Illness Perception and therapeutic regimen adherence
CHAPTER I
THE PROBLEM AND ITS SCOPE
INTRODUCTION
The world is laden with different kinds of sickness and diseases nowadays; these conditions originate from sources easily prevented or if not controlled by proper management and control. Hypertension is well-recognized as one of the leading risk factors for coronary heart diseases. (Roger Harms K. B., June 29, 2012) There are around 970 million people worldwide who have high blood pressure; approximately 330 million from developed countries and 640 million from developing countries. (Kearney et al., 2005) The number is expected to increase to 1.56 billion people by the year 2025; this translates to about 1 out of every 4 adults being afflicted with hypertension. (Ting Choon Meng H. T., January 16, 2005) It is prevalent in developing as well as in developed countries. (Ting Choon Meng H. T., January 16, 2005) A study found out that around 900 million people in developing countries have high blood pressure but that only one-third are aware of their disease. Moreover, only 100 million of these people receive treatment, while only 5 per cent of the total is controlled. However, hypertension control was reported only in 31% of individuals diagnosed with hypertension, one such reason is that it is also referred to as the “silent killer” because of it being asymptomatic. In fact it is very common in the Philippines where it affects around 10.5 million Filipinos. 25% of this figure is unaware that they have the condition and adherence to treatment is around 50-70%, 13% of this is only controlled over the last three decade. (World Health Organization, 2003)
A number of effective medications have been discovered, developed, and improved for the treatment of hypertension. Medication adherence is crucial to hypertension control and has generally been defined as consumption of 80% of the prescribed antihypertensive medication. (Benson, June 13, 2012) Only 50% of people with hypertension regularly follow advice of their physicians concerning drug therapy, and dietary regimens. (World Health Organization, 2003) Stopping medications and treatment can cause the blood pressure to rise even higher than before, and when left uncontrolled, hypertension can lead to serious cardiovascular problems such as stroke, heart attack, heart failure, heart rhythm irregularities, and kidney failure. Thus, failure of adherence will result to an absence of compelling reason to persistently take medication. This aspect of condition contributes further challenges related to the perceptions of clients about hypertension.
There is a varying degree on how a patient views their illness, the topic is very diverse and unique to each patient that a variety of factors come together to influence the course of the illness, these may be: additional medical conditions, stress levels, and social support which all have an impact on health and well-being, especially when ill. Recent studies have suggested that people 's illness perceptions bear a direct relationship to several important health outcomes, including their level of functioning and ability, utilization of health care, adherence to treatment plans laid out by health care professionals, and even overall mortality as seen on the February 2012 issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science, Keith Petrie, of the University of Auckland, and John Weinman, of the Institute of Psychiatry at King 's College. Even though some patients may agree that the nature of hypertension is asymptomatic, they will predict their blood pressure by symptom presentations. There is still a spectrum of unstudied outlook toward their current condition waiting to be further understood. Studies have concluded that those patients that view their condition as a bother or they sometimes refer to it as “high-pertension” were less compliant with their treatment and had a lower blood pressure control rate, also those with three or more problems (such as symptoms and interference with daily routines) were five times more likely to have modified their dosage instructions than those without problems, it could be said that the more the patient feels his current condition as “inconvenient” the more likely he is to not adhere properly to the medication regimen properly prescribed. Heurtin-Roberts and Reisin (1992);Enlund et al. (2001).
This phenomenon is steadily growing and is consistently prevalent in the Philippines, affecting 1 out of 4 Filipinos (Department of Health, 2010), the researchers took it upon themselves to conduct a study addressing this circumstance. The researchers would like to find out what specific factors contribute to this occurrence and subsequently their compliance to their medications. And to answer as to why exploring patient’s illness perceptions, can be a crucial component of good clinical care.
CONCEPTUAL FRAMEWORK This study would make use of this conceptual framework.
Figure 1. Conceptual Framework
The independent variable of the study is the Illness Perception. According to the Common Sense Model, patients taking actions to reduce these health risks are guided by their subjective or common sense perceptions of the illness. These are form based on their reactions to external and internal stimuli through two parallel pathways: cognitive and emotional representations. (Leventhal et al., 2003) The Illness Perception is dependent to the Adherence to prescribed medication and Self-management requirement.
The researchers wanted to find out what variables affect the illness perception of hypertensive patients towards their adherence to their therapeutic regimen and self-management requirement. The researchers included possible intervening variables: Age, Gender, Average BP, Number of hypertension drugs, Co-morbidity and Number of years suffering from hypertension.
STATEMENT OF THE PROBLEM This study is limited to identify the illness perception of hypertensive patients and determine their level of adherence to prescribed medications and self-management regimen. Furthermore, this study specifically aimed to answer the following problems:
1. What is the status of the respondents in terms of:
a. Age
b. BP
c. Number of HTN drugs
d. Co-morbidity
e. Gender:
f. Number of years suffering
2. What is the status of the respondents in terms of the illness perception of hypertensive patients?
3. What is the status of the respondents in terms of:
a. Adherence to prescribed medication
b. Self-management recommendation
4. Is there a significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, and number of years suffering) to the independent variable (Illness perception)? Use
5. Is there a significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, number of years suffering) to the dependent variables (adherence to prescribed medication and self-management recommendation)?
6. Is there a significant relationship between the independent variable (illness perception) to the dependent variables (adherence to prescribed medication and self-management recommendation)?
HYPOTHESIS
This study made use of null hypothesis at 0.05 level of significance.
Ho1. There is no significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, and number of years suffering) to the independent variable (illness perception).
Ho2. There is no significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, number of years suffering) to the dependent variables (adherence to prescribed medication and self-management recommendation).
Ho3. There is no significant relationship between the independent variable (illness perception) to the dependent variables (adherence to prescribed medication and self-management recommendation).
SIGNIFICANCE OF THE STUDY This study endeavors to know illness perceptions and adherence to therapeutic regimens among patients in GTLMH with hypertension in Iligan City.
To Hospital Administrators of GTLMH. This study will help the hospital administrators of GTLMH to be aware of the current situation and the figures of the patient’s illness perception and their therapeutic regimen. By knowing these, the hospital administrators will be able to devise a plan of action addressed to the situation and to develop ways on how to enhance these plans/programs.
Department of Health, City Health Office. This study will serve as an insight for the improvement of patients with hypertension by adhering to therapeutic regimens and have a positive perception about self here in the Philippines specifically in Iligan City. As we all know, it is better to prevent disease than having it already and find ways to cure it. The Department of Health has a number of programs in relation to hypertension like the Cardiovascular Disease Program and the Healthy Lifestyle Program. With this, the government together with the DOH will be aware and be given priority by enhancing these programs and put these programs into action to promote healthy lifestyle in the Philippines especially to the patients with hypertension.
Community. This study will be able to benefit the community by its results and to make them be aware of the current situation when it comes to the therapeutic regimen of hypertensive patients. This will also help them understand how the perception of these hypertensive patients towards their illness affect their adherence to its therapeutic regimen.
College of Nursing
Faculty. Nurse Educators will be able to impart and emphasize to the students the essence of the patient’s perception towards their illness. Nurse Educators also serve as a reference by doing counseling to the patients with hypertension to be aware of what should be done and what should not be done. They are also the one who will educate the student nurses through theories and teach the prevention and control of the disease to be aware on what to do and how to handle patients with hypertension especially in the clinical setting.
Students. Aside from knowing the pathophysiology of the disease, this study will help the students know and consider the psychological aspect in terms of caring for their patients.
Future Researchers. The results of this study will be of great help to researchers who plans to conduct a related or follow up study. They may conduct it to a more specific group of people (e.g., ethnic group or culture) and make correlations in between groups. Moreover, they may also expand the scope of their study such as including respondents who are visiting private hospitals and clinics.
SCOPE AND DELIMITATIONS This study is limited to identify the illness perception of hypertensive patients and determine their level of adherence to prescribed medications and self-management regimen. This will focus on the level of adherence and self-management to therapeutic regimen of 100 hypertensive patients with regards to their illness perception in the outpatient department of GTLMH. The respondents would be patients from the Out-Patient Department (OPD) of Gregorio T. Lluch Memorial Hospital (GTLMH), who are coming over for a clinic visit. They must have a hospital record and has been visiting the OPD for at least once in 6 months. The respondents’ diagnosis of hypertension is not limited to being diagnosed at GTLMH. The demographic profile of the respondents would include age, gender, average BP, number of hypertensive drugs, co-morbidity, and number of years suffering from hypertension. This is regardless of how long the respondents have been diagnosed with Hypertension.
A total of 100 OPD patients will serve as respondents to the study.
This is a cross-sectional study of a convenience sample drawn from the patients with hypertension in GTLMH.
DEFINITION OF TERMS The following terms were defined operationally to project the functional meaning of the words for the purpose of clarity and ease of comprehension.
Adherence. The obedience of the respondents to medical advice or prescriptions of the doctors.
Age – The length of time that a respondent has lived from the time of birth up to the present. Average BP – this is the usual BP of the respondents according to the respondents’ chart.
Co-Morbidity – The presence of two or more coexisting medical conditions or disease processes that are additional to an initial diagnosis. (Elsevier, 2009).
Gender – The status of a respondent whether male or female.
Hypertension – This is defined as a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts with the health care provides (Brunner and Suddarth’s Medical Surgical Nursing, 10th Edition)
Illness Perception – The status of how a respondent interprets or understands his or her condition.
Maintenance Drugs – These are drugs being maintained by the respondents as prescribed by their respective physicians.
Number of years suffering from hypertension – the number of years a respondent is suffering from hypertension from the time he or she was diagnosed up to the present.
Self-Management Requirement – These are the set of interventions and skills followed by a respondent to manage his or her disease as recommended by his or her physician or from other sources of information (e.g., television, journals)
Therapeutic Regimen – The systematic plan for treating, healing or curing of Hypertension.
CHAPTER II
REVIEW OF RELATED LITERATURE
In this chapter the researchers will talk about hypertension and its cause and how it could affect the clients who are experiencing this kind of illness. This study will tackle about the perceptions of hypertensive clients about their illness and how they would manage to their prescribed regimens and medications, and with the studies of some published researches relating to the variables that may cause hypertension.
Related Literature Hypertension is a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts with the health care provider (Smeltzer et al., 2010). It is also known as high blood pressure and is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements the systolic and diastolic, which depends on whether the heart muscle is contracting or relaxed between beats. According to a study in Harvard School of public health (HSPH), high blood pressure, as well as smoking are the leading preventable risk factors for premature mortality in the United States. (Mozafarrian et al., 2009). Researchers found out that premature deaths each year for high blood pressure is 395,000. (Mozafarrian et al., 2009).
A new study says hypertension ranks among the nation 's leading causes of death, spurred largely by economic barriers to blood pressure medication, excessive sodium intake and inadequate consumption of potassium (Moyer 2010). There are lots of risk factors that could contribute to high blood pressure. One of this is age. Age is considered as a risk factor because it increases the blood pressure when you reach a higher age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause. And second is race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications are more common in blacks. Third is not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with contraction – and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight. Fourth is smoking. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of the artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke can also increase your blood pressure. These are some of the common risk factors that could cause hypertension. Though it has been proven that hypertension cannot be cured but it can be treated and managed effectively, a healthy lifestyle includes eating a low-fat, low-salt diet rich in vegetables and fruits, engaging in regular physical activity, maintaining optimal weight, not smoking, and limiting alcohol intake (Ona 2011). According to (Smeltzer et al., 2010) hypertension is more prone to men with the age above 60 years old and postmenopausal women and with family history of cardiovascular disease (in female relative younger than 65 years of age or male relative younger than 55 years). If left untreated, it may indicate vascular damage vascular damage, with specific manifestations related to the organs served by the involved vessels. Coronary Artery Disease (CAD) with angina or myocardial infarction (MI) is a common consequence of hypertension. Left ventricular hypertrophy occurs in response to the increased workload placed on the ventricle as it contracts against higher systemic pressure. When heart damage is extensive, heart failures ensues (Smeltzer et al., 2010).
The goal of hypertension treatment is to prevent death and complications by achieving and maintaining the arterial blood pressure below 140/90 mm Hg (Smeltzer et al., 2010). Research findings demonstrate that weight loss, reduced alcohol and sodium intake, and regular exercise are effective lifestyle adaptations to reduce blood pressure (Mayo Clinic, 2012). The client needs to understand the disease process and how lifestyle changes and adherence to medication can help control hypertension. The healthcare provider can encourage clients to consult dieticians to help develop a plan for weight loss like restricting sodium and fat intake which could worsen the client’s condition. The patient should be advised to limit intake, and tobacco should be avoided-not because smoking is related to hypertension, but because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies the risk. It can be beneficial to clients who have support groups for weight control, smoking cessation, and stress reduction. If the client is asked to participate in blood pressure screening, accurate measurement of blood pressure is critical for making appropriate clinical decisions in management of high blood pressure to reduce cardiovascular risk and prevent target organ damage. An inaccurate measurement of blood pressure could lead to a patient being falsely classified as hypertensive or falsely classified as having high normal or normal blood pressure as well as lead to faulty clinical decisions regarding patient progression in an exercise program. For clients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medications include diuretics, beta-blockers, or both. Patients are first given a minimal amount of doses of medication and if hypertension does not fall less than 140/90 mm Hg, the dose is increase gradually and additional medications are added to achieve control. To promote compliance, clinicians try to prescribe the simplest treatment schedule possible, ideally one pill once each day (Smeltzer et al., 2010). The major goals for the clients include understanding of the disease process and its treatment, compliance to medications, and absence of complications.
Related Studies
Here, are some of studies from local and foreign researchers which is very helpful and essential from this study. Most of the studies focus on adherence to treatment regimens, beliefs of the clients having hypertension, illness perception of clients having hypertension and therapeutic noncompliance over the years.
Studies local and abroad have shown that illness perception of patients have a direct link on the therapeutic regimen adherence of these hypertensive people, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors (Martin et al., 2005). Another study shows that it was found out that most hypertensive patients had misunderstanding about the causes, symptoms and self-care behaviour to prevent other related disease, including their dietary control (Chen et al., 2009). For positive and effective change in the health behaviours of the clients having hypertension, there is a need for new strategies that allows the clients to take care of themselves. In relation to our study, the Common Sense Model (CSM) of illness self-regulation (Leventhal et al., 1984) suggests that beliefs about illness have five core dimensions: cause, identity, perceived control, severity of illness consequences, and time line. Subsequent research has integrated further dimensions including illness coherence – a belief that the illness ‘makes sense’ – to this core set of illness beliefs (Moss-Morris, et al., 2002). The Common Sense Model foresees that illness perceptions will motivates emotional outcomes such as illness-related distress (Hagger et al., 2003). Client does not view it as a degenerative process of damage to the vascular system, but rather as a binary risk process, within which either you can be a winner by simply being not ill or a loser. This makes non-adherence to treatment a gamble with a potential positive outcome (Anthony et al., 2012). The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. . The relationships were independent of systolic blood pressure, age, the total number of antihypertensive medication, and comorbidity (Chen et, al. 2009). In addition to that it has also been found out that factors that affect the patients ' adherence to prescribed medications and self-management recommendations differ greatly. Despite its subjectivity, identity showed significantly predictive effects on adherence to self-management. Understanding patients ' lay views on hypertension allows health professionals to provide effective care for better adherence to therapeutic regimens (Chen et, al. 2009). A study conducted by Dela Cruz et al., 2008 studied that patient’s beliefs regarding their illness influence their adherence on a major way on a study conducted to Filipino-Americans with hypertension regarding their illness beliefs, perceptions and practice, corresponds to the biochemical model in relation to causes, consequences and treatment of it. The study of Taddeo et, al. 2008 indicated that there is a high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors to consider in teens are their developmental stage and challenges, emotional issues and family dysfunction. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact oncompliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory (Jin et, al. 2008). On a study conducted in by (Ross S, et al. 2004) “Analysis shows that patients who believe in the necessity of medication are more likely to be compliant. Beliefs about illness and about medicines are interconnected; aspects that are not directly related to compliance influence it indirectly. Beliefs about specific medications and about hypertension are predictive of compliance. Information about health beliefs is important in achieving concordance and may be a target for intervention to improve compliance”. Control of the disease exhibited direct effects on adherence to prescribed medications and self-management, while the cause of the illness only showed direct effects on adherence to prescribed medications.
CHAPTER III
METHODOLOGY
This chapter describes the methodology that was used in the study. It specifically describes the research design, the respondents and sampling procedure, the instruments that were used, the data gathering procedure, and the statistical tools.
RESEARCH DESIGN A cross-sectional, descriptive, quantitative research design will be used in the study. Cross-sectional studies form a class of research methods that involves observation of all of a population, or a representative subset, at one specific point in time. A descriptive study establishes only associations between variables. In quantitative research your aim is to determine the relationship between one thing (an independent variable) and another (a dependent variable) in a population. This type of research design is chosen to facilitate in answering the statement of the problem, particularly to determine the illness perception and adherence to therapeutic regimen among hypertensive patients in Gregorio T. Lluch Memorial Hospital (GTLMH).
RESEARCH LOCALE The study will be conducted at Gregorio T. Lluch Memorial Hospital.
Figure 2. Map of Gregorio T. Lluch Memorial Hospital
GTLMH is the only public hospital in Iligan City that would not only cater patients within the city but also nearby towns of Lanao del Norte and Misamis Oriental. It has an 80 bed capacity. The OPD is divided into 5 areas: Pediatrics, Medicine, Surgery, Dental and OB-GYNE clinics. The OPD caters 30 patients per day and follows a first – come, first - serve basis.
RESPONDENTS and SAMPLING METHOD The respondents of the study would consist of 100 hypertensive patients of GTLMH who frequently visit the OPD for check-up. The total number of respondents is identified using the Slovin’s formula. n = N / (1 + Ne^2) n = Number of samples
N = Total population e = Error tolerance n = 30 / (1 + [30*0.05]^2) n= 30 / (1 + 2.25) n= 9.230769231 ~ 10
10 respondents The respondents of this study will be limited only to patients diagnosed with hypertension, is currently taking prescribed maintenance drug(s) and has a record at OPD of GTLMH. The respondents will be chosen using a simple random sampling.
DATA GATHERING AND PROCEDURE A letter of consent to conduct the study will be given to the Chief of Hospital of GTLMH for approval. Upon approval, another letter of consent will be given to the head of the OPD with the approved letter from the Chief of Hospital serving as an attachment. Once approved, respondents would then be identified using random sampling method, and be given a letter of consent to participate in the study. The respondents can accept or refuse to participate in the study. The researchers will explain what the study will be about, including its significance and benefits. The respondents will be assured that whatever information they will provide will remain confidential in order to protect their identity. Data gathering will start after the acceptance of this proposal. It would be conducted on the 11th of September up to the 15th of September, during OPD hours.
RESEARCH INSTRUMENT The questionnaire is divided into 3 sections: Part 1 would be the Demographic Profile, Part II the Illness Perception Questionnaire-Revised (IPQ-R), and Part III the Drug Attitude Inventory (DAI) The Demographic Profile of the respondents would include their age, gender, average BP, number of hypertensive drugs maintained, co-morbidity, and the number of years suffering from hypertension. For Part II, to know how the respondents perceived their illness, this study will make use of the Illness Perception Questionnaire-Revised by Moss-Morr et al., (2002). The IPQ-R comprises of three components: illness representations, causes and identity. The illness representations consist of 32 items on seven subscales: timeline, timeline – cyclical, consequences, treatment control, personal control, coherence, and emotional representations. The items will be scored as follows: 1 – Strongly Disagree (Strongly unfavorable to the concept) 2 – Disagree (Somewhat unfavorable to the concept) 3 – Neither Agree nor Disagree (Undecided) 4 – Agree (Somewhat favorable to the concept) 5 – Strongly Agree (Strongly favorable to the concept) A higher score reflects a stronger belief in a specific dimension. The cause component is composed of 18 questions on four subscales: psychology, risk factor, balance, and cultural attribution. This component is used to inquire about the respondents’ attributions about their illness. The items will be scored as follows: 1 – Strongly Disagree (Strongly unfavorable to the concept) 2 – Disagree (Somewhat unfavorable to the concept) 3 – Neither Agree nor Disagree (Undecided) 4 – Agree (Somewhat favorable to the concept) 5 – Strongly Agree (Strongly favorable to the concept) A higher score reflects a stronger belief of the causal attribution of the illness. Illness identity of the IPQ-R consists of 3 sets of items: Symptom Score (symptoms that patients identified as related to hypertension), Symptom Occasions (symptoms experienced before and after the hypertension diagnosis), and Blood Pressure Prediction (symptoms used for BP prediction). The symptom score will be obtained by asking the respondents to rate 30 symptoms with Yes or No dichotomous responses. Only those symptoms identified by the patients as being hypertension – related will be counted in the symptom score. The symptom occasion will be assessed by asking the respondents if they have experienced symptoms before and after they were diagnosed with hypertension. The blood pressure prediction on the other hand will be obtained by asking the respondents if they can predict their blood pressure by presenting the symptoms. This will be rated using an ordinal response scale of Yes, Uncertain, or No. The total number of symptoms that will be used for blood prediction will also be counted. Mean score of each of the three components will be computed individually.
Another questionnaire that will be use in our study is the Drug Attitude Inventory. This questionnaire includes a series of questions, each with True or False answers, pertaining to various aspects of the patient’s perceptions and experiences of treatment. The original scale consists of 30 questions but a simplified form consisting of 10 questions has been validated.
Lastly, the DAI-10 contains six items (Questions 1, 3, 4, 7, 9, 10) that a patient who is fully adherent to prescribed medication would answer as ‘True’, and four items (Questions 2, 5, 6, 8) they would rate as ‘False’.
True answers are scored as +1; False answers are scored as -1. The sets of questionnaires will be developed in the Visayan dialect for an easy and proper understanding on the part of the respondents.
STATISTICAL TOOLS TO BE USED For problem 1 (for variables a, b, c, d, and f), the researchers will be using the descriptive statistical tool, mean, coefficient of variation, and percentage. The descriptive statistical tool is used to describe the patterns and general trends in the data set. This will be used to examine or explore one variable at a time. However, the relationship between two variables can also be prescribed as with correlation and regression. The tools of descriptive statistics include measurement data frequencies and means by using cross tabulations and graphs. The mean is used to acquire the average values, and/or distribution. The coefficient of variation is used to compare the degree of variation from one data series to another. Percentage is used to express how large/small one quantity is, relative to another quantity. For variable e, the researchers will also use the percentage statistical tool. For problems 2 and 3, the researchers will use the mean to acquire the average values, coefficient of variation to compare the degree of variation from one data series to another, and percentage to express how large/small one quantity is, relative to another quantity.
For problem 4, the researchers will use the Pearson Correlation Coefficient for testing significant relationship and Chi Square Test for Independence for gender and other categorical variables.
For problem 5, the researchers will use the Pearson Correlation Coefficient for testing significant relationship for all variables and Chi Square Test for Independence for gender and other categorical variables.
For problem 6, the Pearson Correlation Coefficient will be used to test the significant relationship. If the results are significant the researchers will apply regression analysis to find the predictors of adherence and self management.
Bibliography
Books
Elsevier. (2009). Mosby 's Medical Dictionary, 8th Edition.
Leventhal H, Brissette I & Leventhal EA (2003) The common sense model of self-regulation of health and illness. In The Self-Regulation of Health and Illness Behaiour (CameronLC & LeventhalH eds). Routledge, Taylor & Francis Book, London, pp.42–65.
Suzanne C. O 'Connell Smeltzer, Brenda G. Bare. Brunner and Suddarth’s Medical Surgical Nursing, 10th Edition.
Journal
Benson, S. (June 13, 2012). Patient Compliance in Hypertension. Patient Compliance in Hypertension .
Roger Harms, Kenneth Berge, Philip Hagen, Scott Litin. (June 29, 2012). Risk Factor. Coronary Artery Disease .
Ting Choon Meng, H. T. (January 16, 2005). Hypertension Statistics. Hypertension Statistics .
Hagger MS & Orbell S (2003) A meta-analytic review of the common-sense model of illness representations. Psychology and Health 18, 141–184.
Hagger MS & Orbell S (2005) A confirmatory factor analysis of the revised illness perception questionnaire (IPQ-R) in a cervical screening context. Psychology and Health 20, 161–173.
Meyer D, Leventhal H & Gutmann M (1985) Common-sense models of illness: the example of hypertension. Health Psychology 4,115–135.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD & Buick D (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 17, 1–16.
Ross S, Walker A & MacLeod MJ (2004) Patient compliance in hypertension: role of illness perceptions and treatment beliefs.Journal of Human Hypertension 18, 607–613.
Mindanao State University
Iligan Institute of Technology
COLLEGE of NURSING
Andres Bonifacio Avenue, 9200 Iligan City Philippines
Telephone No.: (+63) 221-0744
Chief of Hospital:
Greetings! The undersigned are fourth year BS Nursing Graduating Students from Mindanao State University – Iligan Institute of Technology. And part of our curriculum is for us to conduct research studies. In line with this, we would like to ask your permission to allow us to conduct interviews and give questionnaires regarding our study entitled, “Illness Perception and Therapeutic Regimen Adherance among Hypertensive Out-Patients of GTLMH.”
We would like to assure you that whatever data we will gather will be treated with utmost confidentiality and will be used in this study alone.
We are looking forward for your kind approval and participation. Thank you very much and God bless you always.
Respectfully yours,
Gweneth Jill D. Baldado
Researcher
Nodger Jude D. Dalman
Research
Hannah Grace Q. Encabo
Researcher
Noted by:
Khandy Lorraine B. Guerrero
Research Adviser
Vincent G. Tabil
Clinical Coordinator, MSU-IIT CON
Clowe D. Jondonero
Dean, MSU-IIT CON
Mindanao State University
Iligan Institute of Technology
COLLEGE of NURSING
Andres Bonifacio Avenue, 9200 Iligan City Philippines
Telephone No.: (+63) 221-0744
“ILLNESS PERCEPTION AND THERAPEUTIC REGIMEN ADHERENCE AMONG HYPERTENSIVE OPD CLIENTS AT GTLMH”
Name of Principle Investigators: Gweneth Jill D. Baldado Nodjer Jude D. Dalman Hannah Grace Q. Encabo
Name of Organization: Mindanao State University – Iligan Institute of Technology College of Nuring
This Informed Consent Form has two parts:
• Information Sheet (to share information about the study with you)
• Certificate of Consent (for signatures if you choose to participate)
Part I: Information Sheet
Introduction
We are senior student nurses from MSU-IIT College of Nursing. We are doing a research on illness perception and therapeutic regimen adherence among hypertensive OPD clients in GTLMH. We are going to give you information and invite you to be part of this research. You do not have to decide today whether or not you will participate in the research. Before you decide, you can talk to anyone you feel comfortable with about the research.
This consent form may contain words that you do not understand. Please ask us to stop as we go through the information and we will take time to explain. If you have questions later, you can ask them us the researchers.
Purpose of the research
Hypertension is one of the leading causes of death in the Philippines. We want to find out if you are aware of your current condition and how you deal with it. We would also like to know if you understand the effects of the medications that you are taking for your high blood pressure.
Type of Research Intervention
This research will involve your participation in answering a questionnaire that will include the demographic profile, the Illness Perception Questionnaire-Revised (IPQ-R), and the Drug Attitude Inventory (DAI)
Participant Selection
You are being invited to take part in this research because we feel that to get reliable results, we should ask those who have hypertension so that you can relate to our questions.
Voluntary Participation
The choice that you make will have no bearing on your job or on any work-related evaluations or reports. You may change your mind later and stop participating even if you agreed earlier.
Procedures
The researchers will approach you at the OPD and hand you the questionnaire. Fill out a survey which we will provide and collect. You may answer the questionnaire yourself, or it can be read to you and you can say out loud the answer you want me to write down. If you do not wish to answer any of the questions included in the survey, you may skip them and move on to the next question. We will collect the filled out survey in your convenient time or when you will ask us to get them.
Duration
The research takes place over 10 days in total. During that time, we will wait for you to finish and will be available for any inquries.
Risks
There is a risk that you may share some personal or confidential information by chance, or that you may feel uncomfortable talking about some of the topics. However, we do not wish for this to happen. You do not have to answer any question or take part in the survey if you feel the question(s) are too personal or if talking about them makes you uncomfortable.
Benefits
There will be no direct benefit to you, but your participation is likely to help us find out more about the illness perception and therapeutic management of hypertension.
Reimbursements
You will not be provided any incentive to take part in the research.
Confidentiality
The research being done in the hospital may draw attention and if you participate you may be asked questions by other people in the community. We will not be sharing information about you to anyone outside of the research team. The information recorded is confidential, your name is not being included on the forms, only a number will identify you, and no one else except the researchers themselves will have access to your survey.
Right to Refuse or Withdraw
You do not have to take part in this research if you do not wish to do so, and choosing to participate will not affect your job or job-related evaluations in any way. You may stop participating at any time that you wish without your job being affected. We will give you an opportunity at the end to review your remarks, and you can ask to modify or remove portions of those, if you do not agree with the notes or if we did not understand you correctly.
Who to Contact
If you have any questions, you can ask us now or later. If you wish to ask questions later, you may contact any of the following:
Gweneth Jill D. Baldado +639057177953, gwehen@yahoo.com
Nodjer Jude D. Dalman +639059480137, lias_mart@yahoo.com
Hannah Grace Q. Encabo +639177160354 , hannah_encabo@yahoo.com
Part II: Certificate of Consent
I have been invited to participate in research entitled “Illness Perception and Therapeutic Regimen Adherence Among Hypertensive OPD Clients at GTLMH”
I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and any questions I have been asked have been answered to my satisfaction. I consent voluntarily to be a participant in this study.
Print Name of Participant ___________________________________________________
Signature of Participant ___________________________________________________
Date ___________________________ Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the potential participant, and to the best of my ability made sure that the participant understands that the following will be done:
1. A questionnaire will be provided to the subject and he/she will be asked to fill it out.
2. The filled out questionnaire will be collected to which time the subject finds it convenient.
I confirm that the participant was given an opportunity to ask questions about the study, and all the questions asked by the participant have been answered correctly and to the best of my ability. I confirm that the individual has not been coerced into giving consent, and the consent has been given freely and voluntarily. GWENETH JILL D. BALDADO
NODJER JUDE D. DALMAN
HANNAH GRACE Q. ENCABO
Date ___________________________ Day/month/year
Mindanao State University
Iligan Institute of Technology
COLLEGE of NURSING
Andres Bonifacio Avenue, 9200 Iligan City Philippines
Telephone No.: (+63) 221-0744
ILLNESS PERCEPTION AND THERAPEUTIC REGIMEN ADHERANCE AMONG HYPERTENSIVE OPD CLIENTS AT GTLMH
General Instructions: Please write legibly the information needed on the space provided and place a single check mark inside the box.
Part I – DEMOGRAPHIC PROFILE
Name (optional): _____________________________ Age: ___ Gender: ( ) M ( ) F
Address: ___________________________________ Religion: _________
Civil Status: ( ) Single ( ) Married ( ) Separated ( ) Widowed
Average BP: ____________________
Number of Hypertensive drugs maintained:______________________
Other disease/s:_________________________
Number of years suffering from Hypertension:___________________________
Part II - ILLNESS PERCEPTION QUESTIONNAIRE-REVISED BY MOSS-MORR ET AL., (2002)
YOUR VIEWS ABOUT YOUR HIGH BLOOD PRESSURE
We are interested in your views about your high blood pressure.
These are statements other people have made about their high blood pressure. Please show how much you agree or disagree with each of the following statements about your high blood pressure by ticking one of the boxes.
Views about your High blood pressure
Strongly Disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
Having this high blood pressure makes me feel anxious
I expected to have this high blood pressure for the rest of my life
I get depressed when I think about my high blood pressure
I go through cycles in which my blood pressure gets better and worse
My high blood pressure causes difficulties for those who are close to me
My blood pressure has serious financial consequences
I have the power to influence my high blood pressure
My high blood pressure is a serious condition
The course of my high blood pressure depends on me
My high blood pressure is likely to be permanent rather than temporary
My high blood pressure is very unpredictable
Views about your High blood pressure (continued)
Strongly disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
My high blood pressure makes me feel afraid
My high blood pressure makes me feel angry
My high blood pressure strongly affects the ways other see me
My high blood pressure will improve in time
My high blood pressure has major consequences on my life
What I do can determine whether my high blood pressure gets better or worse
My high blood pressure will last for a long time
My treatment can control my high blood pressure
My treatment will be effective in curing my high blood pressure
When I think about my high blood pressure I get upset
I have a clear picture or understanding of my high blood pressure
The negative effects of my high blood pressure can be prevented (avoided) by my treatment
Your views about symptoms you may have experienced
We would like to ask you about any symptoms you may have experienced since finding out about your high blood pressure.
Some people do experience symptoms related to high blood pressure whilst others don’t.
Similarly, some people experience symptoms that are related to their medicines and others don’t.
Here is a list of common symptoms.
Please show whether you have experienced each of the following symptoms recently by circling YES or NO.
For each symptom that you have experienced recently, please then show whether you believe it is related to your HIGH BLOOD PRESSURE or MEDICATION you take for your high blood pressure.
If you don’t know whether the symptom is related to your high blood pressure or the medicine you take for your high blood pressure, please circle Don’t Kn
Symptom
If you have experienced this symptom recently
If answer is yes
This symptom is related to my high blood pressure
This symptom is related to the medicine I take for my high blood pressure
Pain
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Sore throat
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Nausea
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Breathlessness
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Weight Loss
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Fatigue
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Stiff Joints
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Sore eyes
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Wheeziness
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Headaches
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Upset stomach
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Sleep difficulties
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Dizziness
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Loss of strenght
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Loss of libido
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Impotence
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Feeling flushed
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Fast heart rate
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Pins and needles
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Your views about symptoms you may have experienced (continued)
If you have experienced any other symptoms recently that you believed may have been related to your high blood pressure or medicine that you take for your high blood pressure, please write them below.
Please show whether you believe they are related to your high blood pressure or to the medicine you take for your high blood pressure by circling yes, no or don’t know.
Symptom
This symptom is related to my high blood pressure
This symptom is related to the medicine I take for my high blood pressure
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
IF YOU HAVE EXPERIENCED SYMPTOMS THAT YOU THINK ARE RELATED TO YOUR HIGH BLOOD PRESSURE, PLEASE ANSWER THE FOLLOWING QUESTIONS. IF NOT, PLEASE GO ON TO THE NEXT PAGE.
We are interested in your views about your symptoms related to your high blood pressure.
These are statements other people have made about their symptoms.
Please show how much you agree or disagree with them by checking one of the boxes.
VIEWS ABOUT YOUR HIGH BLOOD PRESSURE SYMPTOMS
Strongly disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
There is lot which I can do to control my symptoms
My symptoms come and go in cycles
The symptoms of my high blood pressure change a great deal from day to day
YOUR VIEWS ABOUT CAUSES OF HIGH BLOOD PRESSURE
We are interested in your own views about what causes your high blood pressure.
Below is a list of possible causes.
Please show how much you agree or disagree that they were causes FOR YOU by checking one of the boxes for each possible cause.
As people are very different, there are no correct answers for these questions.
Possible causes of your high blood pressure
Strongly Disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
Stress or worry
Hereditary-it runs through the family
A germ or virus
Diet or eating habits
Chance or bad luck
Poor medical care in my past
Pollution in the environment
My own behavior
My mental attitude e.g. thinking about life negatively
Family problems or worries
Overwork
My emotional state (e.g. feeling down, lonely, anxious, empty)
Ageing
Alcohol
Smoking
Accident or injury
My personality
Poor immune system
In the table below, please list the three most important factors that you believe cause your high blood pressure.
You may use any of the items from the box above, or you may have additional ideas on your own.
If you can’t think of three things that you think caused your high blood pressure, just write one or two.
The most important cause of my high blood pressure for me:
PART III – DRUG ATTITUDE INVENTORY (Hogan et al, 1983)
We are interested in your perceptions and experiences of treatment.
Decide whether you believe it to be True or False as applied to your own experience with medications.
You are asked to read each question carefully and put a checked on the box whether your answer is True or False.
QUESTION
TRUE
FALSE
1
For me, the good things about medication outweigh the bad.
2
I feel strange, "doped up", on medication.
3
I take medications of my own free choice.
4
Medications make me feel more relaxed.
5
Medication makes me feel tired and sluggish.
6
I take medication only when I feel ill.
7
I feel more normal on medication.
8
It is unnatural for my mind and body to be controlled by medications.
My thoughts are clearer on medication.
10
Taking medication will prevent me from having a breakdown.
Bibliography: Leventhal H, Brissette I & Leventhal EA (2003) The common sense model of self-regulation of health and illness. In The Self-Regulation of Health and Illness Behaiour (CameronLC & LeventhalH eds). Routledge, Taylor & Francis Book, London, pp.42–65. Roger Harms, Kenneth Berge, Philip Hagen, Scott Litin. (June 29, 2012). Risk Factor. Coronary Artery Disease . Ting Choon Meng, H. T. (January 16, 2005). Hypertension Statistics. Hypertension Statistics . Hagger MS & Orbell S (2003) A meta-analytic review of the common-sense model of illness representations. Psychology and Health 18, 141–184. Hagger MS & Orbell S (2005) A confirmatory factor analysis of the revised illness perception questionnaire (IPQ-R) in a cervical screening context. Psychology and Health 20, 161–173. Meyer D, Leventhal H & Gutmann M (1985) Common-sense models of illness: the example of hypertension. Health Psychology 4,115–135. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD & Buick D (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 17, 1–16. Ross S, Walker A & MacLeod MJ (2004) Patient compliance in hypertension: role of illness perceptions and treatment beliefs.Journal of Human Hypertension 18, 607–613. COLLEGE of NURSING Andres Bonifacio Avenue, 9200 Iligan City Philippines COLLEGE of NURSING Andres Bonifacio Avenue, 9200 Iligan City Philippines
THE PROBLEM AND ITS SCOPE
INTRODUCTION
The world is laden with different kinds of sickness and diseases nowadays; these conditions originate from sources easily prevented or if not controlled by proper management and control. Hypertension is well-recognized as one of the leading risk factors for coronary heart diseases. (Roger Harms K. B., June 29, 2012) There are around 970 million people worldwide who have high blood pressure; approximately 330 million from developed countries and 640 million from developing countries. (Kearney et al., 2005) The number is expected to increase to 1.56 billion people by the year 2025; this translates to about 1 out of every 4 adults being afflicted with hypertension. (Ting Choon Meng H. T., January 16, 2005) It is prevalent in developing as well as in developed countries. (Ting Choon Meng H. T., January 16, 2005) A study found out that around 900 million people in developing countries have high blood pressure but that only one-third are aware of their disease. Moreover, only 100 million of these people receive treatment, while only 5 per cent of the total is controlled. However, hypertension control was reported only in 31% of individuals diagnosed with hypertension, one such reason is that it is also referred to as the “silent killer” because of it being asymptomatic. In fact it is very common in the Philippines where it affects around 10.5 million Filipinos. 25% of this figure is unaware that they have the condition and adherence to treatment is around 50-70%, 13% of this is only controlled over the last three decade. (World Health Organization, 2003)
A number of effective medications have been discovered, developed, and improved for the treatment of hypertension. Medication adherence is crucial to hypertension control and has generally been defined as consumption of 80% of the prescribed antihypertensive medication. (Benson, June 13, 2012) Only 50% of people with hypertension regularly follow advice of their physicians concerning drug therapy, and dietary regimens. (World Health Organization, 2003) Stopping medications and treatment can cause the blood pressure to rise even higher than before, and when left uncontrolled, hypertension can lead to serious cardiovascular problems such as stroke, heart attack, heart failure, heart rhythm irregularities, and kidney failure. Thus, failure of adherence will result to an absence of compelling reason to persistently take medication. This aspect of condition contributes further challenges related to the perceptions of clients about hypertension.
There is a varying degree on how a patient views their illness, the topic is very diverse and unique to each patient that a variety of factors come together to influence the course of the illness, these may be: additional medical conditions, stress levels, and social support which all have an impact on health and well-being, especially when ill. Recent studies have suggested that people 's illness perceptions bear a direct relationship to several important health outcomes, including their level of functioning and ability, utilization of health care, adherence to treatment plans laid out by health care professionals, and even overall mortality as seen on the February 2012 issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science, Keith Petrie, of the University of Auckland, and John Weinman, of the Institute of Psychiatry at King 's College. Even though some patients may agree that the nature of hypertension is asymptomatic, they will predict their blood pressure by symptom presentations. There is still a spectrum of unstudied outlook toward their current condition waiting to be further understood. Studies have concluded that those patients that view their condition as a bother or they sometimes refer to it as “high-pertension” were less compliant with their treatment and had a lower blood pressure control rate, also those with three or more problems (such as symptoms and interference with daily routines) were five times more likely to have modified their dosage instructions than those without problems, it could be said that the more the patient feels his current condition as “inconvenient” the more likely he is to not adhere properly to the medication regimen properly prescribed. Heurtin-Roberts and Reisin (1992);Enlund et al. (2001).
This phenomenon is steadily growing and is consistently prevalent in the Philippines, affecting 1 out of 4 Filipinos (Department of Health, 2010), the researchers took it upon themselves to conduct a study addressing this circumstance. The researchers would like to find out what specific factors contribute to this occurrence and subsequently their compliance to their medications. And to answer as to why exploring patient’s illness perceptions, can be a crucial component of good clinical care.
CONCEPTUAL FRAMEWORK This study would make use of this conceptual framework.
Figure 1. Conceptual Framework
The independent variable of the study is the Illness Perception. According to the Common Sense Model, patients taking actions to reduce these health risks are guided by their subjective or common sense perceptions of the illness. These are form based on their reactions to external and internal stimuli through two parallel pathways: cognitive and emotional representations. (Leventhal et al., 2003) The Illness Perception is dependent to the Adherence to prescribed medication and Self-management requirement.
The researchers wanted to find out what variables affect the illness perception of hypertensive patients towards their adherence to their therapeutic regimen and self-management requirement. The researchers included possible intervening variables: Age, Gender, Average BP, Number of hypertension drugs, Co-morbidity and Number of years suffering from hypertension.
STATEMENT OF THE PROBLEM This study is limited to identify the illness perception of hypertensive patients and determine their level of adherence to prescribed medications and self-management regimen. Furthermore, this study specifically aimed to answer the following problems:
1. What is the status of the respondents in terms of:
a. Age
b. BP
c. Number of HTN drugs
d. Co-morbidity
e. Gender:
f. Number of years suffering
2. What is the status of the respondents in terms of the illness perception of hypertensive patients?
3. What is the status of the respondents in terms of:
a. Adherence to prescribed medication
b. Self-management recommendation
4. Is there a significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, and number of years suffering) to the independent variable (Illness perception)? Use
5. Is there a significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, number of years suffering) to the dependent variables (adherence to prescribed medication and self-management recommendation)?
6. Is there a significant relationship between the independent variable (illness perception) to the dependent variables (adherence to prescribed medication and self-management recommendation)?
HYPOTHESIS
This study made use of null hypothesis at 0.05 level of significance.
Ho1. There is no significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, and number of years suffering) to the independent variable (illness perception).
Ho2. There is no significant relationship between the intervening variables (age, gender, average blood pressure, number of hypertension drugs, co-morbidity, number of years suffering) to the dependent variables (adherence to prescribed medication and self-management recommendation).
Ho3. There is no significant relationship between the independent variable (illness perception) to the dependent variables (adherence to prescribed medication and self-management recommendation).
SIGNIFICANCE OF THE STUDY This study endeavors to know illness perceptions and adherence to therapeutic regimens among patients in GTLMH with hypertension in Iligan City.
To Hospital Administrators of GTLMH. This study will help the hospital administrators of GTLMH to be aware of the current situation and the figures of the patient’s illness perception and their therapeutic regimen. By knowing these, the hospital administrators will be able to devise a plan of action addressed to the situation and to develop ways on how to enhance these plans/programs.
Department of Health, City Health Office. This study will serve as an insight for the improvement of patients with hypertension by adhering to therapeutic regimens and have a positive perception about self here in the Philippines specifically in Iligan City. As we all know, it is better to prevent disease than having it already and find ways to cure it. The Department of Health has a number of programs in relation to hypertension like the Cardiovascular Disease Program and the Healthy Lifestyle Program. With this, the government together with the DOH will be aware and be given priority by enhancing these programs and put these programs into action to promote healthy lifestyle in the Philippines especially to the patients with hypertension.
Community. This study will be able to benefit the community by its results and to make them be aware of the current situation when it comes to the therapeutic regimen of hypertensive patients. This will also help them understand how the perception of these hypertensive patients towards their illness affect their adherence to its therapeutic regimen.
College of Nursing
Faculty. Nurse Educators will be able to impart and emphasize to the students the essence of the patient’s perception towards their illness. Nurse Educators also serve as a reference by doing counseling to the patients with hypertension to be aware of what should be done and what should not be done. They are also the one who will educate the student nurses through theories and teach the prevention and control of the disease to be aware on what to do and how to handle patients with hypertension especially in the clinical setting.
Students. Aside from knowing the pathophysiology of the disease, this study will help the students know and consider the psychological aspect in terms of caring for their patients.
Future Researchers. The results of this study will be of great help to researchers who plans to conduct a related or follow up study. They may conduct it to a more specific group of people (e.g., ethnic group or culture) and make correlations in between groups. Moreover, they may also expand the scope of their study such as including respondents who are visiting private hospitals and clinics.
SCOPE AND DELIMITATIONS This study is limited to identify the illness perception of hypertensive patients and determine their level of adherence to prescribed medications and self-management regimen. This will focus on the level of adherence and self-management to therapeutic regimen of 100 hypertensive patients with regards to their illness perception in the outpatient department of GTLMH. The respondents would be patients from the Out-Patient Department (OPD) of Gregorio T. Lluch Memorial Hospital (GTLMH), who are coming over for a clinic visit. They must have a hospital record and has been visiting the OPD for at least once in 6 months. The respondents’ diagnosis of hypertension is not limited to being diagnosed at GTLMH. The demographic profile of the respondents would include age, gender, average BP, number of hypertensive drugs, co-morbidity, and number of years suffering from hypertension. This is regardless of how long the respondents have been diagnosed with Hypertension.
A total of 100 OPD patients will serve as respondents to the study.
This is a cross-sectional study of a convenience sample drawn from the patients with hypertension in GTLMH.
DEFINITION OF TERMS The following terms were defined operationally to project the functional meaning of the words for the purpose of clarity and ease of comprehension.
Adherence. The obedience of the respondents to medical advice or prescriptions of the doctors.
Age – The length of time that a respondent has lived from the time of birth up to the present. Average BP – this is the usual BP of the respondents according to the respondents’ chart.
Co-Morbidity – The presence of two or more coexisting medical conditions or disease processes that are additional to an initial diagnosis. (Elsevier, 2009).
Gender – The status of a respondent whether male or female.
Hypertension – This is defined as a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts with the health care provides (Brunner and Suddarth’s Medical Surgical Nursing, 10th Edition)
Illness Perception – The status of how a respondent interprets or understands his or her condition.
Maintenance Drugs – These are drugs being maintained by the respondents as prescribed by their respective physicians.
Number of years suffering from hypertension – the number of years a respondent is suffering from hypertension from the time he or she was diagnosed up to the present.
Self-Management Requirement – These are the set of interventions and skills followed by a respondent to manage his or her disease as recommended by his or her physician or from other sources of information (e.g., television, journals)
Therapeutic Regimen – The systematic plan for treating, healing or curing of Hypertension.
CHAPTER II
REVIEW OF RELATED LITERATURE
In this chapter the researchers will talk about hypertension and its cause and how it could affect the clients who are experiencing this kind of illness. This study will tackle about the perceptions of hypertensive clients about their illness and how they would manage to their prescribed regimens and medications, and with the studies of some published researches relating to the variables that may cause hypertension.
Related Literature Hypertension is a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts with the health care provider (Smeltzer et al., 2010). It is also known as high blood pressure and is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements the systolic and diastolic, which depends on whether the heart muscle is contracting or relaxed between beats. According to a study in Harvard School of public health (HSPH), high blood pressure, as well as smoking are the leading preventable risk factors for premature mortality in the United States. (Mozafarrian et al., 2009). Researchers found out that premature deaths each year for high blood pressure is 395,000. (Mozafarrian et al., 2009).
A new study says hypertension ranks among the nation 's leading causes of death, spurred largely by economic barriers to blood pressure medication, excessive sodium intake and inadequate consumption of potassium (Moyer 2010). There are lots of risk factors that could contribute to high blood pressure. One of this is age. Age is considered as a risk factor because it increases the blood pressure when you reach a higher age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause. And second is race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications are more common in blacks. Third is not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with contraction – and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight. Fourth is smoking. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of the artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke can also increase your blood pressure. These are some of the common risk factors that could cause hypertension. Though it has been proven that hypertension cannot be cured but it can be treated and managed effectively, a healthy lifestyle includes eating a low-fat, low-salt diet rich in vegetables and fruits, engaging in regular physical activity, maintaining optimal weight, not smoking, and limiting alcohol intake (Ona 2011). According to (Smeltzer et al., 2010) hypertension is more prone to men with the age above 60 years old and postmenopausal women and with family history of cardiovascular disease (in female relative younger than 65 years of age or male relative younger than 55 years). If left untreated, it may indicate vascular damage vascular damage, with specific manifestations related to the organs served by the involved vessels. Coronary Artery Disease (CAD) with angina or myocardial infarction (MI) is a common consequence of hypertension. Left ventricular hypertrophy occurs in response to the increased workload placed on the ventricle as it contracts against higher systemic pressure. When heart damage is extensive, heart failures ensues (Smeltzer et al., 2010).
The goal of hypertension treatment is to prevent death and complications by achieving and maintaining the arterial blood pressure below 140/90 mm Hg (Smeltzer et al., 2010). Research findings demonstrate that weight loss, reduced alcohol and sodium intake, and regular exercise are effective lifestyle adaptations to reduce blood pressure (Mayo Clinic, 2012). The client needs to understand the disease process and how lifestyle changes and adherence to medication can help control hypertension. The healthcare provider can encourage clients to consult dieticians to help develop a plan for weight loss like restricting sodium and fat intake which could worsen the client’s condition. The patient should be advised to limit intake, and tobacco should be avoided-not because smoking is related to hypertension, but because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies the risk. It can be beneficial to clients who have support groups for weight control, smoking cessation, and stress reduction. If the client is asked to participate in blood pressure screening, accurate measurement of blood pressure is critical for making appropriate clinical decisions in management of high blood pressure to reduce cardiovascular risk and prevent target organ damage. An inaccurate measurement of blood pressure could lead to a patient being falsely classified as hypertensive or falsely classified as having high normal or normal blood pressure as well as lead to faulty clinical decisions regarding patient progression in an exercise program. For clients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medications include diuretics, beta-blockers, or both. Patients are first given a minimal amount of doses of medication and if hypertension does not fall less than 140/90 mm Hg, the dose is increase gradually and additional medications are added to achieve control. To promote compliance, clinicians try to prescribe the simplest treatment schedule possible, ideally one pill once each day (Smeltzer et al., 2010). The major goals for the clients include understanding of the disease process and its treatment, compliance to medications, and absence of complications.
Related Studies
Here, are some of studies from local and foreign researchers which is very helpful and essential from this study. Most of the studies focus on adherence to treatment regimens, beliefs of the clients having hypertension, illness perception of clients having hypertension and therapeutic noncompliance over the years.
Studies local and abroad have shown that illness perception of patients have a direct link on the therapeutic regimen adherence of these hypertensive people, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors (Martin et al., 2005). Another study shows that it was found out that most hypertensive patients had misunderstanding about the causes, symptoms and self-care behaviour to prevent other related disease, including their dietary control (Chen et al., 2009). For positive and effective change in the health behaviours of the clients having hypertension, there is a need for new strategies that allows the clients to take care of themselves. In relation to our study, the Common Sense Model (CSM) of illness self-regulation (Leventhal et al., 1984) suggests that beliefs about illness have five core dimensions: cause, identity, perceived control, severity of illness consequences, and time line. Subsequent research has integrated further dimensions including illness coherence – a belief that the illness ‘makes sense’ – to this core set of illness beliefs (Moss-Morris, et al., 2002). The Common Sense Model foresees that illness perceptions will motivates emotional outcomes such as illness-related distress (Hagger et al., 2003). Client does not view it as a degenerative process of damage to the vascular system, but rather as a binary risk process, within which either you can be a winner by simply being not ill or a loser. This makes non-adherence to treatment a gamble with a potential positive outcome (Anthony et al., 2012). The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. . The relationships were independent of systolic blood pressure, age, the total number of antihypertensive medication, and comorbidity (Chen et, al. 2009). In addition to that it has also been found out that factors that affect the patients ' adherence to prescribed medications and self-management recommendations differ greatly. Despite its subjectivity, identity showed significantly predictive effects on adherence to self-management. Understanding patients ' lay views on hypertension allows health professionals to provide effective care for better adherence to therapeutic regimens (Chen et, al. 2009). A study conducted by Dela Cruz et al., 2008 studied that patient’s beliefs regarding their illness influence their adherence on a major way on a study conducted to Filipino-Americans with hypertension regarding their illness beliefs, perceptions and practice, corresponds to the biochemical model in relation to causes, consequences and treatment of it. The study of Taddeo et, al. 2008 indicated that there is a high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors to consider in teens are their developmental stage and challenges, emotional issues and family dysfunction. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact oncompliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory (Jin et, al. 2008). On a study conducted in by (Ross S, et al. 2004) “Analysis shows that patients who believe in the necessity of medication are more likely to be compliant. Beliefs about illness and about medicines are interconnected; aspects that are not directly related to compliance influence it indirectly. Beliefs about specific medications and about hypertension are predictive of compliance. Information about health beliefs is important in achieving concordance and may be a target for intervention to improve compliance”. Control of the disease exhibited direct effects on adherence to prescribed medications and self-management, while the cause of the illness only showed direct effects on adherence to prescribed medications.
CHAPTER III
METHODOLOGY
This chapter describes the methodology that was used in the study. It specifically describes the research design, the respondents and sampling procedure, the instruments that were used, the data gathering procedure, and the statistical tools.
RESEARCH DESIGN A cross-sectional, descriptive, quantitative research design will be used in the study. Cross-sectional studies form a class of research methods that involves observation of all of a population, or a representative subset, at one specific point in time. A descriptive study establishes only associations between variables. In quantitative research your aim is to determine the relationship between one thing (an independent variable) and another (a dependent variable) in a population. This type of research design is chosen to facilitate in answering the statement of the problem, particularly to determine the illness perception and adherence to therapeutic regimen among hypertensive patients in Gregorio T. Lluch Memorial Hospital (GTLMH).
RESEARCH LOCALE The study will be conducted at Gregorio T. Lluch Memorial Hospital.
Figure 2. Map of Gregorio T. Lluch Memorial Hospital
GTLMH is the only public hospital in Iligan City that would not only cater patients within the city but also nearby towns of Lanao del Norte and Misamis Oriental. It has an 80 bed capacity. The OPD is divided into 5 areas: Pediatrics, Medicine, Surgery, Dental and OB-GYNE clinics. The OPD caters 30 patients per day and follows a first – come, first - serve basis.
RESPONDENTS and SAMPLING METHOD The respondents of the study would consist of 100 hypertensive patients of GTLMH who frequently visit the OPD for check-up. The total number of respondents is identified using the Slovin’s formula. n = N / (1 + Ne^2) n = Number of samples
N = Total population e = Error tolerance n = 30 / (1 + [30*0.05]^2) n= 30 / (1 + 2.25) n= 9.230769231 ~ 10
10 respondents The respondents of this study will be limited only to patients diagnosed with hypertension, is currently taking prescribed maintenance drug(s) and has a record at OPD of GTLMH. The respondents will be chosen using a simple random sampling.
DATA GATHERING AND PROCEDURE A letter of consent to conduct the study will be given to the Chief of Hospital of GTLMH for approval. Upon approval, another letter of consent will be given to the head of the OPD with the approved letter from the Chief of Hospital serving as an attachment. Once approved, respondents would then be identified using random sampling method, and be given a letter of consent to participate in the study. The respondents can accept or refuse to participate in the study. The researchers will explain what the study will be about, including its significance and benefits. The respondents will be assured that whatever information they will provide will remain confidential in order to protect their identity. Data gathering will start after the acceptance of this proposal. It would be conducted on the 11th of September up to the 15th of September, during OPD hours.
RESEARCH INSTRUMENT The questionnaire is divided into 3 sections: Part 1 would be the Demographic Profile, Part II the Illness Perception Questionnaire-Revised (IPQ-R), and Part III the Drug Attitude Inventory (DAI) The Demographic Profile of the respondents would include their age, gender, average BP, number of hypertensive drugs maintained, co-morbidity, and the number of years suffering from hypertension. For Part II, to know how the respondents perceived their illness, this study will make use of the Illness Perception Questionnaire-Revised by Moss-Morr et al., (2002). The IPQ-R comprises of three components: illness representations, causes and identity. The illness representations consist of 32 items on seven subscales: timeline, timeline – cyclical, consequences, treatment control, personal control, coherence, and emotional representations. The items will be scored as follows: 1 – Strongly Disagree (Strongly unfavorable to the concept) 2 – Disagree (Somewhat unfavorable to the concept) 3 – Neither Agree nor Disagree (Undecided) 4 – Agree (Somewhat favorable to the concept) 5 – Strongly Agree (Strongly favorable to the concept) A higher score reflects a stronger belief in a specific dimension. The cause component is composed of 18 questions on four subscales: psychology, risk factor, balance, and cultural attribution. This component is used to inquire about the respondents’ attributions about their illness. The items will be scored as follows: 1 – Strongly Disagree (Strongly unfavorable to the concept) 2 – Disagree (Somewhat unfavorable to the concept) 3 – Neither Agree nor Disagree (Undecided) 4 – Agree (Somewhat favorable to the concept) 5 – Strongly Agree (Strongly favorable to the concept) A higher score reflects a stronger belief of the causal attribution of the illness. Illness identity of the IPQ-R consists of 3 sets of items: Symptom Score (symptoms that patients identified as related to hypertension), Symptom Occasions (symptoms experienced before and after the hypertension diagnosis), and Blood Pressure Prediction (symptoms used for BP prediction). The symptom score will be obtained by asking the respondents to rate 30 symptoms with Yes or No dichotomous responses. Only those symptoms identified by the patients as being hypertension – related will be counted in the symptom score. The symptom occasion will be assessed by asking the respondents if they have experienced symptoms before and after they were diagnosed with hypertension. The blood pressure prediction on the other hand will be obtained by asking the respondents if they can predict their blood pressure by presenting the symptoms. This will be rated using an ordinal response scale of Yes, Uncertain, or No. The total number of symptoms that will be used for blood prediction will also be counted. Mean score of each of the three components will be computed individually.
Another questionnaire that will be use in our study is the Drug Attitude Inventory. This questionnaire includes a series of questions, each with True or False answers, pertaining to various aspects of the patient’s perceptions and experiences of treatment. The original scale consists of 30 questions but a simplified form consisting of 10 questions has been validated.
Lastly, the DAI-10 contains six items (Questions 1, 3, 4, 7, 9, 10) that a patient who is fully adherent to prescribed medication would answer as ‘True’, and four items (Questions 2, 5, 6, 8) they would rate as ‘False’.
True answers are scored as +1; False answers are scored as -1. The sets of questionnaires will be developed in the Visayan dialect for an easy and proper understanding on the part of the respondents.
STATISTICAL TOOLS TO BE USED For problem 1 (for variables a, b, c, d, and f), the researchers will be using the descriptive statistical tool, mean, coefficient of variation, and percentage. The descriptive statistical tool is used to describe the patterns and general trends in the data set. This will be used to examine or explore one variable at a time. However, the relationship between two variables can also be prescribed as with correlation and regression. The tools of descriptive statistics include measurement data frequencies and means by using cross tabulations and graphs. The mean is used to acquire the average values, and/or distribution. The coefficient of variation is used to compare the degree of variation from one data series to another. Percentage is used to express how large/small one quantity is, relative to another quantity. For variable e, the researchers will also use the percentage statistical tool. For problems 2 and 3, the researchers will use the mean to acquire the average values, coefficient of variation to compare the degree of variation from one data series to another, and percentage to express how large/small one quantity is, relative to another quantity.
For problem 4, the researchers will use the Pearson Correlation Coefficient for testing significant relationship and Chi Square Test for Independence for gender and other categorical variables.
For problem 5, the researchers will use the Pearson Correlation Coefficient for testing significant relationship for all variables and Chi Square Test for Independence for gender and other categorical variables.
For problem 6, the Pearson Correlation Coefficient will be used to test the significant relationship. If the results are significant the researchers will apply regression analysis to find the predictors of adherence and self management.
Bibliography
Books
Elsevier. (2009). Mosby 's Medical Dictionary, 8th Edition.
Leventhal H, Brissette I & Leventhal EA (2003) The common sense model of self-regulation of health and illness. In The Self-Regulation of Health and Illness Behaiour (CameronLC & LeventhalH eds). Routledge, Taylor & Francis Book, London, pp.42–65.
Suzanne C. O 'Connell Smeltzer, Brenda G. Bare. Brunner and Suddarth’s Medical Surgical Nursing, 10th Edition.
Journal
Benson, S. (June 13, 2012). Patient Compliance in Hypertension. Patient Compliance in Hypertension .
Roger Harms, Kenneth Berge, Philip Hagen, Scott Litin. (June 29, 2012). Risk Factor. Coronary Artery Disease .
Ting Choon Meng, H. T. (January 16, 2005). Hypertension Statistics. Hypertension Statistics .
Hagger MS & Orbell S (2003) A meta-analytic review of the common-sense model of illness representations. Psychology and Health 18, 141–184.
Hagger MS & Orbell S (2005) A confirmatory factor analysis of the revised illness perception questionnaire (IPQ-R) in a cervical screening context. Psychology and Health 20, 161–173.
Meyer D, Leventhal H & Gutmann M (1985) Common-sense models of illness: the example of hypertension. Health Psychology 4,115–135.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD & Buick D (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 17, 1–16.
Ross S, Walker A & MacLeod MJ (2004) Patient compliance in hypertension: role of illness perceptions and treatment beliefs.Journal of Human Hypertension 18, 607–613.
Mindanao State University
Iligan Institute of Technology
COLLEGE of NURSING
Andres Bonifacio Avenue, 9200 Iligan City Philippines
Telephone No.: (+63) 221-0744
Chief of Hospital:
Greetings! The undersigned are fourth year BS Nursing Graduating Students from Mindanao State University – Iligan Institute of Technology. And part of our curriculum is for us to conduct research studies. In line with this, we would like to ask your permission to allow us to conduct interviews and give questionnaires regarding our study entitled, “Illness Perception and Therapeutic Regimen Adherance among Hypertensive Out-Patients of GTLMH.”
We would like to assure you that whatever data we will gather will be treated with utmost confidentiality and will be used in this study alone.
We are looking forward for your kind approval and participation. Thank you very much and God bless you always.
Respectfully yours,
Gweneth Jill D. Baldado
Researcher
Nodger Jude D. Dalman
Research
Hannah Grace Q. Encabo
Researcher
Noted by:
Khandy Lorraine B. Guerrero
Research Adviser
Vincent G. Tabil
Clinical Coordinator, MSU-IIT CON
Clowe D. Jondonero
Dean, MSU-IIT CON
Mindanao State University
Iligan Institute of Technology
COLLEGE of NURSING
Andres Bonifacio Avenue, 9200 Iligan City Philippines
Telephone No.: (+63) 221-0744
“ILLNESS PERCEPTION AND THERAPEUTIC REGIMEN ADHERENCE AMONG HYPERTENSIVE OPD CLIENTS AT GTLMH”
Name of Principle Investigators: Gweneth Jill D. Baldado Nodjer Jude D. Dalman Hannah Grace Q. Encabo
Name of Organization: Mindanao State University – Iligan Institute of Technology College of Nuring
This Informed Consent Form has two parts:
• Information Sheet (to share information about the study with you)
• Certificate of Consent (for signatures if you choose to participate)
Part I: Information Sheet
Introduction
We are senior student nurses from MSU-IIT College of Nursing. We are doing a research on illness perception and therapeutic regimen adherence among hypertensive OPD clients in GTLMH. We are going to give you information and invite you to be part of this research. You do not have to decide today whether or not you will participate in the research. Before you decide, you can talk to anyone you feel comfortable with about the research.
This consent form may contain words that you do not understand. Please ask us to stop as we go through the information and we will take time to explain. If you have questions later, you can ask them us the researchers.
Purpose of the research
Hypertension is one of the leading causes of death in the Philippines. We want to find out if you are aware of your current condition and how you deal with it. We would also like to know if you understand the effects of the medications that you are taking for your high blood pressure.
Type of Research Intervention
This research will involve your participation in answering a questionnaire that will include the demographic profile, the Illness Perception Questionnaire-Revised (IPQ-R), and the Drug Attitude Inventory (DAI)
Participant Selection
You are being invited to take part in this research because we feel that to get reliable results, we should ask those who have hypertension so that you can relate to our questions.
Voluntary Participation
The choice that you make will have no bearing on your job or on any work-related evaluations or reports. You may change your mind later and stop participating even if you agreed earlier.
Procedures
The researchers will approach you at the OPD and hand you the questionnaire. Fill out a survey which we will provide and collect. You may answer the questionnaire yourself, or it can be read to you and you can say out loud the answer you want me to write down. If you do not wish to answer any of the questions included in the survey, you may skip them and move on to the next question. We will collect the filled out survey in your convenient time or when you will ask us to get them.
Duration
The research takes place over 10 days in total. During that time, we will wait for you to finish and will be available for any inquries.
Risks
There is a risk that you may share some personal or confidential information by chance, or that you may feel uncomfortable talking about some of the topics. However, we do not wish for this to happen. You do not have to answer any question or take part in the survey if you feel the question(s) are too personal or if talking about them makes you uncomfortable.
Benefits
There will be no direct benefit to you, but your participation is likely to help us find out more about the illness perception and therapeutic management of hypertension.
Reimbursements
You will not be provided any incentive to take part in the research.
Confidentiality
The research being done in the hospital may draw attention and if you participate you may be asked questions by other people in the community. We will not be sharing information about you to anyone outside of the research team. The information recorded is confidential, your name is not being included on the forms, only a number will identify you, and no one else except the researchers themselves will have access to your survey.
Right to Refuse or Withdraw
You do not have to take part in this research if you do not wish to do so, and choosing to participate will not affect your job or job-related evaluations in any way. You may stop participating at any time that you wish without your job being affected. We will give you an opportunity at the end to review your remarks, and you can ask to modify or remove portions of those, if you do not agree with the notes or if we did not understand you correctly.
Who to Contact
If you have any questions, you can ask us now or later. If you wish to ask questions later, you may contact any of the following:
Gweneth Jill D. Baldado +639057177953, gwehen@yahoo.com
Nodjer Jude D. Dalman +639059480137, lias_mart@yahoo.com
Hannah Grace Q. Encabo +639177160354 , hannah_encabo@yahoo.com
Part II: Certificate of Consent
I have been invited to participate in research entitled “Illness Perception and Therapeutic Regimen Adherence Among Hypertensive OPD Clients at GTLMH”
I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and any questions I have been asked have been answered to my satisfaction. I consent voluntarily to be a participant in this study.
Print Name of Participant ___________________________________________________
Signature of Participant ___________________________________________________
Date ___________________________ Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the potential participant, and to the best of my ability made sure that the participant understands that the following will be done:
1. A questionnaire will be provided to the subject and he/she will be asked to fill it out.
2. The filled out questionnaire will be collected to which time the subject finds it convenient.
I confirm that the participant was given an opportunity to ask questions about the study, and all the questions asked by the participant have been answered correctly and to the best of my ability. I confirm that the individual has not been coerced into giving consent, and the consent has been given freely and voluntarily. GWENETH JILL D. BALDADO
NODJER JUDE D. DALMAN
HANNAH GRACE Q. ENCABO
Date ___________________________ Day/month/year
Mindanao State University
Iligan Institute of Technology
COLLEGE of NURSING
Andres Bonifacio Avenue, 9200 Iligan City Philippines
Telephone No.: (+63) 221-0744
ILLNESS PERCEPTION AND THERAPEUTIC REGIMEN ADHERANCE AMONG HYPERTENSIVE OPD CLIENTS AT GTLMH
General Instructions: Please write legibly the information needed on the space provided and place a single check mark inside the box.
Part I – DEMOGRAPHIC PROFILE
Name (optional): _____________________________ Age: ___ Gender: ( ) M ( ) F
Address: ___________________________________ Religion: _________
Civil Status: ( ) Single ( ) Married ( ) Separated ( ) Widowed
Average BP: ____________________
Number of Hypertensive drugs maintained:______________________
Other disease/s:_________________________
Number of years suffering from Hypertension:___________________________
Part II - ILLNESS PERCEPTION QUESTIONNAIRE-REVISED BY MOSS-MORR ET AL., (2002)
YOUR VIEWS ABOUT YOUR HIGH BLOOD PRESSURE
We are interested in your views about your high blood pressure.
These are statements other people have made about their high blood pressure. Please show how much you agree or disagree with each of the following statements about your high blood pressure by ticking one of the boxes.
Views about your High blood pressure
Strongly Disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
Having this high blood pressure makes me feel anxious
I expected to have this high blood pressure for the rest of my life
I get depressed when I think about my high blood pressure
I go through cycles in which my blood pressure gets better and worse
My high blood pressure causes difficulties for those who are close to me
My blood pressure has serious financial consequences
I have the power to influence my high blood pressure
My high blood pressure is a serious condition
The course of my high blood pressure depends on me
My high blood pressure is likely to be permanent rather than temporary
My high blood pressure is very unpredictable
Views about your High blood pressure (continued)
Strongly disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
My high blood pressure makes me feel afraid
My high blood pressure makes me feel angry
My high blood pressure strongly affects the ways other see me
My high blood pressure will improve in time
My high blood pressure has major consequences on my life
What I do can determine whether my high blood pressure gets better or worse
My high blood pressure will last for a long time
My treatment can control my high blood pressure
My treatment will be effective in curing my high blood pressure
When I think about my high blood pressure I get upset
I have a clear picture or understanding of my high blood pressure
The negative effects of my high blood pressure can be prevented (avoided) by my treatment
Your views about symptoms you may have experienced
We would like to ask you about any symptoms you may have experienced since finding out about your high blood pressure.
Some people do experience symptoms related to high blood pressure whilst others don’t.
Similarly, some people experience symptoms that are related to their medicines and others don’t.
Here is a list of common symptoms.
Please show whether you have experienced each of the following symptoms recently by circling YES or NO.
For each symptom that you have experienced recently, please then show whether you believe it is related to your HIGH BLOOD PRESSURE or MEDICATION you take for your high blood pressure.
If you don’t know whether the symptom is related to your high blood pressure or the medicine you take for your high blood pressure, please circle Don’t Kn
Symptom
If you have experienced this symptom recently
If answer is yes
This symptom is related to my high blood pressure
This symptom is related to the medicine I take for my high blood pressure
Pain
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Sore throat
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Nausea
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Breathlessness
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Weight Loss
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Fatigue
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Stiff Joints
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Sore eyes
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Wheeziness
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Headaches
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Upset stomach
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Sleep difficulties
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Dizziness
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Loss of strenght
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Loss of libido
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Impotence
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Feeling flushed
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Fast heart rate
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Pins and needles
NO
YES
IF yes
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
Your views about symptoms you may have experienced (continued)
If you have experienced any other symptoms recently that you believed may have been related to your high blood pressure or medicine that you take for your high blood pressure, please write them below.
Please show whether you believe they are related to your high blood pressure or to the medicine you take for your high blood pressure by circling yes, no or don’t know.
Symptom
This symptom is related to my high blood pressure
This symptom is related to the medicine I take for my high blood pressure
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
YES
NO
DON’T KNOW
IF YOU HAVE EXPERIENCED SYMPTOMS THAT YOU THINK ARE RELATED TO YOUR HIGH BLOOD PRESSURE, PLEASE ANSWER THE FOLLOWING QUESTIONS. IF NOT, PLEASE GO ON TO THE NEXT PAGE.
We are interested in your views about your symptoms related to your high blood pressure.
These are statements other people have made about their symptoms.
Please show how much you agree or disagree with them by checking one of the boxes.
VIEWS ABOUT YOUR HIGH BLOOD PRESSURE SYMPTOMS
Strongly disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
There is lot which I can do to control my symptoms
My symptoms come and go in cycles
The symptoms of my high blood pressure change a great deal from day to day
YOUR VIEWS ABOUT CAUSES OF HIGH BLOOD PRESSURE
We are interested in your own views about what causes your high blood pressure.
Below is a list of possible causes.
Please show how much you agree or disagree that they were causes FOR YOU by checking one of the boxes for each possible cause.
As people are very different, there are no correct answers for these questions.
Possible causes of your high blood pressure
Strongly Disagree
Disagree
Neither Disagree nor agree
Agree
Strongly Agree
Stress or worry
Hereditary-it runs through the family
A germ or virus
Diet or eating habits
Chance or bad luck
Poor medical care in my past
Pollution in the environment
My own behavior
My mental attitude e.g. thinking about life negatively
Family problems or worries
Overwork
My emotional state (e.g. feeling down, lonely, anxious, empty)
Ageing
Alcohol
Smoking
Accident or injury
My personality
Poor immune system
In the table below, please list the three most important factors that you believe cause your high blood pressure.
You may use any of the items from the box above, or you may have additional ideas on your own.
If you can’t think of three things that you think caused your high blood pressure, just write one or two.
The most important cause of my high blood pressure for me:
PART III – DRUG ATTITUDE INVENTORY (Hogan et al, 1983)
We are interested in your perceptions and experiences of treatment.
Decide whether you believe it to be True or False as applied to your own experience with medications.
You are asked to read each question carefully and put a checked on the box whether your answer is True or False.
QUESTION
TRUE
FALSE
1
For me, the good things about medication outweigh the bad.
2
I feel strange, "doped up", on medication.
3
I take medications of my own free choice.
4
Medications make me feel more relaxed.
5
Medication makes me feel tired and sluggish.
6
I take medication only when I feel ill.
7
I feel more normal on medication.
8
It is unnatural for my mind and body to be controlled by medications.
My thoughts are clearer on medication.
10
Taking medication will prevent me from having a breakdown.
Bibliography: Leventhal H, Brissette I & Leventhal EA (2003) The common sense model of self-regulation of health and illness. In The Self-Regulation of Health and Illness Behaiour (CameronLC & LeventhalH eds). Routledge, Taylor & Francis Book, London, pp.42–65. Roger Harms, Kenneth Berge, Philip Hagen, Scott Litin. (June 29, 2012). Risk Factor. Coronary Artery Disease . Ting Choon Meng, H. T. (January 16, 2005). Hypertension Statistics. Hypertension Statistics . Hagger MS & Orbell S (2003) A meta-analytic review of the common-sense model of illness representations. Psychology and Health 18, 141–184. Hagger MS & Orbell S (2005) A confirmatory factor analysis of the revised illness perception questionnaire (IPQ-R) in a cervical screening context. Psychology and Health 20, 161–173. Meyer D, Leventhal H & Gutmann M (1985) Common-sense models of illness: the example of hypertension. Health Psychology 4,115–135. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD & Buick D (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 17, 1–16. Ross S, Walker A & MacLeod MJ (2004) Patient compliance in hypertension: role of illness perceptions and treatment beliefs.Journal of Human Hypertension 18, 607–613. COLLEGE of NURSING Andres Bonifacio Avenue, 9200 Iligan City Philippines COLLEGE of NURSING Andres Bonifacio Avenue, 9200 Iligan City Philippines
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Heart failure is a serious public health in the United States, causing chronic illness and often mortality (Boghianimoghadam, 53). The Health Belief Model (HBM), developed by is the framework of choice for this project. It will describe one’s health behavior modification and act as a foundation of health education. The model was created in the 1950s by sociologists who wanted to analyze why people declined to participate in preventive health behaviors (Boghianimoghadam,53). HBM addresses the relationship between a person’s beliefs and behaviors. It offered a way to understand and predict how clients would behave in relation to their health and how they would comply with health care therapies. There are six concepts…
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the Health Belief Model. “The emerging chronic disease epidemic poses both a threat to the public’s health and a challenge to public health practice.” (Resnick & Siegel, 2013, p.3) Based on this epidemic, it is crucial for researchers to conduct interventions that will encourage people to take action and create behavioral changes in order to live healthier…
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The reliability and validity of using only one item to assess general health perception is supported by the literature 23,24. In addition, a systematic review showed good reliability and validity of using a single item to assess different HRQOL domains: pain intensity, fatigue, sleep, depression, and anxiety 27. Furthermore, two studies supported the validity of using a single item to assess physical activity 22,25. The literature showed that using this single item approach could be preferable for patients regardless of the disease population since patients do not have to spend much time and require less cognitive effort to answer the questions 27,30. In this study, the LBP-HRQOL items and total score had a moderate correlation with similar constructs supporting the good construct validity of the…
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Items measuring self-rated health are frequently found in surveys of many kinds. An example is a question asking respondents to characterize their overall state of health using categories such as excellent, good, fair, or poor. Such evaluations may or may not correspond to that which would be provided by a physician.…
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It is true that many individuals assume that illness is a purely biological condition, definable by objectively measured biological traits. However, definitions of illness vary considerably over time and across social groups. In contrast, other individuals and literature argue that illness is a moral category and a social construction. The objective, biological perspective of illness focuses on the physiology or structure/functioning of the human body. The biological standpoint of illness is an objective reality. Scientific research and evidence determines whether or not we have a new illness. The medical model of illness begins with the assumption that illness is an objective label given to anything that deviates from normal biological functioning. It also claims that there is no moral element or political bias in labeling a condition or behavior as an element. Medical professionals are able to determine what is considered an illness and favor this model because there is a curative approach.…
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Encouraging patients to make major lifestyle changes after a critical illness can be frustrating and challenging for nurses. Denial and feeling overwhelmed by a great deal of new information, patients can be reluctant to implement these changes even though the benefits are explained to them in great detail. “The Health Belief Model is a framework for motivating people to take positive health actions that uses the desire to avoid a negative health consequence as the prime motivation” ("Theories and Approaches," n.d., para. 3). Often times, avoiding a negative consequence can be a more powerful incentive than a reward for positive behavior. Four main points in the HBM are: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers (Taylor et al., 2007). As nurses it is our responsibility to prepare our patients to return home and arm them with the best possible tools to avoid a repeat admission. Patients have a lot to absorb, and the lifestyle changes that accompany illness aren’t always welcome changes. We must be willing to look past initial resistance to change at the underlying issues that can be addressed in order to modify behavior.…
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Medication non-adherence is a serious public health issue, leading to increased health care costs, morbidity and mortality among conditions. Medication non-adherence is also one of the main obstacles for effective hypertension care, as between 20%-50% of the patients do not follow their prescribed medication regimen. Despite the large body of empirical evidence available, relatively little is known about the potential differences between the determinants underpinning intentional versus unintentional non-adherence. Shedding light on the factors of medication non-adherence is crucial to develop interventions and health campaigns addressing the issue. Thus, the present study quantitatively examines the patient-related factors of medication non-adherence…
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Illness uncertainty is a broad term that can refer to any part of the health field. For example, the term can be used to describe when a patient is unsure about what condition they have, when they question their provider or the prescribed treatment, or when they are uncertain about tests and procedures in health care(Harrington, 2015, p. 182). While illness uncertainty pertains to the fact that the patient is unsure about something, low health literacy means the patient is unable to understand what they are being told. People with low health literacy to do not have the knowledge or ability to understand the information given to them. When addressing a patient with low health literacy it is important to make sure the patient understands exactly…
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METABOLIC SYNDROME LEARNING OBJECTIVES At the end of lecture students should know – Definition of Metabolic Syndrome – Visceral obesity is an indicator of the syndrome and an independent marker for CVD – Current and some potential future treatment options. METABOLIC SYNDROME CONCEPT (Not New) • 1923 - Kylin first to describe the clustering of hypertension, hyperglycemia, hyperuricemia • 1936 - Himsworth first reported Insulin insensitivity in diabetics • 1965 - Yalow and Berson developed insulin assay and correlated insulin levels & glucose lowering effects in resistant and non-resistant individuals METABOLIC SYNDROME CONCEPT • 1988 - Reaven in his Banting lecture at the ADA meeting…
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Uncertainty in illness is present for both acute and chronic illnesses and can be described as a cognitive stressor, a sense of loss of control, and a perceptual state of doubt which is dynamic in nature. Illness uncertainty can be associated with poor adjustment, but often needs to be evaluated as a threat to have its deleterious effect. For example, illness uncertainty in pain populations is related to increased sensitivity to pain and reduction in tolerance of painful stimuli. Illness uncertainty can result in maladaptive coping, higher psychological distress, and reduced quality of life. Uncertainty can’t be categorized as a good or bad state. It mainly depends on the situations that surround the uncertainty. It can be defined as the inability to understand the meaning of a situation or event and it can develop if the patient doesn’t completely comprehend the total magnitude of the state of his or her illness. The purpose of this paper is to explore the concept of uncertainty in illness and to review three nursing research studies to explain this concept in more detail.…
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5. Constance, Sarah. "Self-Perception and Health." SelfPerception and Health RSS. N.p., 27 Feb. 2009. Web. 20 July…
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General health perception is an important health outcome that can be affected by LBP and other health conditions [135]. and it has been shown that general health perceptions can be affected by different health outcomes (e.g. pain, depression, and functional status) [135]. General health perceptions are considered the best predictors of general medical and mental health service utilization as well as strong predictors of mortality [135]. Also, they are considered an appraisal of biological variables, symptom status, and functional status [136]. Therefore, it is important to study health perceptions; identifying the relationships between health outcomes and general health perceptions among individuals with chronic LBP (CLBP) may help clinicians and researchers understand how people live with LBP. It may also help clinicians to tailor interventions to the needs of individuals with CLBP. Furthermore, it will reinforce the demands…
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Aim: To find out if scores on the Holmes and Rahe Social Readjustment Rating Scale correlated with the subsequent onset of illness.…
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