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Integrating factors associated with hypertensive patients' self-management using structural equation modeling: a
Weiwei Ding1, Tong Li1, Qiying Su2
1Department of Epidemiology and Health Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China, linaihua@mail.sysu.edu.cn.
Insights
Hypertension self-management is complex, with younger patients and those with less knowledge needing more support. Enhancing self-efficacy and social support are key for better hypertension control.
Area of Science:
- Public Health
- Cardiovascular Disease Research
- Health Psychology
Background:
- Hypertension is a global public health concern linked to cardiovascular disease (CVD).
- Effective chronic disease self-management strategies are crucial but their influencing factors require clarification.
- Community-based hypertension management needs a theoretical framework.
Purpose of the Study:
- To integrate factors influencing hypertension self-management.
- To provide a theoretical basis for community hypertension management programs.
- To identify key determinants of successful self-management in hypertensive patients.
Main Methods:
- Cross-sectional study of 268 community-dwelling hypertensive patients.
- Data collected via questionnaires on demographics, disease characteristics, knowledge, social support, self-efficacy, and self-management.
- Structural equation modeling used to analyze relationships based on self-efficacy theory.
Main Results:
- Lower self-efficacy and hypertension self-management were associated with younger age, lower CVD risk, shorter disease duration, less disease knowledge, and reduced social support.
- Social support was inversely related to age, CVD risk, and disease duration, and positively correlated with disease knowledge.
- Hypertension control was less likely with lower self-efficacy and self-management.
Conclusions:
- Medication adherence, a key self-management dimension, requires improvement.
- Self-efficacy is a critical target for intervention development.
- Interventions incorporating technology, education, and mutual-help groups show promise.
- Vulnerable populations, including younger patients with shorter disease duration, need targeted support.
Purpose:
Hypertension is considered a major public health issue worldwide because of its high frequency and concomitant risk of cardiovascular disease (CVD). Chronic-disease self-management has been proven to be cost-effective, but influencing factors and pathways remain complex and unclear. The purpose of this study was to integrate factors associated with hypertension self-management to provide a theoretical reference for community hypertension management.
Methods:
A total of 268 community-dwelling hypertensive patients were enrolled in a cross-sectional study conducted from July to September in 2017. A questionnaire on demographic-disease characteristics, disease knowledge, social support, self-efficacy, and self-management was completed by patients. Structural equation modeling was performed to verify multiple factors in self-management based on the self-efficacy theory.
Results:
The final model showed a good fit to sample data, ie, younger patients with lower CVD risk, shorter disease course, and less disease knowledge and social support predicted less self-efficacy, less hypertension self-management, and less controlled hypertension. Furthermore, social support was negatively correlated with age, CVD risk, and disease course and positively with disease knowledge.
Conclusion:
Medication adherence is the lowest dimension in self-management, and self-efficacy is vital to consider in the development of self-management interventions. Self-management education and mutual-help groups may be potential solutions with the power of technology. Younger patients with lower CVD risk and shorter disease course are vulnerable and need more attention.