Design and Implementation of Self-Care Package for Hypertension Based on Transtheoretical Model: A Study Protocol

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Extended Abstract
Background
Hypertension is among the most common chronic and preventable diseases worldwide. About 20% of the adult population worldwide has high blood pressure. The most effective way to control blood pressure is the patient's compliance with self-care behaviors. Along with paying attention to medication, it is necessary to involve the patient in self-care activities until the end of life. In this regard, previous studies have been limited merely to self-care education ignoring effective psychological approaches to change behavior. Therefore, in order to emphasize the effective psychological skills in changing the current conditions and behavior of patients, we aimed to design a management protocol for blood pressure based on a transtheoretical model and evaluate its effectiveness in increasing self-care, self-efficacy, and health-related quality of life in patients with high blood pressure.
Methods
The present study consists of two stages. In the first stage, the management protocol of blood pressure based on the transtheoretical model will be designed by reviewing scientific texts and national guidelines. Then, the preliminary protocol will be assessed by expert panel in a deep interview session. After applying the opinions of the expert panel, the content of the training package will be prepared. The second stage will include the intervention and evaluation of the protocol’s effectiveness on self-care, self-efficacy, and health-related quality of life in patients with hypertension. The implementation and evaluation of the protocol will be done experimentally through including two intervention and control groups. The intervention in the experimental group will include an 80-minute session per week for eight weeks and 10-minute individual telephone counseling once a week. The target population will include all hypertensive people (aged 45-65 years) visiting health centers in Tabriz, Iran. The participants will be diagnosed as hypertensive people by a specialist physician. Data will be collected using self-care questionnaires in patients with hypertension, stages of changes in hypertension, health-related quality of life, and self-efficacy. Data will be analyzed using SPSS version 22 software. Mean and standard deviation will be used to describe quantitative variables. Frequency and percentage will be used to describe qualitative variables. One and multiple covariance analysis will be used to compare quantitative variables, and chi-square test will be used to compare qualitative variables.
Conclusion
Hypertension is a chronic challenge. So, it is essential to manage the disease by self-care practices, monitor warning signs, and prevent the disease recurrence. In this respect, the use of behavior change theories in the development of self-care and improvement of health indicators can play a major role. Also, using psychological models and self-efficacy can be very useful in converting awareness and knowledge into behavior change. Considering that adherence to treatment in patients with high blood pressure is low in Iran and since hypertension requires the involvement of patients in self-care activities in addition to medication, the implementation of a self-care protocol based on a comprehensive changing behavior theories can be effective in improving self-efficacy, self-care, and quality of life in these patients. This research protocol can pave the way for using research to apply psychological theories in the care of chronic diseases.