ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE IN HYPERTENSIVE PATIENTS IN A TERTIARY CARE TEACHING HOSPITALHTML Full Text
ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE IN HYPERTENSIVE PATIENTS IN A TERTIARY CARE TEACHING HOSPITAL
Kumaraswamy, M. Samraksha, M. N. Meghana * and S. K. Sandeep
Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India.
ABSTRACT: Background: In India, Hypertension is becoming more common and severe, and it is linked to various socio-demographic factors. Many people are ignorant of their illness's severity and the significance of managing it due to a lack of adequate support and education. The first step in developing a preventive program for any health condition is obtaining information regarding the level of awareness. Objective: To assess the knowledge, attitude, and practice and socio-demographic factors among hypertensive patients in tertiary care teaching hospital. Materials and Methods: A prospective cross-sectional study was conducted on the sample size of 410 hypertensive patients admitted in the Medicine Unit of AH&RC during the period from February 2021 to July 2021. Socio-demographic details were collected using data collection forms. KAP scores were determined using a standardized and validated KAP questionnaire on hypertension consisting of 22 questions. Results: In our study, most of the participants were unaware of the risk factors associated with hypertension. 55% had moderate level of knowledge and same percent of participants had moderate attitude level and 78% had adequate practice level towards hypertension. Graduates had adequate knowledge, illiterates had poor knowledge and primary, secondary educated participants had moderate knowledge. Hence there was a significant relation (P=0.001) between education level and knowledge among hypertensive patients. Conclusion: Most of the patients had poor knowledge towards normal BP levels, symptoms, risk factors and complications of hypertension. Hence, this study signifies that patients require support and guidance from the health care professionals for improving their knowledge towards hypertension.
Keywords: Hypertension, Socio-demographic details, KAP, Patient awareness
INTRODUCTION: Hypertension is not a disease but it is a major risk factor for cardiovascular problems 1-3. It has become one of the most prominent medical conditions linked to an increased risk of death from cardiovascular disease.
Hypertension is one of the biggest contributors to the global burden of illness, accounting for 9.4 million deaths annually and also for one-third of all preventable premature deaths 4.
Hypertension is a major risk factor for chronic diseases and deaths worldwide, with the age-standardized prevalence of 24.1% and 20.1% in men and women respectively. This number is growing very fast. It is estimated that the number will reach more than 1.56 billion by the year 2025 5. Socio-demographic factors play an important role in hypertensive patients 6.
Majorsocio-demographic factors which influence the hypertension are: age, gender, occupation, family history, education level, physical activity, hypertension duration, Alcohol intake, smoking 7-14.
A KAP survey means knowledge, attitude, and practice. A proper assessment and understanding of KAP factors is highly useful in chronic conditions, such as hypertension which helps in the better prevention and control by adapting a lifelong healthy lifestyle 2, 4, 11-13. There is a need to investigate KAP among the general population, which helps develop programs for effective health education 14-17.
The patients' knowledge and attitudes have a high influence on the management of the disease condition, which helps improve medication adherence, blood pressure control, morbidity, and mortality 18. Patient’s knowledge about hypertension and the benefits of lifestyle modifications is the key to successfully controlling hypertension. Good knowledge about hypertension helps improve self-management and control lifestyle habits of the patients 6, 19, 20, 21, 22, 23.
Good knowledge about the etiological factors, risk factors and complications of hypertension helps in prevention of its further complications among hypertensive patients. Hypertension has been labelled as ‘silent killer’ because it affects organs in a gradual and irreversible manner before any externally detectable symptoms appear. As a result, patients should be aware of the preventive strategy for hypertension control and adhere to the therapy as strictly as possible 4, 24.
The majority of inpatients treated in this hospital are from rural areas, it is essential to conduct this study here. The majority of them are completely unaware of their illness. As a result, it is necessary to assess their hypertension knowledge, attitude and practice.
Knowledge about hypertension, its etiological factors, risk factors, complications and diet is very important among hypertensive patients 25. Hence, a pharmacist can play an important role in reducing the complications of hypertension by educating hypertensive patients about their disease condition. Hence, this study is conducted to assess hypertensive patients' present knowledge, attitude, and practice towards hypertension in AH & RC.
Primary Objective: To assess the knowledge, attitude, and practice in hypertensive patients in a tertiary care teaching hospital.
Secondary Objective: To assess the socio-demographic factors in hypertensive patients. To assess the knowledge of patients regarding hypertension.
MATERIALS AND METHODS: A prospective cross-sectional study was conducted on the sample size of 410 hypertensive patients admitted in the Medicine Unit of AH & RC during the period of 6 months from February 2021 to July 2021, after getting permission from Institutional Ethics Committee (Reference no: IEC/AH & RC/AC/017/2021). This study included all the inpatients diagnosed with hypertension with or without co-morbid conditions admitted to the medicine unit. Those patients who were not willing to participate were excluded from our study.
A specially designed suitable data collection form was used to collect the socio-demographic details, patient history of illness, personal, social, family and medication. KAP scores were determined using a standardised and validated KAP questionnaire on hypertension consisting of 22 questions.
This questionnaire consists of a total of 22 questions, 10 questions related to hypertension knowledge, 5 questions to assess patient's attitude towards hypertension and 7 questions regarding practice.
The collected data were subjected for Chi-square test using SPSS version 20 software. There was a significant relation between education level and knowledge among hypertensive patients (P=0.001).
RESULTS: A total of 410 hypertensive patients were included in this study during the data collection period.
The objective of this study was to assess the knowledge, attitude and practice in hypertensive patients and to assess the socio-demographic factors in hypertensive patients in tertiary care teaching hospitals.
The collected data was subjected for the Chi-square test using SPSS version 20 software.
TABLE 1: SOCIO-DEMOGRAPHIC FACTORS OF HYPERTENSIVE PATIENTS
|Gender of the Patient||Female||191||46.6|
|Age of the patient||20-45||78||19|
|Family History of Hypertension||No||323||78.8|
|Hypertension Duration||< 5 Years||183||44.6|
|High School or Intermediate||130||31.7|
|Hypertension Medication Administration||Irregular||58||14.1|
TABLE 2: RESPONSES OF KNOWLEDGEBASED QUESTIONS
|Do you know the definition of hypertension?||No||51||12.4|
|Do you think hypertension is dangerous?||No||217||52.9|
|Do you think lowering BP level improves your health?||No||122||29.8|
|Do you think smoking and alcohol consumption causes hypertension?||No||258||62.9|
|Do you think obesity is associated with hypertension?||No||192||46.8|
|Do you think lifestyle change improves blood pressure?||Missing||1||0.2|
|Do you know the symptoms of hypertension?||No||118||28.8|
|Do you think hypertension is a curable disease?||No||201||49|
|Do you know the normal level of BP?||No||179||43.7|
|Do you think you have to take antihypertensives lifelong?||No||119||29|
Table 2, shows the frequency and percentage of the responses of hypertensive patients to knowledge-related questionnaires.
TABLE 3: RESPONSES OF ATTITUDE-BASED QUESTIONS
|Do you think regular medication will improve hypertension?||No||30||7.3|
|Do you think medication alone can control hypertension?||No||279||68|
|Do you think diet control will improve hypertension?||No||106||25.9|
|Do you think low salt intake can control hypertension?||No||168||41|
|Do you think physical activity will help in the control of hypertension?||No||109||26.6|
Table 3, shows the frequency and percentage of the responses of hypertensive patients towards attitude based questions.
TABLE 4: RESPONSES OF PRACTICE-BASED QUESTIONS
|Are you going for a regular checkup?||No||97||23.7|
|Are you following a healthy diet?||No||187||45.6|
|Did you ever experience any side effects of drugs?||No||400||97.56|
|Did you ever take double dose?||No||395||96.34|
|Are you avoiding extra added salt?||No||137||33.4|
|Do you exercise every day?||No||247||60.2|
|Are you taking your drugs regularly?||No||86||21|
Table 4, shows the frequency and percentage of responses of hypertensive patients to practice-based questions.
TABLE 5: ASSOCIATION OF KNOWLEDGE, ATTITUDE, AND PRACTICE SCORES WITH EDUCATIONAL LEVEL
|Graduate||High School or Intermediate||illiterate||Primary School||χ2 Value||P-Value|
*Statistical significance set at 0.05; N: Number of samples; χ2 Value: Chi-square Value.
Interpretation: Chi-square analysis exhibits a statistically significant adequate knowledge score among Graduates (60.5%) and found to be poor knowledge score among illiterates (33.3%) when compared to the subjects with other educational qualifications (χ2(6)= 47.67; P=0.001). The statistics displayed no statistically significant association of educational levels with attitude (χ2(6)= 12.58; P=0.05) and Practice scores (χ2(6)= 8.83; P=0.183).
FIG. 1: ASSOCIATION OF KNOWLEDGE WITH EDUCATIONAL LEVEL
Fig. 1 shows that hypertensive patients with high school level of education had adequate knowledge towards hypertension, hypertensive patients with primary education had moderate knowledge towards hypertension and illiterate hypertensive patients had poor knowledge towards hypertension.
DISCUSSION: A total of 410 hypertensive patients participated in this study. We assessed the socio-demographic factors such as age, sex, family history, duration of hypertension, marital status, diet, social habits, and education status in the hypertensive patients of the medicine unit in AH & RC.
Age: In this study, 48% (197) were aged between 46-60 years.
Gender: 53.4% (219) were males and 46.6% (191) were females. In a study conducted by Manasa Bollampally, 52.5% were males, and 47.5% were females 3.
Family History of Hypertension: 78.8% (323) patients did not have a family history of hypertension and only 87(21.1%) patients had a family history of hypertension. A study conducted at china by Miao Liu revealed that 53% of the total participants were having a family history of hypertension 26.
Hypertension Duration: 44.6% (183) of patients had hypertension for <5 years, followed by 38% (156) with 5-9 years and 12.2% (50) with 10-14 years and 5.1% (21) with ≥15 years.
Diet: We found that 77.1% (316) participants were following mixed diet and 22.9% (94) were vegetarians.
Occupation: In our study, 39% (158) were housewives, 31% (128) were farmers, 17% (69) were business men and others were 13% (55). In a study conducted at North Ethiopia by AH Jufar found that 28.22% of total participants were housewives, 6.74% were farmers, 13.49% were businessmen and others were 51.53% 27. Large number of the participants in this study were farmers because our study site is located in a remote area.
Social History: 65.4% (268) of the participants were not having any social habits such as smoking and alcohol consumption, 12.9% (53) were smokers, 49 (12%) were both smokers and alcoholics and 39 (9.5%) participants were only smokers. In a study conducted by AH Jufar in North Ethiopia found that 80% were non-smokers and 78.4% were non-alcoholic, 20% were smokers, 21.6% were alcoholics 27.
Medication Compliance: 85.5% (352) were taking their hypertensive medication regularly. In a study conducted by Manasa Bollampally at Telangana in India, 64.38% of the total participants were taking their medications regularly 3.
Education Level: Education was one of the major factors which influenced the knowledge level in the hypertensive patients, patients with primary education were 34.1% (140), high school education was 31.7% (130), graduates were 9.3% (38), and illiterates were 24.9% (102). A study conducted by Ayushi Jayeish Shah at Mumbai found that most participants were illiterate 80.5%, Patients with primary education were 66.2%, and patients with secondary-Higher education were 70.7% 28.
Knowledge Level: 87.6% (359) were aware of the definition of hypertension, 71.2% (292) were aware of its symptoms, 62.9% (258) had no idea whether smoking or drinking alcohol caused high blood pressure, 52.9% (217) thought hypertension is not dangerous, and obesity is linked to hypertension, though 46.8% (192) unaware of this. This finding was similar to the previous study conducted by Manasa Bollampally 3.
Attitude Level: 92.7% (380) of the total participants think that regular medication will improve their BP level, 74.1%(304) think that diet control will improve their BP level, 73.4% (301) think that physical activity will help in the control of hypertension and 68% (279) think medication alone cannot control hypertension.
Practice Level: Most of the participants i.e., 76.3% (313) were going for their regular BP checkup, 97.56% (400) did not experience any side effects of drugs, 96.34% (395) never taken double dose, 66.6% (273) were avoiding extra added salt, 60.2% (247) were not doing exercise every day. 54.4% (223) were following a healthy diet in our study. This finding was similar to the previous study conducted by Manasa Bollampally 3.
Overall Knowledge Level: knowledge of the hypertensive patients was graded as (<5) poor, (5-7) Moderate, and (>7) adequate, and 55% (227) had a moderate level of knowledge, 23% (92) had poor level of knowledge and 22% (91) had adequate knowledge. In a study conducted by Manasa Bollampally at Telangana noticed that 47.5% were found with poor knowledge levels and 52.2% with good knowledge level towards hypertension 3.
Overall Attitude Level: Attitude level was graded as (<3) poor, (3-5) moderate and (5) Adequate. 55% (226) had a moderate attitude level, 28% (115) had adequate attitude level and 17% (69) had poor attitude level towards hypertension. In a study conducted by Manasa Bollamapally at Telangana, 46.25% and 53.75% of the total participants were found with poor attitude levels and a good attitudes, respectively 3.
Overall Practice Level: Practice level was graded as (≤3) Poor and (≥4) Adequate. 78% (319) had adequate practice level and 22% (91) had poor practice level towards hypertension. In a study conducted by Manasa Bollamapally at Telangana, 58.75% had poor practice and 41.25% had good practice towards hypertension 3. We noticed that majority of the participants had good knowledge, attitude and practice towards hypertension compared to the study conducted by Manasa Bollampally at Telangana.
Association of Education Level of Hypertensive Patients with Their KAP Level: We noticed that most of the participants had adequate knowledge of hypertension because of their good literacy level. Few of them had poor knowledge of hypertension because of poor literacy level. Thus, the literacy level of patients was found to be one of the key factors influencing their knowledge level.
Out of 410 hypertensive patients, 73.44 % had a positive attitude toward hypertension, and only 26.56% had a negative attitude. Both literate and illiterate hypertensive patients had a positive attitude about hypertension, regardless of their educational level. Because the attitude of hypertensive patients was mostly influenced by their concern and awareness about their health and their level of adherence to the recommendations offered by their physicians, rather than their educational level in our study.
We noticed that the education level of hypertensive patients mainly influenced their knowledge level. There was a significant relationship between the education level and knowledge in the hypertensive patients because of a significant difference in the knowledge scores between illiterates and literates. Hypertensive patient’s education levels have little impact on their attitudes and practices. Hence, both literates and illiterates had a positive attitude and adequate practice regarding hypertension.
We noticed that the patients were knowledgeable about hypertension in general but were less knowledgeable about specific factors related to their condition, their own level of BP control, hypertension risk factors, and its complications. This finding was similar to the study conducted by Olivera 29. Our findings indicate that patients require assistance and direction to improve their disease management. Thus, health care professionals can significantly enhance patient understanding and adherence through patient education regarding diet, exercise, proper medication use, complications, and risk factors associated with hypertension.
CONCLUSION: Patients had adequate knowledge about diet control, physical activity, and regular medication use but poor knowledge about normal BP level, symptoms, risk factors, and complications of hypertension. Hence, this study signifies that patients require support and guidance from health care professionals to improve their knowledge of hypertension. In the future, this research can also assist clinical pharmacists in conducting health-care programs and educational programs in hospitals to educate hypertensive patients about their disease by increasing their knowledge, attitude, and practice. We conclude that this study serves to improve the knowledge and quality of life among hypertensive patients.
ACKNOWLEDGMENT: The authors appreciate Sri Adichunchanagiri College of Pharmacy of Adichunchanagiri University, B. G. Nagar, Mandya, for providing the facilities and services required to complete the study.
CONFLICTS OF INTEREST: None declared
- World Health Organization. International Society of hypertension writing group: 2003 world health organization (WHO)/International society of hypertension (ISH) statement on managementof hypertension. Jhypertens 2003; 21: 1983-92.
- Sadeq R & Lafta R: Knowledge, attitude and practice about hypertension in hypertensive patients attending hospitals in Baghdad, Iraq. South East Asia Journal of Public Health 2017; 7(1): 29-34.
- Bollampally M, Chandershekhar P, Kumar K, Surakasula A, Srikanth S and Reddy T: Assessment of patient’s knowledge, attitude and practice regarding hypertension. Int J Res xMed Sci 2016; 4(6): 3299-04.
- Das AK, Lahiri G, Bose A and Sarkar DK: Assessment of patients’ knowledge, attitude and practice regarding hypertension in a tertiary care hospital. Int J Community Med Public Health 2020; 7: 4967-73.
- Rashidi Y, Manaflouyan H, Azar FP, Nikniaz Z, Nikniaz L and Ghaffari S: Knowledge, attitude and practice of Iranian hypertensive patients regarding hypertension. J of Cardiovascular and Thoracic Research 2018; 10(1): 14.
- Wexler R and Aukerman G: Nonpharmacologic strategies for managing hypertension. Am Fam Physician 2006; 73(11): 1953-6. PMID: 16770925.
- Fryar CD, Ostchega Y, Hales CM, Zhang G and Kruszon-Moran D: Hypertension prevalence and control among adults: United States 2015-2016.
- Ghosh S, Kumar M. Prevalence and associated risk factors of hypertension among persons aged 15–49 in India: a cross-sectional study. BMJ Open 2019; 9(12): 029714.
- Ranasinghe P, Cooray DN, Jayawardena R and Katulanda P: The influence of family history of hypertension on disease prevalence and associated metabolic risk factors among Sri Lankan adults. BMC Public Health 2015; 15(1): 1-9.
- Jena SK and Purohit KC: Smoking status and its effect on blood pressure: A study on medical students. Chrismed Journal of Healtvbh and Research 2017; 4(1): 14.
- Jena SK and Purohit KC: Smoking status and its effect on blood pressure: A study on medical students. Chrismed Journal of Health and Research 2017; 4(1): 14.
- Bashaar M, Saleem F and Thawani V: Evaluation of hypertension related knowledge, attitudes and practices at community level in Kabul. Pharm Pharmacol Int J 2019; 7(3): 106‒112. DOI: 10.15406/ppij.2019.07.00239.
- Parmar P, Rathod GB, Rathod S, Goyal R, Aggarwal S and Parikh A: Study of knowledge, attitude and practice of general population of Gandhinagar towards hypertension. International Journal of Current Microbiology and Applied Sciences 2014; 3(8): 680-5.
- Rajan J, Sakthibalan M, Raj GM and Mangaiarkkarasi A: Knowledge, attitude and practice of hypertension among hypertensive patients in a tertiary care teaching hospital. Int J Basic Clin Pharmacol 2019; 8(5): 1013-8.
- Sabouhi F, Babaee S, Naji H and Zadeh AH: Knowledge, awareness, attitudes and practice about hypertension in hypertensive patients referring to public health care centers in Khoor & Biabanak. Iranian Journal of Nursing and Midwifery Research 2011; 16(1): 34.
- Aubert L, Bovet P, Gervasoni JP, Rwebogora A, Waeber B and Paccaud F: Knowledge, attitudes and practices on hypertension in a country in epidemiological transition. Hypertension 1998; 31(5): 1136-45.
- Buang NF, Rahman NA and Haque M: Knowledge, attitude and practice regarding hypertension among residents in a housing area in Selangor, Malaysia. Medicine and Pharmacy Reports 2019; 92(2): 145.
- Maruf FA, Ojukwu CC and Akindele MO: Perception, knowledge and attitude toward physical activity behaviour: implications for participation among individuals with essential hypertension. High Blood Pressure & Cardiovascular Prevention 2018; 25(1): 53-60.
- Patnaik L, Paul KK, Pattnaik S and Sahu T: Lifestyle pattern and hypertension related knowledge, attitude and practices among diagnosed patients of hypertension attending a tertiary care hospital. Journal of Cardiovascular Disease Research 2017; 8(4).
- Kilic M, Uzunçakmak T and Ede H: The effect of knowledge about hypertension on the control of high blood pressure. International Journal of the Cardiovascular Academy 2016; 2(1): 27-32.
- Zinat Motlagh SF, Chaman R, Ghafari SR, Parisay Z, Golabi MR, Eslami AA and Babouei A: Knowledge, treatment, control and risk factors for hypertension among adults in Southern Iran. International Journal of Hypertension 2015; 2015.
- Almas A, Godil SS, Lalani S, Samani ZA and Khan AH: Good knowledge about hypertension is linked to better control of hypertension; a multicentre cross sectional study in Karachi, Pakistan. BMC Research Notes 2012; 5(1): 1-8.
- Patil VN, Sangeeta D, Sagar K, Pandit PT and Ghongane BB: Survey of knowledge and awareness in patients of hypertension and survey of information that patients receive from physician for hypertension in a tertiary care hospital. WJPPS 2015; 4: 980-1.
- Ralapanawa U, Bopeththa K, Wickramasurendra N and Tennakoon S: Hypertension Knowledge, Attitude, and Practice in Adult Hypertensive Patients at a Tertiary Care Hospital in Sri Lanka. International Journal of Hypertension 2020; 2020.
- Malik A, Yoshida Y, Erkin T, Salim D, Hamajima N. Hypertension-related knowledge, practice and drug adherence among inpatients of a hospital in Samarkand, Uzbekistan. Nagoya Journal of Medical Science 2014; 76(3-4): 255.
- Liu M, He Y, Jiang B, Wang J, Wu L, Wang Y, Zhang D, Zeng J and Yao Y: Association between family history and hypertension among Chinese elderly. Medicine 2015; 94(48).
- Jufar AH, Nuguse FG and Misgna HG: Assessment of health related quality of life and associated factors among hypertensive patients on treatment at public hospitals in Mekelle, North Ethiopia. J Hypert 2017; 6(239): 2167-95.
- Shah AJ, Singh V, Patil SP, Gadkari MR, Ramchandani V and Doshi KJ: Factors affecting compliance to antihypertensive treatment among adults in a tertiary care hospital in Mumbai. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine 2018; 43(1): 53.
- Oliveria SA, Chen RS, McCarthy BD, Davis CC and Hill MN: Hypertension knowledge, awareness, and attitudes in a hypertensive population. Journal of General Internal Medicine 2005; 20(3): 219-25.
How to cite this article:
Kumaraswamy M, Samraksha M, Meghana MN and Sandeep SK: Assessment of knowledge, attitude and practice in hypertensive patients in a tertiary care teaching Hospital. Int J Pharm Sci & Res 2022; 13(9):3778-85. doi: 10.13040/IJPSR.0975-8232.13(9). 3778-85.
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M. Kumaraswamy, M. Samraksha, M. N. Meghana * and S. K. Sandeep
Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India.
21 January 2022
06 April 2022
28 April 2022
01 September 2022