Community-based intervention to improve hypertension management in Thailand

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Hypertension is a common and burdensome condition among older people in Thailand. Extrapolating models from Western society is fraught unless they are able to be tailored and targeted to the host society. This thesis has appraised evidence-based strategies for self-management of hypertension and sought to develop and evaluate an intervention appropriate for rural, community dwelling older individuals in Thailand. Findings from appraisal of the evidence and integrative review identified shared decision-making and mutual goal setting as elements of effective interventions for improving health behaviours and outcomes. In order to ensure a reliable, valid and culturally appropriate measurement for hypertension management in Thailand, the Hill-Bone Compliance to High Blood Pressure Scale, was translated and culturally adapted. The standardized Cronbach’s alpha of all items was 0.64, 0.61 for reduced sodium intake subscale, 0.5 for appointment keeping subscale and 0.69 for medication taking subscale. Pearson’s correlation coefficient demonstrated inter-item correlation values ranged from -0.14 to 0.58. The Thai Hill-Bone HBP Compliance scores were positively correlated with level of systolic and diastolic blood pressure. A sequential explanatory mixed method design, embedding a quasi-experimental with longitudinal study followed by focus group interviews was undertaken. A four week, theoretically derived, community-based intervention program was implemented to improve hypertension management. Adherence to high blood pressure therapy was assessed using the Thai Hill-Bone HBP Compliance Scale, and health related quality of life using the Thai SF-36v1. Participants were 156 (68.6% female). The mean age of participants was 70 years (SD 6.3). The outcomes demonstrated a statistically significant difference between the groups in systolic blood pressure at all 4 time points , and diastolic blood pressure at three time points (post-intervention, 3-month, 6-month follow-up), and waist circumference at 3-month follow-up. Adherence of high blood pressure therapy showed significant differences between groups in 3-month and 6-month follow-up measurement for sum score, salt intake and appointment keeping subscale. The results in health related quality of life demonstrated statistically significant differences between the groups at all 4 time points in the physical functioning domain. Conclusion: This study has summarised the burden of hypertension in Thailand and systematically developed a tailored and targeted method of promoting self-management of hypertension in a model of intervention appropriate to older Thai individuals living in a rural setting. This model of intervention requires further evaluation in a multi-centred randomised controlled trial to demonstrate efficacy and effectiveness.
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