Effectiveness of Structured Teaching Programme on Knowledge, Attitude and Practice among Patients with Hypertension

M. Girija¹*, Dr. N. Kokilavani²

¹Associate Professor, Adhiparasakthi College of Nursing, Melmaruvathur, Kancheepuram District, Tamil Nadu

²Principal, Adhiparasakthi College of Nursing, Melmaruvathur. Kancheepuram District, Tamil Nadu.

Corresponding Author Email: girijamedsurg@gmail.com

ABSTRACT:

The National heart, lung and blood institute has estimated that half of the persons with hypertension do not know that they have prolonged elevation of blood pressure eventually damages blood vessels throughout the body mostly in the eyes, heart, kidneys and brain. The objectives of the study were to assess the knowledge, attitude and practice among patients with hypertension, to find out the effectiveness of structured teaching programme among hypertensive patients, to correlate relationship between demographic factors and knowledge attitude and practice hypertensive patients pre experimental research design was adopted setting for the study was Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research Institute. Hundred(100) newly diagnosed both male and female patients with hypertension between the age group of 40 and 70 years attending OPD Melmaruvathur Adhiparasakthi Institute Of Medical Sciences And Research Institute were selected by using Convenient Sampling Technique. Data was collected by using Questionnaire to assess, knowledge, three point LIKERT scale for attitude and checklist to asses practices On Hypertension. Descriptive And Inferential Statistics like paired ‘t’ test, chi-square test and correlation test was used. The study result revealed that in pretest hypertensive clients had inadequate knowledge with the mean 33.7, attitude with the mean of 47, practice with the mean of 34.7.in post test it was found that hypertensive clients gained knowledge with the mean value of 88, attitude of 85, practice of 85.5. The overall findings of the study showed that structured teaching programme is very effective in improving the knowledge, attitude and practice on hypertension with t value 0.064 at p<0.005 level.

KEY WORDS: Knowledge, attitude, practice, hypertension, structured teaching programme, effectiveness.

INTRODUCTION:

Hypertension is sustained elevation of blood pressure. Once when the time it develops, a patient should have his blood pressure checked frequently because hypertension is a life time condition. The status of hypertension control has improved considerably over the past twenty years. Large scale education programmes provided by various organizations have increased the awareness of hypertension. The percentage of patients with hypertension on medication whose blood pressure controlled has also improved substantially^.1.

Prolonged elevation of blood pressure eventually damages blood vessels throughout the body, mostly in the eyes, heart, kidneys and brain. So that failing vision, coronary occlusion, renal failure and strokes are the usual consequences of prolonged uncontrolled hypertension. WHO statistical fact 2013 shows High Blood Pressure in the United States, about 77.9 million (1 out of every 3) adults have high blood pressure. Data from NHANES 2007–10 showed that of those with high blood pressure,81.5 percent are aware they have it,74.9 percent are under current treatment 52.5 percent have it controlled 47.5 percent do not have it controlled. Among adults age 20 and older in the United States, the following have high blood pressure: For non-Hispanic whites, 33.4 percent of men and 30.7 percent of women. For non-Hispanic blacks, 42.6 percent of men and 47.0 percent of women. For Mexican Americans, 30.1 percent of men and 28.8 percent of women. Projections show that by 2030, prevalence of hypertension will increase 7.2% from 2013 estimates. According to the World Health Statistics 2012 report, India has low rates of hypertension compared to world figures. In India, 23.10 per cent men and 22.60 per cent women above 25 years suffer from hypertension. India also fares better than the global average of 29.20 in men and 24.80 in women respectively. Experts here, however, discount the findings, arguing that the country might actually be headed to be among the most worst disease (hypertension) afflicted countries in the near future. An estimate touts the number of blood pressure patients in the country to rise to about 214 million by 2030 up from about 118 million in 2000.²

The evidence-based nursing practice guideline developed from this referential study for promoting health of adults with hypertension should be reflected in nursing practice in primary healthcare settings. For a future study, focus groups and key informant interview are recommended with nurses who actually provide nursing services in primary healthcare settings to clients who are diagnosed with high blood pressure^.3 Hypertension is the major health problem affecting about 20% of adult population in most of the countries. It is also the major risk for cardio vascular system mortality, which accounts for 20 -50% of all mortality and for mobility, which contributes to disability. Hypertension is a major cause for stroke and kidney failure hence it is called a silent killer. Urbanisation is another factor that profoundly affects blood pressure patterns. In developed countries, hypertension is the more common in rural populations than in urban. This pattern is revised in developing, lower and middle income countries where the first impact of rising rates of hypertension is seen in urban countries.⁴ Hypertension must be recognized as part of a bigger disease conglomerate almost always accompanied by obesity, diabetes, kidney disease or many other co-existing problems involving lifestyle and or genetics.⁵

Hence, the investigator believes that a structured teaching programme on knowledge, attitude and practice executed to the newly diagnosed hypertension patients can help to minimize the problems.

STATEMENT OF THE PROBLEM:

Effectiveness of Structured Teaching programme on Knowledge, attitude and practice among patients with hypertension

OBJECTIVES:

1. To assess the knowledge, attitude and practice among patients with hypertension.

2. To find out the effectiveness of structured teaching programme among patients with hypertension.

3. To correlate relationship between demographic factors and knowledge,,attitude and practice on hypertension.

Assumptions

1. The newly diagnosed patients with hypertension have inadequate knowledge, attitude and practice.

2. Appropriate lifestyle adopted by patients with hypertension minimize the complications.

3. Adequate knowledge, Attitude and Practice enhances to lead a near normal healthy life.

Limitations

1. The study is limited to only newly diagnosed patients between 40 – 70 yrs attending Hypertensive clinic.

2. The study is limited to only Melmaruvathur Adhiparasakthi Institute of Medical Sciences.

METHODOLOGY:

A pre experimental research design was used to assess the effectiveness of structured teaching programme on knowledge, attitude and practice among hypertensive patients at Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research Institute. The study sample consisted of 100 newly diagnosed both male and female hypertensive patients belonging to the age group of 40-70 years attending the hypertensive clinic during the period of study. Convenient sampling technique was adopted.

The inclusion criteria was newly diagnosed hypertensive patients after checking blood pressure thrice , patients between the age group of 40 -70years, patients who could communicate freely in Tamil or English, patients who were attending the outpatient department of Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research Institute

The exclusion criteria were patients who were associated with other health problems, patients who were unable to respond the questionnaire, patients who were not willing to participate in the study and hospitalized patients with complications.

Description of the instrument

The instrument consists of four parts, part I- questionnaire for demographic variables, part II- questionnaire to assess the knowledge of hypertension, part III- a three point LIKERT scale was used to assess the attitude of hypertension, part IV- questionnaire (check list)used to assess the practices of patients on hypertension.

Score interpretation

Part II the level of knowledge was considered ‘inadequate’ if score was below 50%, ‘moderately adequate’ if between

50 -75% and ‘adequate’ when it was above 75%.

Part III Hypertensive patients were interviewed for collecting the information regarding the attitude on hypertension. The score of the positive and negative statement follows

Positive statement

Negative statement

Agree (A)

Uncertain (UC)

Disagree (D)

Agree (A)

Uncertain (UC)

Disagree (D)

There were 25 statements. In that positive statements were 16 and negative statements were nine. The total score for attitude scale was 75. The level of attitude was considered ‘un favorable’ if score was below 50%, ‘favorable’ if between 50 -75% and ‘most favorable’ when it was above 75%.

Part IV hypertensive patients interviewed for collecting the information regarding practice on hypertension. There were a total of 15 check list questions. Each correct response carried one score and each wrong response zero score. The total score on practice was 15.The assessment of practice was considered ‘poor’ if score was below 50%, ‘satisfactory’ if between 50 -75% and ‘good’ when it was above 75%.

Data collection procedure

After getting the written consent from the participants, three to four hypertensive patients were selected and interviewed per day. By using convenient sampling technique the sample were selected and the data was collected regarding Demographic variables, knowledge, attitude and practice with the help of demographic profile, structured knowledge questionnaire, three point LIKERT scale and structured knowledge practice questionnaire. The data collection was done in Tamil and used each questionnaire for each patient. Approximately 45 minutes was spent for each patient. The same data collection procedure was used for 100 hypertensive patients.

DATA ANALYSIS AND STATISTICAL METHODS

Descriptive statistics was used to describe the demographic variables, to assess the knowledge, attitude and practice of pre and post test. Paired ‘t’ test was used to finalize the effectiveness between pre and post test. Chi square test was used to analyze the association between demographic characteristics and knowledge, attitude, practice. Correlation was used to analyze the correlation between knowledge, attitude and practice on hypertension.

RESULTS:

Demographic variables revealed that out of 100 hypertensive patients 30(30%) were between 41-50 years, 30(30%) were between 51-60years,18(18%)were between61-70 years and 22(22%) were between more than 70 year. 46(46%) were male and 54(54%) were female patients. 76(76%) were Hindus, 14(14%) were Christians and 10(10%) were Muslims. 34(34%) were illiterate, 32(32%) were primary education and 30 (30%) were secondary education. 4(4%) were collegiate education, 36(36%) were unemployed, 38(38%) were daily wages and remaining were business (10%) Agriculture(08%) home maker and others were (08%) .60(60%)of clients received information from health personnel, 8(8%) were from radio/television, 14(14%) were from news papers. 76(76%) were belonging to nuclear type of family, and 24(24%) were belonging to joint family.

In pre test the level of knowledge of patients regarding hypertension was 87(87%) have inadequate knowledge, 12(12%) have moderately adequate knowledge and 1(1%) have adequate knowledge. In the post test 7(7%) have moderately adequate knowledge and 93(93%) have adequate knowledge.

The result revealed that there is a positive and statistically significant correlation among knowledge, attitude and practice at p<0.005 level.

Correlation between pretest and post test results of hypertensive patients on knowledge, attitude and practice.

This shows that the pre test mean value for knowledge was 33.7 with the standard deviation of 12.83. but in post test mean value was 88 with the standard deviation of 7.314.

There was no significant association between the demographic characteristics and knowledge like age, sex, religion, educational status, occupation, income, source of information and type of family.

IMPLICATIONS:

For Nursing Practice; The nurses working in clinical setting should practice health education as an integrated part of nursing profession. The planned health teaching programs are to be scheduled in the clinical set up in the fixed dates with time for the patient as well as to the family members.

For Nursing Education; General nursing curriculum needs to be strong strengthen to enable nursing students to assess the life style practices to identify the warning signs of hypertension and to provide supportive educative care for the self care in preventing complications.

For Nursing Administration; An educational programme on educative role of the nurses with the adequate supervision of nursing services would motivate nurses to carry out educative roles.

For Nursing research; develops insight into the development of teaching module and set information for various hypertensive patients towards promotion of healthy life and prevention of complications.

RECOMMENDATIONS:

A comparative study can also be done between rural and urban hypertensive patients. A descriptive study to assess the knowledge and attitude on hypertension among hypertensive patients. A similar study can be conducted among younger generation in order to enhance the knowledge on hypertension to prevent complications.

CONCLUSION:

The results of the present study under taken to assess the effectiveness of structured teaching programme on knowledge, attitude and practice among hypertensive patients showed that, pre test level of knowledge of patients regarding hypertension was 87(87%) have inadequate knowledge, 12(12%) have moderately adequate knowledge and 1(1%) have adequate knowledge. In the post test 7(7%) have moderately adequate knowledge and 93(93%) have adequate knowledge. Thus the structured teaching programme was effective in improving the knowledge, attitude and practice among hypertensive patients.

REFERENCES:

1. Sharon Mantik Lewis et al., Medical Surgical Nursing, St, Louis, Missouri, 2004.

2. Statistical data on hypertension, fact sheet, WHO 2013 https://www.heart.org/idc/groups.

3. Woi-Hyun S. Hong evidence based nursing practice for health promotion in adults with hypertension, Asian Nursing Research Vol.4,Issue 2010: 227-245

4. Garry, L.R Jennings, et.al hypertension guidelines, hyper. ahajournals.org/content/62

5. http.www.google.co.in, www.ash.US .org.

Received on 16.11.2013 Modified on 15.12.2013

Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 136-139

S. No	Variable	Pre test		Pos test		t value	r value
S. No	Variable	Mean	Standard Deviation	Mean	Standard Deviation	t value	r value
1	Knowledge	33.7	12.83	88	7.314	0.042	0.695
2	Attitude	47	14.61	85	9.68	0.039
3	Practice	34.7	14.45	85.5	10.51	0.023
4	Overall	41.7	11.75	85.8	7.49	0.064