Introduction to Nursing Research

 

Practice Problem/Issue and PICOT Question

Hypertension contributes to the death of many people throughout the world, yet there is still poor management of the condition. Establishing effective control measures could significantly help to control the number of deaths worldwide. To control and management hypertension effectively, it is important to identify and manage the lifestyle risk factors associated with the condition as that helps to lower blood pressure. In addition, it is vital to perform regular screening, communicating effectively with patients, monitoring patients on a regular basis, and adhering to treatment. In particular, it is possible to prevent and control the condition quite effectively through lifestyle changes (diet and regularly engaging in exercise) as these help to significantly regulate blood pressure.

PICOT Question

For male adults between the ages of 40 and 70 with hypertension, and with multiple co-morbidities (P), will the change in lifestyle (engaging regularly in exercise and eating healthier and balanced meals) (I), compared to patients who use medication to treat/manage their hypertension (C), help to regulate their blood pressure and reduce the risk of developing cardiovascular diseases (O) in their recovery period within 6 months (T).

 

 

 

 

 

 

References

Dua, S., Bhuker, M., Sharma, P., Dhall, M., & Kapoor, S. (2014). Body Mass Index Relates to Blood Pressure Among Adults. North American Journal of Medical Sciences, 6(2), 89–95. http://doi.org/10.4103/1947-2714.127751

Background: The blood pressure and anthropometric measurements are important for evaluating the health of children, adolescents as well as adults.

Aim: The aim is to study the blood pressure and body dimensions and to find out the prevalence of overweight/obesity and hypertension among adults.

Materials and Methods: A cross-sectional study was conducted of all the people belonging to the Punjabi community, residing in Roshanara area and Jaina building in Delhi, for the past 20 years and aged 18-50 years. The men were engaged in transport business and women were mainly housewives.

Results: Mean values of all the measurements, that is, height, weight, upper arm circumference, pulse rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were higher among males as compared with females, except skinfold thicknesses. Body mass index (BMI) and fat percentage was found to be higher among females as compared with males. There was a significant positive correlation between BMI, fat percentage, and blood pressure both SBP as well as DBP. Odds ratio showed that overweight/obese subjects were more likely to have hypertension than those with normal BMI.

Conclusion: Prevalence of prehypertension among overweight/obese suggested an early clinical detection of prehypertension and intervention including life style modification, particularly weight management.

Howes, F., Warnecke, E., &Nelson, M. (2013). Barriers to lifestyle risk factor assessment and management in hypertension: A qualitative study of Australian general practitioners. Journal of Human Hypertension, 27, 474-478 doi:10.1038/jhh.2013.9

Hypertension is a leading cause of mortality and disease burden worldwide, yet its management remains suboptimal. Identification and management of lifestyle risk factors should be a clinical priority in all patients because of the beneficial effects of lifestyle intervention on blood pressure. The objective of this qualitative focus group study was to identify barriers to lifestyle management in hypertension in Australian general practice. Purposeful sampling was used to select large group practices. Six focus groups (n=30) were audio recorded and transcribed. An iterative thematic analysis was conducted. Overall participants felt they had the required knowledge to provide broad lifestyle advice. However, cynicism dominated due to an overwhelming lack of success in practice. Patient reluctance and ambivalence were identified as major barriers but participants were willing to share the responsibility. Other barriers included time, reduced access to allied health and broader determinants of health. General practitioners need to be empowered to allow continuation of valuable lifestyle advice and counselling. The results emphasise the importance of ongoing lifestyle assessment and tailoring of management to the complex interplay of factors that impact on a patient’s ability to adopt and maintain lifestyle change. System issues need to be addressed to provide better streamlined care.

Legido-Quigley H, Camacho Lopez PA, Balabanova D, Perel P, Lopez-Jaramillo P, Nieuwlaat R, et al. (2015) Patients’ knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: A qualitative study. PLoS ONE 10(4): e0122112. https://doi.org/10.1371/journal.pone.0122112

Abstract

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.

Rao, C. R., Kamath, V. G., Shetty, A., & Kamath, A. (2013). High blood pressure prevalence and significant correlates: A quantitative analysis from Coastal Karnataka, India. ISRN Preventive Medicine, doi:10.5402/2013/574973

Abstract

Hypertension is a premier risk factor for cardiovascular disease which can be recognized if sought and treated effectively. Effective management of high blood pressure is possible when the magnitude of the problem is identified. So, a cross-sectional community based survey among 1,239 respondents aged ≥30 years was designed to estimate the prevalence and the sociodemographic correlates of hypertension among adults aged ≥30 years. Data was collected by personal interviews, followed by anthropometric and blood pressure measurements. Analysis was done using Statistical Package for the Social Sciences (SPSS) version 11.5. The prevalence of hypertension was 43.3%, with the prevalence being more among males (51.6%) as compared to females (38.9%). Of the total prevalence 23.1% (287) were known cases, and 20.2% (250) were newly detected cases. Based on the seventh report of the Joint National Committee (JNC VII) on high blood pressure, prehypertension was noted among 38.7%. Advancing age, male gender, current diabetic status, central obesity, overweight and obesity as defined by body mass index, and family history of hypertension were identified as significant correlates for hypertension by multivariate logistic regression.

Shima, R., Farizah, M. H., & Majid, H. A. (2014). A qualitative study on hypertensive care behavior in primary health care settings in Malaysia. Patient Preference and Adherence, 8, 1597–1609. http://doi.org/10.2147/PPA.S69680

Abstract

Purpose: The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings.

Patients and methods: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.

Results: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.

Conclusion: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities.

Tong, X., Taylor, A. W., Giles, L., Wittert, G. A., Shi, Z. (2014). Tea consumption is inversely related to 5-year blood pressure change among adults in Jiangsu, China: A cross-sectional study. Nutrition Journal, 13(98). doi: 10.1186/1475-2891-13-98.

Abstract

Background: Data relating to the association between tea consumption and blood pressure change are inconsistent. The aim of this analysis was to investigate the association between tea consumption and the change in blood pressure (BP) in Chinese adults over a 5-year period.

Methods: Data from 1109 Chinese men (N= 472) and women (N= 637) who participated in the Jiangsu Nutrition Study (JIN) were analysed. BP was measured in 2002 and 2007. Tea (green, black and total tea) consumption was quantitatively assessed at the follow-up survey in 2007.

Results: Total tea and green tea consumption were inversely associated with 5-year diastolic BP (DBP) but not systolic BP (SBP) change. In the multivariable analysis, compared with no consumption of tea, those with daily total tea/green tea consumption of at least10 g had 2.41 mmHg and 3.68 mmHg smaller increase of DBP respectively. There was a significant interaction between smoking and total tea/green tea consumption and DBP change. The inverse association between total tea/green tea consumption and DBP change was significant only in non-smokers. Green tea consumption was inversely associated with SBP change only in non-smokers and those without central obesity.

Conclusion: The consumption of green tea is inversely associated with 5-year BP change among Chinese adults, an effect abrogated by smoking.