ARTICLE INFO

Article Type

Original Research

Authors

Arabshahi   A. (1)
Gharlipour   Z. (2)
Mohammadbeigi   A. (3)
Mohebi   S. (*4)






(*4) Department of Health Education & Health Promotion, Health Faculty, Qom University of Medical Sciences, Qom, Iran
(1) “Student Research Committee” and “Department of Health Education & Health Promotion, , Health Faculty”, Qom University of Medical Sciences, Qom, Iran
(2) Public Health Department, Health Faculty, Qom University of Medical Sciences, Qom, Iran
(3) “Neuroscience Research Center” and “Department of Epidemiology & Biostatistics, Health Faculty”, Qom University of Medical Sciences, Qom, Iran

Correspondence

Article History

Received:  March  10, 2020
Accepted:  April 21, 2020
ePublished:  September 20, 2020

BRIEF TEXT


60% of all deaths in the world are due to chronic diseases. One of these chronic diseases is Hypertension, which is often called as 'silent killer' and is a global problem. Hypertension is often asymptomatic [1, 2].

...[3-9]. Pharmacotherapy and lifestyle modification has not yet been able to completely affect blood pressure control. One of the main reasons for this low effect is the non-adherence of patients to hypertension diet therapy and pharmacotherapy due to the influence of patients' beliefs [10]. On the other hand, all important life events can affect Hypertension. Therefore, to the successful treatment of hypertension, in addition to pharmacotherapy, the role of psychological and sociological factors should be considered [11]. Social support has a protective effect on the negative consequences of the disease. Social support affects adaptation indicators through physiological, emotional, and cognitive effects [12]. …[13, 14]. Social support is assessed through the evaluation of some people as a resource and it is received from various sources such as spouse, family, and friends. One of the components of social support is the support received from the spouse so that this support takes precedence over the support provided by other family members and the community [16]. Educating the patient's spouse for social support can be very helpful in controlling the disease and even preventing it; because there is a strong relationship between the family and the health status of its members [17]. The results of Taher et al. research on the relationship between social support and adherence to diet therapy in patients with hypertension showed that there is a significant relationship between social support and adherence to diet therapy in patients [18].

This study aimed to determine the effect of educational intervention based on social support received from a spouse on promoting adherence to diet therapy in patients with hypertension.

This is an experimental study.

This research was carried on 120 male patients with primary hypertension with their spouses who referred to the Qom health community service centers in 2019.

The sample size of the statistical society was equal to 48 people in each group by considering 90% studying power and 5% first type error, as well as the results of the pilot study, including the difference in the score of social support in the two groups equal to 7 and standard deviation in two groups equal to 9 and 12. Finally, considering the statistical decline, 60 people were determined in each group (n=60). Inclusion criteria for the subjects were the age range of 30-65 years, at least one year of primary hypertension history, the satisfaction of a patient and his spouse from participating in the research, confirmation of uncontrolled blood pressure by a physician, having a health record in the health community service centers and exclusion criteria including the unwillingness of the patient or his spouse to continue cooperation, transfer of the residence place of a patient to another city, having high blood pressure caused by other diseases (secondary blood pressure) and absence of more than one session of the patient's spouse in education sessions. The selection of health community service centers was conducted randomly from 3 different areas of the city. A sampling of patients, who referred to the centers and met the inclusion criteria, was conducted by the available sampling method. The samples were randomly assigned to the test and control groups by block randomization. The size of the blocks was determined 4, and the selection of each block was conducted, randomly.

The HILL-Ben's treatment adherence Questionnaire was used to measure adherence to the hypertensive diet therapy [19, 20] and the Sherbourne & Stewart Social Support Scale (MOS-SSS) was used to measure social support [21, 22]. To measure blood pressure, subjects first rested for 10 minutes and then blood pressure was measured twice with a 5-minute interval from the right hand in a sitting position using the standard BRISK HS20A hand barometer, and it's mean was recorded as systolic and diastolic blood pressure. Education sessions were held in two sessions, each session in 60 minutes for one month only for the wives of male patients with high blood pressure. Data from questionnaires and checklists for recording blood pressure in the male specimen were collected as an organized interview in two stages, the first time before the educational intervention and the second time, 2 months after the educational intervention by a graduate student of health education. The content of education sessions includes familiarity with the disease and its complications, disease control strategies, especially adherence to diet and healthy eating, regular physical activity and regular use of blood pressure control drugs and the role of family and spouses, as well as emphasis on supportive strategies by them in control of the disease. Data were analyzed using Independent T, Paired T, and Chi-Square tests, and multivariate analysis of covariance by SPSS 20 software.

The average age of the experimental and control group was 54.11±6.67 and 56.13±7.54, respectively. The mean duration of the disease in the experimental and control group was 5.81±3.92 and 5.48±2.90, respectively. There was no significant difference in age and duration of the disease between the experimental and control groups (p>0.05). Also, there was no significant difference between the experimental and control groups in terms of education level, job, and income (p>0.05; Table 1).There was no significant difference between the mean of information/emotional support, kindness, positive social interaction and the total score of social support received by the spouse before the intervention between the experimental and control groups (p>0.05), but there was a significant increase in the experimental group after the intervention (p<0.05). There was a significant difference between the mean score of tangible support before the intervention between the experimental and control groups (p=0.012) and it also showed a significant increase in the experimental group after the intervention (p=0.007; Table 2).There was no significant difference between systolic and diastolic blood pressure and adherence to the diet therapy before the educational intervention between the experimental and control groups (p>0.05), but after the intervention, a significant difference was observed between the two groups (p<0.001; Table 3).Multivariate analysis of covariance on diastolic blood pressure and systolic blood pressure in patients showed that the intervention variable caused a significant post-test score of the subjects (p<0.001). Multivariate analysis of covariance on adherence to the diet therapy showed that the variables of intervention, occupation, and adherence to the treatment before intervention caused a significant score of post-test in the subjects (p<0.01; Table 4).

The Findings showed that after the intervention, the mean score of received social support by a spouse in the experimental group was significantly higher than the control group, which is consistent with the results of the study by Mohebbi et al. [23]. The results of the present study showed the positive effect of social support received by a spouse on patients' adherence to diet therapy behaviors. The results of Baqaei et al. [24], Bion et al. [25] and Tadeo et al. [26] also showed that the mean score of adherence to the diet therapy in the experimental group had a significant increase compared to the control group, while in the control group, adherence to the treatment decreased or did not change, and this indicates the positive effect of education. …[27, 28]. The findings are consistent with the findings of Mohebbi et al. [23], Izadirad et al. [29], Baqiyani Moghaddam et al. [30] and Meglion & Hyman [31]. The results of their research showed that after the intervention in the experimental group, the mean score of behaviors such as regular drug use and proper diet increased significantly. ...[32-35]. In the present study, after the educational intervention, the mean systolic and diastolic blood pressure of patients in the experimental group was significantly reduced, which is consistent with the study of Izadirad et al. [29]. The results of the present study are also consistent with the results of the study of Garcia-Penea et al. [36] and Omidi et al. [37] who emphasized the effect of family members and social support in controlling blood pressure…[38-44].

It is suggested that researchers evaluate the impact of the social support variable in a wider range of people with chronic diseases in the country and on the quality of life of patients in other parts of the country. Research on female patients is also necessary to compare gender differences in health-promoting behaviors.

One of the limitations of this study was its performance only on male patients.

Spouse social support-based education promotes adherence to diet therapy and reduces systolic and diastolic blood pressure in patients with hypertension.

The researchers are grateful to all the officials of Qom University of Medical Sciences, the officials of the health community service centers, and all the people who have collaborated in this research.

No conflict has been reported by the authors.

Ethical considerations in the research included obtaining the ethics code from the research assistant of Qom University of Medical Sciences (Ethics ID: IR.MUQ.REC.1397.197), obtaining informed written consent from the participants, and maintaining the personal information of the participants. At the end of the study, the educational package including brochures and pamphlets was presented to the subjects of the control group.

This article is retrieved from the master's thesis of health education from Qom University of Medical Sciences.

TABLES and CHARTS

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