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The effects of nursing intervention on KAP level and health of Kazakh patients with essential hypertension

The effects of nursing intervention on KAP level and health of Kazakh patients with essential hypertension

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Problem Description: 

The epidemiologic study conducted in 2010 on hypertension in various nationalities in Xinjiang showed: the morbidity of hypertension in Kazak, Uygur and Han nationalities are 48.69%, 28.50% and 33.42% respectively with Kazak’s morbidity higher than Han’s, and Uygur’s is equal to that of the nation’s which is 2.56 times higher than that of Han’s. The co-study on cardiovascular diseases by China and the U.S.A found that the vital risks causing high pressure in China in 1980s were due to the excessive body weight, greater degrees of weight gain and the excessive drinking. Some studies abroad suggested that the healthy life habits may lower the risks of high pressure by 55% and the early prevention of high pressure may also lower the risks of stroke and myocardial infarction by 50%. Therefore, the cultivation and formation of healthy life habits can effectively lower the risk factors of blood pressure, so the active prevention and intervention of the risks of high pressure play an important role in both the public health and the social economy.

Among people in the pastureland, the effective measures should be taken to improve life qualities of the patients with high pressure, such as focusing on the health education and health promotion, taking priority in the intervention of high pressure to enhance life standard and quality of the population, promoting the capacity of self health care, correcting the bad life habits and manners and preventing the further development of high pressure.

Solution: 

1.Samples

Cluster random sampling technique was used to select 1,900   Kazak residents over 18 in Gangou village of the South-mountain areas of Urumqi as the research subjects. Of the 1832 valid questionnaires 905 were of the intervention group and 927 were of the controlling group. For the intervention group and the patients with high blood pressure, the comprehensive nursing by means of health education was the main method adopted.

After 8-month education on high blood pressure in the intervention group, we evaluated the intervention effects of the health education on the patients by testing the knowledge of the disease, the attitude and the behaviors  of hypertension.

1) Blood pressure: patients’ blood pressures of the right upper body were measured at fixed time with the same sphygmomanometer. The patients were asked to rest for 30 minutes before measuring the blood pressure for three times with the average figures counted.

2) Body weight: The body weights were measured by the same weighing machine.

Those measured were asked to be empty-stomach, bare-head and bare feet with great  precision.

3) Waist measurement: The people being measured were asked to stand straight with their belly relaxed, arms down, feet closed and the breath normal when being measured. The end of the tape measure was held at the navel and was brought around the waist to the front.

A baseline survey was conducted among Kazak patients with high blood pressure to learn their health conditions and  basic indicators, who were grouped randomly and followed every three months. We did the same to the controlling group. Then the 12-month effects of nursing intervention ,both before and after, were compared comprehensively between the intervention group and the controlling group.

2. Intervention contents

1)The self-compiled book EDUCATION ON THE PREVENTION OF HIGH BLOOD PRESSURE in the language of Kazakh was distributed to each Kazak family.

2)Ask the village committee to broadcast every morning from 12 am. to 5 pm. the knowledge of both harms and prevention of high blood pressure in their native language to increase their understandings of the severities and risks of high blood pressure, drawing them to pay attention to the prevention of high blood pressure. For the intervention group, hypertension self-management handbook was distributed, which informed them some basic knowledge of high blood pressure, the necessary preventive measures and the definitions, tasks and goals in self-management. 

3)The herdsmen attended the lectures on high blood pressure given by the specialists and professors every two months.

4)A propaganda poster on health was conducted every two months.

5)Follow-ups were conducted to have a face-to-face consultation with the  herdsmen of the intervention group.

6)We organized four free out-door volunteer clinics and the health consult activities.

7)The associate propaganda: the consulting service and blood pressure measuring spot were set up at the local hospitals.

8)The food intervention: the salt spoon were given to the intervention group according to the WHO’s suggestions which says 6g salt is the proper amounts everyday.

9)Exercise intervention: the intervention group were guided to do physical exercises and some work  properly based on their ages and body conditions.

10)We also told them the functions of hypertension medicines, the significance of taking medicines on time, dosages for long-term as well as the side-effects of some commonly-used hypertension medicines and the prevention of postural hypotension

11)We communicated with the patients and their relatives by teaching them how to measure the blood pressure and how to control their blood pressure within the aimed goals actively.

12)The follow-up education: we performed the  health consultations and follow-ups dynamically by telephone every month for the patients with high blood pressure. We also did home-visits every three months and the prescriptions for high blood pressure were also given. The changes of each criteria were evaluated after the 8 months intervention.

Achievement: 

1.2  The comparison of  related knowledge of high blood pressure and the attitude and behavior of all the Kazak residents living in the pastureland.

    Our study showed that there were no statistic difference concerning the knowledge , attitudes and behaviors between the intervention group and the controlling group. There were 886 valid questionnaires from the intervention group and 901 from the controlling group with 2.1% and 2.8% vacant visit rate respectively for the reasons of moving away, going out and the refusing.

After 8-month health education, the awareness rate of high blood pressure preventive knowledge in the intervention group increased from 11.9% to 60.0%, the rate of belief rose from 13.8% to 57.3% and the rate of behavior rose from 14.0% to 34.6% with statistic difference before and after the intervention and no changes in the controlling group.

The proportion of the intervened blood pressure level of patients I increased from 30.17% to 34.20%; the blood pressure level of patients II decreased from 15.14% to 10.95%; those with patients III decreased from 6.52% to 2.26%. The blood pressure level divisions were valid in comparison and the order measure were statistically significant.

During the 8 months health education to the Kazak residents in the intervention group, there were statistical difference in the knowledge knowing, the beliefs and the behaviors compared to the controlling group. After the intervention, there were 83.4% residents in the intervention group who knew the normal figures of blood pressure while there were only 16.6% residents in the controlling group knowing it, accounting for the significant difference between the two groups.(x 2=250.94,P=0.000);there were 42.6% people in the intervention group who were aware of the fact that overtaking salt is likely to develop high blood pressure while there were only 6.9% people in the controlling  group knowing it, making the difference significantly between the two groups.(P=0.000);as for the knowledge of the  relationship between over-weight and obesity with high blood pressure, the figures were 74.9% in the intervention group and 15.2% in the controlling group respectively with significant difference(x 2=677.00,P=0.000);for the possibility of blood pressure measure in thirties, the figure were 57.3% in the intervention group and 11.1% in the controlling group respectively with statistic difference in attitudes between the two groups; the figures were 41.8% in the intervention group and 10.6% in the controlling group concerning the measurement of blood pressure persistently, making the  difference significantly.

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