Habibeh Barzegar
1 
, Sheida Sodagar
2 , Mohammadreza Seirafi
1* , Mostafa Farahbakhsh
2 , Touraj Hashemi Nosrat-Abad
3 1 Department of Health Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
2 Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
3 Faculty of Educational Sciences and Psychology, University of Tabriz, Tabriz, Iran
Abstract
Background. Hypertension is one of the most important public health challenges in the world, and self-care is an essential part of hypertension treatment. The present study aimed to investigate the effectiveness of a blood pressure management protocol based on the transtheoretical model on improving self-care, self-efficacy, and health-related quality of life in patients with hypertension.
Methods. This mixed-methods study consisted of two stages that were conducted in Tabriz Health centers in 2022-2023. The first stage was concerned with designing a blood pressure management protocol based on the transtheoretical model. The second stage was centered on a randomized controlled trial (RCT) to evaluate the effectiveness of the designed protocol on increasing self-care, self-efficacy, and health-related quality of life. Thus, 60 people with hypertension were included in the study and were randomly divided into two experimental and control groups. Data was collected via relevant questionnaires in the pre-test stage, immediately after the training (baseline), 2 months after the training in the post-test stage, and 4 months after the training in the follow-up stage. ANCOVA (repeated measures) statistical test was used to evaluate the effect of the intervention at different times.
Results. In the patients of the experimental group, the designed protocol sustainably increased the dimensions of self-care over time (P<0.001). Also, this protocol was effective in increasing self-efficacy and health-related quality of life dimensions in the patients of the experimental group (P<0.001). This increase was not observed for the variables of self-efficacy, self-care, and quality of life in the control group (P>0.05).
Conclusion. The greatest effect of training based on the transtheoretical model was on the patients’ self-care. Furthermore, with the passage of time in the presentation of education, the effect of the intervention decreased. Therefore, it can be concluded that holding short training sessions continuously to stabilize the behavior change of patients with hypertension is necessary.
Extended Abstract
Background
High blood pressure is one of the most chronic, common, and preventable diseases in the world, and the most important solution to controlling blood pressure is the patient's adaptation to self-care behaviors. The implementation of educational programs based on the transtheoretical model can lead to the improvement of self-care behaviors in patients with high blood pressure. Training the principles of self-care without considering the challenges of changing behavior will not be effective enough, and considering that previous studies have targeted limited aspects of self-care behavior such as nutrition or physical activity, there is still a need for research on the impact of careful self-care interventions on outcomes such as self-efficacy and quality of life. Therefore, the present study aimed to investigate the effectiveness of a blood pressure management protocol based on the transtheoretical model on improving self-care, self-efficacy, and health-related quality of life in patients with hypertension.
Methods
This mixed-methods study consisted of two stages that were carried out from October 2022 to October 2023 in Tabriz Health centers. The first stage was a descriptive developmental study. It included the design of a blood pressure management protocol based on the transtheoretical model, which was conducted based on the literature review and expert panel opinions. The second stage was centered on a randomized controlled trial (RCT) that was conducted to evaluate the effectiveness of the blood pressure management protocol based on the transtheoretical model on increasing self-care, self-efficacy, and health-related quality of life in patients with hypertension. The sample size was estimated to be 30 patients in each group using the formula n = (Zα/2+Zβ)2 *σ2 / (μ1- μ2)2 and considering the 80% power of the test, 95% confidence interval, an average change of 50%, and the standard deviation of 0.97. Thus, 60 people with high blood pressure in the age group of 45 to 65 years were included in the study according to the eligibility criteria and were randomly divided into two experimental (30 people) and control groups (30 people). Different questionnaires, such as a questionnaire of demographic characteristics, a self-care questionnaire for patients with high blood pressure, a questionnaire of stages of change in high blood pressure, a health-related quality of life questionnaire (SF-36), and a self-efficacy questionnaire, were utilized for data gathering. Data was collected via the mentioned questionnaires in the pre-test stage, immediately after the training (baseline), 2 months after the training in the post-test stage, and 4 months after the training in the follow-up stage. SPSS software (version 23) was used to analyze the data. ANCOVA (repeated measures) statistical test was used to evaluate the effect of the intervention at different times.
Results
A total of 54 patients participated in this study (25 people in the experimental group and 29 people in the control group). According to the descriptive results, the score of blood pressure self-care in the experimental group increased in the post-test phase compared to the pre-test (59.42 vs. 75.25). However, the score of blood pressure self-care in the control group decreased in the post-test phase compared to the pre-test (57.03 vs. 56.96). The level of self-efficacy in the experimental group increased in the post-test phase compared to the pre-test (214.96 vs. 271.28). The control group’s self-efficacy also increased in the post-test phase compared to the pre-test (218.14 vs. 220). Health-related quality of life in the experimental group increased in the post-test phase compared to the pre-test (109.08 vs. 123.52). On the other hand, the control group’s health-related quality of life decreased in the post-test stage compared to the pre-test (112.48 vs. 111.89). The analytical results showed that in the patients of the intervention group, the blood pressure management protocol based on the transtheoretical model sustainably increased the dimensions of self-care (low-salt diet, smoking, and alcohol cessation, physical activity, physical therapy, weight management, and stress management) over time (P<0.001). Also, the blood pressure management protocol was effective in increasing self-efficacy and health-related quality of life dimensions (physical function, physical pain, general health, vitality, social function, emotional function, and mental health) in the patients of the experimental group (P<0.001). This increase was not observed for the variables of self-efficacy, self-care, and quality of life in the control group (P>0.05).
Conclusion
The study's findings indicated that the training based on the transtheoretical model had the most significant impact on self-care among patients with high blood pressu