@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2020;7(4):303-310

Background
Hypertension is defined as systolic blood pressure above 140 mm Hg and diastolic blood pressure above 90 mm Hg. Hypertension is considered a chronic disease in global health and a risk factor for cardiovascular and cerebral diseases [1, 2].
Previous Studies
…[3, 4]. Hypertension is a common, asymptomatic disease that is easily treatable. However, if left untreated, it can often lead to fatal complications. Also, the medical costs of this disease have created a high economic burden for countries [5]. Self-care is a health-promoting activity that refers to maintaining health through positive health practices and disease management. So that by controlling blood pressure, the problems caused by this disease are reduced, significantly. The results of studies show that patients with hypertension do not pay enough attention to regular physical activity, low-salt and rich diet of fruits and vegetables, and weight control [6, 7]. Training the self-care behaviors is essential in preventing the exacerbation of disease symptoms, reducing the number of hospitalizations, reducing mortality, feeling more healthy, and reducing treatment costs of patients, as well as it is effective in promoting the feeling of comfort, functional abilities, and disease processes [8]. ...[9]. Theories and models provide a systematic view of events, successes, and guidelines for reviewing and diagnosing training, intervention design, and evaluation. In the meantime, the Precede model as a framework is a process for behavior change and examines the possible outcomes of a training program [10]. ...[11-13].
Aim(s)
The aim of this study was to determine the effect of training intervention on promoting self-care behaviors of hypertensive patients based on the Precede model.
Research type
This study is a randomized controlled trial.
Research society, place and time
The study was carried out between the patients with hypertension in the villages covered by Galikesh city of Golestan province in 2018.
Sampling method and number
The sample size was determined to be 45 people in each group considering the study of Hosseini et al. [14]. According to the static drop of 20%, 56 subjects in each group, and a total of 108 subjects were determined for the study. Due to the incompleteness of the questionnaire by 6 people, the information of 102 people was collected. The samples were classified into two groups based on age and gender using the classified random block method. The intervention was performed for 51 patients, and 51 patients were assigned to the control group. The inclusion criteria were hypertension (for systolic blood pressure at or above 140 mm Hg and diastole at or above 90 mm Hg previously approved by a doctor), willingness to participate in the study, age group of 30-60, people with literacy and the ability to attend in training classes. Exclusion criteria also include changing the treatment protocol by the physician during the program, treating high blood pressure with specific diets (e.g. non-pharmacological treatment), simultaneous infection with several diseases (diabetes, kidney disease, and cancer), using psychiatric medication, and non-participation in more than one training session.
Used devices&materials
The data collection tool consisted of two sections of demographic information and the standard questionnaire of the Precede model constructs [14]. Data were collected by interviewing patients without mentioning their names. A pilot study by participating 30 patients with hypertension was performed to approve the reliability of the questionnaire (α=0.69-0.83). After completing the questionnaire in the first stage and analyzing the pre-test data, and determining the most important predictors, training content was developed, and training intervention was designed for the test group. The training sessions were held in 4 60-minute sessions based on the Precede model constructs, one training session per week [15]. The test group was also divided into groups of 12-15 subjects to participate in the training sessions. The post-test was performed 3 months after the training intervention through the questionnaire and interviews in the test and control groups. The data were analyzed using SPSS 19 software through descriptive statistics and the Chi-square, independent T, paired T, and linear regression tests at a significance level of 0.05.
Findings by Text
The average age of the subjects was 51.59±11.95, and their body mass index was 23.30±8.38. 77 participants (75.5%) had primary education, and most of the participants (80.4%) were married. 102 subjects with hypertension participated in this study, of which 78 people (76.5%) were male. The Fisher, Chi-square, and independent T-tests showed no significant difference between the two groups in terms of demographic variables before the training intervention (p<0.05; Table 1). The results showed that 53.9% of patients used a combination of solid and liquid oils in their diet. More than half of them (65.07%) added salt to food during cooking, and about 50 subjects (49.0%) did not have regular physical activity. The Fisher and Chi-square tests showed no significant difference between the two groups in the frequency of factors affecting blood pressure before the training intervention (p<0.05; Table 2). The highest score obtained from 102 participating patients was related to attitude before the training intervention, with an average of 24%, and the lowest score was related to the enabling factors. Also, according to the findings, knowledge, attitude, and reinforcing factors explain a total of 20% of the variance in self-care behaviors in patients with hypertension. Among these variables, enabling factors (β=0.396) and attitude (β=0.256) show the most impact on self-care behaviors (Table 3). Independent T-test showed no significant difference between the two groups in terms of the Precede model constructs, except the construct of enabling factors (p<0.05). The results also showed a significant difference between the Precede model constructs in the test group after the training intervention compared to before the intervention (p<0.05). There was no significant difference between the mean of the constructs in the control group before and 3 months after the intervention, except for the enabling factor. Also, an independent T-test showed a significant difference between the two groups in all constructs except the enabling factors after training intervention (p<0.05). The mean score of self-care behaviors in the test group was significantly increased compared to the control group 3 months after the training intervention (Table 4).
Main comparison to the similar studies
This study aimed to determine the role of training intervention on the promotion of self-care behaviors in patients with hypertension based on the Precede model. Findings show that attitude had the highest score among the constructs. Bacha et al. [16] concluded that attitude and practice were generally poor in the study population, which is contrary to the results of this study. The mean scores of knowledge and attitude of the subjects had a significant increase in the test group compared to the control group 3 months after the training intervention. This finding is consistent with the studies of Ramezankhani et al. [17], Eqbali et al. [6], and Giria et al. [18]. There was no significant difference between the constructs scores of the reinforcing factors between the two groups before the training intervention. However, 3 months after the training intervention, the mean scores of reinforcing factors were significant between the two groups. Base on the research of Aqamolaei et al. [19] a significant difference was observed between the mean scores of reinforcing factors between the two groups 2 months after the training intervention. This finding was also consistent with the findings of Solhi et al. [20], Sanjari et al. In Jiroft [21], Line et al. In Myanmar [22], Liao et al. In Taiwan [23] and was inconsistent with the research of Mertez et al. [24]. Enabling factors are one of the strongest predictors in this study, which is in line with the findings of Tabassinejad et al. [25]. The findings also showed a significant increase in the mean score of enabling factors in the two groups (3 months after the training intervention), which is also consistent with the studies of Hosseini et al. [14] and Babaei et al. [8]. There was no significant difference in the mean score of enabling factors between the 2 groups 3 months after the training intervention, which is inconsistent with the results of the study of Salinaro et al. [26], and Aqamolaei et al. [19]. There was no significant difference in the mean score of self-care behaviors between the 2 groups before and 3 months after the training intervention, which these results are in accordance with the study of Khani Jihuni et al. [27], Hosseini et al. [14], and Babaei et al. [8]. Shayesteh et al. [28] stated that physical activity and a healthy diet in patients with hypertension significantly increased after training intervention in the test group compared to the control group. Liu et al. [29] also showed the effect of training intervention on self-care behaviors in hypertensive patients.
Suggestions
There is no suggestion.
Limitations
One of the limitations of this study is the large number of questions in the questionnaire, which leads to a long process of asking questions and creating fatigue in the subjects. Filling the questionnaire through interviews and conducting the study in the rural population are among the advantages of this study.
Conclusions
It seems that training the self-care behaviors alone with some of the necessary structures to implement strategies for self-care behaviors will be more effective in the stability of self-care behaviors in the subjects.
Acknowledgments
The research team would like to thank the esteemed officials of the Comprehensive Rural Health Service Centers, the patients participating in the study, and the esteemed Vice Chancellor for Research and Technology of Golestan University of Medical Sciences.
Conflict of interest
No conflict of interest has been reported by the authors.
Ethical Permissions
This Study Was Approved By The Research Ethics Committee Of Golestan University Of Medical Sciences With The Ethics Code Of IR.GOUMS.REC.1397.329.
Funding Sources
This research was conducted with the financial support of the Vice-Chancellor for Research and Technology of Golestan University of Medical Sciences.

TABLES and CHARTS

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