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Background: Hypertension is the most common risk factor of premature deaths due to cardiovascular diseases worldwide. Currently, there is no available information of illness perception in Nepalese patients with hypertension and involved variables and their relationships with lifestyle behavior on controlling high blood pressure which is the starting point of this study.
Objective: To describe illness perception, social support, and lifestyle behaviors and to examine the relationships of lifestyle behaviors with involved variables among Nepalese patients with hypertension.
Methods: Two hundred thirteen patients with hypertension (purposive sampling) were recruited from the cardiac out-patient department (OPD) of Dhulikhel Hospital Kathmandu University Hospital, Nepal. Questionnaires composed of demographic information, Brief Illness Perception Questionnaire, Social Support Scale, and Lifestyle Behavior Scale were used. Descriptive statistics, Pearson correlation coefficient, and independent t test were used for data analysis.
Results: Participants perceived hypertension as benign condition which did not have serious consequences, symptoms, and emotional effects in their lives. They had very good social support for managing their hypertension in addition to having good lifestyle behavior. Lifestyle behavior had positive relationships with social support (r = 0.320; P < 0.001) and waist circumference (r = 0.152; P < 0.05) but had inverse relationships with age (r = -0.140; P < 0.05) and illness perception (r = -0.137; P < 0.05). There were no relationships between duration of treatment of illness and body mass index with lifestyle behavior. There were no significant differences of lifestyle behaviour based on level of education and family history of illness.
Conclusions: As patients with appropriate illness perception and adequate social support have exhibited satisfactory lifestyle behaviors, nurses can assess and utilize these factors in engaging patients with hypertension to perform better health behaviors for controlling their blood pressure.
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2. World Health Organization. Global Health Observatory data repository. 2014; Raised blood pressure (SBP ≥ 140 OR DBP ≥ 90. https://apps.who.int/gho/data/view.main.2464?lang=en. Accessed March 15, 2018.
3. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA. 2003;289(19):2560-2571. doi:10.1001/jama.289.19.2560.
4. MIlls KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population -based studies from 90 countries. Circulation. 2016;134(6):441-450. doi:10.1161/CIRCULATIONAHA.115.018912.
5. Brown MT, Bussell JK. Medication Adherence: WHO Cares? Mayo Clin Proc. 2011;86(4):304-314. doi:10.4065/mcp.2010.0575.
6. Leelacharas S, Kerdonfag P, Chontichalalauk J, Sanongdej W. Ilness perceptions, lifestyle behaviours, social support and cardiovascular risks in people with hypertension in urban and rural areas of Thailand. Pacific Rim International Journal of Nurses research. 2015;19(3):245-256.
7. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60:631-637.
8. Hsiao CY, Chang C, Chen CD. An investigation on illness perception and adherence among hypertensive patients. Kaohsiung J Med Sci. 2012;28(8):442-447. doi:10.1016/j.kjms.2012.02.015.
9. Petrie KJ, Weinman J. Patients’ perceptions of their illness: the dynamo of volition in health care. Curr Dir Psychol Sci. 2012;21(1):60-65. doi:10.1177/0963721411429456.
10. Leventhal H, Benyamini Y, Leventhal EA, Patrick-Miller L, Robitaille C. Illness representations: Theoritical Foundations. In: Weinman J, Petrie K, eds. Perceptions of health and illness. London: Harwood Publishers; 1997.
11. Zinat Motlagh SF, Chaman R, Sadeghi E, Eslami AA. Self-care behaviors and related factors in hypertensive patients. Iran Red Crescent Med J. 2016;18(6):e35805. doi:10.5812/ircmj.35805.
12. Tibebu A, Mengistu D, Negesa L. Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia. Patient Prefer Adherence. 2017;11:323-330. doi:10.2147/PPA.S126382.
13. Kang M, Kim J, Bae SS, Choi YJ, Shin DS. Older adults' perception of chronic ilness management in South Korea. J Prev Med Public Health. 2014;47(4):236-243. doi:10.3961/jpmph.2014.47.4.236.
14. Perez A. Acculturation, health literacy, and illness perception of hypertension among Hispanic adults. J Transcult Nurs. 2015;26(4):386-394. doi:10.1177/1043659614524785.
15. Osamor PE. Social support and management of hypertension in South-West Nigeria. Cardiovasc J Afr. 2015;26(1):29-33. doi:10.5830/CVJA-2014-066.
16. Chataut J, Khanal K, Manandhar K. Prevalence and associated factors of hypertension among adults in rural Nepal: a community based study. Kathmandu Univ Med J (KUMJ). 2015;13(52):346-350.
17. Khanal MK, Dhungana RR, Bhandari P, Gurung Y, Paudel KN. Prevalence, associated factors, awareness, treatment, and control of hypertension: Findings from a cross sectional study conducted as a part of community based intervention trial in Surkhet, Mid-Western region of Nepal. PLoS One. 2017;12(10):e0185806. doi:10.1371/journal.pone.0185806.
18. Elliot CA, Hamlin MJ. Combined diet and physical activity is better than diet or physical activity alone at improving health outcomes for patients in New Zealand's primary care intervention. BMC Public Health. 2018;18(1):230. doi:10.1186/s12889-018-5152-z.
19. Polit DF, Sherman RE. Statistical power in nursing research. Nurs Res. 1990;39(6):365-369.
20. Grove SK, Burns N, Gray JR. The practice of nursing research: Appraisal, synthesis, and generation of evidence. 7 th ed. St. Louis, Missouri: Elsevier Saunders; 2013.
21. Behling O, Law KS. Translating questionnaires and other research instruments. Thousand Oaks, CA: Sage Publications; 2000.
22. Bazzazian S, Besharat MA. An explanatory model of adjustment to type I diabetes based on attachment, coping, and self-regulation theories. Psychol Health Med. 2012;17(1):47-58. doi:10.1080/13548506.2011.575168.
23. Karatas T, Ozen S, Kutluturkan S. Factor structure and psychometric properties of the brief illness perception questionnaire in Turkish Cancer patients. Asia Pac J Oncol Nurs. 2017;4(1):77-83. doi:10.4103/2347-5625.199080.
24. Toljamo M, Hentinen M. Adherence to self-care and social support. J Clin Nurs. 2001;10(5):618-627. doi:10.1046/j.1365-2702.2001.00520.x.
25. Nunnally JC. Psychometric theory. 2nd ed. NY, New York: Mc-Graw Hill; 1978.
26. Maharjan S, Chinnawong T, Kritpracha C. Illness perception among patients with hypertension in Nepal. GSTF Journal Nursing Health Care (JNHC). 2017;4(2):79-85.
27. Norfazilah A, Samuel A, Law P, et al. Illness perception among hypertensive patients in primary care centre UKMMC. Malays Fam Physician. 2013;8(3):19-25.
28. Pickett S, Allen W, Franklin M, Peters RM. Illness beliefs in African Americans with hypertension. West J Nurs Res. 2014;36(2):152-1570. doi:10.1177/0193945913491837.
29. Meyer D, Leventhal H, Gutmann M. Common-sense models of illness: the example of hypertension. Health Psychol. 1985;4(2):115-135.
30. Hu H, Li G, Arao T. Prevalence rates of self-care behaviors and related factors in a rural hypertension population: a questionnaire survey. Int J Hypertens. 2013;2013:526949. doi:10.1155/2013/526949.
31. Kilic M, Uzuncakmak T, Ede H. The effect of knowledge about thypertension on the control of high blood pressure. Int J Cardiovasc Acad. 2016;2(1):27-32. doi:10.1016/j.ijcac.2016.01.003.
32. Cai L, Liu A, Zhang L, Li S, Wang P. Prevalence, awareness, treatment, and control of hypertension among adults in Beijing, China. J Atheroscler Thromb. 2012;19(2):159-168. doi:10.5551/jat.10116.
33. Vaidya A, Aryal UR, Krettek A. Cardiovascular health knowledge, attitude and practice behavior in an urbanising community of nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site. BMJ Open. 2013;3(10):e002976. doi:10.1136/bmjopen-2013-002976.
34. Douglas BM, Howard EP. Predictors of self-management behaviors in older adults with hypertension. Adv Prev Med. 2015;2015:960263. doi:10.1155/2015/960263.
35. Chen SL, Tsai JC, Chou KR. Illness perceptions and adherence to therapeutic regimens among patients with hypertension: a structural modeling approach. Int J Nurs Stud. 2011;48(2):235-245. doi:10.1016/j.ijnurstu.2010.07.005.
36. Kucukarslan SN. A review of published studies of patients' illness perceptions and medication adherence: lessons learned and future directions. Res Social Adm Pharm. 2012;8(5):371-382. doi:10.1016/j.sapharm.2011.09.002.
37. Ross S, Walker A, MacLeod MJ. Patient compliance in hypertension: Role of illness perceptions and treatment beliefs. J Hum Hypertens. 2004;18(9):607-613. doi:10.1038/sj.jhh.1001721.
38. Magrin ME, D'Addario M, Greco A, et al. Social support and adherence to treatment in hypertensive patients: a meta-analysis. Ann Behav Med. 2015;49(3):307-318. doi:10.1007/s12160-014-9663-2.
39. Idowu OA, Adeniyi AF, Atijosan OI, Ogwumike OO. Physical inactivity is assoicated with low self-efficacy and social support among patients with hypertension in Nigeria. Chronic Illn. 2013;9(2):156-64. doi:10.1177/1742395312468012.
40. Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: a review from the patient’s perspective. Ther Clin Risk Manag. 2008;4(1):269-286. doi:10.2147/TCRM.S1458.
41. Kloosterboer SM, van den Brekel K, Rengers AH, Peek N, de Wit NJ. An exploration of beliefs and attitudes regarding healthy lifesytle behaviour in an urban population in the Netherlands: results from a focus group study in a community-based prevention project. Eur J Public Health. 2015;25(3):467-471. doi:10.1093/eurpub/cku140.