Abstract 

Background: Hypertension is the most common non-communicable   disease and the leading cause of cardiovascular disease in the world. Current   management of hypertension stressed the importance of salt and diet   modifications. Unfortunately, many hypertensive patients do not have proper   knowledge of this, which results to inadequate practice. Therefore, there is   need to develop strategies that will help to improve knowledge and practice   of salt and diet modifications among hypertensive. 

Objective: To determine the effect of nursing intervention on knowledge and   practice of salt and diet modifications among hypertensive patients.  

Materials and Methods: A quasi experimental design was   conducted using purposive sampling to select the sample size of 38   participants. A researcher-developed questionnaire derived from the   literature review and Hypertension Self-Care Activity Level Effects (H-SCALE)   adapted from Warren-Find low and Seymour (2011) was used to measure knowledge   and practice of salt and diet modification among the participants. Data   gathered from participants were expressed using tables and percentages while   research questions were answered with descriptive statistics of mean and   standard deviation through statistical package for the social science   software version 21. 

Results: the study revealed that   higher percentage of the participants (81.6%) had poor of knowledge of salt   and diet modification pre-intervention, also 92.1% of the participants   reported poor practice before intervention. Intervention was given to the   participants and results showed a positive change in knowledge and practice   of salt and diet practice post-intervention. 

Conclusion: regular training should   be given to hypertensive patients by nurses to improve their knowledge and   practice of salt and diet modification for effective blood pressure control. 

Keywords: Hypertension, Knowledge,   Practice, Salt and Diet modification, Nigeria 

Introduction 

The burden of hypertension and other noncommunicable diseases is rapidly increasing and this poses a serious threat to the economic development of many nations. Hypertension is a global public health challenge due to its high prevalence and the associated risk of stroke and cardiovascular diseases in adults. 

Globally, hypertension is implicated to be responsible for 7.1 million deaths and about 12.8% of the total annual deaths (World Health 

Organization (WHO), 2018). Africa, among other WHO regions was rated highest with increased prevalence of high blood pressure, estimated at 46% from age 25 years and above in which Nigeria contributes significantly to this increase (Okwuonu, Emmanuel, & Ojimadu 2014; Ekwunife, Udeogaranya, & Nwatu, 2018; WHO, 2018). This is so in spite of the availability to safe and potent drugs for hypertension and existence of clear treatment guidelines, hypertension is still grossly not controlled in a large proportion of patients worldwide. 

Current national recommendations for the prevention and treatment of high blood pressure emphasized non-pharmacological therapy, also termed “lifestyle modification” which includes salt and diet modification. However, there is a dearth of information on the knowledge and practice of salt and diet modification among hypertensive patients attending Nigeria’s health institutions (Abubakar et. al, 2017). Hence, poor knowledge of salt and diet modifications, and inability to practice these were one of the identified patient- related barriers to hypertension control (Tesema et.al, 2016). This gap may also be attributed to the type of information or training programmes given to patients on salt and diet modification. 

Therefore, this study might help to improve the knowledge of hypertensive patients on salt and diet modification which in turn may affect its practice thus reducing the death burden, complications and economic cost of poorly controlled hypertension among patients and in the society. 

Objective 

The aim of the study was to determine the effect of nursing intervention on knowledge and practice of lifestyle modification among hypertensive patients. The following research questions were expected to be answered: 

1. What is the pre-intervention knowledge and practice of salt and diet modification among hypertensive patients? 

2. What is the post-intervention knowledge and practice of salt and diet modification among hypertensive patients? 

Methods 

It is a quasi-experimental study, which adopted one pre-test-post-test design, conducted between February and September 2019, at a secondary health facility (General Hospital), South-west, Nigeria. The study was carried out among hypertensive patients attending medical outpatients department (MOPD) in the general hospital. The hospital was purposively selected being the only secondary health facility located in one of the densely populated communities in a major commercial city of South-west, Nigeria. 

Sample size and sampling procedure: Sample size was calculated using Taro Yamane method of sample size determination, n = calculated sample size, Population size (N) = 42 based on daily clinic attendance of hypertensive patients, and margin of error = 0.05 with a confidence level of 95% given a sample size of 38 participants. Inclusion criteria were male and female patients who were ≥18 years of age, diagnosed to be hypertensive and attending medical out-patients department (MOPD), available and willing to participate in the study, who could communicate either in English or Pidgin English. Exclusion criteria were other patients at MOPD who were not diagnosed to be hypertensive, or with any co-morbidity that could interfere with participation in the training, and have attended previous educational programme on salt and diet modification. Participants were selected based on the inclusion criteria using purposive sampling. 

Data collection tools and procedures: Data were gathered using researcher-developed questionnaire derived from the literature review with the opinions of experts in the field to assess participants’ knowledge of salt and diet practice and modified Hypertension Self-Care Activity Level Effects (H-SCALE) developed by WarrenFindlow and Seymour (2011) to assess practice of salt and diet modification among the participants.The questionnaire consists of three parts. The first part includes the demographic characteristics of the participants with eight (8) items; the second part assessed the participants’ knowledge of salt and diet modification. The knowledge of salt and diet modification questions includes twelve (12) items with maximum and minimum scores of 12 and 0 respectively. Participants’ knowledge scores of 9-12 points indicate high knowledge, 6-8 points indicate moderate knowledge and scores <6 points indicate poor knowledge. The third part assessed the practice of salt and diet modification among the participants with seven items which were used to assess practices related to eating a healthy diet, avoiding salt while cooking and eating, and avoiding foods high in salt content. Responses were coded ranged from never (1) to always (3). Responses were summed up creating a range of scores from three (3) to twenty one (21). Scores of eleven (11) and above indicates that participants followed the low-salt diet and was considered as having good low salt diet practice while score <11 indicate poor salt diet practice. The psychometric properties of the instrument was checked by experts in the field using face and content validity criteria, the reliability of the instrument was determined using split-half method and the Cronbach’s alpha reliability coefficient on knowledge of salt and diet modification was 0.78, while salt and diet practice was 0.72 which showed high reliability of the instrument. The method of data collection involved three phases: 

Phase 1: this involved meeting with the consultant and nurses in charge of MOPD of the General Hospital to explain the purpose of the study and its benefits, and to seek their cooperation for the success of the study. This took place during the first week of the study. In the second week of the study, the researcher with two research assistants visited the MOPD to listen to health talk given to the patients by the nurses and other health personnel, gaps were identified which was used to modify the training modules. The participants were met to discuss the purpose, course and potential benefits of the study. Interested participants were enrolled for the study after obtaining their consent. Further selection of the participants continued in the third and fourth week. A pre-test instrument (questionnaire) was given to the selected participants to complete during the selection. No external interference was allowed during data collection, researcher and research assistants stayed with the participants throughout the period of completing the questionnaire after which they were thoroughly checked for completeness before retrieval from the participants.The results from this phase were also used to modify the training module for better intervention. Reminder for the training programme was given through phone calls, text messages and visits on the clinic- days prior to the training. 

Phase 2: A developed intervention package was implemented based on feedback obtained from pre-intervention knowledge and practice score with learning modules which was used for the educational training of hypertensive patients on salt and diet modification. The intervention package had two modules of learning which was delivered for two hours weekly for two weeks. Different instructional methods were utilized to deliver the programme including lectures, group discussion, questions and answers, chats/pictures and educational hand out. Follow-up through phone calls and text messages was done every week after intervention to ensure adequate practice before the post-intervention test. 

Phase 3: A post-test was given one month postintervention with the same instruments used during the pre-test. Data collected were coded and processed using statistical package for social science (SPSS), version 21. Frequency table was constructed and data were expressed on it. The research questions were answered using descriptive statistics of mean and standard deviation. 

Ethical Consideration: The ethics committee of the researcher’s institution approved the study with approval reference BUHREC102/19 dated 27th February, 2019 and written permission of the State Health Service Commission was also obtained to conduct the study. Participants were informed about the purpose of the study and their consents both verbal and written were taken before the study commences. Participation was voluntary and participants have the right to withdraw at any stage of the study. 

Results 

The socio-demographic data reveals that greater number of the participants was females (68.4%) possibly, because females tend to pay more attention to their health and engaged more in physical and emotion stress than their male counterparts. Majority, (44.7%) participants were between the ages of 46 to 60 years, also many of the participants (28.9%) have primary education and 42.1% were self-employed. This could also be related to the fact that the study was carried out in one of the largest commercial city in South-west Nigeria and research facility was located in one of the densely populated communities in the state which often require constant subsidized health care services (Table 2)