Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran

Identifying Risk Indicators of Cardiovascular Disease in Fasa Cohort Study (FACS): An Application of Generalized Linear Mixed-Model Tree

BACKGROUND

Today, cardiovascular disease (CVD) is the most important cause of death around the world. In this study, our main aim was to predict CVD using some of the most important indicators of this disease and present a tree-based statistical framework for detecting CVD patients according to these indicators.

METHODS

We used data from the baseline phase of the Fasa Cohort Study (FACS). The outcome variable was the presence of CVD. The ordinary Tree and generalized linear mixed models (GLMM) were fitted to the data and their predictive power for detecting CVD was compared with the obtained results from the GLMM tree. Statistical analysis was performed using the RStudio software.

RESULTS

Data of 9499 participants aged 35‒70 years were analyzed. The results of the multivariable mixed-effects logistic regression model revealed that participants' age, total cholesterol, marital status, smoking status, glucose, history of cardiac disease or myocardial infarction (MI) in first- and second-degree relatives, and presence of other diseases (like hypertension, depression, chronic headaches, and thyroid disease) were significantly related to the presence of CVD (P<0.05). Fitting the ordinary tree, GLMM, and GLMM tree resulted in area under the curve (AUC) values of 0.58 (0.56, 0.61), 0.81 (0.77, 0.84), and 0.80 (0.76, 0.83), respectively, among the study population. In addition, the tree model had the best specificity at 81% but the lowest sensitivity at 65% compared to the other models.

CONCLUSION

Given the superior performance of the GLMM tree compared with the standard tree and the lack of significant difference with the GLMM, using this model is suggested due to its simpler interpretation and fewer assumptions. Using updated statistical models for more accurate CVD prediction can result in more precise frameworks to aid in proactive patient detection planning.

Vietnamese version of the Hypertension Knowledge-Level Scale (HK-LS): Translation and validation

Introduction

In Vietnam, the prevalence of hypertension is increasing rapidly. Patients need to be conscious of the disease for timely prevention and treatment. The Hypertension Knowledge Level Scale (HK-LS) is commonly used to assess knowledge about hypertension.

Methods

Data collection was took place in a hospital in Binh Thuan province, Vietnam in February 2020 with a total of 184 paticipants. Translation and adaptation of the HK-LS, validate the questionnaire through in-person interviews with outpatients diagnosed with hypertension. The translation process followed WHO guidelines. The appraisal process evaluates through reliability (Cronbach's alpha coefficient) and validity (meaningful relationship between the response results of the scale and the patient's characteristics).

Results

The Vietnamese version of the HK-LS was translated and proven to be reliable (Cronbach's alpha=0.72) and valid (statistically significant difference between age groups (P=0.021) and educational background (P=0.007).

Conclusion

The HK-LS was translated from English into Vietnamese; the questions are clear, intelligible, and suitable for surveying patients in Vietnam.

How well do obesity indices predict undiagnosed hypertension in the Persian cohort (Shahedieh) adults community population of all ages?

Background and Aims

Hypertension is the leading preventable risk factor for cardiovascular disease, chronic kidney disease and cognitive impairment, and mortality and disability worldwide. Since prevention, early detection, and treatment of blood pressure improve public health, the aim of present study was to determine the best obesity indices and estimate the optimal cut-off point for each one to predict the risk of elevated/stage 1 and undiagnosed hypertension in the population of center of Iran based on American ACC/AHA 2020 guidelines.

Methods

This cross-sectional study was performed on 9715 people who enrolled in 2018 in Persian Adult Cohort in Shahedieh area of Yazd, Iran in 2018. The anthropometric indices including body mass index (BMI) and waist circumference (WC), wrist circumference, hip circumference, waist-to-hip ratio, and waist-to height ratio of individuals, were extracted. The receiver operating characteristic curve was utilized to determine the optimum cut-off point of each anthropometric index to predict hypertension stages and compare their predictive power by age-sex categories. Statistical analysis was done using SPSS version 23.0.

Results

The results showed that BMI has the best predictive power to recognize the risk of elevated/stage 1 hypertension for female (area under the curve [AUC] = 0.72 and optimal cut-off = 30.10 kg/m2) and WC for male (AUC = 0.66 and optimal cut-off = 93.5 cm) in 35-45 age group. BMI had the best predictive power for the risk of undiagnosed hypertension for 35-45 years old male (AUC = 0.73 and optimal cut-off = 28.90 kg/m2) and female (AUC = 0.75 and optimal cut-off = 5.10 kg/m2), and hip circumference revealed similar predictive power for female as well (AUC = 0.75 and optimal cut-off = 112 cm).

Conclusion

Based on our findings, BMI and WC, which are simple, inexpensive, and noninvasive means, are the best markers to predict the risk of elevated/stage 1 and undiagnosed hypertension in young Iranians. It shows that the approach of reducing hypertension prevalence through primary prevention, early detection, and enhancing its treatment is achievable.

Assessment of Public Knowledge of Hypertension Among the Saudi Population

Background Hypertension is a major risk factor for cardiovascular illness and premature death and is becoming more prevalent worldwide. To promote better educational strategies regarding hypertension, it is crucial to identify the most significant knowledge gaps among the general public. This study aimed to assess the knowledge of hypertension among the general public in Saudi Arabia. Methodology A cross-sectional, questionnaire-based study was conducted in Saudi Arabia. The target population was the general public aged ≥18 in Saudi Arabia. Statistical analysis was conducted using RStudio (R version 4.1.1). Numerical data were described as mean ± standard deviation or median and interquartile range (IQR) whenever applicable. P-values <0.05 indicated statistical significance. Results A total of 1,404 respondents were collected. After exclusion, 1,399 records were analyzed in this study. More than half of the respondents were females (59.5%) aged 18-39 years (52.7%) and had a university degree (64.8%). Additionally, 46.0% were employed. Approximately one-quarter of the sample had hypertension (26.3%), while 73.3% had a family history of hypertension The median score was 16.0 (IQR = 12.0-18.0) with a minimum and a maximum of 0.0 and 22.0, respectively. Reliability testing revealed that knowledge items had a good internal consistency (Cronbach's alpha = 0.859 based on 22 knowledge items). There was no significant association between knowledge and gender and having a personal history of hypertension. However, the knowledge score differed significantly by age, educational level, employment status, and having a family history of hypertension. On the multivariate analysis, knowledge scores were independently higher among participants in the higher age categories. Moreover, having a university degree, a postgraduate degree, and a family history of hypertension were independently associated with higher knowledge scores. Conclusions This study found that the general public in Saudi Arabia had good levels of knowledge about hypertension. Being knowledgeable about hypertension not only improves adherence to treatment plans among antihypertensive patients but also aids in avoiding its occurrence and consequences among non-hypertensive patients by adopting self-care. Serial and frequent studies on this issue are recommended to gather more evidence on this topic. Ongoing hypertension education is essential to enhance knowledge to minimize the burden of this prevalent issue.

Construct Validity and Reliability of the Arabic Version of Hypertension Knowledge-Level Scale Among Saudi Population

Background Knowledgeable people are more likely to follow their treatment plan and reduce hypertension morbidity and mortality. This study aimed to construct the validity and reliability of the Arabic version of the Hypertension Knowledge-Level Scale (HK-LS) among Saudis. Methods This cross-sectional questionnaire research targets hypertensives and non-hypertensives. Cronbach's alpha and Spearman's correlation matrix analysis measured the questionnaire's construct validity. Wilcoxon rank sum tests examined HK-LS tools' discriminant validity. A p<0.05 was considered significant. Results A total of 1424 responses were received. However, the 1419 individuals were evaluated after applying exclusion criteria. About 60% of the participants were female, with the most common age groups being 18-29 years (38.5%) and 40-49 years (24.0%). A personal history of hypertension was reported by 26.1%, and a family history of hypertension by 73.3% of the subjects. Cronbach's alpha for the whole HK-LS was 0.883, suggesting that the tool was reliable. All the items of the HK-LS questionnaire were significantly correlated with each other, except for a non-significant correlation between statements two and seven (r=0.05, p=0.091). The strongest correlations were apparent between items 19 and 20 (r=0.70, p<0.0001), items one and two (r=0.64, p<0.0001), and items 18 and 19 (r=0.56, p<0.0001). However, the weakest associations were reported among items two and six (r=0.06, p<0.05), items two and nine (r=0.07, p<0.05), and items one and 19 (r=0.07, p<0.05). The discriminant validity showed that a personal history of hypertension was associated with significantly higher scores of two HK-LS subscales, including definitions and complications. In addition, the overall knowledge score was significantly higher among participants with a positive history of hypertension among family and/or friends.  Conclusions The Arabic version of the HK-LS was found to be a reliable and valid tool for measuring knowledge about hypertension among the Saudi population. This reliable instrument can assist medical professionals in establishing education programs.

The prevalence and predictors of cardiovascular diseases in Kherameh cohort study: a population-based study on 10,663 people in southern Iran

BACKGROUND

The prevalence of cardiovascular disease (CVD) is rapidly increasing in the world. The present study aimed to assess the prevalence and Predictors factors of CVD based on the data of Kherameh cohort study.

METHODS

The present cross-sectional, analytical study was done based on the data of Kherameh cohort study, as a branch of the Prospective Epidemiological Studies in Iran (PERSIAN). The participants consisted of 10,663 people aged 40-70 years. CVD was defined as suffering from ischemic heart diseases including heart failure, angina, and myocardial infarction. Logistic regression was used to model and predict the factors related to CVD. Additionally, the age-standardized prevalence rate (ASPR) of CVD was determined using the standard Asian population.

RESULTS

The ASPR of CVD was 10.39% in males (95% CI 10.2-10.6%) and 10.21% in females (95% CI 9.9-10.4%). The prevalence of CVD was higher among the individuals with high blood pressure (58.3%, p < 0.001) as well as among those who smoked (28.3%, p = 0.018), used opium (18.2%, p = 0.039), had high triglyceride levels (31.6%, p = 0.011), were overweight and obese (66.2%, p < 0.001), were unmarried (83.9%, p < 0.001), were illiterate (64.2%, p < 0.001), were unemployed (60.9%, p < 0.001), and suffered from diabetes mellitus (28.1%, p < 0.001). The results of multivariable logistic regression analysis showed that the odds of having CVD was 2.25 times higher among the individuals aged 50-60 years compared to those aged 40-50 years, 1.66 folds higher in opium users than in non-opium users, 1.37 times higher in smokers compared to non-smokers, 2.03 folds higher in regular users of sleeping pills than in non-consumers, and 4.02 times higher in hypertensive individuals than in normotensive ones.

CONCLUSION

The prevalence of CVD was found to be relatively higher in Kherameh (southern Iran) compared to other places. Moreover, old age, obesity, taking sleeping pills, hypertension, drug use, and chronic obstructive pulmonary disease had the highest odds ratios of CVD.

Public's Knowledge of Hypertension and its Associated Factors: A Cross-Sectional Study

Background:

Hypertension is a significant challenge for healthcare systems globally. It is estimated to cause 7.5 million deaths worldwide annually. Knowledge of hypertension plays a crucial role in behavioral changes required to prevent and manage the condition. This study aimed to assess the public's knowledge of hypertension’s risk factors, symptoms, complications, and treatment.

Methods:

This cross-sectional, descriptive, and exploratory study included a convenience sample of 723 Jordanian adults. The Hypertension Knowledge Test was used to measure the participants' knowledge of hypertension’s risk factors, symptoms, complications, and treatment.

Results:

The participants' mean score of total hypertension knowledge was 11.5 ±3.82 (52.2%), with 85.9% (n=621) having inadequate knowledge. Their mean scores for hypertension’s risk factors, symptoms, complications, and treatment were 7.45 ±2.35 (62.1%), 2.29 ±1.21 (45.8%), 1.38 ± 0.943 (46%), and 0.391 ± 0.603 (19.6%), respectively. Four factors were found to be significant predictors of participants' knowledge, such as age (p=0.002), education level (p<0.001), family history (p<0.001), and receiving hypertension-related information (p<0.001).

Conclusion:

The participants had inadequate knowledge regarding hypertension’s complications, risk factors, symptoms, and treatment. Public health education programs that focus on hypertension knowledge are required. Nurses and other healthcare providers should take the initiative in hypertension education. Strategic planning and designing of hypertension programs are required to fit the needs of the Jordanian public to enhance their knowledge of hypertension and related preventive and control measures.

Additive association of knowledge and awareness on control of hypertension: a cross-sectional survey in rural India

OBJECTIVE

To determine whether there is an interaction between knowledge about hypertension and awareness of hypertension on the treatment and control of hypertension in three regions of South India at different stages of epidemiological transition (see Video, Supplemental Digital Content 1, http://links.lww.com/HJH/B426).

METHODS

Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Chittoor. Sampling was stratified by age group and sex. We measured blood pressure and administered a questionnaire to determine knowledge and awareness of hypertension. Logistic regression was used to assess associations of awareness and knowledge about hypertension with its treatment and control in participants with hypertension, while examining for statistical interaction.

RESULTS

Among a total of 11 657 participants (50% male; median age 45 years), 3455 had hypertension. In analyses adjusted for age and sex, both knowledge score [adjusted odds ratio (aOR) 1.14 [95% confidence interval (CI) 1.12--1.17)] and awareness [aOR 104 (95% CI 82--134)] were associated with treatment for hypertension. Similarly, both knowledge score [aOR 1.10; 95% CI (1.08--1.12)] and awareness [aOR 13.4; 95% CI (10.7--16.7)], were positively associated with control of blood pressure in those with hypertension, independent of age and sex. There was an interaction between knowledge and awareness on both treatment and control of hypertension (P of attributable proportion <0.001 for each).

CONCLUSION

Health education to improve knowledge about hypertension and screening programs to improve awareness of hypertension may act in an additive fashion to improve management of hypertension in rural Indian populations.

Improving hypertension surveillance from a data management prospective: Data requirements for implementation of population-based registry

BACKGROUND

Hypertension (HTN) has become a major public health problem which can cause serious complications when it is not well-controlled. Prevention and effective care of HTN require a population-based registry. Thus, establishing this registry can be used to collect comprehensive, timely, and reliable data on epidemiology cases. The aim is to create a registry for the collection of highly required prospective data that will present an in-depth analysis of the characteristics of all individuals with HTN and track them over a particular chronological interval.

MATERIALS AND METHODS

The study was divided into three phases: At first, a comprehensive literature review was conducted to determine the proposed data classes and data fields. Then, the final minimum data set was designed by a two-round Delphi consensus approach of 20 experts of cardiologists, nephrologists, nutritionist, and health information management. Finally, a web-based registry system was developed by a Structured Query Language environment.

RESULTS

A total of two clinical and nonclinical data categories with nine data classes and 68 data fields were selected for their inclusion in the registry following the consensus phase. A web-based registry was designed with a modular and layered architecture.

CONCLUSIONS

This study provides an appropriate information infrastructure for active tracing and monitoring of individuals with HTN. It has provided a practical information system allowing quality improvement, aggregate reporting for planning, and research purposes.

The prevalence and predictors of pre-hypertension and hypertension in Kherameh cohort study: a population based study on 10,663 persons in south of Iran

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) mortality and morbidity among Iranians. The present study aimed to estimate the prevalence of pre-HTN and HTN and some of its related factors in south of Iran. This cross-sectional survey was conducted on the data of the Persian cohort study in Kherameh. The participants consisted of 10,663 people aged 40-70 years. HTN was defined as either systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mmHg or taking medications. Pre-HTN was defined as SBP = 120-139 mmHg and/or DBP = 80-89 mmHg. The logistic regression method was used to identify the factors associated with pre-HTN and HTN. The age-standardized prevalence rate (ASPR) of pre-HTN was 19.66% (95% CI: 19.45-19.86%) and 18.59% (95% CI: 18.36-18.83%) in males and females, respectively. Also, the ASPR of HTN was 21.44 (95% CI: 21.22-21.65%) in males and 33.53% (95% CI: 33.22-33.85%) in females. Male gender, old age, being unemployed, low education level, high body mass index (BMI), no smoking, diabetes, cerebro-cardiovascular disease, suffering from another chronic disease, family history of CVD, and negative family history of cancer and other chronic diseases were independently associated with pre-HTN (p < 0.05). All variables, except for gender, smoking, and family history of cancer, were significantly associated with HTN. Drug abuse was also correlated to HTN (p < 0.05). This study revealed the increased prevalence of HTN in rural and urban areas. Therefore, the health system needs to develop strategies to raise the accessibility of screening and diagnostic services.

Knowledge and Associated Factors of Blood Pressure Control Among Hypertensive Patients Attending Chronic Illness Follow-Up Clinic at University of Gondar, Comprehensive Specialized Hospital, Northwest, Ethiopia

Introduction

As hypertension is a chronic cardiovascular disease that contributes to a high proportion of morbidity and mortality worldwide, favorable knowledge is crucial to control it.

Objective

The objective of this study was thus to assess knowledge and associated factors of blood pressure control among hypertensive patients at the chronic illness follow-up Clinic of the University of Gondar comprehensive-specialized hospital, Gondar, Ethiopia.

Methods

An institution-based cross-sectional study was conducted from March to April 2018. A systematic random sampling technique was used to select participants. Bi-variable and multivariable logistic regressions were done to assess the relationship between dependent and independent variables. The adjusted odds ratio with a 95% confidence interval was used to determine the presence and strength of association between covariates and the outcome variable.

Results

A total of 404 participants took part in the study with a response rate of 97.3%. The overall good knowledge about blood pressure control was 51.7% (95% CI=46.3-56.8). Females were 3.79 (AOR= 3.79, 95% CI: (1.55, 9.28)) more knowledgeable about blood pressure control than males. In the multivariable analysis, the odds of being knowledgeable were 2.80 (AOR= 2.80, 95% CI (1.44, 5.46)), 8.05 (AOR=8.05, 95% CI (2.93, 22.10)), and 7.53 (AOR=7.53, 95% CI (2.52, 22.49)) for can read and write, secondary, preparatory and above education, respectively, compared to cannot read and write. Occupation was significantly associated with the knowledge of plod pressure control. For example, merchants 7.66 (AOR=7.66, 95% CI (3.01, 19.47)), government employee 6.33 (AOR=6.33, 95% CI (1.90, 22.07)), and self-employed 4.58 (AOR=4.58, 95% CI (1.80, 11.70)) times more likely to be knowledgeable than farmers, respectively. Participants with family history of hypertension were 2.36 (AOR=2.36, 95% CI (1.42, 3.92)) times more knowledgeable than their counterparts.

Conclusion

In this study, knowledge of blood pressure control was lower compared to the finding of a study done at Bishoftu hospital, Ethiopia. But it is higher than studies in other African countries. Both pharmacological and non-pharmacological awareness is vital for blood pressure control.

Differences in knowledge of hypertension by age, gender, and blood pressure self-measurement among the Israeli adult population✰

BACKGROUND

Hypertension (HTN) is the most important risk factor for death and disability worldwide. Hypertensive patients' HTN knowledge was shown to be associated with control of HTN. Understanding factors affecting HTN knowledge might help control HTN.

OBJECTIVES

To examine differences in HTN knowledge by age, gender, ethnicity, years of education and whether HTN was diagnosed, and to explore whether HTN knowledge is affected by self-measurement of blood pressure (BP), in Israel's general population.

METHODS

A cross-sectional, descriptive, correlational design was used. A convenience sample of 430 Israeli adults, sampled in community centers across Israel, in four age groups (18-34, 35-49, 50-64, and above 64) were interviewed by 17 registered nurses, using a structured questionnaire with open-ended questions, during March 2017 and March 2018. ANOVA and chi-square tests for assessing differences between age groups in sociodemographic characteristics and BP measurement were used. Factors predicting knowledge of various HTN aspects and total HTN knowledge were explored by logistic and ordinal regression analyses.

RESULTS

Older participants, those with more years of education, and those who self-measured blood pressure had better knowledge of particular aspects of HTN and higher total HTN knowledge. Women had greater knowledge of normal systolic and diastolic BP.

CONCLUSIONS

Higher age, more years of education, and blood pressure self-measurement were associated with higher total HTN knowledge. The attention of health authorities should be drawn to improving HTN knowledge among younger adults, and to including blood pressure self-measurement in the regular practices of the general population.

Translation and cross-cultural adaptation of the Hypertension Knowledge-Level Scale for use in Brazil

OBJECTIVE

to make the translation, cross-cultural adaption and content and face validation of the Hypertension Knowledge-Level Scale for use in Brazil.

METHODS

methodological research carried out in six stages: translation, synthesis, back-translation, expert committee's assessment, pre-test and validation. Validation was performed through the Delphi technique in two rounds. The participants were two translators and two back-translators, eight professionals in the expert committee, 40 adult participants in the pre-test, 35 experts in the first validation round and 28 in the second validation round. Data analysis included Cronbach's alpha, content validity index and one-tailed t-test.

RESULTS

the translation and cross-cultural adaptation allowed for language adjustments so that the items were comprehensible and suitable for use in Brazil. The content validity index of the Brazilian version of Hypertension Knowledge-Level Scale was 0.96 and Cronbach's alpha was 0.92.

CONCLUSIONS

the scale was translated, cross-culturally adapted to Brazilian Portuguese, had its content and face validated and proved reliable to evaluate the knowledge of adults about hypertension.

Awareness, treatment, and control of hypertension among adult population in a rural community of Singur block, Hooghly District, West Bengal

BACKGROUND

Hypertension is an important treatable public health problem both globally and in India with an increasing prevalence significantly in both urban and rural population. It is one of the leading causes of adult mortality and morbidity, but poorly controlled hypertension remains a major health problem.

OBJECTIVE

The objective of this study was to find out awareness, treatment, and control of hypertension among study population and association of hypertension awareness with sociodemographic factors, if any.

MATERIALS AND METHODS

This study was conducted from May 2013 to April 2014 in the rural community of Singur block, West Bengal. Data were collected with respect to sociodemographic characteristics as well as records related to hypertension such as awareness, treatment, and control of hypertension. Blood pressure (BP) measurement of individuals aged 20 years and above of both sexes was done. Pearson's Chi-square test was performed to find out the association between the categorical variables. SPSS 19.00 software was used for analysis.

RESULTS

Nearly 48.2% of the participants were aware of their elevated BP; 47.1% of the participants were taking pharmacological treatment, mostly allopathic and only 8.8% had their BP under control. A statistically significant association was found between age, education, and socioeconomic status (per capita income) with awareness of hypertension.

CONCLUSION

Lack of awareness of the disease and very low rate of control of hypertension among those who were treated became the major issues. These findings emphasize the need for dissemination of knowledge about the disease and counseling of the patients during treatment continuation.

Changes in Hypertension-Related Knowledge and Behavior and Their Associations with Socioeconomic Status among Recently Urbanized Residents in China: 2013⁻2016

The rapid urbanization in China has brought with it some health benefits, but it also brought about a negative influence on the lifestyle of residents. We conducted this study to assess the change in hypertension-related knowledge and behavior from 2013 to 2016 among recently urbanized residents and determine their association with socioeconomic status (SES). This research used data from two cross-sectional studies conducted in Hezuo community in Chengdu, Sichuan province of China. A total of 2268 and 2601 individuals, respectively, participated and completed standard questionnaires. According to the results, the median (IQR) scores of health knowledge was 1 (0,3) and 3 (1,5), respectively, (p < 0.001) and the median (IQR) scores of health behavior was 6 (5,6) and 5 (5,6), respectively, (p < 0.001) in 2013 and 2016. The rate of sufficient knowledge increased from 8.8% to 18.1% (p < 0.001), while the rate of correct behavior decreased from 54.5% to 45.5% (p < 0.001) in three years. Logistic regression analysis showed that higher education was associated with sufficient hypertension-related knowledge (p < 0.05), and those with higher education, unemployment, and retirement were more likely to have sufficient behavior (p < 0.05). The impact of SES on knowledge was stable between 2013 and 2016. The behavior difference between the middle school educated and the illiterate increased from 2013 to 2016 (p < 0.05), and the behavior difference between the unemployed and manual workers decreased from 2013 to 2016 (p < 0.05). Our results revealed that hypertension-related knowledge improved with no corresponding improvement in self-reported behavior among recently urbanized residents from 2013 to 2016. Organizational strategy should be implemented to improve health education on knowledge, and what is more, translate knowledge into behavior. All these measures should be given more attention to the lower educated and manual workers among recently urbanized residents to eliminate the SES disparity.

A Theory-Based Self-Care Intervention with the Application of Health Literacy Strategies in Patients with High Blood Pressure and Limited Health Literacy: A Protocol Study

The purpose of this study is to assess the effectiveness of a theory-based self-care intervention with the application of health literacy strategies in patients with high blood pressure and limited health literacy. This is a randomized controlled trial, with measurements at baseline and 1 and 3 months follow-up. 100 patients with high blood pressure and limited health literacy will be randomly allocated to either an intervention group or a usual care control group. We will mainly establish the intervention model based on the principal health belief model components. Patients randomized to the intervention group will receive four educational sessions during four weeks. Considering the limited health literacy level of the patients of the study, health literacy strategies will be used in educational material design for enhancing the quality of the intervention. In order to cover these strategies, we will design four standard animated comics and fact sheets with illustrations and photos consistent with the health belief model constructs and educational sessions' topics. Data will be collected using some questionnaires and will be analyzed using the SPSS software. The findings of this study may assist with the development of a theoretical model for self-care intervention in patients with high blood pressure and limited health literacy.

Relationship between health literacy and knowledge among patients with hypertension in Isfahan province, Iran

Background

Hypertension is usually symptomless, and is not seriously attended until it causes some chronic complications. Individuals’ skills in understanding and applying information about health subjects may have a substantial impact on patients’ behavior and health.

Objective

to determine the relationship between health literacy and knowledge among patients with hypertension in Isfahan province, Iran.

Methods

This cross-sectional study was conducted on 700 patients with hypertension selected according to multistage random and quota types in Isfahan province (Iran). Data collection tools included Health Literacy for Iranian Adults (HELIA) and Hypertension Knowledge Level Scale (HK-LS), which were completed by patients. Data were analyzed by SPSS version 23 using Pearson’s correlation, one way ANOVA, and Independent-samples t-test. The significance level was set at 0.05.

Results

The mean (SD) of participants’ age was 60.58±11.14 years. Results showed that the relationship between age and health literacy (r=−0.354, p<0.001) and knowledge (r=−0.129, p<0.001) was statistically significant. More than three quarters of participants (75.5%) are inadequate and partially adequate of health literacy. There was a significant correlation between the blood pressure knowledge and the mean score of health literacy (r=0.0407, p<0.001).

Conclusion

The present study confirmed that the majority of the patients with hypertension had inadequate health literacy and there was a significant correlation between the blood pressure knowledge and the mean score of health literacy. Therefore, adequate education should be provided in health centers to increase the health literacy and knowledge about hypertension in hypertensive people. So it is suggested that future studies will be conducted on the use of various educational media in hypertensive people.

Knowledge, attitude and practice of Iranian hypertensive patients regarding hypertension

Introduction: This study aimed at evaluating knowledge and awareness of hypertension and the risk factors for hypertension among hypertensive patients.

Methods: In this study, 110 hypertensive patients were enrolled and filled out two self-administered questionnaires. The first questionnaire was about the demographic characteristics and the second one was about the knowledge (n = 10), attitude (n = 9) and practice (n = 8). The internal consistency and the stability of the questionnaires were approved. The Mann-Whitney U test and Kruskal-Wallis and Spearman correlation coefficient were used for statistical analysis.

Results: Seventy-three percent of participants know the normal range of hypertension. Most of the participants truly knew that stress (87.3%), obesity (70.9%) and aging (48.2%) are risk factors for hypertension. About 60% of participants knew the complications of uncontrolled hypertension. About 82.7% of participants believed that after adaptation of body to hypertension, there is no need to use antihypertensive drug. About 13.6% of participants measured their blood pressure daily and 11.8% of them measured it once a month. The educational level of participants was significantly associated with knowledge score (P = 0.01). There was a significant correlation between knowledge (P < 0.001) and attitude and also attitude and practice (P < 0.001) scores.

Conclusion: These findings have important implications for developing proper and continuous self-management hypertension education programs in Iran which should mostly emphasize on the practical information about control and prevention programs.

Factors Predicting Self-Care Behaviors among Low Health Literacy Hypertensive Patients Based on Health Belief Model in Bushehr District, South of Iran

The aim of this study was to determine the factors influencing adherence to self-care behaviors among low health literacy hypertensive patients based on health belief model. A cross-sectional study was conducted among 152 hypertensive patients with low health literacy. Patients with limited health literacy were identified by S-TOFHLA. The data were collected using H-scale for assessing self-care behaviors and, HK-LS for assessing knowledge of hypertension. A researcher-made questionnaire was applied for collecting data of health belief model constructs. Data were analyzed by SPSS version 22 with using multiple logistic regression analyses. Perceived self-efficacy was associated with all self-care behaviors except medication regimens. There was a significant association between perceived susceptibility and adherence to both low-salt diet (OR = 3.47) and nonsmoking behavior (OR = 1.10). Individuals who had more perceived severity (OR = 1.82) had significantly greater adherence to their medication regimens. Perceived benefits and barriers were not significantly associated with either type of hypertension self-care behaviors. It seems that designing and implementation of educational programs to increase self-efficacy of patients and promote their beliefs about perceived susceptibility and severity of complications may improve self-care behaviors among low health literacy hypertensive patients.

Prevalence and Associated Factors of Prehypertension and Hypertension in Iranian Population: The Lifestyle Promotion Project (LPP)

BACKGROUND

This population-based study aimed at investigating the prevalence and associated factors of prehypertension/hypertension in Iran.

METHODS AND FINDINGS

The data (n = 2818) for this study were collected in 2015 as a part of the major Lifestyle Promotion Project (LPP) conducted in East Azerbaijan (urban and regional parts). The data for socio-demographic status, dietary information, and physical activity and anxiety levels were collected through validated questionnaires. Then, physical examination including systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI) and conicity index was performed. First-morning spot urine (SU) sample was collected to assume salt intake. The One-way ANOVA, logistic regression, chi-square test and independent t-test were used for statistical analysis. The prevalence of prehypertension, stage I and stage II hypertension, and overall hypertension was 47.3%, 13.6%, 5.45% and 22.6% respectively. The mean systolic (p = 0.004) and diastolic (p<0.001) blood pressure in men were significantly higher than women. Results of logistic regression analysis showed that in both sexes, family history of hypertension, obesity, abdominal obesity, anxiety and having high levels of sodium intake were associated with high blood pressure (p< 0.05). Additionally, 45.8% of the hypertensive patients were aware of their disease, 10.0% of the aware patients, and 44.5% of everyone with high blood pressure were receiving antihypertensive medication.

CONCLUSIONS

Our data showed that prehypertension/hypertension is a major health problem in Iran. Focusing on identifying risk factors to hypertension, regular drug intake, good nutrition, physical activity, and changing lifestyles of patients with hypertension are essential.