ผลของโปรแกรมการจัดการตนเองต่อความร่วมมือในการรักษาด้วยยาและระดับความดันโลหิตในผู้ที่เป็นโรคความดันโลหิตสูงในชุมชน

Abstract

This quasi-experimental research study examined the effects of a self-management program on medication adherence scores and blood pressure levels among people with hypertension in a community. The objectives of the study were to compare medication adherence scores and blood pressure levels of people in the experimental group who received the self-management program for 8 weeks, between before and after receiving the program, and between the experimental group and control group who receiving regular nursing care. The sample group consisted of 48 people with hypertension, aged 35 to 59 years, with 24 people each in the experimental group and control group. The study was conducted in Sri Bua Ban Subdistrict, Muang District, Lamphun Province during July-August 2021. The research tools consisted of the self-management program consisting of a series of activities developed by the researcher from applying the self-management concept (Kanfer & Gaelick-Buys, 1991) together with related research studies, and consisting of 3 steps: 1) self-monitoring2) self-evaluation and 3) self-reinforcement; a lesson plan for educating people with hypertension on taking antihypertensive medications; a guidebook of general knowledge on antihypertensive medications and blood pressure measurements; a record form for taking antihypertensive medications; and an automatic blood pressure monitor. Data were collected using a demographic questionnaire and a medication adherence scale (in Thai) which passed a content accuracy check by 6 experts, with a CVI index of 0.96 and a coefficient of stability of 0.98. General demographic data were analyzed using descriptive statistics; data on medication adherence scores were analyzed using the Paired Sample T-test and T-test for independent sample; and blood pressure levels were analyzed by the Wilcoxon Matched Pairs Signed-Ranks Test and the MannWhitney U Test. The results revealed that the experimental group had average medication adherence scores (X̅=37.75, S.D.=2.33) higher than before receiving the self-management program (X̅=30.92, S.D.=3.50) and higher than the control group who received regular nursing care (X̅=34.68, S.D.=6.80) with statistical significance (p<0.05). It was found that the experimental group who received the self-management program had lower mean blood pressure levels (X̅=129.83/81.17, S.D.=8.49/10.00) than before receiving the self-management program (X̅=139.54/83.04, S.D.=12.30/13.24) with statistical significance (p<0.05) and less than the control group (X̅=130.88/82.71, S.D. = 13.31/11.71), but it was not statistically significant (p>0.05). After receiving the self-management program, the experimental group had a differences in mean change of blood pressure levels which was drop than the control group with statistically significance (p <0.05). The results show that the self-management program can foster medication adherence scores and reduce blood pressure levels among people with hypertension in a community. The results of this research will be beneficial to community nurse practitioners and health care teams who can use it as guidelines for promoting self-management of people with hypertension in the community. Together with telephone follow-up and home visits, they can educate to build an understanding of hypertension and how to take the right type of antihypertensive medications at the right dose and the right time, continuously and regularly, and be able to properly manage adverse drug reactions to effectively reduce blood pressure levels.