Educational Program with Text Messaging for Community-Dwelling Patients with Hypertension: A Pilot Randomized Controlled Trial

PURPOSE

Controlling blood pressure minimizes the risk of cardiovascular events among patients with hypertension. Despite regular follow-ups, the hypertension management for patients aged ≥45 years is limited as evidenced from a decreased control rate. This pilot study aimed to test a theory-guided educational program for community-dwelling patients with hypertension.

METHODS

Sixty-nine patients with hypertension aged ≥45 years and having high blood pressure (>130/80 mmHg) were recruited in this two-arm pilot randomized controlled trial. Participants in the intervention group underwent a program guided by the Health Promotion Model, whereas those in the control group received usual care. Data were collected at baseline, week 8, and week 12 and used to assess the blood pressure, pulse pressure, self-efficacy, and adherence to hypertension management. Data were analyzed using a generalized estimating equation based on the intention-to-treat principle. Process evaluation was conducted to assess the feasibility and acceptability of the educational program.

RESULTS

The results obtained using the generalized estimating equation revealed that the educational program led to reduction in the systolic blood pressure (β = -7.12, p = .086) and pulse pressure (β = -8.20, p = .007) and to improve self-efficacy (β = 2.61, p = .269) at week 12. The program had a small-to-moderate effect on the reduction of systolic blood pressure (effect size = -0.45) and pulse pressure (effect size = -0.66) and self-efficacy (effect size = 0.23). The participants were highly satisfied with the educational program.

CONCLUSIONS

The educational program was found to be feasible and acceptable and may be incorporated into current hypertension management practices at the community level.

TRIAL REGISTRATION

ClinicalTrials.gov with identifier: NCT04565548.

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status

Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.

A web-based self-care program to promote healthy lifestyles and control blood pressure in patients with primary hypertension: A randomized controlled trial

BACKGROUND

Hypertension is a major risk factor for cardiovascular diseases, which contributes to the worldwide mortality rate. Successful blood pressure control requires adherence to medications and lifestyle modifications. However, motivating patients with primary hypertension to change and sustain behaviors long-term is challenging. A web-based self-care program centered on self-efficacy theory could provide feedback for effective control of blood pressure.

PURPOSE

To examine the effect of a web-based self-care program for patients with primary hypertension on cardiovascular risk-factors (pulse pressure and lipids), self-efficacy, and self-care behaviors (medication adherence and lifestyle).

DESIGN

A two-armed randomized controlled trial with 3-month and 6-month follow-ups.

SETTING AND PARTICIPANTS

A total of 222 patients with primary hypertension were recruited between February 2017 and August 2018 at a cardiology clinic of a medical center in Taipei, Taiwan.

METHODS

Eligible patients were randomized by permuted block randomization into the intervention group (n = 111) and control group (n = 111). Patients in the intervention group received a 6-month web-based self-care program, based on the theory of self-efficacy, while patients in the control group received usual care. Baseline and outcome measures (3 and 6 months) included self-efficacy, evaluated with the Chinese version of the 6-item Self-Efficacy for Managing Chronic Diseases (SEMC6), self-care, using subscales of the Hypertension Self-Care Activity Level Effects Scale (H-SCALE) for lifestyle and medication adherence, and blood pressure and serum lipid data, collected through web-based self-reports and chart review. Generalized estimating equations evaluated the effects of the intervention.

FINDINGS

At baseline, the control group had higher scores on the SEMC6, and lower cholesterol (HDL) compared with the intervention group (t = -2.70, p < 0.05; and t = 1.76, p < 0.05, respectively). Pulse pressure decreased significantly (β = -20.30, 95% CI -23.76, -16.83), and serum triglycerides and low-density lipoprotein cholesterol levels were significantly lower compared with controls at 6 months (all p < 0.001). At 6 months, the intervention group had significantly higher mean scores for the SEMC6 compared with the control group (β = 21.84, 95% confidence interval [CI] 19.25, 24.42) and H-SCALE subscale for medication adherence, diet, weight management, and physical activity compared with controls at 6 months (all, p < 0.001).

CONCLUSIONS AND CLINICAL RELEVANCE

The greatest benefit of this program was allowing participants to immediately consult with the researchers about self-care issues via the website. Lifestyles vary from person to person; therefore, the individuality of each participant was considered when providing feedback. We provided devising interventions for participants that would increase their confidence in self-care for hypertension and ultimately achieve home blood pressure control. We encourage incorporating this program into standard clinical care for patients with hypertension.

The Influential Factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis

AIMS AND OBJECTIVES

To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors.

BACKGROUND

Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied.

DESIGN

A cross-sectional descriptive study.

METHODS

In total, 208 stroke survivors (70.25 ± 9.08 years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE.

RESULTS

The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors.

CONCLUSIONS

The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population.

RELEVANCE TO CLINICAL PRACTICE

Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.

Perceived participation and autonomy post-stroke and associated factors: An explorative cross-sectional study

AIMS

To explore the level and associated factors of perceived participation and autonomy among stroke survivors in Shanghai, China.

DESIGN

Cross-sectional explorative study.

METHODS

From January to December 2018, 431 patients presenting at the neurology departments of three hospitals with a confirmed diagnosis of stroke were recruited. Impact on Participation and Autonomy Questionnaire, modified Rankin Scale, Self-efficacy for Managing Chronic Disease six-item Scale, Medical Coping Modes Questionnaire and Multidimensional Scale of Perceived Social Support were applied to measure their participation, physical function, self-efficacy, coping styles, and social support.

RESULTS

The average score of perceived participation and autonomy was 41.30 (SD 21.22); and 54.3%, 46.9%, 21.6%, and 7.7% of the participants reported poor participation in social relations, family role, autonomy indoors, and autonomy outdoors. Age, physical function, self-efficacy, friend support, and knowledge of stroke were predictors of post-stroke participation. Physical function and self-efficacy were the most relevant factors of nearly all domains of participation except autonomy outdoors, while predictors of autonomy outdoors were social support, resignation coping style, and knowledge of stroke.

CONCLUSION

The stroke patients experienced insufficient participation compared with previous studies in western countries. Patients' physical function and self-efficacy were particularly important and contributed to their participation, while the patient's age, perceived social support, coping styles, and knowledge of stroke also played a role in formulating participation.

IMPACT

The results may be used to provide nurses with a better understanding of the participation among stroke patients and assist them in promoting the post-stroke participation. Nurses should pay special attention to those with older age, worse physical function, lower self-efficacy, less support, little stroke-related knowledge, or who applied resignation coping style since those patients might experience lower participation in their daily life. It needs further studies to explore the causal effects of self-efficacy, coping styles, and social support on post-stroke participation.

Effect of community based practice of Baduanjin on self-efficacy of adults with cardiovascular diseases

BACKGROUND

Low self-efficacy in chronic disease patients is one of the main disturbances which require physical and mental rehabilitation, calling for the development of a home accessible way to improve self-management.

OBJECTIVES

The purpose of this study was to explore the effectiveness of a community based Baduanjin exercise on self-efficacy in adults with cardiovascular disease.

DESIGN

A randomized controlled trial, longitudinal research design was employed.

PARTICIPANTS

After screening by health documents in Community Health Service Station, a total of 134 patients with records of cardiovascular diseases were had been enrolled according to the following inclusion criteria: (1) Community dwelling adults in Xili Community; (2) Patients diagnosed with cardiovascular diseases by community doctors, or other clinicians in health records in the past 3 years (2013-2015); (3) independent walking. Participants were excluded if they: (1) had impaired mobility and limited extremities functionality; (2) had not been in stable health condition and could not adhere to the exercise regime; (3) had communication difficulties and limited ability to follow instructions.

METHODS

Participants were randomly assigned to the Baduanjin group or the control group. Those in the Baduanjin group received 16 weeks of Baduanjin exercise training, while those in the control group kept the original exercise mode unchanged. The Self-Efficacy for Managing Chronic Disease 6-item Scale (SEMCD6) was administered to subjects before and after intervention.

RESULTS

Demographic data showed that 65.12% of the enrolled 129 participants were aged 65 or older, 92.25% received less than 12 years of education, and 68.21% participants' monthly income was less than 1999 RMB. Before intervention, SEMCD6 scores of 86.36% participants in Baduanjin group were below 7 points, while 85.71% in control group; after 16 weeks of Baduanjin exercise, SEMCD6 scores lower than 7 points in Baduanjin group (21.21%) were significantly lower than that of the control group (84.13%). The increase of SEMCD6 scores in Baduanjin group was statistically significant in the confidence to keep the fatigue, to keep the physical discomfort or pain, to keep the emotional distress and do the different tasks and activities (P<0.01).

CONCLUSIONS

Adults with cardiovascular diseases in community have lower level of education, most of whom have a low monthly income; thus, community dwelling cardiovascular disease patients are more suitable for an economic program to persist their long term management of the disease. Baduanjin is a traditional Chinese medicine regimen with less physical and cognitive demand; community based exercise of Baduanjin could help to increase self-efficacy in patients with cardiovascular diseases, thus better self-management of rehabilitation process.

Characteristics of the Spanish- and English-Language Self-Efficacy to Manage Diabetes Scales

Purpose

The purpose of this study was to examine the characteristics of the Spanish-language diabetes self-efficacy scale (DSES-S) and the English-language version (DSES).

Methods

This study consists of secondary data from 3 randomized studies that administered the DSES-S and DSES at 2 time points. The scales consist of 8 Likert-type 10-point items. Principal component analysis was applied to determine if the scales were unitary or consisted of subscales. Univariate statistics were used to describe the scales. Sensitivity to change was measured by comparing randomized treatment with control groups, where the treatment included methods designed to enhance self-efficacy. General linear models were used to examine the association between the scales and the 8 medical outcomes after controlling for demographic variables.

Results

Principal component analysis indicated that there were 2 subscales for both versions: self-efficacy for behaviors and self-efficacy to manage blood levels and medical condition. The measures had similar means across the 3 studies, high internal consistent reliability, values distributed across the entire range, and they showed no evidence of floor effects and little evidence of ceiling effects. The measures were sensitive to change. They were associated with several health indicators and behaviors at baseline, and changes were associated with changes in health measures.

Conclusions

The self-efficacy measures behaved consistently across the 3 studies and were highly reliable. Associations with medical indicators and behaviors suggested validity, although further study would be desirable to compare other measures of self-efficacy for people with type 2 diabetes. These brief scales are appropriate for measuring self-efficacy to manage diabetes.