Self-care of hypertension of older adults during COVID-19 lockdown period: a randomized controlled trial

Khitam Alsaqer, Hatice Bebis, Khitam Alsaqer, Hatice Bebis

Abstract

Background: COVID-19 pandemic has aggravated chronic diseases and health disparities especially hypertension because it is more common among vulnerable populations such as older adults.

Objective: This study aimed to examine the effects of a public health nursing intervention plus m-Health applications for hypertension management on enhancing the self-care, systolic and diastolic of blood pressure, and quality of life in older adults during the lockdown period in Jordan.

Methods: A randomized, controlled trial design was performed in Jordan. A total of 120 participants were randomly allocated to three groups (n = 40); interventional group (public health nursing interventions plus m.Health applications) and two control groups (m.Health applications alone group and standard care group).

Results: After 3 months, the interventional group show significantly decreased in systolic blood pressure - 14 (F = 16.74, P = 0.001), greater improvement in self-care maintenance, monitoring, and confidence (+ 30, + 17.75, + 40.27; P < 0.01, respectively) compared to the two control groups. Greater improvement in role limitations due to physical health and due to emotional problems, pain, energy/fatigue, emotional well-being, and social functioning of quality of life (P < 0.05) compared to the standard care group. No statistical significant difference was found in diastolic blood pressure (F = 3.91, P = 0.141), physical functioning (P = 0.613), and general quality of life (P = 0.060).

Conclusions: This study supports the adoption of technology with nursing intervention as a method of supporting continuity of self-management of chronic illness during the pandemic, and its potential implications for future delivery of health care, not just in Jordan, but across the world.

Trial registration: Clinical Trial.gov (ID NCT04992000 ). Registered August 12, 2021.

Keywords: Aged; COVID-19; Hypertension; Self-care; Telemedicine.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Sample and study process. BP: Blood pressure; PHN: Public health nursing; QoL: Quality of life; SC-HI: Self Care of Hypertension Inventory
Fig. 2
Fig. 2
Before and after changes of Self-care of Hypertension Inventory items mean. A: maintenance, B: monitoring, C: confidence
Fig. 3
Fig. 3
Before and after changes of systolic blood pressure (SBP) and diastolic BP (DBP) means

References

    1. Mobula LM, Heller DJ, Commodore-Mensah Y, Walker Harris V, Cooper LA. Protecting the vulnerable during COVID-19: treating and preventing chronic disease disparities. Gates Open Res. 2020;4:125. doi: 10.12688/gatesopenres.13181.1.
    1. World Health Organization (WHO) Hypertension. Geneva: WHO; 2021.
    1. Khader Y, Batieha A, Jaddou H, Rawashdeh SI, El-Khateeb M, Hyassat D, et al. Hypertension in Jordan: prevalence, awareness, control, and its associated factors. Int J Hypertens. 2019;2019:3210617–3210618. doi: 10.1155/2019/3210617.
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire D, Mohler ER, 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics: 2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322. doi: 10.1161/CIR.0000000000000152.
    1. World Health Organization . Jordan: hypertension. Geneva: WHO; 2018.
    1. Blecker S, Jones SA, Petrilli CM, Admon AJ, Weerahandi H, Francois F, Horwitz LI. Hospitalizations for chronic disease and acute conditions in the time of COVID-19. JAMA Intern Med. 2021;181(2):269–271. doi: 10.1001/jamainternmed.2020.3978.
    1. Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194–204. doi: 10.1097/ANS.0b013e318261b1ba.
    1. Fisher ND, Curfman G. Hypertension: a public health challenge of global proportions. JAMA. 2018;320(17):1757–1759. doi: 10.1001/jama.2018.16760.
    1. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;3:CD005182. doi: 10.1002/14651858.CD005182.pub4.
    1. Milani RV, Bober RM, Lavie CJ. The role of technology in chronic disease care. Prog Cardiovasc Dis. 2016;58(6):579–583. doi: 10.1016/j.pcad.2016.01.001.
    1. Pellegrini D, Torlasco C, Ochoa JE, Parati G. Contribution of telemedicine and information technology to hypertension control. Hypertens Res. 2020;43(7):621–628. doi: 10.1038/s41440-020-0422-4.
    1. Lee JA, Choi M, Lee SA, Jiang N. Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review. BMC Med Inform Decis Mak. 2018;18(1):12. doi: 10.1186/s12911-018-0591-0.
    1. Li R, Liang N, Bu F, Hesketh T. The effectiveness of self-management of hypertension in adults using mobile health: systematic review and meta-analysis. JMIR Mhealth Uhealth. 2020;8(3):e17776. doi: 10.2196/17776.
    1. Kim JY, Wineinger NE, Steinhubl SR. The influence of wireless self-monitoring program on the relationship between patient activation and health behaviors, medication adherence, and blood pressure levels in hypertensive patients: a substudy of a randomized controlled trial. J Med Internet Res. 2016;18(6):e116. doi: 10.2196/jmir.5429.
    1. Moore JO, Marshall MA, Judge DC, Moss FH, Gilroy SJ, Crocker JB, et al. Technology-supported apprenticeship in the management of hypertension: a randomized controlled trial. J Clin Outcomes Manag. 2014;21:110–122.
    1. Morawski K, Ghazinouri R, Krumme A, Lauffenburger JC, Lu Z, Durfee E, Oley L, Lee J, Mohta N, Haff N, Juusola JL, Choudhry NK. Association of a smartphone application with medication adherence and blood pressure control: the MedISAFE-BP randomized clinical trial. JAMA Intern Med. 2018;178(6):802–809. doi: 10.1001/jamainternmed.2018.0447.
    1. Persell SD, Peprah YA, Lipiszko D, Lee JY, Li JJ, Ciolino JD, Karmali KN, Sato H. Effect of home blood pressure monitoring via a smartphone hypertension coaching application or tracking application on adults with uncontrolled hypertension: a randomized clinical trial. JAMA Netw Open. 2020;3(3):e200255. doi: 10.1001/jamanetworkopen.2020.0255.
    1. Zare S, Rezaee R, Aslani A, Shirdeli M, Kojuri J. Moving toward community based telehealth services using mhealth for hypertensive patients. Int J Technol Assess Health Care. 2019;35(5):379–383. doi: 10.1017/S0266462319000655.
    1. Zha P, Qureshi R, Porter S, Chao YY, Pacquiao D, Chase S, O’Brien-Richardson P. Utilizing a mobile health intervention to manage hypertension in an underserved community. West J Nurs Res. 2020;42(3):201–209. doi: 10.1177/0193945919847937.
    1. Kolcu M, Ergun A. Effect of a nurse-led hypertension management program on quality of life, medication adherence and hypertension management in older adults: a randomized controlled trial. Geriatr Gerontol Int. 2020;20(12):1182–1189. doi: 10.1111/ggi.14068.
    1. Wright JH, Caudill R. Remote treatment delivery in response to the COVID-19 pandemic. Psychother Psychosom. 2020;89(3):130–132. doi: 10.1159/000507376.
    1. King Abdullah Univirsity Hospital (KAUH) Home. Jordan: KAUH; 2020.
    1. King Abdullah University Hospital (KAUH). About us. Jordan: KAUH; 2020. Availble from:
    1. Wong FK, Chow SK, Chan TM, Tam SK. Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomised controlled trial. Age Ageing. 2014;43(1):91–97. doi: 10.1093/ageing/aft123.
    1. Zhu X, Wong FK, Wu CL. Development and evaluation of a nurse-led hypertension management model: a randomized controlled trial. Int J Nurs Stud. 2018;77:171–178. doi: 10.1016/j.ijnurstu.2017.10.006.
    1. Dickson VV, Lee C, Yehle KS, Abel WM, Riegel B. Psychometric testing of the self-care of hypertension inventory. J Cardiovasc Nurs. 2017;32(5):431–438. doi: 10.1097/JCN.0000000000000364.
    1. Alsaqer K, Bebis H. Cross-cultural adaptation, validity, and reliability of the Arabic version of the self-care of hypertension inventory scale among older adults. J Cardiovasc Nurs. 2021;36(5):430–436. doi: 10.1097/JCN.0000000000000738.
    1. Care RH . 36-Item Short Form Survey (SF-36) Scoring Instructions. Santa Monica: RAND Corporation; 2020.
    1. Guermazi M, Allouch C, Yahia M, Huissa TB, Ghorbel S, Damak J, et al. Translation in Arabic, adaptation and validation of the SF-36 health survey for use in Tunisia. Ann Phys Rehabil Med. 2012;55(6):388–403. doi: 10.1016/j.rehab.2012.05.003.
    1. Sheikh KA, Yagoub U, Elsatouhy M, Al Sanosi R, Mohamud SA. Reliability and validity of the Arabic version of the SF-36 health survey questionnaire in population of Khat chewers: Jazan region-Kingdom of Saudi Arabia. Appl Res Qual Life. 2015;10(1):1–3. doi: 10.1007/s11482-013-9291-1.
    1. Han HR, Song HJ, Nguyen T, Kim MT. Measuring self-care in patients with hypertension: a systematic review of literature. J Cardiovasc Nurs. 2014;29(1):55–67. doi: 10.1097/JCN.0b013e3182775fd1.
    1. Athilingam P, Jenkins B, Johansson M, Labrador M. A mobile health intervention to improve self-care in patients with heart failure: pilot randomized control trial. JMIR Cardio. 2017;1(2):e3. doi: 10.2196/cardio.7848.
    1. Najafi Ghezeljeh T, Sharifian S, Nasr Isfahani M, Haghani H. Comparing the effects of education using telephone follow-up and smartphone-based social networking follow-up on self-management behaviors among patients with hypertension. Contemp Nurse. 2018;54(4-5):362–373. doi: 10.1080/10376178.2018.1441730.
    1. Schuch F, Vancampfort D, Firth J, Rosenbaum S, Ward P, Reichert T, Bagatini NC, Bgeginski R, Stubbs B. Physical activity and sedentary behavior in people with major depressive disorder: a systematic review and meta-analysis. J Affect Disord. 2017;210:139–150. doi: 10.1016/j.jad.2016.10.050.
    1. Stanczykiewicz B, Banik A, Knoll N, Keller J, Hohl DH, Rosińczuk J, Luszczynska A. Sedentary behaviors and anxiety among children, adolescents and adults: a systematic review and meta-analysis. BMC Public Health. 2019;19(1):459. doi: 10.1186/s12889-019-6715-3.
    1. Callow DD, Arnold-Nedimala NA, Jordan LS, Pena GS, Won J, Woodard JL, Smith JC. The mental health benefits of physical activity in older adults survive the COVID-19 pandemic. Am J Geriatr Psychiatry. 2020;28(10):1046–1057. doi: 10.1016/j.jagp.2020.06.024.
    1. Lee HY, Kim JY, Na KY, Park HY, Han J, Pak Y, Nam B, Pae CH, Lee J, Lim TH, Lee D. The role of telehealth counselling with mobile self-monitoring on blood pressure reduction among overseas Koreans with high blood pressure in Vietnam. J Telemed Telecare. 2019;25(4):241–248. doi: 10.1177/1357633X18780559.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe