MINISTRY OF EDUCATION AND TRAININGMINISTRY OF HEALTH

HANOI MEDICAL UNIVERSITY
………***………

NGUYỄN VĂN TOÀN

A SURVEY ON KNOWLEDGE, ATTIUDESAND
PRACTICEREGARDING TO HYPERTENTIONAMONG ELDERLY
PEOPLE IN SELECTED TWO COMMUNESIN BAC GIANG CITY IN
2014

BACHELOR OF SCIENCE NURSING
ADVANCED PROGRAM IN NURSING
2010 – 2014


HANOI – 2015
MINISTRY OF EDUCATION AND TRAININGMINISTRY OF HEALTH

HANOI MEDICAL UNIVERSITY
………***………

NGUYỄN VĂN TOÀN
A SURVEY ON KNOWLEDGE, ATTIUDES AND PRACTICE
REGARDING TO HYPERTENTION AMONG ELDERLY PEOPLE IN
SELECTED TWO COMMUNES IN BAC GIANG CITY IN 2014

BACHELOR OF SCIENCE NURSING
ADVANCED PROGRAM IN NURSING
2010 – 2014


answering the interview that help me to do this thesis better.
Last but not least, from the bottom of my heart, I would like to thank
my dear family

and friends

who always stand by my side, support and

encourage me to complete this thesis.

Hanoi, June 15th, 2015

Nguyen Van Toan


ii

DECLARATION
I declare that this thesis represents my own work, except where due
acknowledgement is made, and that is has not been previously included in a
thesis, dissertation or report submitted to the university or any other institution
for a degree, diploma or other qualifications.

Signed
Nguyen Van Toan


iii


...................................................................................................................... 13
1.4.4. Other factors ................................................................................... 14
1.5. Framework ............................................................................................ 16
CHAPTER 2 - SUBJECTS AND METHOD .................................................. 17
2.1. Study design .......................................................................................... 17
2.2. Sampling and Setting ............................................................................ 17
2.2.1. Setting ............................................................................................ 17
2.2.2. Sampling ........................................................................................ 17
2.2.3. Sample size .................................................................................... 18
2.3. Research instruments ............................................................................ 18
2.4. Research Indicators and Variables ........................................................ 18
2.5. Bias and controllingbias ........................................................................ 19
2.5.1. Acquired bias ................................................................................. 19
2.5.2. Controlling bias .............................................................................. 19
2.6. Research progress ................................................................................. 20
2.6.1. The process of making research ..................................................... 20
2.6.2. Data collection ............................................................................... 20


v

2.6.3. Data analysis .................................................................................. 20
2.7. Ethical considerations ........................................................................... 21
CHAPTER 3 - RESULTS ................................................................................ 22
3.1. General characteristics of the participants ............................................ 22
3.2. Knowledge, attitude and practice related to hypertension care ............ 24
3.2.1. Knowledge of participants on hypertension .................................. 24
3.2.2. Attitudes towards Hypertension ..................................................... 26
3.2.3. Self-care on Hypertension.............................................................. 27
3.3. Factors associated with hypertension.................................................... 29

LIST OF FIGURES


vii

LIST OF ABBREVIATIONS
ACE: Angiotensin-converting enzyme
ARBs: Angiotensin II receptorblockers
A- Score: Attitude score
BP: Blood pressure
CVD: Cardiovascular
DBP: Diastolic Blood Pressure
HBP: High Blood Pressure
HTN: Hypertension
KAP: Knowledge Attitude Practice
K- score: Knowledge score
P-score: practice score
SBP: Systolic Blood Pressure
WHO: World Health Organization


1

INTRODUCTION
Hypertension is an important public health challenge, which affects
approximately one billion people worldwide [1]. According to the World
Health Organization (WHO), hypertension is the leading risk factor for
mortality (12.7% of deaths attributable) [2]. Each year at least 7.1 million
people die as a consequence of hypertension [3].The overall average
prevalence of hypertension in the world was estimated as 35% (37% in men

people regarding to hypertension.


3

CHAPTER 1 - LITERATURE REVIEW
1.1. Overview of hypertension
1.1.1. Hypertension definition
According to the World Health Organization-International Society

of

Hypertension (WHO/ISH) Guidelines for the Management of Hypertension
[7], hypertension is defined as a systolic blood pressure (SBP) of 140 mmHg or
greater and/or a diastolic blood pressure (DBP) of 90 mmHg or greater in
subjects who are not taking antihypertensive medication.For subjects with
diabetes mellitus, end organ damage or metabolic syndrome, blood pressure
levels of130/80 mmHg or greater are defined as hypertension[8, 9].
A classification of blood pressure levels in adults over the age of 18
is provided in Table 1.
Table 1.Definition and classification of blood pressure (diastolic blood
pressure) levels. (According to Vietnam Ministry of Health’s Guidelines for
Prevention and Management of Hypertension)[8]
Category

SBP

DBP

(mmHg)


and/ or

90-99

Hypertension stage 2 (moderate)

160-179

and/ or

100-109

Hypertension stage3 (severe)

≥ 180

and/ or

≥ 110

Key: SBP= Systolic blood pressure

DBP= Diastolic blood pressure


4

1.1.2. Causes of hypertension
Primary (essential) hypertension:

socioeconomic

determinants, and inadequate access to health care. Worldwide, detection,
treatment and control of hypertension are inadequate, owing to weaknesses in
health systems, particularly at the primary care level[13].
1.1.4. Complications
According to Mayo clinic the excessive pressure on your artery walls caused
by high blood pressure can damage your blood vessels, as well as organs in


5

your body. The higher your blood pressure and the longer it goes uncontrolled,
the greater the damage. Uncontrolled high blood pressure can lead to: heart
attack or stroke, aneurysm, heart failure, thickened, narrowed or torn blood
vessels in the eyes, metabolic syndrome, and trouble with memory or
understanding [14].
1.1.5. Management:
If left uncontrolled, hypertension causes stroke, myocardial infarction,
cardiac failure, dementia, renal failure and blindness. There is strong scientific
evidence of the health benefits of lowering blood pressure through populationwide and individual (behavioral and pharmacological) interventions[13].
According to the British Guidelines for HTN 2004, all people with high
blood pressure, borderline or high normal blood pressure should be advised in
lifestyle modifications. People should maintain normal body weight, reduce
salt intake, limit alcohol consumption, and engage in regular aerobic physical
exercise (brisk walking rather than weightlifting) for ≥ 30minutes per day,
ideally on most of days of the week but at least on three days of the week.
Moreover, people should consume at least five portions/day of fresh fruit and
vegetables; and reduce the intake of total and saturated fat.
Most people with high blood pressure will require at least two blood

The economic aspects of hypertension are critical to modem medicine. The
medical, economic, and human costs of untreated and inadequately controlled
hypertension are enormous. Hypertension is distributed unequally and with
iniquity in different countries and regions of the world. Treatment of
hypertension requires an investment over many years to prolong disease-free
quality years of life. The high prevalence and high cost of the disease impacts
on the microeconomics and macroeconomics of countries and regions. The


7

criteria used for inclusion in clinical guidelines for hypertension impact on the
cost and cost/utility of diagnosis or treatment.
1.2.2. The prevalence of Hypertension in Vietnam
Pham Thai Son in a national survey in Vietnam in 2013 found that the
prevalence of hypertension was high (overall 25.1%, 28.3% in men and 23.1%
in women). The proportions of hypertensive aware, treated and controlled were
unacceptably low (48.4%, 29.6% and 10.7% respectively).
According to Do Thi Phuong (2013), the overall prevalence of hypertension
among total 18,000 participants was 21% and 42% of the people had
prehypertension, only 37% had normal blood pressure[19].
The increasing prevalence of hypertension is attributed to population
growth, ageing and behavioral risk factors, such as unhealthy diet, harmful use
of alcohol, lack of physical activity, excess weight and expose to persistent
stress.
1.2.3. Hypertension and elderly people with hypertension
Hypertension is the most important risk factor of cardiovascular and kidney
diseases; and a leading risk factor for mortality[20]. Hypertension has become
a significant problem in many developing countries. In 2008, nearly a billion
adults aged 25 years and older had hypertension, and three quarters of the

stroke,
and

congestive

dementia

is

also

heart

disease,

increased

in this

chronic kidney
subgroup

of

hypertensive[25]. Cardiovascular disease (CVD) was the leading cause of
death in adults. One major reason for this trendies the patterns of BP changes
and increasing hypertension prevalence with age approximately 1 billion
people worldwide)[20]. Hypertension prevalence is less in women than in men
until 45 years of age,similar in both sexes from 45 to 64 and much higher in
womenthan men over 65 years of age[26]. The severity of hypertension related

shown a low and sometimes no connection between attitude and practices.
For example:Smoking and drinking alcohol have little effect on blood pressure.
Agree/ Uncertain/ Disagree.


10

Practice definition: Practices or behaviors are the observable actions of an
individual in response to a stimulus. This is something that deals with the
concrete, with actions. For practices related to health, one collects information
on consumption of tobacco or alcohol, the practice of screening, vaccination
practices, sporting activities, sexuality etc.
For example: Do you smoke? Yes/ No[28]
1.3.2. Knowledge, attitude and practice regarding to Hypertension
The main reasons for this inadequate control of blood pressure include
demographic characteristics, health beliefs and the presence of other chronic
diseases. Other reasons include lack of hypertension awareness and lack of
knowledge about high blood pressure. While it is difficult or impossible to
change demographic and personal characteristics, cultural norms and
socioeconomic status, increasing knowledge through educational interventions
on treatment can positively.Because hypertension is emerging as a major
public health problem in many developing countries, KAP data on
hypertension as crucial steps in the design of sound prevention and control
programs. It is particularly important to maximize the efficiency of such
programs in these countries to minimize delay in achieving effective
hypertension control[29].In a descriptive survey by Oliviera et al (2005) [30] to
understand the current status of hypertension knowledge, awareness, and
attitudes in a group of hypertensive patients, results showed that patients are
knowledgeable about hypertension in general, but are less knowledgeable
about specific factors related to their condition. According to a cross-sectional

hypertensive aware, treated and controlled were unacceptably low (48.4%,
29.6% and 10.7% respectively). Most Vietnamese adults (82.4%) had good
knowledge about high blood pressure. People received their information on
hypertension from mass media (newspapers, radio, and especially television).
Most people would choose a commune health station (75%) if seeking health


12

care for hypertension. The programmer on hypertension control was able to run
independently at the commune health station. Severity of hypertension and
effectiveness of treatment were the main factors influencing people’s
adherence to the programmer. The hypertension control programmer
successfully reduced blood pressure (systolic blood pressure: -2.2 mmHg in
men and -7.8 mmHg in women; diastolic blood pressure: -4.3 mmHg in men
and -6.8 mmHg in women), the estimated CVD 10- year risk (-2.5% in
women), and increased the proportions of treatment (22% in men and 13.6% in
women) and control (11% in men and 17.3% in women) among hypertensive
people[33].
Assessment for KAP score often based on questionnaires available has been
verified in previous studies or based on questionnaires developed based on the
old question. Depending on the different questions the author will have
different score. For example, according to research by the author Olusegun
Adesola Busari el al have the following scoring method: “Patients’ knowledge,
attitudes and practices on HTN were assessed using a standardized and
structured questionnaire which was developed and pre-tested for the study.It
had both closed and open-ended questions.Consent was obtained after the
purpose of the study was adequately explained to therespondents. The
questionnaire covered sociodemographic, occupational and educational
variables, information on knowledge of HT and its treatment, attitude

that low income was a reason for negative attitudes and wrong practice
amongst HTN adult patient[34].
1.4.3. Information approach and health care worker-patient relationship
According to a survey of under-graduated students in Hue, most people
found information about HTN from their relatives and friends (80.7%), whilst
that from television was 67.7%. However, there were 48.5% found information


14

through health propagandas and health care workers and only 6.2% through
local radiocast.
In another study of Mumtaz, 10% patients reported that a physician or other
health care provider was a source of information about HTN; 6% found
information from television, newspapers, magazines and radio[35].
Health care providers and health propaganda play a very important role in
enhancing the HTN knowledge of people, especially in rural and remote areas.
Besides methods of approaching information, the relationship between
health care providers, especially doctor and patient also affect to their KAP.
Tran Thien Thuan has reported that one of the reasons why people had
ineffective practice regarding HTN was the difficulty of and irregular health
examination in local health care units. Mumtaz also indicated that the better
doctor-patient relationship having, the more effective in providing good control
of blood pressure provide. Greeff in 2006 emphasized that building a trusting
relationship between the health care worker and the patients is one of the most
important aspects when motivation patient[37].
1.4.4. Other factors
In researcher’s opinion, the age of patients can have an impact on the ability
of knowledge absorption, attitudes and effective practice regarding HTN.
When people get older, they may become more conservative. Furthermore,