Enhancing Self-Management through Geragogy-Based Education in Older Adults with Uncontrolled Hypertension: A Randomized Controlled Trial

Authors

  • Kiattisak Ongkulna RN, PhD (Candidate), Faculty of Nursing, Chiang Mai University, Thailand.
  • Linchong Pothiban RN, DSN, Associate Professor, Faculty of Nursing, Chiang Mai University, Thailand.
  • Sirirat Panuthai RN, PhD, Assistant Professor, Faculty of Nursing, Chiang Mai University, Thailand.
  • Rojanee Chintanawat RN, PhD, Assistant Professor, Faculty of Nursing, Chiang Mai University, Thailand.
  • Rojanee Chintanawat RN, PhD, Assistant Professor, Faculty of Nursing, Chiang Mai University, Thailand.

Keywords:

Geragogy, Older adults, Randomized controlled trial, Self-management education, Transformative learning, Uncontrolled hypertension

Abstract

          Uncontrolled hypertension is a major medical problem leading to many serious health consequences. Enhancing self-management is essential for older adults with uncontrolled hypertension to control blood pressure and improve quality of life. Substantial evidence reveals that health literacy and self-efficacy are the strongest factors influencing self-management behaviors. According to geragogy, older adults require a different kind of education to other age groups. This randomized controlled trial investigated the effects of a Geragogy-Based Self-Management Education Program on health literacy, self-efficacy, and self-management behaviors among older adults with uncontrolled hypertension. One hundred participants who met the inclusion criteria were randomly assigned into experimental (n = 50) and control groups (n = 50). The experimental group received the self-management education program based on the geragogy teaching principle combined with transformative learning theory in addition to routine patient education, whereas the control group received only routine patient education. Data were collected at baseline, at the program end, and one and three months after the end of the program using the Health Literacy Scale, Hypertensive Self-Management Self-Efficacy Scale, and Self-Management Behaviors Scale. Data were analyzed using descriptive statistics, two-way repeated measures ANOVA, and independent sample t-test.
          The results demonstrated that after receiving the program, the experimental participants had significantly higher health literacy, self-efficacy, and self-management behaviors at all time-points of measurement than before commencing the program and the control participants. The findings of this study indicated a successful self-management education program. Further studies to ensure efficacy of this program are suggested.

References

World Health Organization. Global health observatory (GHO) data: raised blood pressure [Internet]. 2019 [cited2022 Jul 30]. Available from: http://www.who.int/gho/ncd/risk_factors/ blood_pressure_prevalence_text/en

Aekplakorn W, Puckcharern H, Satheannoppakao W. The report of the Sixth Thai National Health Examination Survey 2019-2020 [Internet]. 2021 [cited 2022 Jul 30].Available from: https://www.hsri.or.th/media/ printedmatter/detail/13443 (in Thai)

Thai Hypertension Society. 2019 Thai guidelines on the treatment of hypertension [Internet]. 2019 [cited 2019 Oct 19]. Available from: http://www.thaihypertension.org/guideline.html (in Thai)

Kaplan NM, Victor RG. Kaplan’s clinical hypertension. 11th ed. Philadelphia: Wolters Kluwer; 2015.

Centers for Disease Control and Prevention. Self-management support and education [Internet]. 2020 Jun 25 [cited 2022 Jul 30]. Available from: https://www.cdc.gov/dhdsp/pubs/guides/best-practices/self-management.htm

Lorig K. Self-management of chronic illness: a model for the future. Generations. 1993;(17)3:11-4.

Wannakhao S, Danyuthasilp C, Siripornpibul T. Effects of a self-management program on blood pressure levels and selfmanagement

behaviors among elderly with hypertension in Uttaradit Province. BCNUT J Nurs. 2019;11(1):126-41(in Thai).

Sungkhao M, Thaniwattananon P. Effect of self-management supporting program on medication adherence and blood pressure level among the older patients with uncontrolled hypertension. Songklanagarin J Nurs [Internet]. 2020 Mar 28 [cited 2022 Jul 30];40(1):84-100. Available from:https://he02.tci-thaijo.org/index.php/nur-psu/article/view/240716 (in Thai)

Truong PV, Apriliyasari RW, Lin MY, Chiu HY, Tsai PS. Effects of self-management programs on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension: meta-analysis of randomized controlled trials. Int J Nurs Pract. 2021;27(2):e12920. https://doi.org/10.1111/ijn.12920

Jandeekaewsakul P, Watthayu N, Suwonnaroop N. Factors predicting self-management behavior among patients with uncontrolled essential hypertension. J Nurs Sci [Internet].2018 Mar 31 [cited 2022 Jul 30];36(1):31-43.Available from: https://he02.tci-thaijo.org/index.php/

ns/article/view/145412 (in Thai)

Truong PV, Jullamate P, Piphatvanitcha N. Factors related to self-management behaviours in hypertensive older adults in Haiduong Province, Vietnam. J Nurs Health Sci.2016;10(3):56-64.

Seesawang J, Thongtang P. Factors associated with selfmanagement ability among older adults with hypertension in Asia: a systematic review of qualitative studies. Nurs Sci J Thail [Internet]. 2019 Mar 29 [cited 2022 Jul 30];37(1):86-107. Available from: https://he02.tci-thaijo.

org/index.php/ns/article/view/183645

My TT, Methakajanasak N, Minh HV. Relationships between hypertension knowledge, self-efficacy, treatment beliefs and self-management behaviors among uncontrolled hypertension patients in Da Nang city, Vietnam. JNSH [Internet]. 2020 Dec 26 [cited 2022 Jul 30];43(4):59-71.

Available from: https://he01.tci-thaijo.org/index.php/nah/article/view/243186

Nutbeam D. Health literacy as a public goal: a challenge for contemporary health education and communication strategies into 21st century. Health Promot Int. 2000;15(3):259-67.https://doi.org/10.1093/heapro/15.3.259

Shi D, Li J, Wang Y, Wang S, Liu K, Shi R, et al. Association between health literacy and hypertension management in a Chinese community: a retrospective cohort study. Intern Emerg Med. 2017;12(6):765-76. doi: 10.1007/s11739-017-1651-7.

Wannasirikul P, Termsirikulchai L, Sujirarat D, Benjakul S, Chanuantong T. Health literacy, medication adherence, and blood pressure level among hypertensive older adults treated at primary health care centers. Southeast Asian J Trop Med Public Health. 2016;47(1):109-20.

Geboers B, de Winter AF, Spoorenberg SLW, Wynia K, Reijneveld SA. The association between health literacy and self-management abilities in adults aged 75 and older,and its moderators. Qual Life Res. 2016;25(11):2869-77.doi: 10.1007/s11136-016-1298-2.

Park NH, Song MS, Shin SY, Jeong JH, Lee HY. The effects of medication adherence and health literacy on health-related quality of life in older people with hypertension. Int J Older People Nurs. 2018;13(3):e12196. doi: 10.1111/opn.12196.

Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman and Company; 1997.

Warren-Findlow J, Seymour RB, Brunner Huber LR. The association between self-efficacy and hypertension self-care activities among African American adults. J Community Health. 2012;37(1):15-24. doi: 10. 1007/s10900-011-9410-6.

Lee E, Park E. Self-care behavior and related factors in older patients with uncontrolled hypertension. Contemp Nurse. 2017;

(6): 607-21. doi: 10.1080/10376178.2017. 1368401.

Knodel J, Teerawichitchainan B, Pothisiri W. Caring for Thai older persons with long-term care needs. JAH. 2018;30(10):1516-35. https://doi.org/10.1177/0898264318798205

Mezirow J. The handbook of transformative learning: theory, research and practice. San Francisco: Jossey-Bass; 2000.

Kopera-Frye K. Health literacy among older adults. New York: Springer Publishing; 2017.

John MT. Geragogy: a theory for teaching the elderly. Act Adapt Aging. 1988;11(3-4):xi-156.

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2008.

Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008;31(5):874-9. doi: 10.2337/dc07-1932.

Pinprapapan E, Panuthai S, Vannarit T, Srisuphan W. Casual model of adherence to therapeutic regimens among Thais with hypertension. Pacific Rim Int J Nurs Res. [Internet].2013 Aug 28 [cited 2022 Jul 30];17(3):268-81.Available from: https://he02.tci-thaijo.org/index.php/

PRIJNR/article/view/8781

Liu Y, Wang Y, Liang F, Chen Y, Liu L, Li Y, et al. The health literacy status and influencing factors of older population in Xinjiang. Iran J Public Health. 2015;44(7):913-9.

Lee Y, Shin S, Wang R, Lin K, Lee Y, Wang Y. Pathways of empowerment perceptions, health literacy, self-efficacy,and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ Couns. 2016;99 (2):287-94. doi: 10.1016/j.pec.2015.08.021.

Ryan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. New York: Guilford Press; 2017.

Downloads

Published

2022-09-12

How to Cite

1.
Ongkulna K, Pothiban L, Panuthai S, Chintanawat R, Chintanawat R. Enhancing Self-Management through Geragogy-Based Education in Older Adults with Uncontrolled Hypertension: A Randomized Controlled Trial. PRIJNR [Internet]. 2022 Sep. 12 [cited 2024 Nov. 13];26(4):690-705. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/259276