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EFFECT OF A TRAINING PROGRAMME ON KNOWLEDGE AND PRACTICE OF LIFESTYLE MODIFICATION AMONG HYPERTENSIVE PATIENTS ATTENDING OUT-PATIENT CLINICS IN LAGOS

NURSING SCIENCE PROJECT TOPICS AND MATERIALS

 

CHAPTER ONE

INTRODUCTION

1.0 Background to the Study

Hypertension is the most common non-communicable disease and the leading cause of cardiovascular disease in the world. Many people with hypertension are unaware of their condition making treatment infrequent and inadequate, which is responsible for it poor control and not always taken seriously (Neutel & Campbell, 2008). Majority who are suffering from hypertension have a type of hypertension called essential hypertension or type one hypertension. Heredity and unhealthy lifestyle have been widely acceptable has being responsible for this type of hypertension. This has become a menace especially in Africa because of the adoption of western lifestyle, coupled with its challenges of unhealthy environment, poverty, lack of health seeking behaviour, lack of health insurance and sedentary life lived by many.

According to Seven Joint National Committee Criteria (JNC7), the precise rule for the treatment of hypertension begins with lifestyle modifications and ends with medication. Unfortunately, many patients diagnosed to be hypertensive don’t usually have proper knowledge about lifestyle modification. Studies on lifestyle modifications have revealed that modifications such as weight loss, taking Dietary Approaches to Stop Hypertension (DASH) diet, exercising and reducing salt consumption would be effective in lowering blood pressure and reducing its complications especially the rate of morbidity and mortality of cardiovascular diseases (Jafari, Shahriari, Sabouhi, Farsani & Babadi, 2016).

Lifestyle modification is advised for all hypertensive, in respective of pharmacological treatment, because it may abolish or even reduce the need for medications. The goal of prescribed lifestyle changes is to lower blood pressure. This lifestyle changes also offers a lot of health benefits and better outcomes for common chronic diseases (Huang, Duggan & Harman, 2008). Yet studies have showed that ignorance and lack of knowledge and awareness are some of the barriers to having a healthy lifestyle and not controlling and preventing high blood pressure. It is assumed that increased 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 behaviours as supported by the results of a study which says `when the score of knowledge in high blood pressure patients increases by one, their score of practice would increase by 0.12. (Jafari, Shahriari, Sabouhi, Farsani & Babadi, 2016).

However, studies have shown that improving knowledge and awareness alone could not be enough to control the effects of diseases by itself but by increasing the score of attitude toward high blood pressure through reinforcement, systolic and diastolic blood pressures would decrease significantly. There are a lot of other barriers that can prevent individual to modifying their lifestyle but studies have showed that increased knowledge, attitudinal and change of perceptions will all lead to practice of lifestyle modification (Jafari, Shahriari, Sabouhi, Farsani & Babadi, 2016).

The recommended lifestyle modification such as, moderate alcohol intake, weight loss of 3% to 9% of body weight, the DASH diet, regular aerobic exercise, and reduced dietary salt are lifestyle modification that controls blood pressure. Depending on the type of intervention, blood pressure reduction of 3 to 11 mm Hg systolic and 2.5 to 5.5 mm Hg diastolic, are believed to have great influence on blood pressure reduction and ability to potentiate antihypertensive drugs. The recommended diet called DASH diet is low in total and saturated fat, sugar, sugary drinks, refined carbohydrates, and red meat  but high in vegetables, fruits, whole grains, poultry, fish and low-fat dairy products. This DASH diet has long been documented to lower weight, risk of type 2 diabetes, heart rate, apolipoprotein B, homocysteine, C-reactive protein, and is accompanying by a lower incidence of stroke, heart failure, and all-cause mortality (Lochner, Rugge & Judkins, 2006).

In a premier trial, it was also documented that a reduction of 14.2/7.4 mmHg in blood pressure is attained when DASH diet is accompany by salt reduction and alcohol, aerobic exercise and weight loss, which also reduces the prevalence of hypertension from 38% to 12% over the period of six months. Reduce salt consumption by hypertensive patents, possibly the   single most important hypotensive measure, entails regularly checking food labels for salt content, staying away from processed foods, and using spices and herbs for flavour. It is generally acceptable that personal efforts from the patients and reinforcing and enabling environment from health personnel will lead to a great success in diet and behavioural modification (Nicoll & Henein 2010).

Knowledge and practice of lifestyle modification among patients with high blood pressure has however been showed to be inadequate in some studies. In UK, Nicoll and Henein (2010) in their study revealed that many hypertensive patients are unwilling to accept that their lifestyle practices or choices have made a worthwhile contributed to their condition and may refuse advice to change, this may be true of other hypertensive patients. Therefore, health education about hypertension, its consequences and lifestyle modification is been advocated to begin as early as possible in population identified to be at risk (American Heart Association, 2010).

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