Perception of uncontrolled blood pressure and behaviours to improve blood pressure: findings from the 2009 Survey on Living with Chronic Diseases in Canada

Self-Care Behaviors in Patients with Hypertension to Prevent Hypertensive Emergencies: a Qualitative Study Based on the Theory of Planned Behavior

Background: Hypertension is a crucial general health issue. Severe and acute hypertension needs urgent medical intervention. Self-care behaviors can help patients with hypertension in controlling blood pressure and preventing hypertensive emergencies. This study aimed to determine the perception of hypertension towards self-care behaviors using constructs of the theory of planned behavior (TPB) in critically ill patients with hypertension to prevent hypertensive emergencies.

Material and Methods: This study was conducted based on the directed qualitative content analysis of 33 critically ill patients with hypertension who participated in semi-structured interviews and focus group discussions. Results: The data were analyzed based on the four main categories of TPB. The attitude category consisted of positive and negative subcategories. The subjective norms category consisted of authority of healthcare staff, family support and approval, and influence of friends subcategories. The perceived behavioral control category included discipline, self-control, receiving consultation, individual concerns, financial problems, access to medicine, food culture, and coronavirus limitations subcategories. The behavioral intention category had intention to perform the behavior and intention to continue a behavior subcategories.

Conclusion: The results revealed the requirement for a multidimensional approach to improve attitude, subjective norms, and behavioral control for performing self-care behaviors to reduce the number of hypertensive emergencies in critically ill patients with hypertension. Factors affecting self-care included socioeconomic status, family support, governmental organizations, and participants’ health condition.

Cardiovascular Disease Risk Awareness and Its Association With Preventive Health Behaviors: Evidence From a Sample of Canadian Workplaces

OBJECTIVE

The aim of this study was to determine Canadian workers' level of awareness about their cardiovascular disease (CVD) risk factors and the association between CVD risk awareness and health behaviors.

METHODS

We used cross-sectional data to compare awareness of CVD risk factors with biometric measures from a workplace screening clinic (n = 320). We assessed the association between risk factor awareness and self-reported health behaviors using logistic regression analyses.

RESULTS

Overall, 39.5% of workers did not know at least one of their CVD risk factors. These individuals were less likely to meet recommended physical activity levels and to consume three daily servings of fruits and vegetables, and more likely to report weekly fast food consumption.

CONCLUSIONS

This study highlights a lack of awareness about cholesterol levels and demonstrates a negative association between low CVD awareness and preventive health behaviors.

Urban and rural differences in hypertension risk factors in Turkey

Objective:

Existing literature shows considerable regional differences in terms of hypertension (HT) prevalence in Turkey. The purpose of this study was to analyze some of the known HT risk factors contributing to the variations between urban and rural areas of Turkey in HT development.

Methods:

We used data from the 2011 Chronic Diseases and Risk Factors Survey that was conducted by the Turkish Ministry of Health on a representative sample of the Turkish adult population aged 20 years or more (n=16.227). HT was defined as having at least one of the following: a mean systolic/diastolic blood pressure of at least 140/90 mm Hg, a previously diagnosed disease, or use of antihypertensive medication. Stepwise multiple logistic regression analysis was used to estimate HT risk factors in urban and rural settings.

Results:

Although the HT prevalence was higher in rural areas (28.4%) than in urban areas (23.9%), in this study, urbanization was found to be a contributing factor in multivariate regression analysis. Furthermore, separate regressions for urban and rural settings revealed that age, obesity, diabetes, hyperlipidemia, and smoking were independently and positively associated (p<0.05) with HT in both settings, while marital status, employment type, mental health, and lifestyle patterns; nutritional habits; and amount of physical activity and sedentary time (p<0.05) were risk indicators in urban areas only.

Conclusion:

The findings of our study demonstrate that contributory factors show some variations between urban and rural settings, and on gender within each setting. Taking into account the variations between urban and rural areas in HT development may provide greater insight into the design of prevention strategies.

Older adults' perception of chronic illness management in South Korea

OBJECTIVES

Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness.

METHODS

We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis.

RESULTS

Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants' compliance with treatment.

CONCLUSIONS

For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

OBJECTIVES

Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness.

METHODS

We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis.

RESULTS

Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants’ compliance with treatment.

CONCLUSIONS

For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

Barriers and facilitating factors for disease self-management: a qualitative analysis of perceptions of patients receiving care for type 2 diabetes and/or hypertension in San José, Costa Rica and Tuxtla Gutiérrez, Mexico

Background

The burden of cardiovascular disease is growing in the Mesoamerican region. Patients’ disease self-management is an important contributor to control of cardiovascular disease. Few studies have explored factors that facilitate and inhibit disease self-management in patients with type 2 diabetes and hypertension in urban settings in the region. This article presents patients’ perceptions of barriers and facilitating factors to disease self-management, and offers considerations for health care professionals in how to support them.

Methods

In 2011, 12 focus groups were conducted with a total of 70 adults with type 2 diabetes and/or hypertension who attended urban public health centers in San José, Costa Rica and Tuxtla Gutiérrez, Chiapas, Mexico. Focus group discussions were transcribed and coded using a content analysis approach to identify themes. Themes were organized using the trans-theoretical model, and other themes that transcend the individual level were also considered.

Results

Patients were at different stages in their readiness-to-change, and barriers and facilitating factors are presented for each stage. Barriers to disease self-management included: not accepting the disease, lack of information about symptoms, vertical communication between providers and patients, difficulty negotiating work and health care commitments, perception of healthy food as expensive or not filling, difficulty adhering to treatment and weight loss plans, additional health complications, and health care becoming monotonous. Factors facilitating disease self-management included: a family member’s positive experience, sense of urgency, accessible health care services and guidance from providers, inclusive communication, and family and community support.

Financial difficulty, gender roles, differences by disease type, faith, and implications for families and their support were identified as cross-cutting themes that may add an additional layer of complexity to disease management at any stage. These factors also relate to the broader family and societal context in which patients live.

Conclusions

People living with type 2 diabetes and hypertension present different barriers and facilitating factors for disease self-management, in part based on their readiness-to-change and also due to the broader context in which they live. Primary care providers can work with individuals to support self-management taking into consideration these different factors and the unique situation of each patient.

Monitoring and evaluating efforts to control hypertension in Canada: why, how, and what it tells us needs to be done about current care gaps

Blood pressure surveillance, monitoring, and evaluation of programs to prevent and control hypertension are critical because increased blood pressure is a leading risk for premature death and disability. Since 2003, the Hypertension Outcomes Research Task Force has existed in Canada, with members who assist in the development and revision of surveys and conduct analyses that help guide hypertension programs. Although the Task Force has tracked a 5-fold increase in the control of hypertension (from 13% in 1985-1992 to 65% in 2007-2009), surveillance data also indicate that many "care gaps" remain. Fifty-four percent of people with diabetes and 34% of those without diabetes have blood pressure readings greater than their target. Treatment rates are high in those who are diagnosed (95%), but 17% of people with hypertension remain undiagnosed. Younger men (more so than women) are too often unaware of having hypertension. Although they are more likely to be aware of their diagnosis, older women are 2 times more likely to have uncontrolled hypertension than men; systolic blood pressure is high in over 80% of those with uncontrolled blood pressure (90% in women); and often people with hypertension are not provided comprehensive advice on healthy behaviours, or assisted in developing plans to control their blood pressure. Many current surveys do not have adequate statistical power to assess vulnerable populations; surveys of Aboriginal populations do not usually assess blood pressure, such that the burden of hypertension in these high risk populations cannot be assessed.

Comparison of hypertension management between cancer survivors and the general public

Proper management of hypertension is important for better survival and quality of life of cancer survivors who have hypertension. We aimed to compare hypertension management between cancer survivors and the general population. A nationwide, multicenter, cross-sectional survey was administered to adult cancer patients, currently receiving treatment or follow-up, who had been diagnosed with hypertension. Comparison group was selected from among participants in the health behavior survey of the third Korean National Health and Nutrition Examination Survey. Self-reported hypertension management was surveyed, including antihypertensive medication adherence, frequency of blood pressure (BP) monitoring and perceived BP control. Multivariate logistic regression analysis was used to evaluate the relationship between cancer survivorship and each outcome measure. Compared with the general population, cancer survivors were more likely to report full adherence (92.7% vs. 73.0%; adjusted odds ratio (aOR)=3.45; 95% confidence interval (CI), 2.08-5.73), more frequent BP measurement (≥ 24 per year: 50.1% vs. 24.7%; aOR=2.51; 95% CI, 1.83-3.46), and very good perceived BP control (60.8% vs. 26.2%; aOR=4.34; 95% CI, 3.13-6.02). Cancer survivors appear to be better with antihypertensive medication adherence and BP monitoring than those without cancer, and as a result, they appear to be under better BP control. However, several methodological limitations of our study prompt further research on this issue.

A framework for discussion on how to improve prevention, management, and control of hypertension in Canada

Increased blood pressure is a leading risk for premature death and disability. The causes of increased blood pressure are intuitive and well known. However, the fundamental basis and means for improving blood pressure control are highly integrated into our complex societal structure both inside and outside our health system and hence require a comprehensive discussion of the pathway forward. A group of Canadian experts was appointed by Hypertension Canada with funding from Public Health Agency of Canada and the Heart and Stroke Foundation of Canada, Canadian Institute for Health Research (HSFC-CIHR) Chair in Hypertension Prevention and Control to draft a discussion Framework for prevention and control of hypertension. The report includes an environmental scan of past and current activities, proposals for key indicators, and targets to be achieved by 2020, and what changes are likely to be required in Canada to achieve the proposed targets. The key targets are to reduce the prevalence of hypertension to 13% of adults and improve control to 78% of those with hypertension. Broad changes in government policy, research, and health services delivery are required for these changes to occur. The Hypertension Framework process is designed to have 3 phases. The first includes the experts' report which is summarized in this report. The second phase is to gather input and priorities for action from individuals and organizations for revision of the Framework. It is hoped the Framework will stimulate discussion and input for its full intended lifespan 2011-2020. The third phase is to work with individuals and organizations on the priorities set in phase 2.