A Blood Pressure Management Protocol Based on the Transtheoretical Model: Designing and Effectiveness Evaluation

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 pressure, as improvements in self-efficacy and quality of life require more time to manifest. Additionally, the results revealed that the effectiveness of the intervention diminished over time as the educational program was delivered. Therefore, it is essential to conduct brief, ongoing training sessions to reinforce behavior changes in patients with high blood pressure. With the integration of psychologists into health centers following the health sector transformation program, there is an opportunity to develop self-care content for chronic diseases using change models like the transtheoretical model and to train psychologists to encourage individuals with chronic conditions to participate in training. Implementing a self-care protocol based on the transtheoretical model for patients with hypertension could enhance their self-care practices, potentially leading to improved quality of life by keeping blood pressure within an optimal range.