A Study to assess the Knowledge and Practice regarding Hypertension and its association with The level of Blood Pressure among adults in Nanchiyampalayam at Dharapuram with A View of Conducting an Awareness Programme.

 

Little Flower P¹, Vijayarani Prince²

¹Lecturer, Bishop’s College of Nursing, C.S.I Mission Compound, Dharapuram-638 656.

²Principal, Bishop’s College of Nursing, C.S.I Mission Compound, Dharapuram-638 656.

 

ABSTRACT:

Hypertension is one of the leading causes of death and disability among the adults globally. The increasing incidence of hypertension will exert a devastating price on the physical and economic health of the global community. It remains an important health challenge and it is as “iceberg” disease. It is called as a silent killer because people who have it are often symptoms free. Many of us are living a life that leads to high blood pressure or Hypertension. As people age, the situation gets even worse. However according to experts, Hypertension is not predestined, reducing salt intake, adopting a desirable dietary pattern, losing weight and exercising can all help prevent Hypertension. This study was aimed to assess the knowledge and practice regarding hypertension and its association with the level of blood pressure among adults in Nanchiyampalayam at Dharapuram with a view of conducting an awareness programme. The research approach used for the study was descriptive approach. The conceptual framework used for the study was based on the revised Rosenstock’s Health Belief Model (1988). The design used for the study was descriptive survey design. Non probability Purposive sampling technique was used to collect 100 samples of adults for this study. Structured interview schedule was used to assess the knowledge and practice. Level of blood pressure was checked by using Sphygmomanometer daily for three days in the morning. Data gathered were analyzed by using descriptive and inferential statistics. The study findings revealed that majority 76% of the adults had moderately adequate knowledge, and majority 78% of the adults had moderately adequate practice. Majority 53% of the adults had grade 3 level blood pressure. Mean score of knowledge and practice regarding hypertension was 18.45(SD± 3.59) and 8.7(SD± 2.09). And there was a positive correlation between (r=0.4) of knowledge and practice. There was no significant association between knowledge scores regarding hypertension and level of blood pressure (χ²=10.84) at (P<0.05) level. There was significant association between practice scores regarding hypertension and level of blood pressure (χ²=22.44) at (P<0.05) level. There was association between knowledge scores and marital status (χ²=15.13), education (χ²=18.48) and occupation (χ²=22.29). And there was no association between practice scores among adults with their demographic variables except for marital status (χ²=12.49). The study findings revealed that there was a significant correlation between knowledge and practice scores regarding hypertension among adults and there was a significant association between practice scores regarding hypertension and level of blood pressure. Knowledge and practice influences hypertension among adults and adequate practice may help the individual to maintain normal blood pressure.

 

 

 

INTRODUCTION:

A healthy lifestyle contributes to continued health in the middle years of adults. During adulthood, individuals may confront with physical vulnerability. Some of the health problems are common in middle adulthood  including hypertension, diabetes, elevated serum cholesterol concentration and cardiac diseases. With normal aging, diet, stress, smoking and other lifestyle factors may contribute to the process of diminished elasticity of the blood vessels, fatty degeneration and calcification¹ .These are likely to account for increases in blood pressure as adults grow older. Higher the blood pressure and longer it goes uncontrolled, greater the damage². Uncontrolled high blood pressure can lead to damage to arteries, aneurysm, heart failure, blocked or ruptured blood vessels in brain, stroke, metabolic syndrome, weakened and narrowed blood vessels in kidneys, thickened, narrowed or torn blood vessels in the eyes can result in vision loss. Uncontrolled high blood pressure also may affect the ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure³. Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in India), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease. Therefore, health care professionals must identify and treat patients with hypertension and also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population⁴. Each year, May 17th is designated World Hypertension Day, which promotes awareness of the prevention, detection, control, treatment and complications of hypertension. As hypertension has either direct or indirect effect on heart disease, stroke, kidney disease and diabetes. The theme for 2012 is ‘Healthy Lifestyle-Healthy Blood Pressure’⁵. The day was initiated to increase the awareness of hypertension. This was especially important because of the lack of appropriate knowledge among hypertensive patients.

 

Globally, 7 million people die and 1.5 billion suffer every year because of high blood pressure or hypertension. Incidence of cases of high blood pressure had reached 26.1% in 2007⁶. In India, 196 million adults are affected with hypertension.

 

The prevalence of hypertension in Tamil Nadu was 14.8%, male 1, 44,024 and females 179,230 In India, studies shown that the prevalence of hypertension was 59.9/1000 in males, and 69.9/1000 in females respectively in the urban communities and 35.5/1000 in males and 35.9/1000 in females in rural communities⁷. The incidence is found usually between the age group of 20-60 years of age. In Chennai the overall prevalence of hypertension was 20 per cent, it was higher among men (23.2 per cent) than women (17.1 per cent)⁸.

 

STATEMENT OF THE PROBLEM:

A study to assess the knowledge and practice regarding hypertension and its association with the level of blood pressure among adults in Nanchiyampalayam at Dharapuram with a view of conducting an awareness programme.

 

METHODOLOGY:

RESEARCH APPROACH:

Descriptive approach was used to conduct the present study.

 

RESEARCH DESIGN:

Descriptive survey design was used to conduct the study.

 

SETTING:

The study was conducted in (urban) Nanchiyampalayam area at Dharapuram.

 

POPULATION:

The population of the study was adults.     

 

SAMPLE:

The samples who are aged between 40-60 years with hypertension, residing in Nanchiyampalayam, Dharapuram.

 

SAMPLE SIZE:

The study consists of 100 adults who are diagnosed as hypertension.

 

SAMPLING TECHNIQUE:

Non probability, Purposive sampling technique was used to select the sample.

 

CRITERIA FOR THE SAMPLE SELECTION:

INCLUSION CRITERIA:

·      Adults who are diagnosed as hypertension.

·      Adults who are available at the time of data collection.

·      Both male and female adults.

EXCLUSION CRITERIA:

·      Adults who are not willing to participate in the study.

·      Adults who are associated with any other illness.

 

Development and the description of the tool:

PART-I:

It consists of selected demographic variables of adults such as age, sex, marital status, education, religion, occupation, family income, type of family, family history of hypertension, duration of treatment, and source of health information.

 

PART-II:    

Structured interview schedule was used to assess the knowledge regarding hypertension among adults with hypertension. It consists of 35 multiple choice questions. Each question has 4 options among which one was the correct answer.

 

PART-III:

Structured interview schedule was used to assess the practice which consists of 15 dichotomous questions regarding hypertension among the adults with hypertension. It has 9 positive and 6 negative questions.

 

PART-IV:

It includes checking the level of blood pressure among adults by using Sphygmomanometer.

 

SCORING PROCEDURES:

The level of blood pressure was interpreted as

 

VALIDITY:

The validity of the tool was established in consultation with the four nursing experts in the field of community health nursing and one medical expert in the field at community medicine. The tool was modified according to the suggestions and recommendation of the experts.

The accuracy of the sphygmomanometer was assessed Karl Pearson formula was used. The value was found to be reliable systolic blood pressure(r=0.87) and diastolic blood pressure(r=0.85).

 

RELIABILITY:

The reliability of the sphygmomanometer was established by using interrater method and Karl Pearson formula was used systolic blood pressure(r=0.76) and diastolic blood pressure(r=0.84).

 

The reliability of the structured interview schedule on knowledge questionnaire was assessed by testing the stability and internal consistency. Stability was assessed by test retest method using Karl Pearson’s co-efficient formula. The value was found to be reliable (r=0.94). Internal consistency was assessed by spilt half technique using spearman’s brown prophecy formula. The value was found to be reliable (r=0.95).

 

The reliability of the structured practice questionnaire regarding hypertension was computed by test retest method. Karl Pearson’s co-efficient formula was used and the value was found to be reliable (r=0.98). The spilt half method where the Spearman’s brown prophecy formula was used to find out the Internal consistency of the tool and found to be reliable (r=0.9).

 

Procedure for Data Collection:

The data was collected in Nanchiyampalayam at Dharapuram. Written permission was obtained from the Municipal health officer in Dharapuram and oral consent was obtained from the study subjects after explaining the purpose of the study. 100 samples who met the inclusion criteria were selected by using Non probability purposive sampling technique. Demographic variables, knowledge and practice regarding hypertension among adults were assessed by using structured interview schedule. Blood pressure was assessed by using Sphygmomanometer daily for three days. The average value of blood pressure was taken for three consecutive days. 50-60 minutes was spent for each samples. 3-4 samples were interviewed per day. After collecting the data from 100 samples, an awareness programme was conducted regarding hypertension in the community health centre, Nanchiyampalayam. In an one day 8 sessions were conducted with the duration of 45 minutes. 10-15 members had attended each session.

 

The awareness programme was conducted with the use of food display, posters, models and charts which was contented with meaning, causes, types, clinical manifestations, management, complications, and preventive measures such as exercise, diet, and life style modification behaviour.150 members were attended the

 

DATA ANALYSIS:

The data related to assessment of knowledge and practice of adults in Nanchiyampalayam, regarding hypertension was analyzed in terms of descriptive statistics and inferential statistics.

 

RESULT:

Section –A:

Regarding age, the majority 31(31%) of the adults were belonged to the age group of 46-50 years . Regarding sex majority 64 (64%) of the adults were females .Regard to marital status, majority 82(82%) of adults were married. Regarding education, majority 51 (51%) of the adults had no formal education. With regard to religion, majority 74 (74%) of adults were Hindus.  Regarding to occupation, majority 79 (79%) of the adults were self employees. Regard to monthly income, majority 34(34%) of the adults were belongs to Rs.2000-3000.Regarding to type of family, majority 68 (68%) of the adults belonged to nuclear family. With regard to family history of hypertension, half 50 (50%) of the adults had a family history of hypertension, and 50(50%) had no family history of hypertension. Regard to duration of treatment, majority 45 (45%) of the adults  were taking treatment for 1year -5 years. Regarding to source of health information, the majority 51 (51%) of the adults had health information from health workers.

 

The study findings were consistent with the findings of Mary. P., (2009) performed to assess the knowledge regarding diet among hypertensive patients. The findings of the study showed that 9% had inadequate knowledge, 47% had moderately adequate and 44% had adequate knowledge.

 

Section –B:

Regarding level of blood pressure majority 53(53%) of adults had grade 3(stage-1), 20(20%) had grade 1(normal), 19(19%) had grade 2(high normal hypertension), 7(7%) had grade 4(stage-2), and 1(1%) of had grade 5(stage-3) level of blood pressure.

 

The study findings were consistent with the findings of Wizner. B, et. al., (2000) on knowledge about hypertension and blood pressure. The findings of the study shows that 24.1% of participants had blood pressure values exceeding 140/90 mmHg (stage-1).

 

Section-C:

Table :1 Correlation between knowledge and practice regarding hypertension among adults. n=100

S. No	Variable	Mean scores	Standard deviation	Coefficient of correlation	Table value
1	Knowledge	18.45	3.59	0.4	0.195
2	Practice	8.7	2.09

 

df=98        P<0.05

 

The data analysis showed that there was positive correlation between (r=0.4) knowledge and practice regarding hypertension among adults at 0.05 level.

 

Section-D:

Table : 2 Association between the knowledge scores regarding hypertension among adults with their level of blood pressure. n=100

p<0.05                            N.S= Non significant                               S=Significant

 

 

Chi Square values were calculated to find the association between the knowledge scores regarding hypertension among adults with their level of blood pressure. There  was no significant association between the knowledge scores and level of blood pressure (χ²=10.84) at (P<0.05) level.

 

 

Section-E:

Table 3 Association between the practice scores regarding hypertension among adults with their level of blood pressure. n=100

p<0.05                N.S= Non significant                                S=Significant

 

 

 

 

Chi Square values were calculated to find the association between the practice scores regarding hypertension among adults with their level of blood pressure. There was a significant association between practice scores and level of blood pressure (χ²=22.44) at (P<0.05) level.

 

Section-F:

The findings of the study shows that there was statistically significant association between level of knowledge scores with marital status (χ²=15.13), education (χ²=18.48) and occupation (χ²=22.29).

The study findings were consistent with the findings of malhotra.r.et.al., (2010) on prevalence, awareness, treatment and control of hypertension in the elderly population of singapore. The findings of the study showed that 30.8% were unaware that they had hypertension, 32.0% were not being treated for the disease and 75.9% had suboptimal control of their blood pressure. Among those aware of their hypertension, only 1.9% was untreated. And age, gender, ethnicity, education, housing type, body mass were significantly correlated with lack of awareness, treatment and control of hypertension.

 

CONCLUSION:

This present study assessed the knowledge and practice regarding hypertension and its association with the level of blood pressure among adults. The results showed that (76%) of adults had moderately adequate knowledge  and 78(78%) of adults had moderately adequate practice on hypertension.

 

An  awareness programme was  played an important role to the  community people regarding hypertension which change their practice, help them to modify  their  life style and treat the hypertension without facing any complications in future. The people perceived that the

hypertension is manageable and non life threatening condition

 

NURSING IMPLICATIONS:

Nursing Service:

·      Community health nurse can conduct screening programme in the  community area.

·      The awareness programme can be conducted by community health nurse to making awareness regarding hypertension in the community.

·      Nurses as the change agent can introduce various preventive measures to prevent the complications of hypertension.

·      Community health nurse can conduct in service education, organize workshop, seminars and conference at PHC and sub centres regarding prevention of hypertension.

Nursing Education:

·      Students can conduct various health education programme in community regarding prevention of hypertension.

·      Teachers can motivate the students to do mini project among various age groups on hypertension.

 

Nursing Administration:

·      Nurse administrators have more responsibility as supervisors on creating awareness among various age groups regarding hypertension by facilitating free distribution of booklets, handouts, and charts regularly to various age groups in urban and rural areas.

·      The nurse administrator can organize in service education for the VHN, ANM regarding hypertension and early detection, control and preventive measures and prevention of complications.

·      The nurse administrator can organize a screening programme to screen the cases for hypertension and refer for treatment.

 

Nursing Research:

·      The findings may be utilized by the emerging researchers for their reference purpose.

 

RECOMMENDATIONS:

A correlation study can be conducted among adults with hypertension with various lifestyle modifications for control of hypertension.

 

A comparative study can be done in urban and rural areas to assess the difference in their knowledge level and blood pressure. Similar study can be conducted with larger samples.

 

LIMITATIONS:

The study was time consuming to make the adults to understand as there is an individual difference in their understanding level.

 

REFERENCE:

1.   Park .K, (2009). “The text book of Preventive and social medicine”. (20^th ed.). Jabalpur : Banasidas Bhanot publication. Pp: 323-327.

2.     Ms. Prabhu Aswini,(January 2010).” Hypertension A growing Problem in India”. Health Screen: 18-20.

3.     Craven Ruth. F, (2003).”Fundamentals of nursing human health and function”. (4^thed.). Philadelphia: Lippincott Williams and Wilkin publication. Pp: 279, 871.

4.     Indrani. T.K, (2003).”Nursing manual of nutrition and therapeutic diet”. (1^st ed.). New Delhi: Jaypee brothers publication. Pp: 254-255.

5.     Godfrey B.S, et.al., (July 2010).” Hypertension-related knowledge, attitudes and life-style practices among hypertensive patients in a sub-urban Nigerian community”. Journal of Public Health and Epidemiology. 2(4).71-77.

6.     Kanchana S, et.al., (April 2011).” Effectiveness of exhibition on hypertension”. Nightingale Nursing Times, 7(1): 48-50.

7.     http://www.worldhypertensionleague.org/pages/WHL-member-countries-Report-2010.aspx.

8.     http://m.timesofindia.com/city/hyderabad/NINs-new-diet-guide lines/article show/9105543.com.

 

 

 

 

Received on 31.03.2017           Modified on 20.06.2017

Accepted on 18.09.2017       © A&V Publications all right reserved