Effect of self - care education on quality of life in patients with primary hypertension: comparing lecture and educational package

The effect of educational intervention on self-care behavior in hypertensive older people: Applying the health belief model

BACKGROUND

Hypertension is a worldwide health issue. Increasing aging has given rise to the prevalence of this problem. Disease management using educational intervention based on theoretical frameworks is effective for influencing self-care behavior. The goal of this study is to investigate the effects of educational intervention on self-care behaviors that influence hypertension control among the elderly population during 2020 based on the health belief model.

MATERIALS AND METHODS

A quasi-experimental study was conducted on rural older people in Ardestan, Iran. Assessments were done before and after three educational intervention sessions with a control group. The random sampling has done on 99 hypertensive elderly people in two rural centers of Ardestan from 2019 to 2020. Awareness variables, components of the health belief model, and blood pressure were assessed before and three months after the intervention. Data analysis was done using descriptive and analytical statistics.

RESULTS

The study groups did not differ significantly in terms of the variables studied at the beginning of the study. After three months, the variables of awareness, self-care, and perceived sensitivity constructs, perceived severity, perceived benefits, and guide to action showed a significant rise in the experimental group compared to the control group. In addition, the effectiveness of educational intervention significantly increased self-care behavior in the experimental group.

CONCLUSIONS

Educational intervention based on the health belief model can be effective to reduce the barriers of self-care behaviors. In order to have a lasting change in behavior, the use of behavioral change patterns that ecologically take into account interpersonal, organizational, and social factors is suggested too.

Association between different types of dietary carbohydrate and breast cancer

BACKGROUND

Among modifiable lifestyle factors, unhealthy dietary intake is associated with higher risks of breast cancer (BC). This paper aimed to investigate the association of different types of dietary carbohydrate with BC risk among women 20-75 years old.

DESIGN

This case-control study was carried out on 180 women with BC and 360 healthy individuals as the control group. Basic information including anthropometric measurements, medical history, physical activity, alcohol consumption, reproductive histories, smoking, and education level were collected. The amount of intake of carbohydrate, simple sugar, sucrose, maltose, and fructose were assessed using food frequency questionnaire (FFQ).

RESULTS

The amounts of intake of total carbohydrate [odds ratio (OR) = 1.76; 95% confidence interval (CI) (1.24-2.14); P = 0.01], simple sugar (OR = 1.95, 95% CI (1.42-3.39); P = 0.01), sucrose (OR = 1.97, 95% CI (1.18-3.12); P = 0.02), maltose (OR = 4.07, 95% CI (1.68-8.14); P = 0.03), and fructose (OR = 1.104, 95% CI (1.06-1.36); P = 0.01) were positively associated with BC after adjustments for age, body mass index (BMI), smoking, using alcohol, physical activity, and dietary intake of calorie, protein, and fat. No significant association was found between the intake of glucose, galactose, and lactose with BC.

CONCLUSIONS

The results of this study identified that some types of dietary carbohydrates may play a role in the development of BC. Different monosaccharides and disaccharides may have different effects on the risk of breast cancer. Further longitudinal studies are warranted to identify the effects of carbohydrates on BC and to explore the underlying mechanisms.

Awareness Development and Usage of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Randomized Controlled Trial

Background

Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management.

Objective

The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging).

Methods

A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL).

Results

During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001).

Conclusions

Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage “low-salt culture” and educate family members.

Trial Registration

Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo

International Registered Report Identifier (IRRID)

RR2-10.2196/15523

The Effect of a Spiritual Care on Hope in Patients Undergoing Hemodialysis: A Randomized Controlled Trial

Background:

The most common psychological problem in hemodialysis patients is low hope. Hope is an important source of adaptation for the survival of the patients with a chronic disease.

Objective:

This study aimed to evaluate the effect of spiritual care on hope in patients undergoing hemodialysis.

Methods:

In this randomized controlled trial conducted in Iran in 2017, 60 hemodialysis patients with ending-stage of renal disease under hemodialysis treatment were randomly assigned into two experimental (n=30) and control (n=30) groups. The spiritual care program consisting of protectionist care, supporting the patient's rituals and using support systems was administered in four sessions of 60 minutes individually, twice a week, morning or evening in hemodialysis ward. Snyder’s Hope Questionnaire was completed before and after the intervention in both groups. Data were analyzed in SPSS software version 16.

Results:

Prior to the intervention, there was no significant difference between the experimental and control groups (p=0.262); however, following the intervention, the difference was statistically significant with regard to the mean scores of hope in the experimental (36.43 ± 3.37) and control (35.20 ± 7.00) groups (p=0.04).

Conclusion:

According to the findings of the present study, spiritual care promotes hope in Muslim patients undergoing hemodialysis; therefore, nurses can adopt the spiritual care to this end.

Improvement in oral health related quality of life among the elderly: a randomized controlled trial

Background

The present study was conducted to determine the impact of educational intervention based on adult learning theory on oral health related quality of life of the elderly.

Materials and methods

This study (IRCT20120910010804N13) was performed with 92 elderly patients referred to the dental clinic of Ahvaz Jundishapur University of medical sciences. Participants were randomly divided into experimental and control groups. The data were gathered by a questionnaire with demographic variables, variables of oral health related quality of the elderly, and variables for assessing the effectiveness of adult learning theory. Following pre-test, educational programs were conducted for the interventional group. After 1 month, the questionnaire was again administered to both groups. Next, the results of pre-test and post-test were analyzed using SPSS-23 at a significance level of 0.05.

Results

Educational intervention was significant in terms of overall oral health related quality of life and the overall effectiveness score of adult learning theory (P < 0.001). There was a significant difference between the two groups in terms of the mean change score of three physical, psychosocial, and pain dimensions following the educational intervention (P < 0.001).

Conclusion

Education based on adult learning theory is recommended for improving oral health related quality of life among the elderly.

Trial registration

Iranian Registry of Clinical Trials, IRCT20120910010804N13. Registered on 2018-12-16.

https://www.irct.ir/trial/35239

The association between self-care and quality of life in hypertensive patients: findings from the Azar cohort study in the North West of Iran

Background: Hypertension affects the quality of life of patients and their caregivers. The aim of this study was to assess the knowledge and self-care behaviors and health-related quality of life (HRQOL) among hypertensive people. Methods: All people aged 35 years and older with hypertension were invited to participate in this study. Information on self-care behavior for hypertension (H-scale), and health-related quality of life (WHOHRQOL-BRFF) were completed by trained interviewer. Data analysis was done using SPSS 16. Results: The median age of hypertensive patients was 62.5(25th to 75th percentile: 55 to 72 years), the correlation between quality of life and overall self-care scores was not significant(r =-0.048, P =0.520). Physical activity was the only significant predictor for quality of life,showing that the quality of life of hypertensive people increased by 3.371 units per day of being physically active in the cohort study (β =0.223, P<0.01). The only significant predictor of quality of life among the elderly was medication use (β =-0.572, P<0.001). Quality of life of participants decreased 3.456 units per day as a result of medication adherence. Conclusion: No association was observed between self-care and HRQOL total score in hypertensive patients in the study. Among the self-care domains, only medication adherence and physical activity had significant association with social health. There was a reverse association between smoking and HRQOL.

Comparing the effects of education using telephone follow-up and smartphone-based social networking follow-up on self-management behaviors among patients with hypertension

BACKGROUND

Little is known about the benefits of social networks in the management of patients.

OBJECTIVE

The aim of this study was to compare the effects of self-management (SM) education using telephone follow-up and mobile phone-based social networking on SM behaviors among patients with hypertension.

METHODS

This randomized clinical trial was conducted with 100 patients. They were randomly allocated to four groups: (i) control, (ii) SM training without follow-up, (iii) telephone follow-up and (iv) smartphone-based social networking follow-up. The hypertension SM behavior questionnaire was used for data collection before and six weeks after the study.

RESULTS

Those patients who underwent SM education training (with and without follow-up) had statistically significant differences from those in the control group in terms of SM behaviors (p < .001). There was no statistically significant difference between different types of follow-up.

CONCLUSION

SM education using telephone follow-up and/or smartphone-based social networking follow-up influenced SM behaviors among patients with hypertension.

Comparison of Two Different Educational Methods for Teachers' Mammography Based on the Health Belief Model

BACKGROUND

Breast cancer is the most common cancer in women. One way to decrease the burden of this cancer is early detection through mammography. This study compared the effectiveness of two different educational methods for teachers' uptake of mammography based on the Health Belief Model.

MATERIALS AND METHODS

The current study was a randomised trial of 120 teachers over 40 years old in two groups receiving multimedia or group education, both based on the Health Belief Model. Participants completed questionnaires before, immediately and three months after educational intervention. Mammography was evaluated before and after educational intervention.

RESULTS

The participants in the two groups were demographically similar. Comparison showed no difference noted in the scores of knowledge, perceived barriers, susceptibility, and severity constructs between two groups (p > 0.05). Health motivation and benefit were perceived to be higher in the group education compared to the multimedia group. There was a significant difference in mammography between two groups after the intervention (p= 0.003).

CONCLUSIONS

Planning and implementation of educational program based on the Health Belief Model can raise knowledge and increase participation in mammography especially with group education.

Preoperative Education and Decreasing Preoperative Anxiety Among Children Aged 8 - 10 Years Old and Their Mothers

BACKGROUND

Preoperative anxiety is associated with adverse clinical, behavioral, and psychological outcomes. Various effective interventions targeting preoperative anxiety in children exist.

OBJECTIVES

The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management.

PATIENTS AND METHODS

After obtaining the institutional ethics committee approval and written informed parental consent, 36 ASA-I, II children (age range, 8 - 10 years) underwent small operations were included in this prospective randomized study. The participants were allocated into the intervention (n =18) and control (n =18) groups. Children in the first group were prepared routinely. In the second group children and their mothers received data about anesthesia and operation by the booklet. Children-maternal anxiety was assessed using the anxiety level form, at the night and in the morning before surgery. Few days after surgery mothers, residents, and children experiences and satisfaction from anxiety management were assessed in the focus group discussion.

RESULTS

Mean scores and standard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6, respectively (P = 0.06). In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery (P = 0.00). Comparison between groups was not significant (P = 0.6) and (P = 0.1). The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 (P = 0.00), respectively. In the intervention group, mothers' anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 (P = 0.04). Comparison between groups was not significant (P = 0.7) and (P = 0.1). According to the focus group discussions, booklet study, provided education, sympathy of medical team, spiritual issues and beliefs reduced anxiety and fear of surgery. Anesthesia and lack of knowledge of what will happen, crying and restlessness of children increased preoperative anxiety.

CONCLUSIONS

In this study, the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children (in mothers it was significant P < 0.05). Since there is a direct relation between mothers' and their children's anxiety, using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers.

Associação entre a qualidade de vida e adesão à medicação de indivíduos hipertensos

Objetivo Avaliar a associação entre a qualidade de vida e a adesão a medicação de indivíduos hipertensos. Métodos Estudo transversal, realizado com 432 hipertensos cadastrados em sistema informatizado público federal. Os dados foram coletados no domicilio por entrevista estruturada com questões relacionadas a variáveis socioeconômicas, clínicas, avaliação da adesão ao tratamento e o WHOQOL-BREF para a qualidade de vida. Utilizou-se o teste de H de Kruskal-Wallis para medir a associação entre as escalas da qualidade de vida e a classificação da adesão ao tratamento. Resultados Os escores mais baixos estavam presente no domínio autoavaliação e os mais altos foram encontrados no social. Os indivíduos que possuíam adesão extrema ao tratamento anti-hipertensivo apresentaram escores mais altos na avaliação da qualidade de vida em comparação com indivíduos classificados como não adesão extrema ao tratamento anti-hipertensivo. Conclusão A associação entre a qualidade de vida e adesão a medicação em indivíduos hipertensos não foi preditiva, sendo que os melhores escores estavam presentes nos indivíduos hipertensos que apresentaram alta adesão a medicação e os piores escores da qualidade de vida se apresentaram nos indivíduos de não adesão extrema e limítrofe a não adesão total.

Effect of music on postoperative pain in patients under open heart surgery

Background:

Music, as a non-pharmacological and inexpensive nursing intervention, can be used easily as a complementary technique in reducing pain along with other methods. While some studies have demonstrated pain to decrease after music, others found music to be ineffective on pain.

Objectives:

The aim of this study was to investigate the effect of music on postoperative pain in patients under open heart surgery.

Patients and Methods:

A quasi-experimental study was performed on 60 patients under open heart surgery referred to ICU of Shahid Beheshti hospital in Kashan city. Patients were randomly divided into two groups including experimental and control groups. Patients in music group listened to nonverbal music for 30 minutes after surgery by headphones. The control group did not receive any intervention other than routine care. Before and after intervention, pain intensity was measured and recorded by visual analog scale in two groups. Data was analyzed using Chi-Square and t-tests.

Results:

Before intervention, the mean of pain intensity was 6.32 ± 0.21 and 6.10 ± 0.21 for experimental and control groups, respectively; and the difference was not significant (P = 0.21). After intervention, the mean of pain intensity was 3.11 ± 0.12 and 5.81 ± 0.38 for experimental and control groups, respectively; and the difference was significant (P = 0.04).

Conclusions:

Listening to the relaxant music can reduce postoperative pain. It is suggested that relaxant music be used as a complementary method in patients in order to reduce prospective pain.