Self-Efficacy Support on Medication Adherence and Self-Efficacy Levels in Hypertension Patients
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      Background:Health professionals are responsible for the education of hypertension patients.

      Aim:The aim of this research is to see how self-efficacy support affects hypertension
      patients' medication adherence and self-efficacy levels.

      Methods: This research is randomized controlled interventional research. The research is
      conducted inTurkey June-December2021.The research sample included 63hypertension patients who
      met the research's research requirements.According to the sequence of the arrival at the
      hospital, data were separated into groups with odd(intervention group)and double(control
      group)numbers.The necessary forms for both groups' pre-test data were filled out
      face-to-face. The intervention group received hands-on blood pressure measurement training
      with the "Hypertension Training Manual",including how to self-measure blood pressure.Over the
      course of the research, patients were asked to check their blood pressure twice a day at home
      and record the results.The patients in the intervention group were reminded of their blood
      pressure measurement three times a week by SMStechnique for three months to avoid forgetting
      it.Three months later, the same forms for the post-test data of both groups were filled out
      with an online survey method.The data were evaluated using the single-blind study.
    

Detailed description: 
      Background:Health professionals are responsible for the education of hypertension patients.

      Aim:The aim of this research is to see how self-efficacy support affects hypertension
      patients' medication adherence and self-efficacy levels.

      The Research's Population and Sample Hypertension patients who applied to the cardiology
      outpatient clinics at a Hospital in Turkey between June and December 2021 formed the target
      population of the research. The research sample included 63 hypertension patients over the
      age of 18 who met the research requirements and agreed to participate.

      A priori power analysis was used to determine the sample size, and it was determined that
      each of the intervention and control groups needed at least 30 hypertension patients for the
      research's power to exceed 80% at the 95% confidence interval, 0.05 significance level, and
      medium effect size. Given the possibility of data loss owing to a variety of factors, it was
      decided to include 100 hypertension patients in the research sample. Because 12 patients
      wished to withdraw from the research and 25 patients did not complete the final applications,
      the research sample consisted of 63 hypertension patients, 31 in the intervention group and
      32 in the control group.

      Criteria for Research Inclusion All intervention and control groups were required to meet the
      inclusion criteria below.

        -  With a diagnosis of essential hypertension, follow up for at least 6 months,

        -  Using antihypertensive drugs,

        -  Not changing the antihypertensive medication in the last 1 month,

        -  Not having mental or communication problems,

        -  Being the age of 18 or older,

        -  Having at least primary education level,

        -  Not being a pregnant or nursing mother. Data Collection Data Collection Tools To Be Used
           in the Research The research data were collected using the "Patient Descriptive
           Information Form", "Self-Efficacy-Efficacy Scale", and "Medication Adherence
           Self-Efficacy-Efficacy Scale in Hypertensive Patients." Patient Introductory Information
           Form This form, which has been developed by the researchers based on the literature and
           has 19 questions, includes the socio-demographic characteristics of the patients and
           their disease-related features.

      Self-Efficacy - Efficacy Scale The scale evaluates generic self-efficacy-efficacy perception
      and does not belong to any subjective category. The Self-Efficacy-Efficacy Scale is a
      23-item, 5-point Likert-type scale with a minimum of 23 points and a maximum of 115 points.

      Medication Adherence Self-Efficacy Scale in Hypertensive Patients The scale consists of 13
      items and is in a four-point Likert type. The scale can be used to determine the lowest 13
      and highest 52 points. The increase in the scale score shows that the individuals' compliance
      with the antihypertensive medication is above average.

      Used Materials for Self-Efficacy Support Hypertension Education Booklet The Hypertension
      Education Booklet, which was created by the researchers based on the literature review,
      contains information about the disease and its treatment, treatment methods, lifestyle
      changes that are effective in the management of hypertension, the importance of treatment
      compliance, and blood pressure measurement at home.

      For the booklet, 1 internal medicine specialist, 3 nurse faculty members, and 1 specialist
      nurse provided expert opinions. In addition, three hypertension patients were given the
      booklet to assess its comprehension, and arrangements were made based on their ideas. The
      survey was completed after Item and Content validity analyses were performed.

      Blood Pressure Monitor Given the uncertainty of measurement by auscultation, the Hypertension
      Guidelines in the 2015 Canadian Education Program advocate using an automatic
      sphygmomanometer for office blood pressure measurement.Blood pressure is now measured at home
      using an upper arm blood pressure monitor. As a result, an appropriate blood pressure
      monitor, which enables self-measured blood pressure monitoring at home, with the BAP project
      number TSA-2021-8985 was delivered within the scope of the project. The device complies with
      the European Norm EN 60601-1-2.

      Phone "Don't forget to measure your blood pressure in the morning and evening!" message sent
      3 times a week by SMS method to the patients in the intervention group. In addition, the
      patients were contacted by phone at the end of the first, second, and third months to acquire
      information regarding the research process.

      Research Implementation The objective of the research and the manner of application was
      explained to all patients in the intervention and control groups who met the eligibility
      requirements. Patients who agreed to take part in the research were required to complete an
      "Informed Consent Form for Volunteers." As a pre-test, both groups were given the "Patient
      Introductory Information Form","Self-Efficacy-Efficacy Scale", and "Medication Adherence
      Self-Efficacy Scale in Hypertensive Patients" through a face-to-face interview.

      Separation of Groups Patients were sorted into odd and even numbers according to the order in
      which they arrived at the hospital in the research, regardless of their age or gender, as
      long as the number of participants in the intervention and control groups was equal. The
      method was repeated until a total of 100 data points were collected, with odd numbers
      representing the intervention group and even numbers representing the control group.

      Intervention Group Patient education and blood pressure measurement training took place in
      the ECG room of the outpatient clinic which is equipped to instruct patients. The
      "Hypertension Education Booklet" was used to instruct the patients. Following that, the
      patient received blood pressure measurement training, including a demonstration of how to
      self-measure blood pressure. The patient was instructed to repeat the same process. The
      researcher provided retraining in the event of errors or shortcomings. The training continued
      until the patient performed the accurate measurement. It took around half an hour. The
      patients were given a blood pressure monitor to use at home to test their blood pressure.
      Patients were asked to take their blood pressure at home twice a day and record the results
      during the research. Patients in the intervention group were texted three times a week for
      three months to remind them to take their blood pressure.

      The patients were called by phone after the first month to control the procedure and acquire
      information about the research process. In addition, the patients' queries were answered and
      information on the various events that occurred was acquired. Similarly, patients were also
      reached by phone after the second month to control the process and acquire information about
      the research process. The same forms were given to the patients in the intervention group as
      a post-test at the end of the third month, utilizing an online survey method.

      Control Group The control group received no intervention after the pre-test data of the
      control group were gathered face to face. The same forms were collected as post-test data via
      an online survey method at the end of the third month.

      Pre-Application The researcher invited two patients who applied to the outpatient clinic to
      read and answer the survey questions before the research to assess the intelligibility of the
      questions in the data collection form. All of the questions were found to be clear and of
      adequate scope. The data of the patients, taken to the pre-application, were not included in
      the research data.

      Data Evaluation The statistics were evaluated using the single-blind study. The data were
      analyzed in the SPSS 20 Package Program. To establish their distribution among the groups,
      frequency and percentage distributions were utilized. The intervention and control groups
      were compared using the chi-square test. To compare two independent groups, an "independent
      sample t-test" was utilized. To compare two dependent groups, a "Paired t-test" was
      performed. Descriptive statistics (mean and standard deviation) were used. The statistical
      significance cut-off value was set at 0.05.
    

Intervention name(s): self-efficacy support
Intervention type(s): Behavioral
Intervention description(s): self-efficacy support
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Supportive Care
Keywords: Nursing, hypertension, self-efficacy, self-efficacy support