension control, higher social support, and were younger were more likely to have higher hypertension self-care behavior scores. The results highlight the need for interventions that focus on improving an individual's self-efficacy and social support to enhance hypertension self-care. The findings of this study can help nurses better understand hypertension self-care behavior in elderly, low-income Korean women.

The Association Between Self-Efficacy and Hypertension Self-Care Activities Among African American Adults

Chronic disease management requires the individual to perform varying forms of self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy to manage hypertension and six clinically prescribed hypertension self-care behaviors. We interviewed 190 African Americans with hypertension who resided in the greater metropolitan Charlotte area about their self-efficacy and their hypertension self-care activities. Logistic regression for correlated observations was used to model the relationship between self-efficacy and adherence to hypertension self-care behaviors. Since the hypertension self-care behavior outcomes were not rare occurrences, an odds ratio correction method was used to provide a more reliable measure of the prevalence ratio (PR). Over half (59%) of participants reported having good self-efficacy to manage their hypertension. Good self-efficacy was statistically significantly associated with increased prevalence of adherence to medication (PR=1.23, 95% CI: 1.08, 1.32), eating a low-salt diet (PR=1.64, 95% CI: 1.07-2.20), engaging in physical activity (PR=1.27, 95% CI: 1.08-1.39), not smoking (PR=1.10, 95% CI: 1.01-1.15), and practicing weight management techniques (PR=1.63, 95% CI: 1.30-1.87). Hypertension self-efficacy is strongly associated with adherence to five of six prescribed self-care activities among African Americans with hypertension. Ensuring that African Americans feel confident that hypertension is a manageable condition and that they are knowledgeable about appropriate self-care behaviors are important factors in improving hypertension self-care and blood pressure control. Health practitioners should assess individuals' self-care activities and direct them toward practical techniques to help boost their confidence in managing their blood pressure.

Correlates of self-care behaviors for managing hypertension among Korean Americans: A questionnaire survey

Background While self-care behaviors have been documented as one of the main determinant of hypertension control, studies investigating correlates of self-care behaviors have been rare regarding hypertension among minority population. Objectives The purpose of this study was to examine factors associated with self-care behaviors for hypertension using a community sample of Korean Americans. Design A descriptive cross-sectional design. Settings Community setting in the Baltimore–Washington metropolitan area. Participants The sample included 445 middle-aged (40–64 years of age) Korean Americans with hypertension (systolic BP ≥ 140 and/or diastolic BP ≥ 90 mmHg; or taking antihypertensive medication). Methods Guided by Social Cognitive Theory, a variety of personal (age, gender, marital status, employment status, years in U.S., duration of hypertension, hypertension knowledge, hypertension belief, and hypertension control self-efficacy) and environmental (social support) factors were examined in relation to hypertension self-care behaviors, including medication-taking, exercise, diet, and weight control. Results The model explained 18.0% of the total variance in self-care scores. Hierarchical multiple regression revealed that personal factors contributed significantly to the explanatory model, whereas social support did not add much. Examination of individual regression coefficients showed that Korean Americans who were older, who had longer duration of hypertension, and who had higher hypertension control self-efficacy were more likely to have higher self-care scores. Conclusions Hypertension control self-efficacy emerged as the most significant contributing factor to hypertension self-care. Future intervention programs should focus on improving hypertension control self-efficacy as a modifiable personal factor.

Does Participatory Decision Making Improve Hypertension Self‐Care Behaviors and Outcomes?

This study examined patients' perceptions of their providers' participatory decision making (PDM) style and hypertension self-care behaviors and outcomes. Five hundred fifty-four veterans with hypertension enrolled in the Veterans' Study to Improve the Control of Hypertension rated providers' PDM styles using a validated 3-item instrument. Behaviors assessed included presence of a home blood pressure monitor, monitoring frequency, and self-reported antihypertensive medication adherence. Overall, veterans with hypertension rated providers as highly participatory. In adjusted analyses, a lower PDM score was associated with decreased odds of having a home monitor (odds ratio, 0.90 per 10-point decrement in PDM score; 95% confidence interval, 0.83-0.98) but not with monitoring frequency, adherence, or blood pressure control. Providers' involvement of patients in decision making, reflected in ratings of PDM style, may be important to securing patients' participation in their own care, but alone this factor seems insufficient. No relationship between PDM score and blood pressure control was observed.