Date of Award

4-29-2021

Degree Type

Thesis

Degree Name

PhD in Nursing

First Advisor

Dr Farid Panjwani

Second Advisor

Dr Eunice Ndirangu

Third Advisor

Dr Pammla Petrucka

Department

School of Nursing and Midwifery, Pakistan

Abstract

Background: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertensionrelated complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-8) (James et al., 2014), and its predictors among a select sample of hypertensive individuals in Pakistan.
Methods: This study was conducted in two phases. Phase 1 employed a sequential mixed method study to assess the levels and factors effecting self-care practices of hypertensive individuals residing in an urban cosmopolitan setting within Karachi, Pakistan. Patients were screened using the Hypertension Self-Care Activity Level Effects (H-SCALE) questionnaire, while socio-demographic predictors of self-care were identified using a study specific checklist. Qualitative in-depth interviews were done with participants who were found to be adherent and non-adherent in the six clinical domains of H-SCALE. The results of Phase 1 were used to develop individualized interventions and facilitated hypertensive participants to modify their diets and activity patterns within their context. These interventions were tested for operational feasibility using indicators of attendance, acceptance and pre-post scores of the H-Scale.
Results: A total of 402 patients were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. The highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas the lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self -care behaviors, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors in the given population. Overall, fear of relapse of the illness, avoidance of repeated visits to the hospital, and potential for averting repeat of uncomfortable procedures motivated the interviewees to improve their behaviors towards self-care. In addition, the support from family members in taking responsibility for the patient’s care was credited with having an influence on promotion and uptake of self-care; whereas stressors from the family, affordability, and experiences with health services’ accessibility and quality were seen as deterrents to selfcare. Clear, individualized instructions with facilitation in decision-making with the family was seen to be helpful in making modifications towards improving self-care behaviors.
Conclusion: The overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in the given urban-dwelling sample of the Pakistani population which is reflected in their behaviors. There is a need to introduce individualized healthcare supportive and educative programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications.

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1

Last Page

257

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