Effectiveness of a Self-Management Program among Patients with Uncontrolled Hypertension

Abstract

Introduction Overweight and obesity are significant factors associated with poor blood pressure control among patients with hypertension. Self-management plays a crucial role in enhancing skills for health behavior modification, which contributes to weight reduction and achieving clinically targeted blood pressure levels. 

Objectives This study aimed to examine the effects of a self-management program on self-management behaviors, body weight, and systolic blood pressure among patients with uncontrolled hypertension. 

Design This study employed a quasi-experimental design with two groups, pretest and posttest based on the self-management concept. This framework has been proven to be effective in disease control, reducing the risk of complications, and enhancing quality of life among patients with chronic illnesses. The program was developed using the self-management model proposed by Nonglak Methakanjanasak, aiming to comprehensively empower patients in managing their own health. It emphasized the development of four key self-management skills: 1) self-monitoring, 2) performing specific tasks, 3) information seeking, and 4) self-adjusting to accommodate changes in disease progression and treatment. The program was tailored to the context of patients with uncontrolled hypertension, with the goal of promoting weight reduction and lowering systolic blood pressure through the continuous improvement of self-management skills.

Methodology This study was conducted at a hypertension clinic in a tertiary hospital between September 2022 and March 2023. The sample consisted of 60 patients purposively selected according to inclusion criteria: diagnosed with hypertension with uncontrolled blood pressure, not in a critical stage, aged between 18 and 60 years, with a body mass index greater than 25 kg/m², able to communicate in Thai, without limitations in ambulation, capable of using a mobile phone and the LINE application, and willing to participate in the study. Participants were randomly assigned to either the experimental or control groups, with 30 participants in each group, using a lottery method on the day of clinic visit. The research instruments included: 1) a personal information questionnaire; 2) a 25-item self-management behavior questionnaire focusing on dietary control and exercise, validated by five experts with a content validity index of .96 and a Cronbach’s alpha coefficient of .83; and 3) a 12-week self-management program. The program comprised four main activities: (1) self-monitoring, including recording blood pressure, body weight, dietary intake, and step counts; (2) performing specific tasks, such as practicing dietary control, food selection, calorie restriction, and walking with step counting; (3) information seeking, through an 8-minute educational video and additional counseling; and (4) self-adjusting, involving modification of behaviors or activities in response to disease progression and treatment, supported by weekly individual counseling via the LINE application (approximately 5 minutes per session). Data collection included self-management behavior scores, body weight, and systolic blood pressure, which were measured before the intervention and at week 12. Data were analyzed using descriptive statistics and inferential statistics, including Independent t-test and Paired t-test.

Results The mean age of participants in the experimental group (M = 50.02, SD = 7.12 years) and the control group (M = 52.56, SD = 6.01 years) did not differ significantly. After the intervention, the experimental group demonstrated significantly higher mean scores for self-management behaviors in dietary control (M = 2.81, SD = 0.37) compared with the control group (M = 2.53, SD = 0.44; t =2670, p < .01), as well as in exercise behaviors (M = 3.12, SD = 0.51 vs. M = 2.01, SD = 0.68; t = 7.150, p < .001). In addition, the experimental group experienced a greater mean reduction in body weight of 1.90 kg compared with the control group (95% CI: –2.67 to –1.13, t = 5.967, p < .001). Furthermore, systolic blood pressure decreased significantly more in the experimental group than in the control group (mean difference = –10.57 mmHg, 95% CI: –15.56 to –5.57, t = –4.040, p < .001).

Recommendation The self-management program was effective in promoting self-management behaviors, reducing body weight, and lowering systolic blood pressure among patients with uncontrolled hypertension who were overweight. Therefore, healthcare professionals may apply this program in the care of patients with similar contexts, with ongoing monitoring and evaluation to support effective achievement of target blood pressure control.