Comparing and determining factors associated with hypertension self-care profiles of patients in two multi-ethnic Asian countries: cross-sectional studies between two study populations

Exploring factors associated with hypertension self-care in primary care: The role of nurse education levels and patient-related factors

AIM

To explore the association between nurse education levels and patient-related factors with hypertension self-care.

BACKGROUND

Although self-care development is recognized as a healthcare provider-patient encounter, the attribution of nurse education level to hypertension self-care is not well addressed.

DESIGN

A cross-sectional study.

METHODS

Hypertensive patients from 15 primary care facilities were sampled, and self-care was assessed using the Self-Care of Hypertension Inventory version 2.0, with standardized scores ≥70 indicating adequate self-care. Data on patient-related factors were obtained from electronic health records, self-reports and laboratory tests, while nurse education levels were categorized as standard (baccalaureate-prepared) or higher (post-baccalaureate specialty).

RESULTS

A total of 1493 participants were included in this study, with a median age of 66 years and 77.7% being female. Approximately 10% of participants had adequate self-care, and 66% received care from higher educated nurses. The study showed the relation between nurse education levels and the self-care of the patients. Adequate hypertension self-care was significantly associated with higher educated nurse providers and patient-related factors, including intermediate to higher education, non-overweight/obese and the absence of age-related comorbidities.

CONCLUSIONS

Hypertensive patients who had been provided care by higher educated nurses and their favourable sociodemographic, lower cardiometabolic risk and no concomitant disease were more likely to demonstrate adequate self-care.

Health literacy and self-care among patients with chronic kidney disease in a primary care setting

INTRODUCTION

The study objective was to determine the levels of self-care and health literacy (HL) and their associations among patients with chronic kidney disease (CKD).

METHODS

This was a cross-sectional, questionnaire-based study conducted in a public primary care setting in Singapore. A total of 289 participants aged 21-80 years with hypertension were recruited. Self-care profiles were measured using the Hypertension Self-Care Profile (HTN-SCP; range 0-240, domain range 0-80). Health literacy was measured using the Short-Form Health Literacy Scale (HLS-SF12; range 0-50, limited literacy ≤33).

RESULTS

The mean self-care score was 182.7 (standard deviation [SD] 23.2). The median HL score was 34.7 (interquartile range [IQR] 31.9-40.3), and 31.1% of participants had limited HL. Self-care was not associated with age, CKD status, household income and education, but was associated with gender and HL score. In the final regression model, lower HL scores (adjusted β = 1.03, 95% confidence interval [CI] 0.7 to 1.36, P < 0.001) and male gender (adjusted β = -5.29, 95% CI -10.56 to -0.03, P = 0.049) were associated with lower self-care scores. The HL scores were associated with self-care domains of self-efficacy (HL: β = 0.30, 95% CI 0.17 to 0.42, P < 0.001), motivation (HL: β = 0.40, 95% CI 0.26 to 0.53, P < 0.001) and behaviour (HL: β = 0.38, 95% CI 0.26 to 0.50, P < 0.001).

CONCLUSION

Thirty-one percent of the participants had limited HL. Self-care was not associated with age, race, CKD status, household income or education. Male gender and limited HL were associated with lower self-care. Self-care was associated with self-efficacy, motivation and behaviour. Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD.

Health motivations and perceived barriers are determinants of self-care behaviour for the prevention of hypertension in a Malaysian community

INTRODUCTION

Self-care behaviour is fundamental in preventing hypertension in the general population. According to the Health Belief Model, health beliefs and perceptions influence the success in adopting disease prevention strategies. While factors influencing hypertension self-care behaviour have been examined previously in patient populations, they have not been assessed in the general community.

METHODS

This was a cross-sectional study conducted between 12 June 2020 to 26 July 2021. An online survey was administered via email and social media to Malaysians in the Selangor and Kuala Lumpur communities. Respondents were over 18 years old, without a formal diagnosis of hypertension. The survey evaluated hypertension knowledge, Health Belief Model constructs, self-care behaviour frequency, and motivators and barriers to self-care behaviour. Multiple linear regression was performed to determine the main predictors of self-care behaviour, and descriptive statistics were used to characterise motivators and barriers of each self-care behaviour.

RESULTS

Only health motivations (β = 0.217, p < 0.001) and perceived barriers (β = 0.571, p < 0.001) significantly influenced self-care behaviour. Maintaining a healthy diet, regular physical activity and blood pressure checks need to be improved in the community, particularly in reducing salt and calorie intake. Lack of time, limited choices and laziness are the biggest challenges that need to be tackled in adopting a healthy diet and an active lifestyle in the community. Many are ignorant towards their health status, therefore, do not prioritize blood pressure screenings, suggesting a need to enhance community blood pressure checks for early diagnosis of hypertension.

CONCLUSION AND IMPLICATIONS

Motivations and barriers were the main determinants of self-care behaviour in the Selangor and Kuala Lumpur community. Targeting these aspects of self-care behaviour should be considered when developing interventions and education programmes tailored to local cultural, environmental and personal factors, to more effectively reduce the hypertension prevalence and burden.

Evaluating the Dimensionality and Reliability of the Thai Self-Care of Hypertension Inventory Version 2.0

PURPOSE

Self-care is essential for hypertensive individuals to promote optimal health and illness treatment. We developed the Thai Self-Care of Hypertension Inventory (SC-HI) version 2.0 from the original US version using a multi-stage approach for cross-cultural adaptation. Scales previously studied outside a US context had different dimensions and factor solutions. Therefore, we examined the Thai SC-HI's factorial validity, construct validity, and internal reliability within a Thai context.

METHODS

We administered a cross-sectional survey with hypertensive patients in 10 primary care settings, and conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on two sets of separate samples from each of five sites to examine the model's factorial validity and construct validity. We estimated scale reliability with Cronbach's alpha and McDonald's omega coefficients.

RESULTS

Participants were predominantly female, older adults, with mean age 66 years (SD = 11.94; range 36-97 years). The self-care maintenance scale had three factors and demonstrated good fit when the error covariances were respecified. The two-factor self-care management scale had different factorial solutions compared to previous models. The CFA result showed good fit indices for the Thai, original US, and Brazilian models. The self-care confidence scale was unidimensional, with partially supported fit indices that improved after we respecified the error covariances. Reliability coefficients estimated by difference methods were nearly equal: slightly lower than desired for self-care maintenance (.68-.70) and inadequate for self-care management (.62-.65); self-care confidence reliability was adequate (.89-.90).

CONCLUSION

The Thai SC-HI has good psychometric characteristics and reflects the original instrument's theoretical basis.

Self-Care Management for Hypertension in Southeast Asia: A Scoping Review

Background

Self-care practices such as lifestyle modifications in diet, exercise, and stress management are effective in reducing the incidence of and enhancing better management of hypertension. However, little is known about the self-care management practices of people with hypertension in Southeast Asia (SEA) countries where the prevalence of hypertension is sharply increasing.

Methods

A scoping review of research and grey literature (2006-2021) was performed using Scoping Review Frameworks by Arkey and O'Malley. For the research literature, ten databases were searched followed by a manual search of the reference lists of relevant topical papers. Criteria for inclusion included both qualitative and quantitative primary data studies, focused on adult (18 years and over) hypertensive patients, self-care management methods, conducted in SEA. The study protocol has been registered at Open Science Framework (https://osf.io/s4nvk/).

Results

Out of 1667 studies examined, there were 57 studies that met criteria and were included in this review. Results indicate a paucity of relevant literature. Moreover, most studies reviewed showed an incident rate of 50% or more incidence of behavioural risk factors in people diagnosed with hypertension, including overweight/obesity, poor physical exercise, poor/low-quality dietary intake, and not adhering to medication. Few studies indicated adequate traditional self-care practice among SEA hypertension populations. Use of a non-prescription herbal as the medication is identified in some studies. Several reviewed articles indicated that there is individual variation in the facilitators and barriers to implementing self-care practices and we put it into a working framework. The facilitators and barriers are relevant to personal choice (internal factors) or to the environment or context (external factors).

Conclusion

Enhancing self-care management of hypertension in SEA may require a multi-focused approach including targeting personal choice as well as external factors such as cultural relevance, environment, and resources.