A theory guided nursing intervention for management of hypertension among adults at rural area

Abstract

Background and objective: Hypertension is one of the most important preventable causes of premature morbidity and mortality in the world. Many people with hypertension both in developing and developed countries have no adequate control of their blood pressure. Lifestyle modification and adherence to antihypertensive drugs play an important role in controlling hypertension and in preventing its long-term complications. Aim: This study was conducted to assess the effect of application of Pender's Health Promotion Model on management of hypertension among adults in rural area. Methods: Quasi-experimental design was utilized. The sample of this study was a purposive sample of 150 adults with hypertension. Setting: This study was conducted at El-Shahid Fekry village and Abu-Mashhour village at Menoufia Governorate. Tools used were (1) An interview questionnaire containing three parts of the model: a) Individual characteristics and experience, b) behavior-specific cognitions and affect, and c) behavioral outcomes. (2) Physical measurement included anthropometric measurements. Results: The highest percentages of hypertension were among age group between 50-60 years (44.7%), female (69.3%), and illiterate (34.7%). There was statistical significant improvement among the study group than the control group at the posttest of the systolic and diastolic blood pressure in relation to the components of Pender's health promotion model (p = .0001). Conclusions and recommendations: Application of Pender's Health Promotion Model was effective in management of hypertension. Also, nursing educational intervention was successful in improving knowledge, lifestyle behaviors and blood pressure measurement among adults in the study group than the control group. Recommendations: Health education programs to increase awareness of adults about risk factors of hypertension and the disease process is essential to empower and motivate them to adopt healthy lifestyle and adhere to medication to manage the disease and prevent complication.

Health Promotion Model: An Integrative Literature Review

“…A different study aimed to assess the effect of application of HPM on management of hypertension among 150 adults in Egypt, showed that there was statistical significant improvement among the study group than the control group at the posttest of health-promoting behavior, and the highest mean score was in the posttest of nutrition dimension followed by medication adherence, stress management and physical activity, but smoking had no statistical significant improvement [18]. Moreover, a significant difference among 80 health volunteers in Iran found between the mean scores of physical activity and other structures of HPM in the experimental group after the intervention and its score before intervention [19].…”

“…The second category included eleven studies which evaluated the HPM as a mean to predict physical activity (PA) in a sample of Iranian adolescent boys [7], compared perceived self-efficacy, exercise benefits, exercise barriers, and commitment to exercise between patients diagnosed with osteoporosis and osteoarthritis, and assessing the influence of perceived exercise self-efficacy, exercise benefits, and barriers on commitment [8], explored perceived exercise self-efficacy, benefits and barriers, and commitment to exercise among Jordanians with chronic illnesses [14], explored perception of exercise benefits and barriers among Jordanian patients' with End Stage Renal Disease (ESRD) [11], used HPM to provide insight into the relationship between dietary and fluid non-adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support among Jordanian patients with ESRD receiving hemodialysis [9], conducted an evaluation of an educational program based on the HPM and stages of change to improve physical activity (PA) behavior among Iranian adolescents [10], used Pender's HPM to describe and identify the predictors of health-promoting behaviors in Nepalese migrant workers in Korea [13], examined the psychometric properties of the Arabic version of Bandura's Exercise Self-Efficacy scale (ESE-A) among Jordanian patients with different chronic diseases [16], assessed the effect of application of Pender's HPM on management of hypertension among adults in rural area [18], examined the impact of performing a HPM intervention on physical activity of the health Volunteers [19], and investigated the effect of Pender's HPM to improve the nutritional behavior of overweight and obese women admitted to Fatemiyeh…”

“…Moreover, some studies explored perception of exercise benefits and barriers along with the factors associated with such perceptions among patients with ESRD [11], assessed the relationship between perceived exercise self-efficacy, benefits and barriers, and commitment to exercise planning [14], used HPM to describe and identify the predictors of health-promoting behaviors among migrant workers [13], and examined facilitators and barriers that migrant women identified related to breast self-examination, clinical breast examination, and mammography [22]. Furthermore, some studies assessed the effect of application of HPM on management of hypertension among adults [18], investigated the effect of HPM to improve the nutritional behavior of overweight and obese women [20], and examined relationships among health responsibility, resilience, neighborhood perception, social support, and health promoting behaviors in adolescents [21].…”

“…The second category is the studies that tested a samples and populations of chronic illness. The samples were 75 patients with a clinical diagnosis of osteoporosis and 75 patients with osteoarthritis [8], 190 patients with ESRD receiving hemodialysis [9], 190 patients with ESRD [11], 402 outpatient with chronic illnesses [14], 272 patients with chronic illness [16], and 150 adults with hypertension [18].…”

“…The 17 research studies that met the inclusion criteria were retrieved and reviewed, where 16 of them used quantitative research methodologies [6]- [21], and one used qualitative methodology [22]. Cross-sectional research design was the most commonly used design in the quantitative studies, and two studies used quasi experimental design [18] [20], and one study used a randomized clinical trial [10] (See Figure 1). …”