Adherence to Self-Care Practices and Associated Factors among Patients Diagnosed with Hypertension Attending the Medical Outpatient Clinic at Kenyatta National Hospital

Abstract

Self-care practices are mainly the activities that a hypertensive patient undertakes with an intention of improving the quality of their well-being. Poor self-care practices can lead to uncontrollable hypertension which then leads to serious complications, disabilities and even death. The main objective was to examine the adherence of self-care practices and related factors among hypertensive patients attending medical outpatient clinic at Kenyatta National Hospital. This was a hospital based analytical cross-sectional study. The target population was 420 adults aged above 18 years and taking antihypertensive medications. Based on Fisher’s et. al 1998 formula the sample size was 168 participants. Systematic random sampling technique was used and data collection was through interviewer-administered structured questionnaire. Self–care practice was assessed using a validated Hypertension Self- Care Activity Level Effects (H-SCALE) containing six sub scales of self –care undertakings which include adherence to medication, managing body mass index, exercising, regulating alcohol intake, cessation of smoking and reducing salt intake. Good self-care practice adherence towards hypertension was at 34.7% while 65.3% had poor adherence to self-care practices. The study had three objectives whereby 37.3% of the subjects had good level of knowledge on hypertension while 62.7% had poor level of knowledge on hypertension. Good self-care practice adherence towards hypertension was at 34.7% while 65.3% had poor adherence to self-care practice. Binary logistic regression analysis was done to test association between sociodemographic characteristics and self-care practices among hypertensive patients and good knowledge on hypertension was found to be significantly associated with self-care practices (Odds Ratio (OR)=3.20,95% CI:1.64-6.24, P=0.001), indicating that knowledge is a key independent predictor in hypertension management. This study revealed that the level of knowledge on hypertension was poor at 62.7%, the level of good self-care practice among hypertensive patients was low at 34.7% The most adhered to practice was cessation of smoking at 92.7%, adherence to medication was 86.5%, adherence to alcohol moderation was 57.8%, adherence to weight management was 30.9% adherence to physical activity was 27.3% and the lowest adhered to was low salt diet at 15.1%. The findings further revealed that good knowledge of hypertension was statistically significantly associated with 3.2 times higher likelihood of good adherence to self-care practice, indicating that knowledge is a key pillar in the management of hypertension for a better control of blood pressure. In view of the findings, the public health facilities including KNH should strengthen their efforts in providing targeted structured education programs to the patients and their family on hypertension, management and complications. This will promote a better understanding and improve adherence hence better control of blood pressure. The study also recommends that regular check-up and follow-up of patients ‘compliance with self-management protocol should be given to identify factors that potentially hinder the patients’ adherence to hypertension self-care protocol.