Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial

The Importance of Social Support in the Management of Hypertension in Brazil

BACKGROUND

The prevalence of hypertension (HTN) is high in Brazil, and control rates are low. Little is known about the factors that contribute to HTN control from a family-based perspective.

OBJECTIVES

Guided by the Family Management Style Framework, specific aims were to (1) describe the prevalence of adequate blood pressure (BP) control in individuals cared for the Family Health Strategy, (2) identify facilitators and barriers to HTN management, and (3) identify individual contextual sociocultural influences (sociocultural context and social and Family Health Strategy support), definition of the situation, and management behaviors that help or interfere with individual functioning (BP control in the individual with HTN).

METHODS

This descriptive, cross-sectional study included 213 individuals with HTN randomly selected from 3 Family Health Strategy units from July 2016 until July 2017.

RESULTS

Most of the individuals were female (n = 139, 65.3%), retired (n = 129, 60.5%), and White (n = 129, 60.2%) and had less than a high school education (n = 123, 57.6%). Family income (n = 166, 77.8%) was less than 5500 reals (US $1117/month). Mean (SD) systolic BP was 137.1 (±24.1) mm Hg, and mean (SD) diastolic BP was 83.8 (±18.6) mm Hg, with 47.9% (n = 102) having uncontrolled BP. In the multivariate logistic model, only high levels of perceived social support were significantly associated (odds ratio, 3.29; 95% confidence interval, 1.44-7.5; P = .005) with controlled BP.

CONCLUSIONS

Social support is strongly associated with BP control. Optimizing support may play an important role in BP control and preventing HTN-related complications.

Group-delivered interventions for lowering blood pressure in hypertension: a systematic review and meta-analysis

BACKGROUND

Hypertension is the leading modifiable cause of cardiovascular disease. Primary care management is predominantly individual and remains suboptimal. Interventions delivered to groups incorporate peer support and potentially offer efficient use of limited resources. Evidence for the benefits of group-delivered interventions in hypertension is unclear.

AIM

To determine whether group-delivered hypertension interventions improve blood pressure (BP) outcomes compared to usual care (UC).

DESIGN AND SETTING

Systematic review, meta-analyses, and meta-regression of randomised controlled trials in community, primary, or outpatient care settings.

METHOD

MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched from inception to 20 March 2024 for randomised controlled trials comparing group-delivered interventions to UC for adults with hypertension. Primary outcomes were changes in systolic and diastolic BP, achievement of study BP targets and medication adherence; quality was assessed using the Cochrane Risk of Bias 2 tool. Data were pooled according to intervention type using random effects meta-analyses; predictors of BP lowering were modelled with meta-regression.

RESULTS

Overall, 5326 citations were retrieved; 59 intervention groups (IGs) from 54 studies (13 976 participants) were included. Compared to UC, systolic BP reduced by 7.2 mmHg (95% confidence interval [CI] = 4.7 to 9.6; 23 IGs) following exercise, 4.8 mmHg (95% CI = 3.2 to 6.4; 26 IGs) following lifestyle education, and 3.6 mmHg (95% CI = 0.3 to 6.9; seven IGs) following psychotherapeutic interventions. Corresponding reductions in diastolic BP were 3.9 mmHg (95% CI = 2.6 to 5.2; 21 IGs), 2.9 mmHg (95% CI = 1.8 to 3.9; 24 IGs), and 1.2 mmHg (95% CI = -1.9 to 4.3; seven IGs). Achievement of target BP and medication adherence were infrequently reported, with equivocal findings (relative risks 1.1, 95% CI = 1.0 to 1.2, P = 0.02, 11 IGs and 1.0, 95% CI = 1.0 to 1.1, P = 0.60, seven IGs, respectively). In multivariable models, higher baseline BP and pre-existing cardiovascular morbidity were associated with greater BP reductions.

CONCLUSION

Group-delivered interventions were effective at lowering BP for people with hypertension compared with UC; their feasibility and cost-effectiveness in primary care require further study.

Family Self-management Program for Hypertension Management and Sodium Consumption Adherence: A Parallel Randomized Control Trial Among Family Caregivers and People With Hypertension

BACKGROUND

Hypertension (HTN) has become a serious health problem in developing countries. The family has an important role in maintaining blood pressure (BP) at home, and sodium diet compliance in people with HTN needs to be developed. Therefore, this research aimed to evaluate the effectiveness of a family self-management program (FSMP) in HTN management and compliance with sodium consumption in rural areas of Indonesia. Study Design: A parallel-group, single-blind randomized controlled trial.

METHODS

One hundred twenty-six eligible participants were randomly allocated to an intervention (n=63) and a control group (n=63). Participants in the intervention group received a 24-week (6-month) FSMP intervention. The primary outcome measures included the systolic and diastolic BP, the Score Sodium Questionnaire (SSQ), and the Morisky Medication Adherence Scale 8 (MMAS-8). The Knowledge of Health Care for HTN questionnaire and the Efficacy and Behavior Toward Health Care for Patients with HTN questionnaire were used to assess the secondary outcome.

RESULTS

The final results were analyzed from 121 participants (n=61 intervention and n=60 control group). The repeated analysis of variance (ANOVA) test results demonstrated significant effects on the management of HTN and adherence to sodium consumption as indicated by systolic (P=0.004) and diastolic BP (P=0.006), SSQ (P<0.001), MMAS 8 (P<0.001), caregivers' knowledge (P<0.001), caregivers' self-efficacy (P<0.001), and caregivers' behaviors (P=0.005).

CONCLUSION

The FMSP emerges as a promising strategy for managing BP and adherence to sodium consumption in people with HTN through the support of family caregivers and selfmanagement activities.

The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review

INTRODUCTION

Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia.

METHODS

We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2.

RESULTS

Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence.

CONCLUSIONS

Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.

Keeping patients safe through medication review and management in the community

BACKGROUND

There are numerous publications on inpatient medication errors. However, little focus is given to medication errors that occur at home.

AIMS

To describe and analyse the types of medication errors among community-dwelling patients following their discharge from an acute care hospital in Singapore.

METHOD

This is a retrospective review of a 'good catch' reporting system from December 2018 to March 2022. Medication-related errors were extracted and analysed.

FINDINGS

A total of 73 reported medication-related error incidents were reviewed. The mean age of the patients was 78 years old (SD=9). Most patients managed their medications independently at home (45.2%, n=33). The majority of medications involved were cardiovascular medications (51.5%, n=50). Incorrect dosing (41.1%, n=39) was the most common medication error reported. Poor understanding of medication usage (35.6%, n=26) and lack of awareness of medication changes after discharge (24.7%, n=18) were the primary causes of the errors.

CONCLUSION

This study's findings provide valuable insights into reducing medication errors at home. More attention must be given to post-discharge care, especially to preventable medication errors. Medication administration and management education can be emphasised using teach-back methods.

A Systematic Review of the Hill-Bone Compliance to Blood Pressure Therapy Scale

Background

Poor medication adherence hampers hypertension control and increases the risk of adverse health outcomes. Medication adherence can be measured with direct and indirect methods. The Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale, one of the most popular adherence measures, indirectly assesses adherence to hypertension therapy in three behavioral domains: appointment keeping, diet and medication adherence.

Aim

To synthesize evidence on the use of the HBCHBPT Scale, including psychometric properties, utility in diverse patient populations, and directions for future clinical use and research.

Methods

We searched electronic databases, specifically CINAHL, PubMed, PsychInfo, Embase, and Web of Science. We included original studies that used the HBCHBPT Scale or its subscales to measure a health outcome, or methodological studies involving translations and validations of the scale. We extracted and synthesized data following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.

Results

Fifty studies were included in this review, 44 on hypertension, two on diabetes, and others on other chronic conditions. The scale was successfully translated into numerous languages and used in descriptive and intervention studies. The scale demonstrated sound psychometric properties (Cronbach's α coefficient 0.75) and sensitivity to capture intervention effects when used to evaluate the effectiveness of high blood pressure adherence interventions. The medication-taking subscale of HBCHBPT performs best and is widely used in diverse contexts to assess medication adherence for chronic conditions.

Conclusion

The HBCHBPT Scale has high versatility globally and has been used in various settings by various healthcare worker cadres and researchers. The scale has several strengths, including high adherence phenotyping capabilities, contributing to the paradigm shift toward personalized health care.

Covariates of Knowledge, Attitude, Practice, and Burdens among the Caregivers of Hypertensive Patients

Caregivers of hypertensive patients play a significant role in ensuring adequate patient care and lowering the risk of hypertension-relatedcomplications. Caregivers are ideal study subjects for identifying gaps in hypertension management. Our study aimed to assess the knowledge, attitude, and practice (KAP) of hypertensive patients' caregivers, to identify their extent of involvement in patients' care, and to assess their care-related attributes. A descriptive cross-sectional study was conducted from August 2020 to February 2021 in the eight largest tertiary care medical college hospitals and all eight divisions of Bangladesh, with 949 caregivers enrolled. Data were collected using a pretested interviewer-administered questionnaire through snowball sampling and analyzed using a one-way ANOVA, independent-sample T-test, and chi-square test. Among the 949 interviewed caregivers, 541 (57.0%) were female, and 479 (50.5%) were aged 18 to 25 years. The percentage scores regarding overall knowledge, attitude, and practice of the caregivers were 54.83 ± 17.95, 47.95 ± 24.05, and 61.26 ± 17.50, respectively. Caregivers' education, history of hypertension, residence, age, relationship with the patient, occupation, and caregiving duration were significantly associated with the KAP scores. In addition, factors such as relationship with the patient, age, educational status, occupation, residence, and caregiving duration/day had significant correlations with all types of burden. Findings of this study suggest the necessity for awareness programs for the caregivers of hypertensive patients to diminish the gap in their KAP and improve their mental and physical health.

Effectiveness of educational interventions on hypertensive patients' self-management behaviours: an umbrella review protocol

BACKGROUND

Although different educational interventions have been widely used to manage and treat hypertension, alone or in combination with other interventions, there is a significant variation in their claimed effectiveness.

REVIEW QUESTION/OBJECTIVE

The objective of this umbrella review is to determine the effectiveness of educational interventions, alone or in combination with other interventions, for improving blood pressure control and self-management practices among hypertensive patients. The review question is: Do educational interventions, alone or in combination with other interventions, improve self-management practices among patients with hypertension?

METHODS

We will conduct a review of systematic reviews involving studies that implemented educational interventions, alone or in combination with other interventions, designed to change self-care practices among hypertensive patients who are 18 years and above, regardless of their sex and ethnicity. Following the guidelines set forth in the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, a comprehensive literature search will be conducted from September to December 2023 on six electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar. Search terms will be developed using database-specific indexed terms and text words derived from the review aim. We will present the effects of the educational interventions, alone or in combination with other interventions, on hypertension self-management practices. We will report the outcome data with 95% CIs for each study. Relative risk, mean differences or ORs will be used, depending on the measuring indices in each study.

ETHICS AND DISSEMINATION

Ethical approval is not required as this study will use aggregated data from previously published systematic reviews. However, we have registered the protocol in PROSPERO. We confirm that all methods will be performed following the guidelines of the Declaration of Helsinki. The findings from this study will be disseminated through presentations at academic conferences and publication in peer-reviewed international journals.

PROSPERO REGISTRATION NUMBER

CRD42022375581.

The life experience of leprosy families in maintaining interaction patterns in the family to support healing in leprosy patients in Indonesian society. A phenomenological qualitative study

Background

Family involvement in overcoming the severity of leprosy is very important in the life of leprosy sufferers in communities who experience the clinical and, psychological, social and behavioral consequences of the disease. However, this need, psychosocial, is felt to be not optimal. This study is to identify how the experiences of family members as caregivers provide assistance to individuals with leprosy in improving healing and maintaining patterns of interaction in the family.

Methods

The design uses qualitative research with in-depth, face-to-face interviews with family members in a semi-structured manner with the hope of obtaining complete data. Using purposive sampling with Participatory Interpretative Phenomenology analysis, there are 12 families with 15 family members consisting of 4 men and 11 women.

Results

This study produced a family theme that tried to follow what would happen to individuals with leprosy, with four sub-categories: 1) Using various coping alternatives to recognize the disease, 2) Family members in the shadow of leprosy, 3) Trying to empathize with other family members. sick, 4) Caring for the emotional response of the family and seeking support.

Conclusions

This analysis shows that deficiency in cognitive aspects can be closed by maintaining a lifestyle in the family through efforts to understand, support, establish communication, increase maximum involvement in restoring self-confidence, especially in individuals with leprosy with psychosocial problems in the family. The results of this study can be used as psychosocial support in maintaining communication between family members to support treatment programs and accelerate the recovery of leprosy.

Although families have high empathy for the physical, psychological, and social problems faced by individuals with leprosy, they are rarely involved in the personal affairs of individuals with leprosy, and there are indications that they left them to cure their disease. Meanwhile, overcoming problems in their own way without involving other family members, becomes the main choice for people with leprosy to avoid conflicts between family members, because they realize that leprosy is a disgrace in their family. However, the interaction between family members is an Indonesian culture that continues to be preserved. And for whatever reason, the culture of interaction between family members cannot be abandoned, even though there are obstacles that must be faced because this is a tool to strengthen kinship. The writer found that the family tried to help in healing leprosy suffered by their family members, even though they were in the shadow of leprosy. Through various coping strategies implemented, families try to help the healing process of their illness, with the hope that they will rise from adversity and have high motivation to recover. And restoring the confidence of people with leprosy is important to support a definitive treatment program.

Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change

Background

Nepal has a high prevalence of hypertension which is a major risk factor for cardiovascular diseases globally. It is inadequately controlled even after its diagnosis despite the availability of effective treatment of hypertension. There is a need for an in-depth understanding of the barriers and facilitators using theory to inform interventions to improve the control of hypertension. This formative study was conducted to address this gap by exploring the perceived facilitators and barriers to treatment and control of hypertension in Nepal.

Methods

We conducted in-depth interviews (IDIs) among hypertensive patients, their family members, healthcare providers and key informants at primary (health posts and primary health care center) and tertiary level (Kathmandu Medical College) facilities in Kathmandu, Nepal. Additionally, data were collected using focus group discussions (FGDs) with hypertensive patients. Recordings of IDIs and FGDs were transcribed, coded both inductively and deductively, and subthemes generated. The emerging subthemes were mapped to the Capability, Opportunity, and Motivation-Behaviour (COM-B) model using a deductive approach.

Results

Major uncovered themes as capability barriers were misconceptions about hypertension, its treatment and difficulties in modifying behaviour. Faith in alternative medicine and fear of the consequences of established treatment were identified as motivation barriers. A lack of communication between patients and providers, stigma related to hypertension and fear of its disclosure, and socio-cultural factors shaping health behaviour were identified as opportunity barriers in the COM-B model. The perceived threat of the disease, a reflective motivator, was a facilitator in adhering to treatment.

Conclusions

This formative study, using the COM-B model of behaviour change identified several known and unknown barriers and facilitators that influence poor control of blood pressure among people diagnosed with hypertension in Kathmandu, Nepal. These findings need to be considered when developing targeted interventions to improve treatment adherence and blood pressure control of hypertensive patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11548-4.

Effects of a family dyadic partnership program for people with hypertension in a rural community: A pilot randomised controlled trial

OBJECTIVE

To evaluate the feasibility, acceptability and preliminary effectiveness of a theory-based patient-family carer partnership intervention for people with hypertension in a Chinese rural community.

DESIGN

A pilot randomised controlled trial using pretest and post-test design.

SETTING

Rural China PARTICIPANTS: Forty-four hypertensive patients and their family carers (family dyads) were randomly recruited from a village clinic located in China between November 2019 and January 2020.

INTERVENTIONS

Participants were randomised to either an intervention group receiving a five-session patient-family carer partnership intervention over 10 weeks or a control group receiving usual care.

MAIN OUTCOME MEASURES

The feasibility and acceptability of patient-family carer partnership intervention and the changes in patients' systolic blood pressure, diastolic blood pressure and percentage of normal controlled blood pressure.

RESULTS

The patient-family carer partnership intervention was a feasible and acceptable program with high recruitment (81.5%) and completion rates (95.5%) and positive feedback from participants. Greater improvement in the percentage of normal controlled blood pressure was identified in the intervention group tested by the χ² tests, with P = .03. Two-way ANOVA results indicated its interaction (Group × Time) effects on patients' systolic blood pressure (P < .001), diastolic blood pressure (P < .001), dyadic partnership quality (P = .002), self-care (P < .001), self-efficacy (P = .02), antihypertensive drug treatment rate (P = .02), prescription adjustment (P = .03), perceived anxiety (P < .001) and health-related quality of life (EuroQol five-dimensional five-level: P = .02; EuroQol visual analogue scale: P < .001); family carers' dyadic partnership quality (P = .002), perceived depression (P = .04) and health-related quality of life (P = .02) were significant.

CONCLUSION

Our findings support the feasibility and acceptability of the patient-family carer partnership intervention and indicate benefits in improving patients' blood pressure control, dyadic relationship and psychological well-being of family dyads in rural area. Further research to test the longer-term effect in a large-sized population is recommended.