|Year : 2020 | Volume
| Issue : 1 | Page : 58-64
Effect of a training programme on knowledge and practice of lifestyle modification among hypertensive patients attending out-patient clinics in lagos
Oluwatosin Mary Oyewole1, Olaolorunpo Olorunfemi2, Foluso Ojewole3, Mojolaoluwa Omolade Olawale1
1 Department of Medical Surgical Nursing, School of Post Basic Nursing, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
2 Department of Medical Surgical Nursing, School of Nursing, University of Benin Teaching Hospital, Benin-City, Edo State, Nigeria
3 School of Nursing, Babcock University Illisha Remo, Ogun State, Nigeria
|Date of Submission||29-Nov-2018|
|Date of Decision||22-Jul-2019|
|Date of Acceptance||15-Oct-2019|
|Date of Web Publication||27-Dec-2019|
Mr. Olaolorunpo Olorunfemi
Department of Medical Surgical Nursing, School of Nursing, University of Benin Teaching Hospital, Benin-City, Edo State
Source of Support: None, Conflict of Interest: None
Background: Hypertension is the leading cause of cardiovascular disease and death in the world. Research shows that the best way to remediate this problem is through lifestyle modification, but the percentage of hypertensive patients with the right knowledge about life-style modification is very low. It is therefore imperative to develop different ways of improving the practice and knowledge of life-style modification. Consequently, this study aim to determine the effectiveness of a training programme on knowledge and practice of lifestyle modification among hypertensive patients. Materials and Methods: A quasi-experimental design was conducted with accidental sampling to select the sample size (n = 30). A modified structured questionnaire from World Health Organization (WHO), Hypertension Knowledge-Level Scale (HK-LS) were used to measure knowledge of hypertension, knowledge of lifestyle modification and practice. Tables, percentages, mean, Standard Deviation and t-test were used for data analysis at 0.05 levels of significance, through statistical package for the social science software. Results: The result showed that the t-test of the pre-knowledge about hypertension among hypertensive patients differed significantly from post-knowledge after intervention (t = 4.90, p = 0.001). In addition, there is significant different between the pre and post knowledge level about lifestyle modification after intervention (t = 3.62, p = 0.001). Significant different was also observed between the pre and post practice of lifestyle medication after intervention (t = 3.56, p = 0.001). Conclusions: The health care providers, especially the nurses, must provide a continuous and focused training programme for hypertensive patients in order to improve their knowledge and practice of lifestyle modification.
Keywords: Education, hypertension, knowledge, life style, Nigeria
|How to cite this article:|
Oyewole OM, Olorunfemi O, Ojewole F, Olawale MO. Effect of a training programme on knowledge and practice of lifestyle modification among hypertensive patients attending out-patient clinics in lagos. Iranian J Nursing Midwifery Res 2020;25:58-64
|How to cite this URL:|
Oyewole OM, Olorunfemi O, Ojewole F, Olawale MO. Effect of a training programme on knowledge and practice of lifestyle modification among hypertensive patients attending out-patient clinics in lagos. Iranian J Nursing Midwifery Res [serial online] 2020 [cited 2020 Jan 19];25:58-64. Available from: http://www.ijnmrjournal.net/text.asp?2020/25/1/58/274126
| Introduction|| |
Hypertension is the most common non-communicable disease and the leading cause of cardiovascular disease in the world and many people with hypertension are unaware of their condition making treatment infrequent and inadequate. In terms of economic burden, poorly controlled blood pressure is a considerable important public health concern among older adult in the world. It has been proven that lifestyle modifications are capable of lowering hypertension.
Despite this 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 in South-East Nigeria, it was revealed that about 87.10% of the participants were not aware of weight reduction, regular exercise, fruit intake, cigarette smoking, and alcohol moderation as lifestyle modification therapy.
Knowledge and practice of lifestyle modification among patients with high blood pressure has however been showed to be inadequate in some studies. In 2016, Jafari et al. postulated that having a partial knowledge and awareness alone will not lead to a change in health behaviours and practical application of knowledge., On the contrary to that, in UK, Nicoll and Henein revealed that many hypertensive patients are unwilling to accept that their lifestyle practices and suggest that health education about hypertension, its consequences and lifestyle modification must be considered. Therefore, this study aims to find out the effect of training programme on knowledge and practice of lifestyle modification among hypertensive patient.
| Materials and Methods|| |
This is quasi-experimental design, which was conducted from December 2016 to July 2017 and adopted pre-test- post-test design, accidental sampling was used to select sample size of 30. The sample size was calculated according to slovin's formula, n = sample size, population size (N) = 32, and margin of error (e) = 0.05, with confidence level of 95%. The setting was Lagos University Teaching Hospital (LUTH), and the target population was male and female adult clients who have been diagnosed to be hypertensive and attending general and medical out-patient clinic in LUTH with a target population of 32.
The inclusion criteria were as follows: patients who were willing to participate in the study and who consented after carefully going through a detailed procedure of bioethical principles in conducting research studies on human participants, patients who were formally registered in the out-patient clinic and confirmed with their registration cards, and patients who were 21 years and above. The exclusion criterion was any patient with comorbidities that could limit him or her ability in participating in the training program and other activities of the study were excluded.
A modified structured questionnaire from World Health Organization (WHO), Hypertension Knowledge-Level Scale (HK-LS) was used to measure knowledge of hypertension, knowledge of lifestyle modification and practice. The data gathering tools were the demographic characteristic questionnaire, knowledge of hypertension, knowledge of lifestyle modification and practice scale. The knowledge of hypertension scale includes 20 items with maximum and minimum scores of 20 and 0, respectively. Scores 15-20 indicate high knowledge, 10-14 indicate moderate knowledge, and scores <10 indicate low knowledge. The knowledge of lifestyle modification scale includes 14 items with maximum and minimum score of 14 and 0, respectively. Scores 12-14 indicate high knowledge, 8-11 indicate moderate knowledge and, scores <7 indicate low knowledge of lifestyle modification. The practice of lifestyle modification scale includes 12 Multiple Choices Questions (MCQs) with maximum and minimum score of 96 and 0, respectively. Score ≥48 indicate positive practice and scores ≤47 indicate negative practice of lifestyle modification. The HK-LS is a global standardized tool which was designed and reported by sultan et al. in 2012. The reliability and content validity of the scale were obtained as 0.82 and 60.3% respectively. Furthermore, the psychometric properties of the questionnaire was checked by an expert in the field, using face and content validity criteria and the reliability of the instrument was established through a pretest method by administering 15 questionnaires to both male and female hypertensive patients with the same criterion attending physician clinic in Crystal Specialist Hospital Akowonjo, Lagos. In this way, Cronbach Alpha co-efficient was used to test reliability using 10 well-filled questionnaires. The value obtained was 0.79, which indicated high reliability of the instrument. There were three phases in this study. Phase 1: This was for mobilization. Three major events took place in this phase; the researcher met with the consultants and nurses in General out-Patient Department (GOPD) and Medical out-Patients (MOP) clinics in LUTH to explain the purpose of the study and its benefits at the first week of the study. This was also to seek their cooperation for the success of the study. The researcher and research assistances visited the clinics Monday to Friday, in the second week of the study, to listen to health talk given to the patients by nurses and other health personnel, gaps were identified which was used to modify the training modules [Table 1]. Interested participants were selected for the study after seeking their consent. Further selection of interested participants continued in the third week. Questionnaires were administered as a pretest instrument to the clients attending hypertension clinic in the hospitals. The results from this phase were also used to modify the training program for better intervention. Participants were follow-up via phone calls (at least a call per week for the period of the training) and text messages, reminding them to come for the training programme. Phase2: Three weeks training program was planned and applied to the group, participants were met with at the seminar room of the clinic. In the first week of the training, 18 participants were available on the first day of the training programme using teaching aids, others were follow-up and this yielded another 12 attendee for the training which covers the first module, week two and three follow-up produced good results as 24 participants were available for the training which covers the second, third and fourth modules using teaching aids. 6 other participants were given training at different occasions in other to meet up with the sample size. Phase 3: after the application of training program for experimental group, a post-test was conducted with the same questionnaire used for pre-test. Data obtained were coded and analyzed using the Statistical Package for Social Science (SPSS) version 21.00 statistical software (IBM corp. released 2012. IBM SPSS statistics for widows, version 21 Armonk, NY: IBM Corp). Variables and research questions were analyzed using descriptive and t-test statistics.
|Table 1: Training Programme module about lifestyle modification among Hypertensive Patients|
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Ethical approval for this study was obtained from three institutional ethical committees where the study took place, with approval reference BUHREC608/16 on November 30th, 2016, Babcock university, REF: LREC/06/10/77 and REF: ADM/DCST/HREC/APP/1398 from LUTH on 5th January 2017. The interviewer explained the importance and what the participants and others stand to benefit from the study. Therefore, obtained informed consent from the participants before the study commences. The participation in the study was voluntary, and they have the right to pull out from the study at any level as the study progresses.
| Results|| |
[Table 2] shows that the greater numbers of the participants were female 70.00% in the group. This may be due to the fact that female termed to visit the clinics more, unlike male who pays more attention to their cars and electronics. Majority, 70% were married. Also majority, though below average, 43.30%, have tertiary education. Greater percentages of the participants (76.70%) were Christians. 93.30% are 46.70% in the group are Yoruba. This is due to the fact that this study was carried out in South-west Nigeria where the majority are Yoruba.
|Table 2: Socio-demographic data of Hypertensive Patients Attending out-Patient Clinics in Lagos, Nigeria|
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[Table 3] shows that 70% in the group answered that the best cooking method is not frying. 53.30% in the group attest boiling or grilling as the best method. 60% answered that individual with hypertension should not eat too much salt even when they are on medications. [Table 4] shows that 56.70% have good knowledge about lifestyle modification pre-test and 80% have good knowledge about lifestyle modification after training program. 13.30% have poor knowledge pre-test and poor knowledge is completely eliminated after the application of training program (0%).
|Table 3: Pre intervention knowledge about lifestyle modification among Hypertensive Patients Attending out-Patient Clinics in Lagos, Nigeria|
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|Table 4: Summary of responses on knowledge about lifestyle modification pre intervention|
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[Table 5] shows increase in practice (adequate ≥41) from 56.70% to 76% at the experimental group after application of training program which is relatively high when the scores are comparing with each other. Inadequate practice (0-47) reduced from 43.30% to 24%.
|Table 5: Summary of responses on practice of lifestyle modification post intervention|
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Finally, [Table 6] shows that, there is a statistical different between pre- and post-knowledge of hypertension with t = 4.9, p = 0.001 after intervention. The study also show that the level of knowledge about lifestyle modification improved after intervention among the experimental group with t = 3.62, p = 0.001. Decisively, the study show that the practice of life style modification is low in the pre-test while there is a significant improvement in post- test after application of training program among the group, with t and p value of (t = 3.56, p = 0.001).
| Discussion|| |
The study shows that there is fair knowledge about hypertension among the group but the knowledge about lifestyle modification is very low. In 2015, Abd El-Hay and Mezeyan findings contradict this present finding. They opined that many patients diagnosed with hypertension are not aware of it, and this is because most times hypertension does not come with symptom particularly in early phase, hence leading to delay diagnosis which might have caused complications without awareness. This study also shows that there is a relationship between the intervention and knowledge about hypertension. This is in agreement with the fact that there is a relationship between knowledge the training programme as supported by Precede-proceed theory. The participants knowledge about lifestyle modification which is low and inadequate practice of lifestyle modification seen among the participants of this study is in agreement with the submission of Okwuonu, Emmanuel and Ojimadu, 2014, who found that in south East, Nigeria, majority of the participants were not aware that exercise, moderate alcohol consumption and salt restriction have great effect on blood pressure control. Likewise, it was further found that they were not also aware of the roles of unsaturated oil, reduction in diary food, fruits and vegetables play in the control of blood pressure. Hence there was negative correlation between the level of practice and blood pressure control.
Lack of awareness of lifestyle modification and inability to practice was identified to post a barrier to hypertension control. The findings suggested that there is inadequate levels of knowledge and practice of non-drug intervention to achieve the ultimate goal of improving health by controlling hypertension. Therefore public education campaigns regarding compliance non-drug intervention should be encouraged. In other words, this lack of knowledge about lifestyle modification has been due to lack of health seeking behavior of the patients or lack of adequate information on the part of the health personnel. This is also supported by of Tilahum, Tesemman and Gizaw, 2015, who posited that advice given on lifestyle modification is not enough to affect their practice behavior and knowledge but reinforcement and motivation in the form of training. The inadequate practice showed in this study further buttress the fact that doctors and nurses' advice given on lifestyle modification is not enough to affect their practice, behavior and knowledge. This is supported by the study carried out in US which says, the fact that hypertension treatment is focused on pharmacotherapy, advice on dietary adjustment and training on lifestyle modification is usually over looked by the health personnel leading to lack reinforcement, which will ultimately lead to inadequate practice of lifestyle modification. These findings is also synonymous to a study that says despite participants understanding that lifestyle modification controls hypertension and prevents complications, practice is less among hypertensive patients. Furthermore, the post-test score for practice of lifestyle modification showed adequate improvement among the participants, and also indicate that there is improved knowledge about hypertension, lifestyle modification and practice. This is an indication that the training programme was very effective and agree with the fact that when enough time is given to divulging relevant information on the importance of lifestyle in the control of blood pressure, it can lead to a better practice of lifestyle modification. These findings also in agreement with a study showed that more than 50% of the participants will adopt lifestyle modification once they have information about the effects. Likewise, the findings above further support the importance of a focused training programme to improve knowledge of hypertension, and practice of lifestyle modification. This study substantiates a study which stated that increase in 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. Also, incongruence with a study who found out that the hypertensive patients become aware of lifestyle modification, more than 50% will adopt it.
Finally, some limitations were encountered in the course of the study despite the research objectives being met. First, it was difficult randomizing the participants because the number of patients seen at the general out-patients clinic per day who met the inclusion criteria was few. Hence, accidental sampling method was used, which could limit the generalization of this study. Secondly, having all the patients in one session for the training programme and for posttest was difficult, hence, the participants were taking in sessions, which could also affect the result.
| Conclusion|| |
The health care providers, especially the nurses, should provide a continuous, focused health education and training for the hypertensive patients to empower them in practicing positive health behaviors that will help them control their blood pressure.
Based on the findings of this study, the following recommendations are made; the health sector should intensify effort on health educating the populace on the type of lifestyle that put them at risk of developing hypertension through regular jingle via mass media. Other recommendation is that more time be given to this assignment; more than the usual 10-15 minutes' health talk at the medical out-patient clinics and should be more focused and intentional towards promoting lifestyle modification. Finally, the result of this study provides an evidence for responsiveness to change in knowledge and practice of life-style modification after an educational training was introduced. In this respect, holding educational training program is a basic instrument that can be used to effect positive behavioural changes needed in management of hypertensive patient. Life style modification is the way to go, if management of hypertension and other non-communicable diseases would be effective.
The researchers would like to thank the nurses who participated in the study despite their tight schedule, and all hypertensive patients attending out-patient clinics in Lagos.
Financial support and sponsorship
Conflicts of interest
Nothing to declare.
| References|| |
Gowshall M, Taylor-Robinson SD. The increasing prevalence of non-communicable diseases in low-middle income countries: The view from Malawi. Int J Gen Med 2018;11:255.
Al-Wehedy A, Abd Elhameed SH, Abd El-Hameed D. Effect of lifestyle intervention program on controlling hypertension among older adults. J Educ Pract 2014;5:61-71.
Okwuonu CG, Emmanuel CI, Ojimadu NE. Perception and practice of lifestyle modification in the management of hypertension among hypertensives in south-east Nigeria. Int J Med Biomed Res 2014;3:121-31.
Jafari F, Shahriari M, Sabouhi F, Farsani AK, Babadi ME. Effects of a lifestyle modification program on knowledge, attitude and practice of hypertensive patients with angioplasty: A randomized controlled clinical trial. Int J Community Based Nurs Midwifery 2016;4:286-96.
Nelson M. Drug treatment of elevated blood pressure. Aust Prescr 2010;33:108-2.
Agyei-Baffour P, Tetteh G, Quansah DY, Boateng D. Prevalence and knowledge of hypertension among people living in rural communities in Ghana: A mixed method study. Afri Health Sci 2018;18:931-41.
Nicoll R. Henein MY. Hypertension and lifestyle management: How useful are the guidelines? Br J Gen Pract 2010;60:879-800.
Abd El-Hay SA, Mezayen SE. Knowledge and perceptions related to hypertension lifestyle behavior modification and challenges that is facing hypertensive patients. IOSR J Nurs Sci (IOSR-JNHS) 2015;4:15-26.
Porter CM. Revisiting precede–proceed: A leading model for ecological and ethical health promotion. Health Educ J 2016;75:753-64.
Gao Y, Chen G, Tian H, Lin L, Lu J, Weng J, et al
. Prevalence of hypertension in China: A cross-sectional study. PloS One 2013;8:e65938.
Olorunfemi O, Ojewole F. Medication belief as correlate of medication adherence among patients with diabetes in Edo State, Nigeria. Nurs Open 2018;6:197-202.
Kahan S, Gielen AC, Fagan PJ, Green LW, editors. Health Behavior Change in Populations. JHU Press; 2014.
Tilahun T, Tesemma S, Gizaw D. Knowledge, attitude and practice of non-pharmacologic therapy among hypertensive patients in Bishoftu, Ethiopia. J Health Med Nurs 2015;19:2422-8419.
Alhalaiqa F, Al-Nawafleh A, Batiha AM, Masa'deh R, AL-Razek AA. A descriptive study of adherence to lifestyle modification factors among hypertensive patients. Turk J Med Sci 2017;47:273-81.
Durai V, Muthuthandavan AR. Knowledge and practice on lifestyle modifications among males with hypertension. Indian J Community Health 2015;27:143-9.
Yang MH, Kang SY, Lee JA, Kim YS, Sung EJ, Lee KY, et al
. The effect of lifestyle changes on blood pressure control among hypertensive patients. Korean J Family Med 2017;38:173-80.
Ike SO, Aniebue PN, Aniebue UU. Knowledge, perceptions and practices of lifestyle-modification measures among adult hypertensives in Nigeria. Trans Royal Soc Trop Med Hyg 2010;104:55-60.
Baliz Erkoc S, Isikli B, Metintas S, Kalyoncu C. Hypertension knowledge-level scale (HK-LS): A study on development, validity and reliability. Int J Environ Res Public Health 2012;9:1018-29.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]