Effect Of Community-based Self-management Program Among Hypertension Patient

ObjectiveTo evaluate the effects of community-based self-management program among hypertension patients in different areas in China, and to accumulate and provide scientific evidence for a nation-wide promotion on Chronic Disease Self-management Program (CDSMP) at the community level in China.Subjects and MethodsThis study was designed and conducted by taking the reference of CDSMP model from Stanford University and on the basis on past experiences of Hypertension Self-management Program in Shanghai. Through literature review, through field investigation, expert panel's and hoc discussion and evaluation, the study sites was selected in six provinces (autonomous regions or municipalities) including Beijing, Tianjin, Liaoning, Jiangxi, Guangdong and Ningxia.Study subjectWith the principles of informed consent, a total of 1019 (351 males,618 females, with average age of 61.4+9.5 years old) hypertensive patients from 56 communities (34 urban communities,22 rural communities) in Beijing, Tianjin, Liaoning, Jiangxi, Guangdong and Ningxia (autonomous regions or municipalities) were recruited in the study. as research sites, in the community were researched.Study MethodologyThe study methods administrated in this study was a combination of qualitative and quantitative one.In terms of quantitative research, a questionnaire survey was conducted to collect the basic information about awareness, knowledge and behaviors related to hypertension, such as blood pressure self-monitoring and treatment, behavioral risk factors including high salt intake, etc. before and after the six week's intervention. In terms of qualitative research:an indepth Through interviews was organized among different population groups, such as Health Department officials, health workers in CDCs, community leaders or members of neighborhood committees, community doctors, team leaders of self-management training groups, and other informative people from the research sites in different settings to understand their attitude towards to hypertension self-management program, their acceptability and willingness to support in different areas with various social-economic background.The total community intervention lasted for four months (Oct.2009 to Jan.2010). While,the weekly based patient-centered self-management on hypertension was conducted in the training workshops in accordance with a "guidance manual for self-management of hypertension". Each trainging workshop lasted about two hours in six successive weeks.Results1) Health knowledge:After 6-week intervention, some awareness rate related to hypertension such as diagnostic criteria, stroke and coronary heart diseases lack of exercise could increase the susceptibiblity to high blood pressure, means of correct hypertension treatment and the awareness rate of low salt intake was increased by 32.1%,24.8%,16.1%,30.3%, and 31.7% respectively (P<0.05).2) Behavior change:Some health behavior like more fruit and vegetable intake and physical exercises frequency were increased by 5.9% and 12.3%. While, risk behaviors such as high-salt diet and mental stress were decreased by 10% and 14%(P <0.05); Smoking and alcohol consumption dropped by 1.9%,0.3%(P> 0.05).3) Self-efficacy:The patient medication compliance score increased 0.7 points, and management of hypertension reduces the confidence score of 0.4 points, to overcome the negative impact on the confidence of the disease scoring 0.4 points lower (P<0.05).4) Blood pressure control:The proportion of normalized time-point blood pressure was increased by 19.3% in compare with that before intervention (P<0.05).5) Frequency of blood pressure self-monitoring:the proportion of blood pressure self-monitoring of in subjects increased by 12.8%, and the proportions of patients could insisted on communications with their community doctors increased by 19.1%,(P<0.05).6) Of all the study subjects,89.2% expressed their satisfaction to the training course.ConclusionsThis study results indicated that such community-based self-management program among hypertension patients could improve self-efficacy by restoring patient's confidence in managing their illness and a positive attitude toward life. It also could build patient self-management skills, improved thire self-management capabilities and enhance communications not only between patients and their peers, but also to the doctors. By these, the increasing number of patients could live a happy life with effective controlling their blood pressure.Therefore, such hypertension self-management program is one of the applicable, cost-effective community-based techniques in controlling chronic diseases in China.