Community-based interventions in hypertensive patients: a comparison of three health education strategies

BMC Public Health

Pei-Xi Wang²  Sen-Hua Ding¹  Wei-Quan Lin²  Mian-Qiu Zhang¹  Yi-Xiong Lei²  Song-Tao Tang¹  Chu-Hong Lu¹ 

[1]Community Health Services Center of Liaobu, Dongguan, China

[2]Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China

关键词: Serum lipids;    Blood pressure;    Hypertension;    Health education;    Community-based intervention;   

Others  :  1122835
DOI  :  10.1186/s12889-015-1401-6

 received in 2014-08-28, accepted in 2015-01-12,  发布年份 2015

【 摘 要 】

Background

Community-based health education programs may be helpful in improving health outcomes in patients with chronic illnesses. This study aimed to evaluate community-based health education strategies in the management of hypertensive patients with low socioeconomic status in Dongguan City, China.

Methods

This was a randomized, non-blinded trial involving 360 hypertensive patients enrolled in the community health service centre of Liaobu Town, Dongguan City, China. Participants were randomized to receive one of the three community-based health education programs over 2 years: self-learning reading (Group 1), monthly regular didactic lecture (Group 2), monthly interactive education workshop (Group 3). Outcomes included the changes in the proportion of subjects with normalized blood pressure (BP), hypertension-related knowledge score, adherence to antihypertensive treatment, lifestyle, body mass index and serum lipids.

Results

After the 2-y intervention, the proportion of subjects with normalized BP increased significantly in Group 2 (from 41.2% to 63.2%, p<0.001), and increased more substantially in Group 3 (from 40.2% to 86.3%, p<0.001), but did not change significantly in Group 1. Improvements in hypertension-related knowledge score, adherence to regular use of medications, appropriate salt intake and regular physical activity were progressively greater from group 1 to group 2 to group 3. Group 3 had the largest reductions in body mass index and serum LDL cholesterol levels.

Conclusion

Interactive education workshops may be the most effective strategy in community-based health promotion education programs for hypertensive patients in improving patients’ knowledge on hypertension and alleviating clinical risk factors for preventing hypertension-related complications.

【 授权许可】

   
2015 Lu et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Kengne AP, June-Rose McHiza Z, Amoah AG, Mbanya JC: Cardiovascular diseases and diabetes as economic and developmental challenges in Africa. Prog Cardiovasc Dis 2013, 56:302-313.
• [2]James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al.: 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014, 311:507-520.
• [3]Ma YQ, Mei WH, Yin P, Yang XH, Rastegar SK, Yan JD: Prevalence of hypertension in Chinese cities: a meta-analysis of published studies. PLoS One 2013, 8:e58302.
• [4]Ribeiro AG, Ribeiro SM, Dias CM, Ribeiro AQ, Castro FA, Suárez-Varela MM, et al.: Non-pharmacological treatment of hypertension in primary health care: a comparative clinical trial of two education strategies in health and nutrition. BMC Public Health 2011, 11:637. BioMed Central Full Text
• [5]Shaw R, Bosworth HB: Baseline medication adherence and blood pressure in a 24 month longitudinal hypertension study. J Clin Nurs 2012, 21:1401-1406.
• [6]Meyer D, Leventhal H, Gutmann M: Common-sense models of illness: the example of hypertension. Health Psychol 1985, 4(2):115-135.
• [7]Wade AH, Weir DN, Cameron AP, Tett SE: Using a Problem Detection Study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy. J Hum Hypertens 2003, 17:397-405.
• [8]Horne R: One to be taken as directed: reflections on non-adherence (non-compliance). J Soc Adm Pharm 1993, 10(4):150-156.
• [9]Weinman J: Providing written information for patients: psychological considerations. J R Soc Med 1990, 83:303-305.
• [10]Viswanathan H, Anderson R, Thomas J III: Evaluation of an antiretroviral medication attitude scale and relationships between medication attitudes and medication non-adherence. AIDS Patient Care STDS 2005, 19(5):306-316.
• [11]Guo R. The study of evaluation of the community TCM intervention and the quality of life in hypertensive patients (Chinese). Master thesis. China Academy of Chinese Medical Sciences, Clinical Medicine Department;2013
• [12]Hu DY. Prevention and treatment of hypertension - from the guidelines to practice. Beijing: Peking University Medical Press; 2010/3.
• [13]Ling Y, Fang ZW, Shen WZ, Zhang Y, Zhao XP: The effectiveness evaluation on the Pengpu Community Health Center implementation of the health education and health promotion for community hypertension patients(Chinese). Chinese Primary Health Care 2004, 18(9):37-39.
• [14]Chen M, Wang XK, Zhu YH: The importance of health education in community (Chinese). Soft Sci Health 2008, 6:469-470.
• [15]Liu LS, Wang W, Yao SH: Guidelines for the prevention and treatment of hypertension in China (Chinese). Chin, J Hypertens; 2010.
• [16]Kruger SH, Gerber JJ: Health beliefs and compliance of black South African outpatients with antihypertensive medication. J Soc Adm Pharm 1998, 15(3):201-209.
• [17]Gao X, Nau DP, Rosenbluth SA, Scott V, Woodward C: The relationship of disease severity, health beliefs and medication adherence among HIV patients. AIDS Care 2000, 12(4):387-398.
• [18]Saounatsou M, Patsi O, Fasoi G, Stylianou M, Kavga A, Economou O, et al.: The influence of the hypertensive patient’s education in compliance with their medication. Public Health Nurs 2001, 18(6):436-442.
• [19]Health policy implications for patient education in physical therapy. Available at: http://www.findarticles.com/p/articles/mi_qa3956/is_199901/ai_n8843473. Accessed November 4, 2013.
• [20]WHO. Integrating prevention into health care. Available at: http://www.who.int/mediacentre/factsheets/fs172/en/print.html. Accessed December 7, 2014.
• [21]Chen JB, Ma J, Li CP, Cui Z: Tobacco smoking and nicotine dependence among Tianjin city dwellers: a population-based cross-sectional study (Chinese). Chin J Public Health 2013, 7:988-991.
• [22]Chen JB, Cui Z, Li CP, Ma J: Relationships between nicotine dependence and age-associated factors (Chinese). Chin J Health Educ 2012, 10:802-805.
• [23]Chen GB, Zhou XN, Chen YL, Chen YH, Dai Z, Fu FH, et al.: Investigation of Nicotine Dependence and its influencing factors of smokers in China (Chinese). Med Soc 2013, 12:001-004.
• [24]Yang LQ, Wang HZ, Weng C, Zheng YR, Wei BR, Zheng JS. A case control study on influence factors of alcohol dependence in patients with hypertension (Chinese). 2011;11:1475–1476.
• [25]Liu MX: Health information needs and the choice of communication mode of community patients with hypertension in city (Chinese). Chengdu University of Science and Technology, Department of Communications, Master thesis; 2012.
• [26]Glynn LG: Murphy AW. Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews, Smith SM; 2010.
• [27]Hennessy S, Leonard CE, Yang W, Kimmel SE, Townsend RR, Wasserstein AG: Effectiveness of a two-part educational intervention to improve hypertension control: a cluster-randomized trial. Pharmacotherapy 2006, 26:1342-1347.
• [28]Hunt JS, Siemienczuk J, Touchette D, Payne N: Impact of educational mailing on the blood pressure of primary care patients with mild hypertension. J Gen Intern Med 2004, 19:925-930.
• [29]McKinstry B, Hanley J, Heaney D, McCloughan L, Elton R, Webb DJ: Impact on hypertension control of a patient-held guideline: a randomised controlled trial. Br J Gen Pract 2006, 56:842-847.
• [30]Watkins CJ, Papacosta AO, Chinn S, Martin J: A randomized controlled trial of an information booklet for hypertensive patients in general practice. J R Coll Gen Pract 1987, 37:548-550.