Health beliefs about hypertension among hypertensive elderly people in Khammam urban locality: health belief model

INTRODUCTION

Increased globalization, urbanization, improvements in science and technology, information technology made life style changes; prone to increased risk of non communicable diseases (NCDs) like cancer, diabetes, hypertension, cardiovascular diseases, stroke, etc.^1,2

Worldwide raised blood pressure affects 1.13 billion people.³ In 2008, it was reported that 40% of adults aged 25 and above have been diagnosed with hypertension.⁴ Hypertension is responsible for at least 45% of deaths due to heart disease and 51% of deaths due to stroke.⁵

In the South-East Asia, nearly 35% of the adult population has hypertension, which accounts for 1.5 million deaths annually.⁵ In India, in 2015, the prevalence of hypertension, among people aged more than 18 years was 26.6% among males and 24.7% among females.⁶ The prevalence of hypertension among elderly was 40.5%.⁷ The urban and rural divide in the prevalence of hypertension is closing from 25% to 30% in urban and from 15% to 25% in rural populations.⁸

Beliefs about hypertension determine behaviour of the hypertensive people towards hypertension and its complications. Health beliefs about hypertension can be studied by health belief model (HBM), which consists of five constructs; perceived susceptibility and perceived severity as perceived threat; perceived benefits, perceived barriers, cues to action and self efficacy.^9,10

In India, few studies were conducted to study the health beliefs and behaviour among hypertensive people in the light of health belief model. So, the present study will be undertaken. The objectives of the study were to know the socio-demographic characteristics and to quantify the health beliefs among elderly hypertensive people.

METHODS

A cross sectional study was done for a period of 6months from January 2018 to June 2018 among people aged 50 years and above who were hypertensive in Khammam urban locality. In this study people 50 years and above were considered as elderly persons. People who were willing to participate were included in the study. People with known diabetes and renal diseases, and cardiovascular disorder; who are bed ridden were excluded. He/she will be asked, measured and then checked for blood pressure records or anti-hypertensive medication for diagnosis of hypertension. Randomly 160 people were selected for the study.

Data collection tool is a semi-structured questionnaire. The questionnaire consists of socio demographic variables, health belief components perceived susceptibility and perceived severity (as perceived threats), perceived benefits, perceived barriers and self efficacy questions. Each question will be provided with three alternative responses- yes, no or neutral. Each individual’s response will be decoded into good belief and not good (bad) beliefs. Good beliefs are those beliefs that sustain positive health behaviour for the control blood pressure (BP). The study questionnaire of Tanya and Robinson was modified and used.¹¹

The questionnaire in the English language will be translated into local Telugu language and back to English. Well Calibrated digital BP apparatus will be used for measuring blood pressure.

Data will be analysed by IBM SPSS soft ware version 22. All the socio-demographic variables will be represented by mean±SD (standard deviation), or percentages or proportions. Analysis will be done using proportions. Ethical clearance was obtained from Institutional ethical committee.

RESULTS

A total of 160 elderly people participated in the study; and the Mean age of the individuals was 62.1±9.25. There were more males (59.4%) than females (40.6%). The average per capita income of the families was Rs.6822. The illiterates were 40%; and unemployed were 43.8% (Table 1).

The average number of years the individuals known to have hypertension was 6.38 years. The current systolic blood pressure in most of the elderly was in between 140-149 mm of Hg followed by 160-169 mm of Hg, and followed by 150-159 mm of Hg. The current diastolic BP in most of the elderly was 81-90 mm of Hg was followed by <80 mm of Hg, and followed by 91-100 mm of Hg (Table 2).

In the study, health beliefs were quantified. More than half of elderly had perceived threat of hypertension (54.6%). Of these threats, most of the elderly had perceived threat of heart attack (56.2%). The health beliefs of perceived benefits were 44%. Perceived benefit of reduced salt intake was noticed in large number of the elderly people (68.8%) but the belief eating lot of fruits and vegetable helps in lowering BP was low (31.2%). The belief of effect of smoking on blood pressure is falsely perceived. Perceived threats of barriers were 62.7%. The construct cue to action among elderly was 40% and self efficacy was 68.8%. The pay attention to messages given by television, radio, news papers for control of BP was less (23.6%). Most of the people followed doctor advice (63.1%).

DISCUSSION

The control of hypertension was demonstrated by different health promotion models.¹¹ In this study health beliefs associated with hypertension were quantified.

In a study conducted by Barros et al in Brazil, the average number of years of diagnosis hypertension was 9.35 years. In the same study, most of the participants systolic BP was <130 mm of Hg (28.6%) and 140-159 mm of Hg (26.3%). Most of the elderly people diastolic BP was <85 mm of Hg (56.4%) and 90-99 mm of Hg (22.6%).¹²

Compared to Brazil study, in the present study the average number of years of diagnosis hypertension was less (6.38 years). Most of the elderly people systolic BP was in the range of 140-149 mm of Hg (31.4%); and diastolic BP was in the range of 80-89 mm of Hg (37.5%) and <80 mm of Hg (34.3%).

In the present study, less than half of the people felt cost not as a barrier for treatment (46.9%). In a study done in Washington, more than half of the respondents (57.5%) felt that treatment of high BP is not at all expensive.¹³

In a study done on health belief model and hypertension treatment compliance in Nigeria, 89.8% of the respondents knew that hypertension could lead to serious health problems or complications.¹⁴ On comparison, in the present study, more than 50% of the people felt that hypertension may cause ill health. In the adult respondents, 41.5% had poor compliance in taking antihypertensive medication and about 50% of them take their medication as prescribed.¹⁴ In the study, less people felt difficulty to take antihypertensive medications at correct time, at correct doses (9.4%).

In cues to action component, 28.1% take advice from friends and family members. In study done in Nigeria, 28.9% adult respondents said friends were extremely concerned about their hypertension.¹⁴

CONCLUSION

The information obtained will be useful for planning health education or health promotion programs based on the needs and deficiencies of the people.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Review Committee.

REFERENCES

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