@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2019;6(2):95-101

Background
... [1-7]. Aging is often associated with an increased risk of chronic disorders. … [8].
Previous Studies
... [9, 10]. Hazavehei et al. [11] emphasized on the necessity of developing a curriculum based on the Health Belief Model (HBM) and the constructs that influence self-care behaviors. The findings of various studies also show that many factors, such as self-efficacy, social support and perceived barriers affect the self-care behaviors and quality of life of the elderly with hypertension [12]. As Fogari & Zoppi in their research suggest that increasing self-care behaviors in relation to blood pressure control will have a positive effect on quality of life in the elderly [13]. On the other hand, self-efficacy is a good determinant of changing self-care behaviors. Roozbahani et al. emphasized on the relationship between self-efficacy in hypertensive elderly with self-care behaviors, which particular emphasis should be placed on self-efficacy to control hypertension [14]. ... [15-17]. Motivational interviewing is a form of client-centered communication and a guide to changing maladaptive behaviors through discovery, identification, resolving doubts and ambivalence [18]. ... [19].
Aim(s)
The purpose of this study was to assess the effect of motivational interviewing based on the health belief model on hypertension, self-care, and quality of life of rural aged people.
Research type
This research was a semi-experimental study without a control group.
Research society, place and time
This research was carried out on rural people aged over 60 years, who were covered by city health centers of Ramhormoz in 2017.
Sampling method and number
Eftekhar Ardebili et al. results were used to determine the sample size [20]. Sample size was determined to be 111 individuals with α = 0.05 and β = 0.25, which was increased to 120 subjects due to the possibility of falling. Multi-stage random sampling was used to select the elderly. Inclusion criteria were taking blood pressure control medication, having primary hypertension, no heart failure and hypertension complications, and the exclusion criterion was unwillingness to participate in the study.
Used devices&materials
Data were collected using standard questionnaires. The first section included demographic information, such as age, sex, marital status, occupation, education level, systolic-diastolic blood pressure, duration of hypertension, history of hypertension, and medication use. Height meter and scale were used to measure height and weight. Body mass index was calculated by dividing weight (kg) by squared height (m2). Also, systolic and diastolic blood pressures were measured and all measurements were performed by health worker using a blood pressure monitoring device. The second section included questions about BHM constructs, including the Social Support Questionnaire from the Lee et al. [21] study with 4 questions, Perceived Barriers Questionnaire from the Kamran et al. [22] study with 4 questions, Self-efficacy Questionnaire from the Warren-Findlow et al. study [23] with 5 questions, blood pressure self-care questionnaire of Lem & Fresco [4] study with 4 questions and the 31-item Lipad quality of life. To perform the study, the researcher obtained necessary permissions from the School of Health and Ethics committee of Jundishapur University of Medical Sciences, Ahvaz, Iran and the necessary coordination was made with the authorities. He referred every day to the health houses and with the participation of the health workers based in the centers, selected the elderly who were eligible to participate in the study. He also provided the written consent form to literate subjects and gave verbal explanations to illiterate subjects in the presence of another person, who was one of the first-degree relatives of elderly to obtain the written consent. Since most of the subjects were illiterate or had low level of education, the questionnaire was completed by a qualified interviewer. The educational intervention was designed based on valid studies and pre-test results. The training sessions contents were extracted from the five-session motivational intervention interview guidelines [26]. The elderly participated in two sessions (8 sessions in total) per week for 30-45 minutes in small groups of 4 in lifestyle modification classes. After 2 months of educational intervention with follow-up, the subjects completed the questionnaires again and the impact of the educational intervention was evaluated. Data were analyzed using LISREL 8.5 and SPSS 22 software. Confirmatory factor analysis and path analysis test were used to fit and confirm the model fit. [27]. Data were analyzed using LISREL 8.5 and SPSS software. Pearson-Fillon Z test was also used to convert R to Z to compare self-care correlation coefficient with social support, perceived barriers, self-efficacy and quality of life before and after educational intervention [28].
Findings by Text
The mean age of participants was 71.80 ± 9.03 years (Table 1).After the educational intervention, the mean scores of the research variables were significantly improved (Table 2).Correlation coefficients of all variables except for the perceived barriers with self-care before and after educational intervention were statistically significant (Table 4).Model fit indices before intervention were as follows: Chi-square (X2) = 14.60, Degree of freedom (df) = 3, root mean square error of approximation (RMSEA) = 0.183, Comparative fit index (CFI) = 0.85, goodness-of-fit index (GFI) = 0.95 and normalized fitness index (NFI) = 0.84, whereas after the intervention they obtained as follows: chi-square (X2) = 3.29, Degree of freedom (df) = 3, root mean square error of approximation (RMSEA) = 0.029, Comparative fit index (CFI) = 1.00, goodness-of-fit index (GFI) =0.99 and normalized fitness index (NFI) = 0.98. Path analysis results showed that 13% of self-care variance and 8% of quality of life variance were explained before educational intervention, but after educational intervention, these rates reached 40% and 31%, respectively.
Main comparison to the similar studies
According to the findings of this study, promoting health-promoting behaviors can reduce systolic and diastolic blood pressure in the elderly. These results were consistent with the findings of Farahandi et al. [29], Prasanna et al. [30], Izadirad et al. [31], Fargally et al. [32] and Sadeghi et al. [33]... [34]. The results of the present study indicated the improvement of quality of life in elderly through educational intervention with group motivational interviewing approach. The results of Khazri et al. study [35] also showed that the quality of life score of the elderly with hypertension was significantly increased in the experimental group after the self-care empowerment intervention. ... [36-38].
Suggestions
The long-term effects of this intervention need to be examined.
Limitations
There were some limitations in the implementation of this study, for example this was a quasi-experimental study without control.
Conclusions
Motivational interviewing has led to a better explanation of the health belief model in self-care and the quality of life by modifying the mental beliefs of aged people.
Acknowledgments
We thank the officials of Ahvaz Jundishapur University of Medical Sciences and all the elderly who helped us with this research.
Conflict of interest
None declared.
Ethical Permissions
The present study is extracted from the dissertation approved by Ahvaz Jundishapur University of Medical Sciences (SDH-9612) and was conducted with the ethics code of IR.AJUMS.REC.1396.491.
Funding Sources
The research was funded by the Vice Chancellor for Research of Ahvaz Jundishapur University of Medical Sciences.

TABLES and CHARTS

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