Determinants of adherence to recommended lifestyle modification practices among patients with hypertension aged 30-79 years attending Embu level five hospital, Kenya

Abstract

Achievement of adequate blood pressure control among patients with hypertension requires a combination of pharmacological therapy and lifestyle modifications. The patients’ adherence to lifestyle modification strategies to control hypertension is not well documented in Embu County. Therefore, this study assessed the determinants of adherence to lifestyle modification strategies among patients with hypertension. The study adopted an analytical cross-sectional survey design. It was conducted at Embu Level 5 Hospital in Embu County, Kenya among 179 patients with hypertension aged 30-79 years attending the medical outpatient clinic. The participants were selected using systematic sampling method. Participants for focus group discussion(FGD) were purposively selected from among those who had the highest or the lowest adherence scores. Quantitative data were collected using semi-structured researcher developed and administered questionnaires and modified H-scale test. Qualitative data were collected by use of three FGDs facilitated using a semi-structured discussion guide. Prior to data collection, Ethical approval was sought from Chuka University Research and Ethics Committee as well as authorization from the National Commission for Science, Technology and Innovation (NACOSTI). Quantitative data was analyzed via Statistical Package for Social Science (SPSS) 29.0. Descriptive statistical methods among them frequency distribution, percentages, mean and standard deviations were used for summarizing the data. The relationship between study variables was tested using Chi-square tests and multivariate logistic regression analysis at 95% confidence interval. The results of the study were presented in tables, figures and in narrative form. The results showed that the mean age of the participants was 58.2+12.21 with most participants (29.8%, n=69) aged between 60-69 years. Most participants (63.5%, n=115) were married and 47.5% (n=86) had been on treatment for more than three years. Approximately two thirds (65.2%, n=118) attended follow-up clinic for hypertensive patients monthly. Only 29.3%(n=53) of the participants adhered to the recommended lifestyle modification practices. Employment status (aOR = 0.30, 95% CI [0.10, 0.91], p = .033), level of income (aOR = 2.71, 95% CI [1.28, 5.72], p = .009) and perception of the importance of lifestyle modification practices (aOR = 2.93, 95% CI [1.39, 6.16], p = .005) were significant individual related predictors of adherence to lifestyle modification practices. None of the home-based factors were significant predictors of adherence to lifestyle modifications since all p > .05. However, in the FGD, availability of social support emerged as an important determinant of adherence. In conclusion, the level of adherence to lifestyle modification is low. Unemployment, higher income levels, perceived importance of lifestyle modifications practices and availability of social support increased adherence to recommended lifestyle modification practices. It is recommended that the Ministry of Health need to develop and implement targeted health messages on lifestyle and offer subsidy for drugs used in management of hypertension. Further, the health care providers should use every available opportunity to counsel patients on lifestyle modification practices. Further research is recommended on the effect of patient education on adherence to recommended lifestyle modification practices.