Effectiveness of Information booklet on knowledge regarding Hypertension and Supplementation of beetroot juice among hypertensive patients in a selected Hospital Mangaluru

Ms. Sunitha P.¹, Mrs. Sucy George²

¹M.Sc (N), Department of Medical Surgical Nursing, Athena  College of Nursing, Mangaluru, Karnataka. India.

²Professor, Department of Medical Surgical Nursing, Athena College of Nursing, Mangaluru, Karnataka. India.

*Corresponding Author E-mail: suni.pk74@gmail.com

ABSTRACT:

Hypertension (HTN) is an enormous health problem and is one of the biggest health challenges in the 21st century. Effective management in hypertension requires a multi-sectorial approach. Dietary management plays a vital role in managing blood pressure especially beetroot juice which contains nitrates helps in vasodilation thus reducing hypertension. The aim of this study was to assess the effectiveness of information booklet on knowledge regarding hypertension and supplementation of beetroot juice among hypertensive patients and To find the association between mean pre-test knowledge score about hypertension and supplementation of beet root juice with the selected demographic variables. A pre-experimental one group, pre-test post-test design was used for the study. Purposive sampling technique was used to select 30 hypertensive patients. The investigator assessed the knowledge regarding HTN and supplementation of beetroot juice in managing hypertension using structured knowledge questionnaire and then the information booklet was administered to the subjects. The collected data was analysed by using descriptive and inferential statistics. The mean post-test knowledge score (x₂=23.87) was higher than the mean pre-test knowledge score (x₁=17.40). The mean difference between post-test and pre-test knowledge score was highly significant. The obtained ‘t’ value (11.75) is higher than the table value (t₂₉=1.70 at p<0.05 level significance). There was no significant association between knowledge score and selected demographic variables like age, gender, religion, education, occupation, income, and duration of illness. (c²=2.143, c²=0.536, c²=0.000, c²=0.536, c²=2.143, c²=0.133, c²=0.536). Hence it can be concluded that information booklet is an effective strategy for providing information and improving the knowledge of adult hypertensive patients.

KEYWORDS: Effectiveness, beetroot juice, information booklet, Knowledge, Hypertensive adult Patients.

INTRODUCTION:

Life is not merely to be alive, but to be healthy. Feeling physically better and having control over your own life can greatly increase one’s mental health as well¹. Hypertension remains the largest attributable risk factor for mortality worldwide^. worryingly, the scale of the problem is increasing, with the proportion of adults with hypertension predicted to increase to almost 1 in 3 (1.57 billion) by 2025. The global burden of disease study has reported hypertension as the 4^th contributor to premature death in developed countries and 7^th in the developing countries.² The public health response to this challenge should drive greater promotion of awareness efforts, studies of risk factors for hypertension, and understanding of the impact of lifestyle changes.³ There are several non-pharmacological methods of controlling blood pressure. Physical activity, dietary approach, yoga, relaxation techniques and reduction in daily salt intake, have been proven to be of use. These interventions modify the risk factors responsible for the development of hypertension.⁴ Nutritional factors play a large role not only in reducing the risk of hypertension. Studies have shown that diet rich in fruits and vegetables especially beetroot juice which contains nitrates, when consumed in body it is converted to nitrous oxide thus reducing the saturated fat and helps in vasodilation and thus can lower the risk of high blood pressure.⁵

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of an information booklet on knowledge regarding hypertension and supplementation of beetroot juice among hypertensive patients in a selected hospital at Mangaluru.

OBJECTIVES OF THE STUDY:

1. To determine the pre-test knowledge level of hypertensive patients regarding hypertension and supplementation of beetroot juice in managing hypertension as measured by structured knowledge questionnaire.

2. To determine the effectiveness of information booklet on hypertension and supplementation of beetroot juice in managing hypertension in terms of gain in post-test knowledge score.

3. To find the association between mean pre-test knowledge score about hypertension and supplementation of beet root juice with the selected demographic variables (age, gender, education, duration of illness).

RESEARCH HYPOTHESIS:

All hypothesis will be tested at 0.05 level of significance

H1:  The mean post-test knowledge level of hypertensive patients regarding hypertension and supplementation of beetroot juice will be significantly higher than the mean pre-test knowledge level.

H2:  There will be significant association between mean pre-test knowledge score and selected demographic variable such as age, gender, occupation, education and duration of illness.

MATERIALS AND METHODS:

Research approach: An evaluative research approach has been adopted for this study.

Research design: In this study, Pre-experimental, one group pre-test and post-test design was adapted.

Research setting: The study was conducted in Athena hospital at Mangaluru.

Population: Population of the study consisted of hypertensive patient in the age group of 25-75 years.

Sample: The sample consisted of 30 hypertensive patients of a selected hospital at Mangalore.

Sampling technique: Purposive sampling technique was used who met inclusion criteria.

Description of the final tools: The tool used in the study consists of 2 parts.

Part 1: Socio Demographic proforma.

Part 2: Structured knowledge questionnaire.

Plan for data analysis:

Data analysis is the systemic organization and synthesis of the research data and testing of research hypothesis using the data.

Data was planned to be analysed on the basis of objectives and hypothesis.

1. Demographic data would be analysed in terms of frequency and percentage.

2. Knowledge level of adult hypertensive patient regarding hypertension and supplementation of beetroot juice before and after introducing information booklet would be analysed in terms of frequency, percentage, mean, median, and standard deviation.

3. The significant difference between the mean pre-test knowledge and post- test knowledge score would be determined by paired ‘t’ test.

4. Chi-square test will be used to find the association between pre-test knowledge score and demographic variables.

RESULTS:

Section I: Description of sample characteristics:

Organisation of the findings:

The data collected is analysed and presented under the following headings:

Section I: Description of the demographic variables.

Section II: Assessment of knowledge among hypertensive patients regarding hypertension and supplementation of beetroot juice in reducing blood pressure.

Section III: Effectiveness of information booklet on knowledge regarding hypertension and supplementation of beetroot juice in reducing BP in terms of gain in knowledge.

Section IV: Association between mean pre-test knowledge score with selected demographic variables

Section I: Description of demographic variables:

This section deals with the description of sample characteristics in terms of frequency and percentage. The findings are presented using Tables and Figures.

Table 1: Frequency and percentage distribution of the sample according to their demographic variables.                                  n=30

Sl. No.	Variable	Frequency	%
1.	Age in years a.  <30 years b.   31-40 years c.   41-50 years d.   51-60 years e.   61 above	2 3 9 8 8	6.7 10.0 30.0 26.7 26.7
2.	Gender a.  Male b.  Female	14 16	46.7 53.3
3.	Religion a.    Hindu b.   Christian c.    Muslim	16 7 7	53.3 23.3 23.3
4.	Education a.    Primary b.   Middle school c.    Higher secondary d.   Graduate & above	9 7 11 3	30.0 23.3 36.7 10.0
5.	Occupation a.    skilled workers b.   unskilled workers c.    home makers d.   not working	4 12 7 7	13.3 40.0 23.3 23.3
6.	Income per month a.    5000-10,000 b.   Rs. 10,001-15,000 c.    above 15000	15 12 3	50.0 40.0 10.0
7	Diet a.   Vegetarian b.   Non vegetarian	4 26	13.33 86.7
8.	Marital status a.    single b.   married	2 28	6.7 93.3
9.	Taking any htn treatment a.    yes b.   no	30 0	100 0
10.	Years of htn treatment a.    < 1 year b.   1-3 years c.   4-6 years d.   7-9 years e.   10 & above	6 6 4 5 9	20.0 20.0 13.3 16.7 30.0
11	Any associated illness a.  yes b.   no	12 18	40.0 60.0
12	Using any complimentary therapy a.   yes b.   no	6 24	20.0 80.0

Section II: Assessment of knowledge among adult hypertensive patients regarding hypertension and supplementation of beetroot juice:

This section deals with the knowledge level of adult hypertensive patients regarding hypertension and supplementation of beetroot juice before and after the introduction of information booklet.

Table 2: Frequency and percentage distribution of sample according to their level of knowledge                                              n=30

Grading of knowledge	Range	%	Pre-test		Post-test
			Frequency	Percentage	Frequency	Percentage
Inadequate	0-10	0-33%	0	0.0	0	0.0
Moderate	11-20	34-66%	25	83.3	2	6.7
Adequate	21-30	67-100%	5	16.7	28	93.3

Maximum score=30

It is evident from the data presented in Table 2 that in the pre-test very few (6.7%) had adequate knowledge and 83.3% had moderate knowledge. In the post-test most of them (93.3%) had good knowledge and (16.7%) of them had moderate knowledge and none of them had inadequate knowledge.

Data presented in Table 3 shows that in the pre-test the score ranged from 12-23 and the mean score was 17.40 with SD 2.966. In the post-test the score ranged from 19-27and the mean score was 23.87 with SD 1.889. The mean gain in score was 6.47

Table 3: Range, mean, S D and mean percentage of pre and post-test knowledge scores                                                            n=30

Area	Range	Mean	SD	Mean %	Mean difference	S E
Pre-test	12-23	17.40	2.966	58.00	6.47	0.542 0.345
Post-test	19-27	23.87	1.889	79.56

Maximum score=30

Table 4: Area wise effectiveness of pre test and post mean knowledge score.

		Mean	Mean (%)	SD	Mean difference	SD of diffrence	Percentage gain	t value
Knowledge 1 (General information) = 9	Pretest Posttest	6.00 7.67	66.67 85.19	1.259 0.802	1.67	1.30	18.52	7.05
Knowledge 2 (Causes, clinical features) = 8	Pretest Posttest	5.30 5.77	66.25 72.08	1.149 0.898	0.47	1.61	5.83	2.58
Knowledge 3] (Preventive measures, management)=10	Pretest Posttest	4.43 7.57	44.33 75.67	1.431 1.357	3.13	1.87	31.33	9.17
Knowledge 4 (Complications) = 3	Pretest Posttest	1.67 2.87	55.56 95.56	0.959 0.346	1.20	0.89	40.00	7.41
Overall knowledge score	Pretest Posttest	17.40 23.87	58.00 79.56	2.966 1.889	6.47	3.01	21.56	11.75

t₂₉=1.70    p<0.05

Data presented in Table 4 reveals area wise pretest and post test knowledge regarding hypertension and supplementation of beetroot juice.

In the area wise general information regarding hypertension and supplementation of beetroot juice, the mean percentage in pretest was 66.67% with SD 1.26 and in post test mean percentage was 85.19% with SD 0.80 and with percentage gain of 18.52%.

In the area wise causes and clinical features of hypertension, the mean percentage in the pretest was 66.25% with SD 1.15 and in post test mean percentage was 72.08% with SD 0.90 and with percentage gain of 5.83%

In the area wise preventive measures and management of hypertension, the mean percentage in the pretest was 44.33% with SD 1.43 and in post test mean percentage was 75.67% with SD 1.36 and with percentage gain of 31.33%.

In the area wise complications of hypertension, the mean percentage in the pretest was 55.56% with SD 0.96 and in the post test mean percentage was 95.56% with SD 0.35 and with percentage gain of 40.00%.

The statistical paired ‘t’ test indicates the enhancement in the mean knowledge scores found to be significant at 5% level for all the aspects under the study.

Section III: Effectiveness of information booklet on knowledge regarding hypertension and supplementation of beetroot juice in terms of gain in knowledge:

In order to test the effectiveness of information booklet in increasing the knowledge paired ‘t’ was computed. To test the statistical significance the following null hypothesis was formulated:

H₀: There will be no significant difference in the mean pre-test and post-test knowledge score of hypertensive patients regarding hypertension and supplementation of beetroot juice.

Table 5: Paired ‘t’ test to test the significance difference between mean pre and post-test knowledge score                                n=30

	Mean score	SD	Mean difference in score	SD Difference	% gain	t value
Pre-test	17.40	2.966	6.47	0.542 0.345	21.56	11.75*
Post-test	23.87	1.889

t₂₉=1.70 p < 0.05                                                                                                                                             * Significant

Data presented in Table 5 shows that the computed ‘t’ value (11.75) is highly significant at 0.05 level of significance. The obtained value (t₂₉=11.75) is higher than the table value (t₂₉=1.70, p < 0.05). Therefore the null hypothesis is rejected and research hypothesis is accepted. It can be inferred that information booklet was effective in improving the knowledge of adult hypertensive patients regarding hypertension and supplementation of beetroot juice.

Section IV: Association between mean pre-test knowledge score with selected baseline variables:

This section deals with the association between pre-test mean knowledge score and selected baseline variables. To find out the association Chi-square test was done. To test the statistical significance the following null hypothesis was formulated:

H₀: There will no significant association between pre-test mean knowledge score and selected baseline variables.

Table 6: Chi-square test to find out association between mean pre-test knowledge score and selected baseline variables             n=30

Sl. No.	Variables	≤ Median	≥ Median	c^2 value	Inference
1	Age in years
	a. < 50	5	9	2.143	Not Significant
	b. >50	10	6
2	Gender
	a. Male	8	6	0.536	Not Significant
	b. Female	7	9
3	Religion
	a. Hindu	8	8	0	Not Significant
	b. Christian and muslim	7	7
4	Education
	a. Above school	6	8	0.536	Not Significant
	b. Below middle school	9	7
5	Occupation
	a. Not working	5	9	2.143	Not Significant
	b. Working	10	6
6	Income
	a.<10000	7	8	0.133	Significant
	b.≥ 10000	8	7
7	Duration of illness
	a.< 6 years	7	9	0.536	Not Significant
	b.>6 years	8	6
8	Associated illness
	a. Yes	5	7	0.556	Not Significant
	b. No	10	8
9	Use of Complementary therapy
	a. yes				Not Significant
	b.no	3	3	0
		12	12

c₁²=3.84, p < 0.05

It is evident from Table 6 that there is no significant association between selected baseline variables like age, gender, religion, education, occupation, income, duration of illness, associated illnesses and use of complementary therapy for hypertension. The obtained value in all these areas (2.143, 0.536, 0.000, 0.536, 2.143, 0.133, 0.536, 0.556, 0.000) were lower than the table value (3.84 ≤ 0.05). Therefore the null hypothesis was retained and research hypothesis was rejected.

DISCUSSION:

In the present study confirmed that there was a considerable improvement of knowledge after the administration of information booklet on HTN and supplementation of beetroot juice and it is also statistically established as significant at 0.05 level. The study revealed that overall pre-test mean knowledge score was 58% and post test score was 79.56% with 21.56% mean knowledge enhancement. The overall mean knowledge score during pre-test is 17.40 and 23.87 in the post-test.

There was no association found between pre test knowledge scores and demographic variables like age (2.143^NS), gender (0.536^NS), religion (0.00^NS), Educational status (0.536^NS), occupation (2.143^NS), duration of illness (0.536^NS), and associated illness (0.556^NS).

A cross-sectional community-based survey was conducted in coastal Karnataka a Southern state of India in 2009, to estimate the prevalence and the socio-demographic correlates of hypertension among 1,239 respondents aged ≥30 years adults. The prevalence of hypertension was 43.3%; prevalence being more among males (51.6%) as compared to females (38.9%). Of the total prevalence 23.1% (287) were known cases and 20.2% (250) were newly detected cases. The study concluded that advancing age, male gender, current diabetic status, central obesity, being overweight and obese as defined by body mass index were identified as significant correlates for hypertension by multivariate logistic regression.⁶

The finding of the study showed significant increase in the post-test knowledge score and the computed ‘t’ value (11.75) was higher than the table value (t₂₉=1.70, p≤0.05)

CONCLUSIONS:

A diseased person can get his/her ailment cured through systematic practice of complimentary therapy like natural dietary approach that is drinking beetroot juice daily. Complimentary therapies are increasingly popular practices that may be useful in preventing or reducing elevated blood pressure. In the modern times, the value of dietary management that is consumption of beetroot extracts is being increasingly recognized for general health and its preventive and curative effects on hypertension. Beetroot juice also helps in restoring harmony and balance within the body, which in turn will reduce stress and blood pressure.⁷

LIMITATIONS OF THE STUDY:

1. Small number of subjects (30) used in the study restricts the generalization of results.

2. The study did not use a control group. The investigator had no control of the events that took place between pre-test and post-test.

3. Information booklet was only restricted for literate patients who can read English and Kannada.

4. The study assessed only the knowledge level regarding HTN and beetroot juice supplemention in reducing BP.

RECOMMENDATIONS:

On the basis of the findings of the study, the following recommendations have been made for further study:

1. A study could be replicated on a larger sample.

2. A similar study could be replicated with a control group.

3. A similar study could be conducted in community settings.

4. A comparative study can be conducted between information booklet and experimental method.

5. A study can be conducted on the effectiveness of information booklet on all CAM for hypertension.

6. A study could be conducted on effectiveness of drinking beetroot juice and observing BP readings.

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Received on 20.02.2021         Modified on 19.03.2021

Accepted on 16.04.2021     © AandV Publications all right reserved

Int. J. Nur. Edu. and Research. 2021; 9(3):265-270.

DOI: 10.52711/2454-2660.2021.00063