Self-efficacy, Self-management and Their Impact on Hypertensive Patients’ Outcomes: A Study from Primary Health Centers in Indonesia
Keywords:
hypertension, self-efficacy, self-management, health-related quality of life, blood pressure
Abstract
Self-management in hypertensive patient outcomes is considered cost-effective treatment with self-efficacy support. Factors correlated with self-efficacy and self-management are complex interactions of intrinsic and extrinsic factors. This study explored the factors related to self-efficacy and self-management and their impact on blood pressure and health-related quality of life (HRQoL) of hypertensive patients in primary health centers. A cross-sectional study from ten primary health centers from South Sumatera province with 407 participants used a questionnaire and medical records. The data were analyzed descriptively, bivariate (chi-square) and multivariate logistic regression backward method. Factors correlated to self-efficacy include disease knowledge (OR = 5.538, P=0.000), social support (OR=4.330, P=0,000), disease courses (OR=2.807, P=0.000) and unemployed/retired (OR=2.174, P=0.002), while the factor correlated to self-management are disease knowledge (OR=2.223, P=0.002), unemployed/retired (OR=1.712, P=0.037), self-efficacy (OR=1.631, P=0.046), age (OR=1.594, P=0.023), and social support (OR=1.461, P=0.099). Self-management is correlated with blood pressure (OR=5.045, P=0.000) and HRQoL (OR=0.541, P=0.005). Blood pressure is correlated with HRQoL (OR=1.703, R=0.027). Hypertensive patients with higher disease knowledge, higher social support, longer disease courses, and unemployed/retired were significantly more likely to have good self-efficacy. Thus, the higher disease knowledge, unemployed/retired, patients with good self-efficacy, older age, and higher social support are more likely to have better self-management. Disease knowledge is the most correlated variable with self-efficacy and self-management in this study. Self-management has a positive effect on blood pressure and HRQoL. Controlled blood pressure is known to have a positive HRQoL. This study provides an overview for the government and health care professionals in recognizing strong predictors and implementing effective strategies in self-management interventions in hypertensive patients.
References
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Ding, W., Li, T., Su, Q., Yuan, M., & Lin, A. (2018). Integrating factors associated with hypertensive patients’ self-management using structural equation modeling: A cross-sectional study in Guangdong, China. Patient Preference and Adherence, 12, 2169–2178. https://doi.org/10.2147/PPA.S180314
Foroumandi, E., Kheirouri, S., & Alizadeh, M. (2020). Patient Education and Counseling The potency of education programs for management of blood pressure through increasing self-ef fi cacy of hypertensive patients : A systematic review and meta-analysis. Patient Education and Counseling, 103(3), 451–461. https://doi.org/10.1016/j.pec.2019.09.018
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Jankowska-Polańska, B., Uchmanowicz, I., Dudek, K., & Mazur, G. (2016). Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient Preference and Adherence, 10, 2437–2447. https://doi.org/10.2147/PPA.S117269
Kemenkes. (2019). Laporan Nasional Riset Kesehatan Dasar. In Kementerian Kesehatan RI.
Khajeh, F. K., Pezeshki, M. Z., & Ghaffarifar, S. (2019). Development of the Persian Hypertension Self-Management Questionnaire. Internasional Cardiovascular Research Journal, 13(7), 17–22.
Khoirunnisa, S. M., & Akhmad, A. D. (2019). Quality of life of patients with hypertension in primary health care in Bandar Lampung. Indonesian Journal of Pharmacy, 30(4), 309–315. https://doi.org/10.14499/indonesianjpharm30iss4pp309
Lawless, M. T., Tieu, M., Feo, R., & Kitson, A. L. (2021). Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Social Science and Medicine, 287(September), 114393. https://doi.org/10.1016/j.socscimed.2021.114393
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Menanga, A., Edie, S., Nkoke, C., Boombhi, J., Musa, A. J., Mfeukeu, L. K., & Kingue, S. (2016). Factor associated with blood pressure control amongst adult with hypertension in Yaounde, Cameroon : a cross-sectional study. Cardiovascular Diagnosis and Therapy, 6(5), 439–445.
O.Silva, G., Andrade-Lima, A., Germano-Soares, A. H., Lima-Junior, D. de, Rodrigues, S. L. C., M.Ritti-Dias, R., & Farah, B. Q. (2020). Factors associated with quality of life in patients with systemic arterial hypertension. International Journal of Cardiovascular Sciences, 33(2), 133–142. https://doi.org/10.5935/2359-4802.20190092
Palmer, P. B., & O’Connell, D. G. (2009). Regression Analysis for Prediction : Understanding the Process. Cardiopulmonary Physical Therapy Journal, 20(3), 23–26.
Qu, Z., Parry, M., Liu, F., Wen, X., Li, J., Zhang, Y., Wang, D., & Li, X. (2019). Self-management and blood pressure control in China : a community-based multicentre cross sectional study. BMJ Open, 9(e025819), 1–11.
Schulz, R. B., Rossignoli, P., Correr, C. J., Fernández-Llimós, F., & Marco De Toni, P. (2008). Validation of the Short Form of the Spanish Hypertension Quality of Life Questionnaire (MINICHAL) for Portuguese (Brazil). Sociedade Brasileira De Cardiologia, 90(2), 127–131.
Shen, Z., Shi, S., Ding, S., & Zhong, Z. (2020). Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Frontiers in Pharmacology, 11(December), 1–10. https://doi.org/10.3389/fphar.2020.569092
Still, C. H., Margevicius, S., Harwell, C., Huang, M. C., Martin, L., Dang, P. B., & Wright, J. T. (2020). A community and technology-based approach for hypertension self-management (Coachman) to improve blood pressure control in african americans: Results from a pilot study. Patient Preference and Adherence, 14, 2301–2313. https://doi.org/10.2147/PPA.S283086
Turan, G. B., Aksoy, M., & Çiftçi, B. (2019). Effect of social support on the treatment adherence of hypertension patients. Journal of Vascular Nursing, 37(1), 46–51. https://doi.org/10.1016/j.jvn.2018.10.005
Wang, C., Lang, J., Xuan, L., Li, X., & Zhang, L. (2017). The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: A cross-sectional study. International Journal for Equity in Health, 16(1), 1–11. https://doi.org/10.1186/s12939-017-0551-9
Warren-Findlow, J., B.Seymour, R., & Larissa R. Brunner Hubber. (2012). The Association Between Self-Efficacy and Hypertension Self-Care Activities Among African American Adult. J Community Health, 37(1), 15–24. https://doi.org/10.1007/s10900-011-9410-6.The
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., … Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Journal of the American College of Cardiology, 71(19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006
WHO. (2019). WHO Guideline : Recommendations on Digital Interventions For Health System Strengthening. In World Health Organization. https://doi.org/10.1177/156482658000200103
Widiawatie, N., Handayani, F., & Sobirin, M. A. (2021). Factors affecting self-efficacy against hypertension self-care in hypertension patients: a scoping review. International Journal of Research in Medical Sciences, 9(3), 914–922. https://doi.org/10.18203/2320-6012.ijrms20210902
Williams, B., Mancia, G., Spiering, W., Rosei, E. A., Azizi, M., Burnier, M., Clement, D., Coca, A., De Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S., Kreutz, R., Laurent, S., … Desormais, I. (2018). 2018 practice guidelines for the management of arterial hypertension of the European society of cardiology and the European society of hypertension ESC/ESH task force for the management of arterial hypertension. In European Heart Journal (Vol. 36, Issue 12). https://doi.org/10.1097/HJH.0000000000001961
Xiao, M., Zhang, F., Xiao, N., Bu, X., Tang, X., & Long, Q. (2019). Health-related quality of life of hypertension patients: A population-based cross-sectional study in Chongqing, China. In International Journal of Environmental Research and Public Health (Vol. 16, Issue 2348, pp. 1–12). https://doi.org/10.3390/ijerph16132348
Zhang, Q., Huang, F., Zhang, L., Li, S., & Zhang, J. (2021). The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model. BMC Public Health, 21(1114), 1–10. https://doi.org/https://doi.org/10.1186/s12889-021-11129-5
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
Animut, Y., Assefa, A. T., & Lemma, D. G. (2018). Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at university of gondar referral hospital, northwest ethiopia: A retrospective follow-up study. Integrated Blood Pressure Control, 11, 37–46. https://doi.org/10.2147/IBPC.S150628
Bandura, A. (1998). Self-Efficacy. In Encyclopedia of Mental Health (Reprinted, Vol. 4, Issue 1994, pp. 71–81). San Diego : Academic Press.
Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and Control of Hypertension: JACC Health Promotion Series. Journal of the American College of Cardiology, 72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008
Choi, J. W., Shin, J. H., Kim, M. J., Park, K. S., Song, K. Il, & Hur, I. C. (2018). Factors related to blood pressure control and effect of an education program performed by family physician on patients with hypertension. Korean Journal of Family Practice, 8(2), 175–181. https://doi.org/https://doi.org/10.21215/kjfp.2018.8.2.175
Ding, W., Li, T., Su, Q., Yuan, M., & Lin, A. (2018). Integrating factors associated with hypertensive patients’ self-management using structural equation modeling: A cross-sectional study in Guangdong, China. Patient Preference and Adherence, 12, 2169–2178. https://doi.org/10.2147/PPA.S180314
Foroumandi, E., Kheirouri, S., & Alizadeh, M. (2020). Patient Education and Counseling The potency of education programs for management of blood pressure through increasing self-ef fi cacy of hypertensive patients : A systematic review and meta-analysis. Patient Education and Counseling, 103(3), 451–461. https://doi.org/10.1016/j.pec.2019.09.018
Fox, C. S., Larson, M. G., Leip, E. P., Culleton, B., Wilson, P. W. F., & Levy, D. (2004). Predictors of New-Onset Kidney Disease in a Community-Based Population. Journal of the American Medical Association, 291(7), 844–850. https://doi.org/10.1001/jama.291.7.844
Gakidou, E., Afshin, A., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S. F., Aboyans, V., Abu-Raddad, L. J., Abu-Rmeileh, N. M. E., Abyu, G. Y., Adedeji, I. A., Adetokunboh, O., Afarideh, M., Agrawal, A., Agrawal, S., Ahmad Kiadaliri, A., … Murray, C. J. L. (2017). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1345–1422. https://doi.org/10.1016/S0140-6736(17)32366-8
Grady, P. A., & Gough, L. L. (2014). Self-Management: A Comprehensive Approach to Management of Chronic Condition. American Journal of Public Health, 104(8), e25–e31.
Horsa, B. A., Tadesse, Y., & Engidawork, E. (2019). Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: A cross sectional study. BMC Research Notes, 12(1), 1–6. https://doi.org/10.1186/s13104-019-4173-8
Hsu, C. Y., McCulloch, C. E., Darbinian, J., Go, A. S., & Iribarren, C. (2005). Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Archives of Internal Medicine, 165(8), 923–928. https://doi.org/10.1001/archinte.165.8.923
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., Smith, S. C., Svetkey, L. P., Taler, S. J., Townsend, R. R., Wright, J. T., Narva, A. S., & Ortiz, E. (2014). 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). In JAMA - Journal of the American Medical Association (Vol. 311, Issue 5). https://doi.org/10.1001/jama.2013.284427
Jankowska-Polańska, B., Uchmanowicz, I., Dudek, K., & Mazur, G. (2016). Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient Preference and Adherence, 10, 2437–2447. https://doi.org/10.2147/PPA.S117269
Kemenkes. (2019). Laporan Nasional Riset Kesehatan Dasar. In Kementerian Kesehatan RI.
Khajeh, F. K., Pezeshki, M. Z., & Ghaffarifar, S. (2019). Development of the Persian Hypertension Self-Management Questionnaire. Internasional Cardiovascular Research Journal, 13(7), 17–22.
Khoirunnisa, S. M., & Akhmad, A. D. (2019). Quality of life of patients with hypertension in primary health care in Bandar Lampung. Indonesian Journal of Pharmacy, 30(4), 309–315. https://doi.org/10.14499/indonesianjpharm30iss4pp309
Lawless, M. T., Tieu, M., Feo, R., & Kitson, A. L. (2021). Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Social Science and Medicine, 287(September), 114393. https://doi.org/10.1016/j.socscimed.2021.114393
Lorig, K. R., & Holman, H. R. (2003). Self-Management Education : History, Definition, Outcomes, and Mechanism. Annals of Behavioral Medicine, 26(1), 1–7.
Menanga, A., Edie, S., Nkoke, C., Boombhi, J., Musa, A. J., Mfeukeu, L. K., & Kingue, S. (2016). Factor associated with blood pressure control amongst adult with hypertension in Yaounde, Cameroon : a cross-sectional study. Cardiovascular Diagnosis and Therapy, 6(5), 439–445.
O.Silva, G., Andrade-Lima, A., Germano-Soares, A. H., Lima-Junior, D. de, Rodrigues, S. L. C., M.Ritti-Dias, R., & Farah, B. Q. (2020). Factors associated with quality of life in patients with systemic arterial hypertension. International Journal of Cardiovascular Sciences, 33(2), 133–142. https://doi.org/10.5935/2359-4802.20190092
Palmer, P. B., & O’Connell, D. G. (2009). Regression Analysis for Prediction : Understanding the Process. Cardiopulmonary Physical Therapy Journal, 20(3), 23–26.
Qu, Z., Parry, M., Liu, F., Wen, X., Li, J., Zhang, Y., Wang, D., & Li, X. (2019). Self-management and blood pressure control in China : a community-based multicentre cross sectional study. BMJ Open, 9(e025819), 1–11.
Schulz, R. B., Rossignoli, P., Correr, C. J., Fernández-Llimós, F., & Marco De Toni, P. (2008). Validation of the Short Form of the Spanish Hypertension Quality of Life Questionnaire (MINICHAL) for Portuguese (Brazil). Sociedade Brasileira De Cardiologia, 90(2), 127–131.
Shen, Z., Shi, S., Ding, S., & Zhong, Z. (2020). Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Frontiers in Pharmacology, 11(December), 1–10. https://doi.org/10.3389/fphar.2020.569092
Still, C. H., Margevicius, S., Harwell, C., Huang, M. C., Martin, L., Dang, P. B., & Wright, J. T. (2020). A community and technology-based approach for hypertension self-management (Coachman) to improve blood pressure control in african americans: Results from a pilot study. Patient Preference and Adherence, 14, 2301–2313. https://doi.org/10.2147/PPA.S283086
Turan, G. B., Aksoy, M., & Çiftçi, B. (2019). Effect of social support on the treatment adherence of hypertension patients. Journal of Vascular Nursing, 37(1), 46–51. https://doi.org/10.1016/j.jvn.2018.10.005
Wang, C., Lang, J., Xuan, L., Li, X., & Zhang, L. (2017). The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: A cross-sectional study. International Journal for Equity in Health, 16(1), 1–11. https://doi.org/10.1186/s12939-017-0551-9
Warren-Findlow, J., B.Seymour, R., & Larissa R. Brunner Hubber. (2012). The Association Between Self-Efficacy and Hypertension Self-Care Activities Among African American Adult. J Community Health, 37(1), 15–24. https://doi.org/10.1007/s10900-011-9410-6.The
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., … Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Journal of the American College of Cardiology, 71(19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006
WHO. (2019). WHO Guideline : Recommendations on Digital Interventions For Health System Strengthening. In World Health Organization. https://doi.org/10.1177/156482658000200103
Widiawatie, N., Handayani, F., & Sobirin, M. A. (2021). Factors affecting self-efficacy against hypertension self-care in hypertension patients: a scoping review. International Journal of Research in Medical Sciences, 9(3), 914–922. https://doi.org/10.18203/2320-6012.ijrms20210902
Williams, B., Mancia, G., Spiering, W., Rosei, E. A., Azizi, M., Burnier, M., Clement, D., Coca, A., De Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S., Kreutz, R., Laurent, S., … Desormais, I. (2018). 2018 practice guidelines for the management of arterial hypertension of the European society of cardiology and the European society of hypertension ESC/ESH task force for the management of arterial hypertension. In European Heart Journal (Vol. 36, Issue 12). https://doi.org/10.1097/HJH.0000000000001961
Xiao, M., Zhang, F., Xiao, N., Bu, X., Tang, X., & Long, Q. (2019). Health-related quality of life of hypertension patients: A population-based cross-sectional study in Chongqing, China. In International Journal of Environmental Research and Public Health (Vol. 16, Issue 2348, pp. 1–12). https://doi.org/10.3390/ijerph16132348
Zhang, Q., Huang, F., Zhang, L., Li, S., & Zhang, J. (2021). The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model. BMC Public Health, 21(1114), 1–10. https://doi.org/https://doi.org/10.1186/s12889-021-11129-5
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
Published
2024-02-13
How to Cite
Rikmasari, Y., Kristina, S. A., Andayani, T. M., & Endarti, D. (2024). Self-efficacy, Self-management and Their Impact on Hypertensive Patients’ Outcomes: A Study from Primary Health Centers in Indonesia. Indonesian Journal of Pharmacy. https://doi.org/10.22146/ijp.5359
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Research Article
