Knowledge, attitude, beliefs and blood pressure control in a community-based sample in Ghana

Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA.
Ethnicity & disease (Impact Factor: 1). 02/2005; 15(4):748-52.
Source: PubMed


Cardiovascular disease, in particular hypertension (HTN), is a significant and growing public health problem in developing countries, such as sub-Saharan Africa. As such, it is imperative to develop a public health approach to the management and treatment of hypertension. In order to address the growing prevalence of hypertension in this region, an in-depth understanding of patients' knowledge, and awareness about the treatment and prevention of hypertension is needed. As part of a faith-based medical clinic in the Sekondi-Takoradi area in Ghana, we conducted a cross sectional survey of 1135 patients who attended a free medical clinic between March 2001 and March 2002, to assess the prevalence, awareness, knowledge, and treatment of HTN. Using qualitative methodology, we also explored patients' beliefs about hypertension and its consequences. Of the 1135 patients, 30% were hypertensive (and 62% of these had Stage II hypertension), 73% were aware of their diagnosis, 59% were being treated, and only 5% had adequate blood pressure (BP) control defined as blood pressure <140/90 mm Hg. Patients with hypertension were typically older (average age was 61 vs 42 for normotensives), obese (30% had a BMI ≥30) and not physically active (65%). These findings resemble trends noted in developed countries. Results of the qualitative interviews indicated that patients had several misconceptions about hypertension that were not consistent with a traditional biomedical model. For example, one person defined high blood pressure as having "too much blood in the body." In collaboration with the Ghana ministry of health we plan to utilize the findings of this study to develop a community-based educational program that will provide culturally competent patient education about hypertension, with a particular emphasis on the misconceptions about the etiology of hypertension and its associated complications.

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    • "Studies on emotional determinants of medication adherence have focused primarily on anxiety and depressive symptoms; however significant stressful events have been reported to be responsible for hypertension [41,42]. We reported 82 patients (20%) exhibiting moderate to severe high scores of stress symptoms which may require clinical attention and management (Table 2). "
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    ABSTRACT: Background Patients with chronic conditions like hypertension may experience many negative emotions which increase their risk for the development of mental health disorders particularly anxiety and depression. For Ghanaian patients with hypertension, the interaction between hypertension and symptoms of anxiety, depression and stress remains largely unexplored. To fill this knowledge gap, the study sought to ascertain the prevalence and role of these negative emotions on anti-hypertensive medication adherence while taking into account patients’ belief systems. Methods The hospital-based cross-sectional study involving 400 hypertensive patients was conducted in two tertiary hospitals in Ghana. Data were gathered on patient’s socio-demographic characteristics, anxiety, depression and stress symptoms, spiritual beliefs, and medication adherence. Results Hypertensive patients experienced symptoms of anxiety (56%), stress (20%) and depression (4%). As a coping mechanism, a significant relation was observed between spiritual beliefs and anxiety (x2 = 13.352, p = 0.010), depression (x2 = 6.205, p = 0.045) and stress (x2 = 14.833, p = 0.001). Stress among patients increased their likelihood of medication non-adherence [odds ratio (OR) = 2.42 (95% CI 1.06 – 5.5), p = 0.035]. Conclusion The study has demonstrated the need for clinicians to pay attention to negative emotions and their role in medication non-adherence. The recommendation is that attention should be directed toward the use of spirituality as a possible mechanism by which negative emotions could be managed among hypertensive patients.
    Full-text · Article · Jun 2014 · International Journal of Mental Health Systems
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    • "Traditionally, the term compliance has been employed to mean the extent to which the patient, when taking a drug, complies with the clinician's advice and follows the regimen (9). Compliance with treatment is defined and characterized when medical or health advice coincides with the individual's behaviour with regard to the use of medication, recommended changes in lifestyle, and attendance to medical appointments (10). "
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    ABSTRACT: Hypertension is an important condition among adults, affecting nearly one billion people worldwide. Treatment with appropriate medication is a key factor in the control of hypertension and reduction in associated risk of complications. However, compliance with treatment is often sub-optimal, especially in developing countries. The present study investigated the factors associated with self-reported compliance among hypertensive subjects in a poor urban community in southwest Nigeria. This community-based cross-sectional study employed a survey of a convenience sample of 440 community residents with hypertension and eight focus-group discussions (FGDs) with a subset of the participants. Of the 440 hypertensive respondents, 65.2% were women, about half had no formal education, and half were traders. Over 60% of the respondents sought care for their condition from the hospital while only 5% visited a chemist or a patent medicine vendor (PMV). Only 51% of the subjects reported high compliance. Factors associated with high self-reported compliance included: regular clinic attendance, not using non-Western prescription medication, and having social support from family members or friends who were concerned about the respondent's hypertension or who were helpful in reminding the respondent about taking medication. Beliefs about cause of hypertension were not associated with compliance. The findings of the FGDs showed that the respondents believed hypertension is curable with the use of both orthodox and traditional medicines and that a patient who 'feels well' could stop using antihypertensive medication. It is concluded that treatment compliance with antihypertensive medication remains sub-optimal in this Nigerian community. The factors associated with high self-reported compliance were identified. More research is needed to evaluate how such findings can be used for the control of hypertension at the community level.
    Full-text · Article · Dec 2011 · Journal of Health Population and Nutrition
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    • "Thus, a total of 73 papers were identified for evaluation (Figure 2). Twenty four papers estimated prevalence of hypertension but one of them was among patients attending a blood pressure (BP) clinic and so was excluded [17]. Eventually, 15 unique published papers including two from Google Scholar [18,19] and one from conference proceedings [20] were included in the analysis of hypertension in Ghana. "
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    ABSTRACT: Hypertension is a major risk factor for many cardiovascular diseases in developing countries. A comprehensive review of the prevalence of hypertension provides crucial information for the evaluation and implementation of appropriate programmes. The PubMed and Google Scholar databases were searched for published articles on the population-based prevalence of adult hypertension in Ghana between 1970 and August 2009, supplemented by a manual search of retrieved references. Fifteen unique population-based articles in non-pregnant humans were obtained. In addition, two relevant unpublished graduate student theses from one university department were identified after a search of its 1996-2008 theses. The age and sex composition of study populations, sampling strategy, measurement of blood pressure, definition of hypertension varied between studies. The prevalence of hypertension (BP > or = 140/90 mmHg +/- antihypertensive treatment) ranged from 19% to 48% between studies. Sex differences were generally minimal whereas urban populations tended to have higher prevalence than rural population in studies with mixed population types. Factors independently associated with hypertension included older age group, over-nutrition and alcohol consumption. Whereas there was a trend towards improved awareness, treatment and control between 1972 and 2005, less than one-third of hypertensive subjects were aware they had hypertension and less than one-tenth had their blood pressures controlled in most studies. Hypertension is clearly an important public health problem in Ghana, even in the poorest rural communities. Emerging opportunities such as the national health insurance scheme, a new health policy emphasising health promotion and healthier lifestyles and effective treatment should help prevent and control hypertension.
    Full-text · Article · Jul 2010 · BMC Public Health
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