Download a study to assess the knowledge ,attitude and practice

A STUDY TO ASSESS THE KNOWLEDGE ,ATTITUDE ANDPRACTICE
OF LIFE STYLE MODIFICATION AMONG HYPERTENSIVE
PATIENTS AT SELECTED HOSPITALS
IN BANGLORE
M.Sc. Nursing Dissertation protocol submitted to
Rajiv Gandhi University of health Sciences, Karnataka, Bangalore.
By
Mr. NOBLE M.S.
M.Sc. NURSING FIRST YEAR
YEAR 2009-2011
Under the guidance of
Mr. Biju Ramachandran
Principal and HOD, department of MSN
K.T.G. college of nursing,
Sreegandhadakavalu, Hegganahalli cross
Sunkadakatte road, Bangalore-560091.
RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES,
BANGALORE , KARNATAKA.
SYNOPSIS PERMORMA FOR REGISRATION OF SUBJECT
FOR DISSERTATION
1. NAME OF THE
CANDIDATE
AND ADDRESS
Mr. NOBLE M.S.
FIRST YEAR M.Sc. NURSING
K.T.G. COLLEGE OF NURSING.
SREERGANDHADAKALALU,
HEGGANAHALLI CROSS.
SUNKADAKATTE ROAD,
BANGALORE- 560091
6
BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“We cannot change our genes or sex, but we can definitely modify our life style there
by protecting our self from hypertension.”
Robert C Schlant (2000)
Hypertension, the silent killer which remains asymptomatic until the damage effect of it
can be seen . Hypertension .an important and common risk factor for considerable morbidity and
mortality not only in the indusrialiased world but also in developing countries. Thus, the problem of
hypertension can be truly considered as pandemic.
A study conducted o prevalence of hypertension report that 972 million people
in the world are suffering with this problem . incidents rate of hypertension range between 3 and 18%
depending on the age ,gender ethnicity and body size of the population studied
The factors contributing to the increased prevalence of hypertension is mainly
based on environmental factors, genetic factors and factors like alcohol intake, high fat intake, body
mass index and hormonal problems/ hypertensive when compared to normotensives develops twice
as much as coronary heart disease, four times as much congestive heart failure and seven times as
much stroke. This risk factors can be conquered through lifestyle modification
Life style modifications are universally accepted, not only as the first step in the
management of hypertension but also as a way to prevent hypertension. In addition to lowering blood
pressure, this measures can also reduce other cardio vascular risk factors. This cost involved is
minimal and there are hardly any risks. Hypertensive patients irrespective of this stage or grade
should be motivated to adopt this measures.
Knowledge regarding hypertension is an important measures used for decreasing the
prevalence of hypertension . study conducted in maliuye, hazarika and et al(2005) reported that only
13.6% of the hypertensive were aware of their elevated blood pressure status only 8.7% were taking
regular treatment. The increase level of knowledge on life style changes will help to have desired
intervention goal in people who are most motivated
6.1 Need for the Study
Hypertension is an iceberg disease. It is continually disturbed variable in population.
W.H.O. survey(2005) showed that in India the prevalence was 59.9 and 69.9 per 1000 in males and
females in urban area and 35.5 and 35.9 per 1000 in male and female in rural area.
In order to reduce the high incident rate now the health system is
giving more emphasis on life style modifications along with other measures. Life style is important
because how we live determine our choices and this choice decide how healthy we are. Our daily
routine may lead us to many risk factors. Habits like eating out at restaurant ant eating fast foods
drinking alcohol, smoking staying up late and not get in enough sleep spending more time in front of
TV, computer and more use of vehicles rather than walking. A study conducted by edyer, Thomas,
Donna and et al(2005)revealed that in lifestyle group mean net reduction in 24 hors ambulatory
systolic and diastolic blood pressure were 9.5mm Hg and 5.3mm Hg respectively . in conclusion
among over weight adult already on antihypertensive medications, a comprehensive lifestyle
intervention can substantially lower B.P. and improve B.P control
Hypertension is an important risk factor for cardio vascular and renal
diseases including stroke coronary heart diseases, heart failure and kidney failure . it has been
estimated that almost a third of B.P. – related deaths occur from coronary heart disease. It is also
estimated that a 3 mm Hg reduction in systolic B.P. could lead to an 80% reduction in stroke
mortality and a 5 percent reduction in mortality from coronary heart disease
Lifestyle can be modified only by individual ‘s own decision . this can be
achieved through adequate knowledge. A study by Doris, Samuel and Stephen(2007) studied the
relation between the knowledge about hypertension and life modification in 591 hypertensive
patients were acquainted with non
pharmacological treatment. Physical activity 49 percentage reduction of salt in take 54 percentage
where saw relaxation techniques where only known to 17 percentage this study concluded that
knowledge in our population insufficient.
As per above studies increased knowledge about life style modification helps to
control blood pressure level and prevent the complications hence the researcher selected the study to
asses the knowledge on life style modifications.
6.2 Review of Literature
Review of literature is a comprehensive description as well as an evaluation of the evidence
related to the given topic[Polit,D.F1999].literature review foundation up on which two base knew
knowledge generally conducted before and data is collected
The review of literature on various studies related to hypertension is arranged under the
following headings
a) studies related to incidence and prevalence
b) studies related to risk factors of hypertension
c)studies related to complication of hypertension
d) studies related to life style modifications
e)studies related to life style modifications
studies related to incidence and prevalence
Kearney,Practicia, whelton and et al 2004 carried a study on world wide prevalence of
hypertension a systematic review of published studies. result revealed was prevalence of
hypertension of varied around the world , with the lowest prevalence in rural India 3.4%in men and
6.8%in women and highest prevalence in Poland 68.9 % in men and 72.5% in women and were
concluded that hypertension is an important public health challenge in both economically developing
and developed countries
Burt,whelton,Rocella and et al (2000) conducted a study on prevalence on hypertension in
US adult population . the study revealed that 24 % of US adults had hypertension. The need for
intense campaign to reduce the prevalence of hypertension was explained in study
Shyamal Kumar, Kalian and et al 2007 conducted a study of urban community survey in
India; growing trend of high prevalence of hypertension in a developing country . participants
were1609 under cross sectional survey of validated and structured questionnaire followed by blood
pressure measurement result showed that systolic hypertension is greater than or equal to 140 mm of
hg was present in 40.9% and diastolic hypertension greater than or equal to 90 mm of hg in 29.3%
Deshmukh , guptha , barambe and et al conducted a study on the prevalence of
hypertension in rural Wardha , central India it was a cross section study . the study revealed that over
all prevalence of hypertension was found to be 20.6% and concluded that prevalence of hypertension
is high an appropriate programme shall be launched considering modifiable risk factors in the area
are BMI and waist and hip ratios .
Joshi , chowdary and et al 2007 done a simple randomized study to measure
prevalence of hypertension in 20 villages broadly represent of east and west godawari region of
Andhra Pradesh random sample of 4535 adults of age 30 years and over reported that 26.6 % are of
male hypertensive patients and 27.5% are of female hypertensive the researcher emphasize the need
of prevention of hypertension
Studies related to the risk factors
Nanette Lawrence Jeanne and et al 2005 studied the ethnic differences in th association between age
and hypertension A randomized control trait shows that hypertension was present in 40% of elderly
men and 50% of elderly women and 60% in non Hispanic white , 71%of non Hispanic African
Americans and 61%of Mexican Americans older than 60 tears of age concluded that age and
ethnicity is risk factor for hypertension.
Burke, hender,loe and et al 2007 done a study on alcohol intake incidence of coronary
disease in Australians. The participants were 258 men and 256 women . the study reported that those
who were drinking 41 to60 gram per day in men are 21 to 40 gram per day in women that hazard
ratio is 95 % and 91% respectively conclusion is that alcohol consumption should be limited to
reduce the heart disease risk.
Stevens, obarzanek, appel and et al (2001) conducted a study on association of BMI and
hypertension . a random control trials shows that 65% of US adults have a body mass index greater
than or equal to 25 kg meter square among 30% are of hypertensive, the study concluded that there is
an increased association of BMI and hypertension
Studies related to complications of hypertension
Giovinna ,leoneni, franeesa and et al 2003 conducted a study on renal dysfunction in renal
hypertension in 358 untreated patients with hypertension .the study revealed the prevalence of renal
dysfunction left ventricular hypertrophy and carotid plague was 18% , 48%,28% respectively the
study concluded that the presence of renal dysfunction and cardio vascular mortality and morbidity
rates in high in patients with hypertension.
Toni Rizzo, Angela, Thomson and et al 2004 conducted a study on risk of coronary heart
disease and stroke in hypertension . a prospective study with 418,343 participant aged 25- 84 years.
None of the study participants had clinical evidence of coronary heart disease and hypertension and
they were followed for an average of 10 years the study revealed that prolonged difference in usual
diastolic blood pressure of 5,7.5 and 10 mm of hg were respectively associated with at least 34 %
,46%,56%% lower incidence of stroke and at least a 21 % ,29% and 37% lower incidence of
coronary heart disease
Studies related to life style modifications
Miller ,Erlinger,Young and et al 2002 done a study on the result of the diet, exercise and
weight lose intervention trail .A randomized controlled trail of 44 hypertensive over weight adults on
a single blood pressure medications , participants were randomized to a life style are controlled
group. Result at the end of intervention was the mean weight loss in the life style group, met of
control was 4.9 kg and also met reductions in systolic and diastolic blood pressure in conclusion
among in hypertensive
over weigh
adults , already on anti hypertensive medications a
comprehensive life style intervention can substantially lower blood pressure and improve blood
pressure control
Dekat and Balzo 2000 conducted a study on a 5 years follow up preventive approach patients with
essential hypertension researcher examine the effect of a 4-56 week programmed consisting of
hypertension control education, physical education and smoking cessation on a long time risk factor
control participants were 220 hypertensive males .at 5 year follow up 80%of cases, the Bp was either
the same or lower than initially , 84% of patients improve their general health. Thus intensive short
term intervention studies made help to reduce some cardio vascular risk factor temporarily
Stewart, noakes,Eales and et al 2005 conducted a study adherence to cardio vascular risk
factors modification in patients with hypertension. A randomized control trial in patients with
hypertension the thing primary outcome measured after the 24 weeks intervention was blood pressure
change. Secondary outcome included patients adherence to the proggramme, their knowledge about
hypertension exercise capacity, body weight, self reported ability control stress adherence to
medication and salt restriction. Secondary outcomes did show positive changes as a result of the
given intervention and concluded that patience in a supportive environment such as the one in this
study were able to modify their cardio vascular risk factors
Dunn, Marcus, Kampert and et al 2000 done a study on comparison on life style and structured
intervention to increase the physical activity and cardio respiratory fitness , a randomized trail
.participants were sedentary men N=116 and women N=119 the intervention was made for 6 months
of intensive and 18 months of maintenance. Intervention on either a life style physical activity on a
traditional structured exercise program. They concluded that both the life style and structured activity
groups had significant and comparable improvements in physical activity and cardio respiratory
fitness.
Svelte, Erlanger, voliner and et al 2005 conducted a study on effect on life style modifications on
blood pressure by race , sex, hypertension status and age . A randomized trail tested multy
component life style interventions on BP in demographic and clinical sub groups . this study
population was 810 individuals they concluded that divorce groups of people can adopt multiple life
style changes that can lead to improved BP control and reduced coronary vascular risk .
Study related to knowledge on life style modification
Jiang, Tang, lie and et al 1999 studied on the awareness treatment and control of
hypertension in patients attending hospital clinics in China. Participants were the patients over the
age of 35 years who were attending out patients clinics in 18 major hospitals in China a cross
sectional survey , a total of 9703 volunteers enrolled , of which 4510(46%)were hypertensive .
among of those hypertensive 24% were unaware of control of hypertension
Megan, eynolds,kristi and et al 2004 conducted a study on level of awareness , treatment
and control of hypertension in different world regions . it was the systematic review of published
studies and the search was restricted to studies published from in January 1980 through July 2003.
result was awareness of hypertension was reported for 46% of studies and varied from 25.2% in
Korea to 75% in Barbados.
Annette and stantum 2001 carried a study on determinants of adherence to medical regiments by
hypertensive patients.50 adults hypertensive patients at health maintenance organization as attend the
questionnaires and home interviews over a ten week period. Structural modeling procedures revealed
that greater expectancy for internal control over health and hypertension, greater knowledge
treatment regimen and stronger social supports were significant determinants of adherence, in turn
higher level of adherence facilitated blood pressure reduction
6.3
STATEMENT OF PROBLEM
6.6
Hypothesis
H0-There is no significant relation ship between knowledge attitude and practice regarding life
style modification among hypertensive patients
H1-There is significant difference between knowledge and attitude regarding prevention of
hypertension
H2- There is significant difference between knowledge and practice regarding prevention of
hypertension
H3- There is significant difference between attitude and practice
regarding prevention of
hypertension
H4- There is significant difference between knowledge and attitude regarding prevention of
hypertension
6.7
ASSUMPTION;
The study based on the following assumptions
● Hypertensive patients have inadequate knowledge regarding practice about prevention and
Control of hypertension
● Knowledge about life style modifications helps in reduction of hypertension and to better
Prevention
● Patients are the best conveyors of information to other patients and to family
● To find out the selected demographic variables.
● Adopting lifestyle modification can prevent complication of hypertension
●Adopting lifestyle modification can prevent complication of hypertension
6.8
DELIMITATION
Study is limited to patients with hypertension who are attending the out patient department and
general wards of the selected hospitals at Bangalore
6.9
PROJECTED OUTCOME
7.2.6
POPULATION
All the hypertensive patients between the ages of 35-65 years
come to out patient department in general hospitals
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE
CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE
DESCRIBE BRIEFLY.
No, The study requires to analyze the knowledge, attitude and practice of life style modification in
hypertensive patients at selected hospital in bangalore
8
LIST OF REFFERENCES;
1) Black J. M. (2005) medical surgical nursing, 7 th edition. New Delhi, B. I. publications
private Ltd, 1489-1507
2) Elliot , H. L., Connel, J.M.C. and Mc Inner, G.I. (2000) “The year in hypertetension 1 st
Edition Bangalore. Panther publisher Pvt Ltd , 1-11
3) ghafoor unnissa and Kamala Krishna swamy (1998) “ Diet and Heart disease” 3 rd edition.
Hyderabad .National institute of Nutrition, 14-15,30-38,65-70,
4) Susan Wods L. (2005) “ cardiac nursing” 5 th Edition. Philadelphia;Lippincott Williams and
wilkins publishers 85
5)Appel
,
L.J.,
Champagne,
C.M.,and
Harsha,
D.
W.(2003)
“
A
STUDY
ON
DETERMINATIONOF EFFECT OF COMPREHENSIVE LIFE STYLE MODIFICATION ON
BLOOD PRESSURE CONTROL” JOURNAL OF
AMERICAN MEDICAL ASSOSSIATION 289(16):2083-2093.
6) Benjamin, emilia J. AND RICHARD, S, (2002) “A STUDY ON MAGNITUDE OF THE
PREVENTION PROBLEM, OPPERTUNITIES AND CHSLLANGES” Journal of American college
of cardiology 40;588-603
7)
Kearney, Patrica, and Whelton (2004) “ A STUDY ON WORLDWIDE PREVALENCE
HYPERTENSION” JOURNAL OF HUPERTENSION, 22(1);11-19
8)
Alexander, C,N, and Smith , J. (1995) .” A STUDY ON SRESS REDUCTION FOR
HYPERTENSION
IN
OLDER
AFRICANS-AMERICANS”
RETRIEVED
FROM
http://www.ncbi.nin.nih.gov/entre/quency
9)BURKE,V. Lee A. and Hunter,E( 2007)” A STUDY ON ALCOHOLINTAKE INCIDENCE OF
CORONARY DISEASE IN ASTRIANS’, retrived from http://www.ncbi.nin.nih.gov/entre/quency
10)Hasarika, and alhawat(2005),” A STUDY ON AWARENESS AND TREATMENT OF
HYPERTENSION’ RETRIVED FROM http:/www.jhpdc.unc.edu/
9
NAME & SIGNATURE OF THE
CANDIDATE
NOBLE M.S
Rajiv Gandhi University of Health Sciences, Karnataka
Curriculum Development Cell
CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Registration No.
;
Name of the candidate
;
Address
; K.T.G. College of Nursing
; Sreegandhadakavalu, Bangalore
Name of the institution
; K.T.G. College of Nursing
Sreegandhadakavalu, Bangalore
Date of admission to Course
;15/05/2009
Title of the topic
;A study to assess the knowledge,attitude and practice of life
style Modification among hypertensive patients at selected
hospitals in Bangalore
Brief Resume of The work
; Attached
Signature of the student
;
Name of the Guide
;;BIJU RAMACHANDRAN
Signature of the Guide
;
Name of the Co- Guide
;
Signature of the co-Guide
;
Name of the HOD
;
Signature of the HOD
;
Name of the principal
;
Principal mobile number
;
Principal E-mail ID
;
Remark of the Principal
;
Signature of the Principal
;