Compliance To Dietary Managements Among Selected Hypertensive Patients At The Outpatient Clinic Of Lautech Teaching Hospital Ogbomoso
High blood pressure (or hypertension) is an epidemic medical condition affecting one third of Nigerian adults. The high disease-related mortality and economic burden associated with hypertension have prompted extensive scientific interest. The development of hypertension is largely influenced by lifestyle risk factors. Poor dietary habits such as a high intake of salt and saturated fats and a low intake of fruit and vegetables, physical inactivity, overconsumption of alcohol, smoking and stress are the major risk factors of hypertension. The complex nature of diet and food intake requires focusing on the whole food and food intake patterns, in addition to the single nutrients and food items, to capture their association with chronic disease. The knowledge and compliance to propoer diet become more important to the life span and eventual management of Hypertension. The study was therefore carried out to assess the compliance to dietary managements among selected hypertensive patients at the outpatient clinic of lautech teaching hospital ogbomoso.
Table of Contents
- 1.1 Background of the Study
- 1.2 Problem Statement
- 1.3 Study Objectives
- 1.4 Significance of the Study
- 1.5 Study Questions
- 1.6 Scope and Limitation of the Study
- 1.7 Definition of Terms
- 1.8 Organization of the Study
Review of Related and Relevant Literature
- 2.2 Conceptual Clarifications
- 2.3 Theoretical Studies
- 2.4 Empirical Studies
- 3.1 Research Design
- 3.2 Study Area
- 3.3 Sources of Data
- 3.4 Population of the Study
- 3.5 Sample Size Determination
- 3.6 Instrumentation
- 3.7 Reliability and Validity of Instrument
- 3.8 Method of Data Analysis
Data Presentation, Analysis and Interpretation
- 4.1 Data Presentation
- 4.2 Data Analysis
- 4.3 Data Interpretation
Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
This chapter is the introductory chapter which presents the background of the study, the statement of the problem, the significance of the study, purpose of the study / broad objective, specific objectives of the study, research questions, hypothesis of the study, scope of the study and operational definition of terms.
1.1 Background to the Study
Hypertension (HTN), characterised by blood pressure (BP) ≥ 140/90 mmHg, is a chronic non-communicable disease responsible for 13% of all global mortality (World Health Organization, 2012). High BP accounts for almost half of all mortality resulting from stroke and coronary heart disease (World Health Organization, 2012). Hypertension is a global epidemic, prevalent among almost one-third of the world population, with the highest prevalence in Africa region, and the lowest in America region (World Health Organization, 2012). Hypertension is prevalent among approximately 29% of American adults 18 years and older (Nwankwo, Yoon, Burt, & Gu, 2013). In 2012, 4.6 million Nigerian adults (32%) had HTN, with a higher prevalence in men compared to women (24% vs 19%, respectively) (Nigerian Bureau of Statistics, 2013a). The prevalence of HTN is age dependent and is considerably higher among older adults than younger people (Nigerian Bureau of Statistics, 2013a). In 2012, 43% of Nigerians older than 65, but only 6% of Nigerians aged 18-24, had HTN (Nigerian Bureau of Statistics, 2013a). Although the global prevalence of HTN has decreased in the last three decades (World Health Organization, 2012), it is estimated that 69% of people who have their first heart attack, or 75% of those with chronic heart failure, have HTN as a comorbid factor (Roger et al., 2012).
Behavioural factors such as excess alcohol consumption, smoking, and physical inactivity are also associated with the risk of HTN (Campbell-Scherer & Green, 2005; Chobanian et al., 2003; Escott-Stump et al., 2012). Individuals with HTN may also be prescribed antihypertension medications (AHT), in addition to dietary and lifestyle modifications, in order to control their condition. Adherence to medication is crucial to prevent the progression of, and to relieve symptoms associated with, the disease (Ho, Bryson, & Rumsfeld, 2009; Morrow et al., 2005).
Medication adherence refers to how well patients comply with the medication as prescribed (Ho et al., 2009; Horne, 2005). Medication adherence is defined by the continuous taking of medication as prescribed (Ho et al., 2009). Non-adherence to medication is common and is directly associated with the higher costs of medical treatment and adverse treatment outcomes (Ho et al., 2009; Nelson, Reid, Ryan, Willson, & Yelland, 2006; Simons, Ortiz, & Calcino, 2008). Individuals with better nutrition knowledge, diet and lifestyle behaviours may have better adherence to medication, thus, may have more successful BP self-management and control (Banning, 2009; Gascón et al., 2004). Therefore, understanding dietary patterns, the level of nutrition knowledge and lifestylerelated factors of individuals with high BP is a fundamental step in developing interventions aimed at preventing and controlling HTN.
1.2 Statement of Problem
In recent years, advanced therapeutic methods and medications have reduced the prevalence of HTN. Despite these progressions, the lifetime risk of developing HTN remains high (Chobanian et al., 2003). There is a 90% lifetime risk of developing HTN in individuals who survive up to 85 years of age but have not developed HTN at 55 to 65 years of age (Vasan, Larson, Leip, Kannel, & Levy, 2001). As a result of the high lifetime risk of HTN, high BP becomes an economic burden on society. Between 1993 and 1994, a report on health system costs associated with CVD and its risk factors, illustrated that HTN is considered to be the second most expensive condition to treat in Nigeria (Mathers & Penm, 1999). In a more recent study, the financial cost of health care services, medication and lost productivity directly related to HTN was estimated to be $93.5 billion in the United States (Heidenreich et al., 2011). Furthermore, the analysis of Nigerian data from the Reduction of Atherothrombosis for Continued Health registry indicated that the annual cardiovascular pharmaceutical cost due to HTN is the second most costly health-related expense after dyslipidaemia (Ademi et al., 2010).
In addition to the social and economic burden of HTN and its high associated chronic disease risk, an individual’s quality of life may be influenced by HTN (Soni, Porter, Lash, & Unruh, 2010; Trevisol, Moreira, Kerkhoff, Fuchs, & Fuchs, 2011). Health-related quality of life (HRQoL) is defined as an individual’s functioning, wellbeing and general health perception in physical and psychological domains (Suurmeijer, Reuvekamp, & Aldenkamp, 2001). Poor HRQoL may itself increase the risk of chronic diseases and add to the social and economic burden of health care and HTN treatment (Daviglus et al., 2003; DomingoSalvany et al., 2002). However, it is not clear if HTN influences HRQoL in all adults equally, or if the association differs based on an individual’s characteristics (such as age and gender). There is increasing evidence indicating that the modification of poor diet and lifestyle plays a pivotal role in preventing HTN (Chobanian et al., 2003). However, the current Nigerian dietary intake is characterised as unhealthy and is considered a great contributor to the burden of disease in Nigeria (National Public Health Partnership, 2001). The majority of Nigerians consume an excessive amount of salt (130-200 mmol sodium per day) in their diet; levels that are almost twice the recommended daily intake (Heart Foundation Nigeria, 2005). More than 70% of Nigerian males and 32% of females aged 19 years and older consume daily sodium amounts greater than the upper limit (2300 mg) specified by the Nigerian Dietary Guidelines (Nigerian Bureau of Statistics, 2015). Moreover, 36% of Nigerians’ daily energy intake is derived from extra foods (Rangan, Schindeler, Hector, Gill, & Webb, 2009), such as fried potatoes, margarine, cakes and muffins, beer, sweetened drinks and meat pies. These extra foods contribute 41% of the total fat and 41% of SFA intake to the diet (Rangan et al., 2009).
Exacerbating the issue, approximately 60% of Nigerian adults are considered to be insufficiently active (not performing at least 30 minutes of moderate intensity physical activity on most days) (Nigerian Bureau of Statistics, 2013b). In addition, more than 16% of Nigerian adults smoke tobacco cigarettes on a daily basis (Nigerian Bureau of Statistics, 2012b), and around 20% consume more than two standard drinks of alcohol daily (Nigerian Bureau of Statistics, 2012b). Collectively, these unhealthy dietary patterns and poor lifestyle behaviours contribute greatly to increased BP and the risk factors of CVD. Controlling high BP is pivotal in order to reduce the incidence of coronary heart disease, stroke, and renal and kidney disease (Chobanian et al., 2003). However, a relatively high rate of uncontrolled HTN exists in Nigeria. Data from the Greater Green Triangle Risk Factor Study in rural Nigeria indicate that 40% of women and almost 60% of men who were aware of their HTN were not treated, and only half of those treated had controlled BP (Janus et al., 2008). Similarly, in 2011/12, 32% of Nigerians aged 18 years and older were medically diagnosed with HTN, of which less than one-third controlled their BP (Heart Foundation Nigeria, 2012).
As a primary approach to control high BP, the Nigerian Heart Foundation and the Seventh Report of the Joint National Committee to Stop Hypertension (JNC7) have recommended that all patients with high BP should modify their diet and lifestyle (Chobanian et al., 2003; Heart Foundation Nigeria, 2010). In addition, some individuals with high BP require AHT to assist with BP control. However, evidence suggests that 30 to 50% of patients do not fully comply with the medication as prescribed (Horne, 2005; Morrow et al., 2005). Medication non-adherence is often due to a number of factors such as forgetfulness, side effects of medication, financial reasons, and personal preferences (Ho et al., 2009b; Nelson, Reid, Ryan, Willson, & Yelland, 2006). Medication non-adherence is positively associated with an increase in adverse chronic disease outcomes and contributes significantly to the economic cost and the burden of disease (Ho et al., 2009). Given the high AHT nonadherence in Nigeria, it becomes a priority to understand the reasons for this nonadherence and explore its associated factors. This will assist with understanding the influential factors in the control and management of high BP in Nigeria.
1.3 Objectives of the Study
The main purpose of this study is to compliance to dietary managements among selected hypertensive patients at the outpatient clinic of Lautech teaching hospital ogbomoso, Osun state. Specifically, the following objectives will guide the study;
- To assess the level of knowledge regarding Dietary Management among hypertensive patients in Lautech Teaching Hospital
- To assess the level of compliance of Dietary Management among hypertensive patients in Lautech Teaching Hospital
- To assess relationship between economic conditions and dietary management
1.4 Research Questions
The following questions were formulated to guide the study based on the research objectives;
- Does the level of knowledge regarding Dietary Management affect hypertensive patients in Lautech Teaching Hospital?
- Does the level of compliance of Dietary Managementaffect hypertensive patients in Lautech Teaching Hospital?
- Does Economic conditions affect dietary management?
1.5 Significance of the Study
This thesis provides several practical contributions for both public health and clinical interventions. The main components explored in this research are dietary patterns, nutrition knowledge and lifestyle. These components are important for the following reasons. Firstly, exploring these components and their association with eating pattern can enhance our understanding of predictors of high BP in the Nigerian population. This may assist health practitioners and researchers to develop interventions and strategies aimed at controlling the risk factors of hypertension and reduce its prevalence in Nigeria.
Secondly, there is a lack of literature on the factors affecting dietary adherence in hypertensive Nigerians. Findings from this research will enhance our understanding of the reasons for poor dieatary adherence among hypertensive Nigerians. Since adherence to diet is pivotal in the treatment and management of hypertension, understanding the factors influencing poor dietadherence can assist with the development of appropriate interventions aiming to improve AHT adherence.
1.6 Scope of Study
The study will be conducted in Lautech Teaching HospitalOgbomoso. The justification for the study is that newly admitted patients level of knowledge about health and disease conditions is vital for their personal learning and; therefore, there is a need to ascertain their knowledge of dietary Management and compliance. The respondents used will be hypertensive patients in Lautech Teaching Hospital.
1.7 Operational Definition of Terms
For the purpose of this study, the key terms have been defined as follows:
In this study refers to the state of being informed on the awareness of dietary Management such as cholera, diarrhea, typhoid, and hepatitis and its preventive measures.
Refers to the strategies and measures adopted by hypertensive patients to avoid the occurrence or spread of dietary Management
Dietary management, also known as “foodservice management”, is the practice of providing nutritional options for individuals and groups with diet concerns through supervision of foodservices.
1.8 Organisation of the Study
This study is organized into five chapters. Chapter one included the background of the study, research problem, research objectives and questions as well as limitation of the study. Chapter two contains the literature review. Chapter three includes the methodology and study area. Chapter Four contains the results and discussion of key findings of the study. Chapter Five finally looks at the summary, conclusions, and recommendations based on the findings.
5.0 Summary, Conclusion and Recommendation
The study was carried out to access the compliance to dietary managements among selected hypertensive patients at the outpatient clinic of lautech teaching hospital ogbomoso. Dietary approaches to modify blood pressure should be an important strategy of cardiovascular health promotion. There is extensive literature demonstrating that multiple individual dietary components and several dietary patterns affect blood pressure. The strongest evidence for lowering blood pressure or preventing hypertension through dietary intervention includes adopting a dietary pattern such as the DASH diet or a Mediterranean diet, eating less saturated fat and total fat, getting plenty of potassium, limiting the amount of sodium in the diet, and limiting alcohol consumption. It is likely that other dietary factors, such as magnesium and fiber, may affect blood pressure, but the current evidence to support their recommendation is unsubstantiated. Additional research that includes population subgroups and explores the role of other nutrient factors, functional foods, and dietary patterns in preventing hypertension is warranted. Despite the proven benefits of a dietary pattern, there are many cultural and societal forces and commercial interests that have an impact on whether people adopt and follow such a diet. Effective clinical and public health interventions that incorporate individual behavior changes that lead to sustained dietary changes and environmental changes that encourage and promote greater access to healthy food choices are needed.
Remarkable progress has been made in the understanding of BP as a CVD risk factor and optimal approaches to the prevention and treatment of hypertension. Major clinical, societal, and research questions still remain to be answered, which will require more and better research evidence. In addition to the importance of accuracy in measurement of BP, team-based care with shared decision-making, maximizing adherence by use of once-daily medications and combination pills when feasible, promotion of lifestyle strategies proven to be effective in lowering BP, active use of the electronic health record and telehealth strategies, and use of performance measures as a component of quality improvement initiatives and financial incentives can improve hypertension management and control rates. Optimizing prevention, recognition, and care of high BP is achievable but is predicated on the assumption that BP can be measured with greater accuracy, there is a progressive shift to team-based care and use of other strategies known to improve BP control, and the capacity to assist patients in adopting a healthier lifestyle is substantially strengthened.
Based on the findings from the series of studies included in this thesis, some recommendations for future research can be made. The focus of future studies should be on measuring these micronutrients, it is recommended that a different measuring tool is developed and appropriately validated.
Finally, there is inconsistency in the literature about the association between dietary compliance and BP control.
Government and other major stakeholders should ensure adequate dissemination of information to BP patients and also impact their dietary choices through food price reduction.
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