Published on International Journal of Health, Nursing, & Medicine
Publication Date: June 14, 2019
Elisabeth Wahyu Savitri, Anastasia Hardyati & Wilhelmus Hary Susilo
Postgraduate Masters in Nursing, Sint Carolus School of Health Sciences
Sint Carolus School of Health Sciences
Hypertension is high blood pressure that settled, where the systolic ≥ 140 mmHg and diastolic ≥ 90 mmHg, measured at least twice on two different conditions within two weeks. Indonesia is a country with a highest incident rate of hypertension in the world (31.7%) with non-modifiable and modifiable risk factor (Moser & Riegel, 2008:435). Health education improved the capability of hypertensive client in modifying their risky lifestyle (modifiable risk factors). The aim of this study was to identify the effect of health education to motivation for diets, exercise and blood pressure controlling in hypertensive patients at Sinto Antonius Hospital and dr. Soedarso general Hospital. The study used a quasi experimental design with 52 respondents taken through simple random sampling technique and using a self-made instrument to measure knowledge and motivation level with reliability scale of 0.946 and 0.915 each. The profile of demographic shown the age of most respondents was more than 40-59 years old (51.9%), most gender was male (53.8%), familial predisposition of hypertension (78.8%), with previous knowledge level below of the average (82.7%) but presume good motivation (67.3%). Using paired t-test statistical analysis,it was found that there was a significant difference on the mean score of knowledge level but there was no significant difference on the motivation level before and after health education.Using the same test, it was found that there was no effect of age, gender, familial predisposition of hypertension and health education to motivation (p>0,05). While using multiple regression statistical analysis, it was found that there was no single factor among the variable of age, gender, familial predisposition to hypertension and health education effected on motivation level (p>0.05). The motivation level has already predominate on good level before and after health education so that the statistical analysis turned to be not significant. It is then recommended that health education is still an important thing to be done by nurses to increase knowledge level of the patient and keep on motivating them for healthy life-style especially on modifiable risk factors.
Keywords: Hypertension, modifiable risk factors, health education, level of knowledge, level of motivation.
Hypertension is defined as persistent high blood pressure, where systolic blood pressure is ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg, when measured at least two measurements and in two different conditions with a distance of two weeks (deWit & Kumagai, 2013). The cause of hypertension is broadly divided into 2 risk factors, namely factors that cannot be changed and factors that can be changed (Moser & Riegel, 2008).
Across the world there are an estimated 8 million deaths every year due to hypertension. In America, it is predicted that there are 1 person out of 3 residents suffering from hypertension (Sood et al, 2010). In Indonesia the prevalence of hypertension sufferers also tends to increase, where hypertension sufferers 31.7% of the population aged 18 years and over (Ministry of Health, 2012). Likewise, hypertension sufferers who seek treatment at the Santo Antonius General Hospital and Dr. Soedarso General Hospital, in 2014 and 2015 ranked the top 5 most diseases.
Health education that is carried out effectively and efficiently is something that nurses can do especially to make lifestyle modifications to risk factors that can be changed. Because with a good understanding of the consequences of the disease, it is expected that hypertensive patients will change lifestyle that is not good into a good and healthy lifestyle (Huang et al, 2010). Good health education has an influence on regular blood pressure control (Johnson et al, 2011). The statement reaffirms that continuous health education programs can have an effect on reducing blood pressure in hypertensive patients (Allaire et al, 2010).
Health education provided is expected to be able to generate good knowledge for people with hypertension which ultimately affects the motivation to carry out healthy life as expected (Notoadmodjo, 2010). The results that individuals get from the learning process including health education that is in the form of the level of knowledge, the knowledge will eventually affect a person’s behavior to do something, this is what is called motivation (Mandala, 2010).
Based on observations of researchers, patients with hypertension at St. Hospital Antonius and Dr. Soedarso Hospital were not given health education. This can be seen from the lack of facilities in hospitals that can be a means of information for patients and families. This study aims to determine whether there is an influence of health education on the motivation to go on a diet, carry out exercises and carry out blood pressure checks in hypertensive patients at the Santo Antonius General Hospital and Dr. Soedarso Hospital.
The population of hypertensive patients at Santo Antonius General Hospital in 2015 was hospitalized as many as 875 people and outpatients were 744 people. The population of hypertensive patients in Dr. Soedarso General Hospital in 2011 who were hospitalized were 308 people and outpatients were 9,695 people. Due to the limitations of research time, respondents in the study were 60 respondents. Based on the Krejcie table, 52 respondents will be re-selected for simple random sampling. To obtain a different paired test sample or Z test, then from the 52 respondents, only 38 respondents will be randomly selected. This research was conducted at General Hospital of Santo Antonius and Dr. Soedarso General Hospital of Pontianak, for 6 weeks, namely from May until June 2016.
Data collection instrument contains questions to determine the level of knowledge of respondents to diet, exercise and blood pressure checks performed before (pre) and after (post) health education. The Motivation Questionnaire, contains a statement about the motivation to run a diet, exercise and blood pressure checks which are also carried out before and 1-2 weeks after health education.
A. Frequency distribution
Table 1. Distribution of respondents based on age, gender, family history of hypertension, level of knowledge, motivation (n= 52)
The majority of respondents were> 40-59 years old (51.9%), male sex (53.8%), had a history of hypertension in their family (78.8%), the level of knowledge before most health education was less than average (82.7 %), the motivation before most health education is the same as or more than the average (67.3%) (Table 1).
B. Analisis Bivariat
Table 2. Effect of age, gender, influence of family hypertension history, level of knowledge of post health education on motivation
There was no effect of age on motivation with P-Value 0.846, no gender influence on motivation with P-Value 0.253, no influence on family hypertension history on motivation with P-Value 0.692, no influence of health education on motivation with P-Value 0.173 (table 2).
C. Multivariate Analysis
Table 3. ANOVAa Regression Linear for Motivation
There is no influence of health education (level of health post education knowledge), age, sex and history of hypertension in the family together towards motivation to go on a diet, exercise (exercise) and blood pressure checks, with P-Value = 0.526 (table 3).
D. Paired Difference Test
Table 4. Pre-Post Knowledge and Motivation
A. Frequency distribution
Systolic blood pressure will increase with increasing age so that after the age of 50 years systolic blood pressure will reach > 140 mmHg (deWit & Kumagai, 2013). Tian Shen, et al (2011) Factors related to the incidence of hypertension found that age above 35 years had a very close or significant relationship with the incidence of hypertension.
Age of 55 years of hypertension will be more experienced by men, but after the age of 55 years on the contrary hypertension will be more experienced by women, because of the onset of monopause (deWit & Kumagai, 2013). According to Tian Shen, et al. (2011) the factors associated with the incidence of hypertension found that male sex had a very close or significant relationship with the incidence of hypertension.
Close family who have hypertension, then that person will be more at risk of developing hypertension (deWit & Kumagai, 2013). Tian Shen, et al. (2011) factors related to the incidence of hypertension found that a history of hypertension in the family had a very close or significant relationship with the incidence of hypertension.
According to Shuqiong, et al (2010) the effects of knowledge-giving programs and lifestyle changes in hypertensive patients in China. The effect of the program given to group I or it can be concluded that the health education provided was significantly able to motivate hypertensive patients to change their lifestyle to be better or as expected compared to the control group.
According to Ra, et al (2011), the development and evaluation of tests regarding knowledge about hypertension in hypertensive patients in Korea. The results of this study state that patients who have higher knowledge are more motivated to control blood pressure than those who have lower knowledge.
B. Effect of age, gender, family history of hypertension, motivation education
1. Effect of age on motivation
The majority of respondents are > 40-59 years old or old or middle age adults. Based on the Pearson Correlations Test conducted to see the relationship between age and motivation, it is seen that age has a relationship or correlation with motivation to do blood pressure checks and exercise motivation, this proves that there is a relationship between age and motivation, especially motivation to do blood pressure checks.
According to Tian Shen, et al. (2011) patients who are more motivated to control blood pressure, diet, exercise or all things that can reduce the risk of increasing blood pressure are patients in middle age 40-50 years.
According to Penney (2012) the age of old adulthood is at the peak of its age, the best achievement in its life so that the desire to maintain these conditions will be increasingly motivated to maintain its health. Humans at age have an increased urge to maintain physical appearance, including maintaining their health because at that age humans have an increase in quality of life and satisfaction with the body and self-esteem.
2. Influence of gender on motivation
The majority of male respondents were 28 respondents (53.8%). Based on the Pearson Correlations Test there is a relationship between gender and motivation, gender has a relationship with motivation, especially conducting blood pressure checks, proving there is a sex relationship with motivation, especially motivation to do blood pressure checks.
According to Eva (2012), the fundamental differences between men and women in facing life defense problems are related to the motivation to carry out something they want to achieve in their lives, men are more dominant than women.
After humans realize that they are a certain gender, it will show a clear motivation to behave in accordance with the gender members, all of their actions will be adjusted accordingly, men are always more motivated in doing things than women (Penney, 2012).
3. The influence of family history of hypertension on motivation
The majority of respondents had a family history of hypertension 41 respondents (78.7%). Based on the Pearson Correlations Test there is a history of hypertension in families with motivation. A history of hypertension in the family has a relationship with motivation to do a blood pressure check. The relationship is quite close to the history of hypertension in families with motivation, especially the motivation to carry out blood pressure checks. According to Shen, et al (2011) patients who are more motivated to control blood pressure, diet, exercise. According to Shiue (2011), a family history of hypertension is certainly a bit used to seeing or dealing with how a hypertensive patient in his family lives his life, both in terms of medication, exercise and diet.
4. Effect of health education on motivation
The majority of respondents had a level of knowledge above the average at the time after health education (71.15%). Based on the Pearson Test proves there is a relationship between the level of knowledge and motivation, especially the level of knowledge about diet and motivation to go on a diet and the level of knowledge of blood pressure checks with the motivation to carry out blood pressure checks.
Health education is a long-term behavioral investment. The results of these actions can be seen a few years later. Immediate impact of health education will only result in a change of knowledge, which is expected to be able to increase the motivation to carry out the health education that has been given (Notoadmodjo, 2010).
Good health education especially for people with hypertension influences regular blood pressure control (Johnson et al, 2011). This statement is reaffirmed that continuous health education programs can have an effect on reducing blood pressure in hypertensive patients (Allaire et al, 2010).
This study is different Wallace, et al (2011) health education that has been given to doctors and patients can make patients more diligent and motivated to control blood pressure and reduce systolic blood pressure by 12 mmHg for 6 months but the health education provided is expected to cause good knowledge for people with hypertension, especially on a diet, doing exercises and regular blood pressure checks. Good knowledge will influence the increasing motivation to carry out healthy life as expected (Notoadmodjo, 2010). The results obtained from the process of health education in the form of a level of knowledge will influence behavior to do motivation (Mandala, 2010).
According to Shen, et al. (2011) patients who are more motivated to control blood pressure, diet, exercise or all things that can reduce the risk of increasing blood pressure are patients in the middle age 40-50 years, and who have a history of hypertension in their families.
There is no influence of age, gender, history of hypertension, family health education on motivation to go on a diet, exercise and blood pressure checks in hypertensive patients. There is no simultaneous influence of health education, age, gender, history of hypertension in the family, motivation to run a diet, exercise and blood pressure checks on hypertensive patients. There is a difference in level of knowledge before and after the health education of patients. There is no difference in motivation before and after health education in hypertensive patients. Recommendations in this study can be the basis for conducting further research with more extended research time. Hypertensive patients want to actively seek information through the media available in the community and not only expect health education, including actively attending health seminars so that the information received is more accurate and complete.