IFESTYLE MODIFICATION PRACTICE AND ASSOCIATED FACTORS AMONG DIAGNOSED HYPERTENSIVE PATIENTS AT DILLA UNIVERSITY

LIFESTYLE MODIFICATION PRACTICE AND ASSOCIATED FACTORS AMONG DIAGNOSED HYPERTENSIVE PATIENTS AT DILLA UNIVERSITY REFERRAL HOSPITAL, GEDEO ZONE, SOUTHERN ETHIOPIA, 2023

1. DILLA UNIVERSITY COLLEGE OF HEALTH SCIENCE AND MEDICINE DEPARTEMENT OF PUBLIC HEALTH LIFESTYLE MODIFICATION PRACTICE AND ASSOCIATED FACTORS AMONG DIAGNOSED HYPERTENSIVE PATIENTS AT DILLA UNIVERSITY REFERRAL HOSPITAL, GEDEO ZONE, SOUTHERN ETHIOPIA, 2023 REASERCH DEFENCE ADVISOR: Mrs. . EVER .S (BSC,MPH 11/30/2023 quantitative result by pHO students 1

2. outlines Introduction Objectives of the study Methods and Materials Result Discussion Recommendation References 8/12/2023 By Dejene M. 2

3. Introduction Hypertension is defined as increased blood pressure SBP is greater than or equals to 140mmHg or DBP greater than or equals to 90mmHg( H. Wakjira , 2020). Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access to early detection. Raised blood pressure is a serious warning sign that significant lifestyle changes are urgently needed ( World Health Day 2013) 8/12/2023 By Dejene M. 3

4. cont …….. Lifestyles modification practice such as eating a balanced diet, cutting back on salt consumption, avoiding harmful alcohol use, engaging in regular exercise, and abstaining from cigarette use ( M. Smachew et al 2022) 8/12/2023 By Dejene M. 4

5. Statement of the problem Globally the disease affects over one billion people, seven million of them die each year as a consequence of severe complications and lack of adequate control( A. Dan-jumbo, P. O . et al 2021) By 2030,23 million cardiovascular deaths are projected, with 85% occurring in low- and middle-income countries . ( A. Dan-jumbo, P. O . et al 2021). Developing countries found in sub-Saharan African also affected by chronic diseases such as hypertension by now 8/12/2023 By Dejene M. 5

6. Cont…… In Ethiopia, non-communicable disease ( NCD) deaths are estimated at around 42 %.Disability Adjusted Life Years (DALYs) due to NCDs in the country have increased from 20% in 1990 to 69% in 2015 ( B. T. J. Bollyky , T . et al ) The factors contributing to the hypertension are mainly environmental, genetic and behavioral factors such as smoking, high alcohol intake and high fat intake. These risk factors can be counteracted through lifestyle modification practice ( I. Ru 2015). 8/12/2023 By Dejene M. 6

7. Cont …… To address this World Health Organization (WHO) developed an action plan to help translate these commitments into action ( F. D. Republic, “2014 – 2016,” 2016 .) This global action plan for prevention and control of NCDs for addressing population-based risk factors and the integrated management of NCDs at the primary healthcare level which recommended lifestyle modification for hypertensive patients ( F. D. Republic, “2014 – 2016,” 2016 .) Even though performing recommended lifestyle modification has such advantages for hypertensive patients 8/12/2023 By Dejene M. 7

8. Many of the study were conducted on NCD specially Hypertension in Ethiopia were focus on the pharmacological managements of hypertension and its prevalence but not on non-pharmacological managements The life-changing procedures of hypertension cases, however, are largely unknown, little research has been done in the study area. The objective of this study is to assess life style modification practice and its associated risk factors 8/12/2023 By Dejene M. 8

9. Significance of the study A lifestyle modification approach that decreases the Blood pressure level in the hypertensive patients by even modest amounts has the potential to substantially reduce morbidity and mortality Understanding the existing condition will enable future actions to be modified by counseling and raising awareness of the need for hypertension sufferers to adopt healthy lifestyle changes 8/12/2023 By Dejene M. 9

10. Cont …… In order to fill in any information gaps Program designers and health educators can focus and modify the hypertension treatment program with the help of the findings on the prevalence of lifestyle modification practices and their associated factors among diagnosed hypertensive patients . 8/12/2023 By Dejene M. 10

11. Cont …… the study's findings will demonstrate a good approximation of the problem's present extent for health professionals and other stakeholders. By offering hypertension patients at DURH scheduled patient counseling services on lifestyle adjustment, the appropriate steps can be made to preserve their lives 8/12/2023 By Dejene M. 11

12. Figure 1: F actors associated with lifestyle modification practice among hypertensive patient adapted from reviewed literatures 11/30/2023 quantitative result by pHO students 12

13. objective General objective To assess lifestyle modification practice and associated factors among diagnosed hypertensive patients at DURH Gedeo Zone, Southern Ethiopia, 2023 Specific objectives To determine lifestyle modification practice among diagnosed hypertensive patients at DURH Gedeo Zone, Southern Ethiopia, 2023 8/12/2023 By Dejene M. 13

14. Cont …… To identify factors associated with lifestyle modification practice among diagnosed hypertensive patients at DURH Gedeo Zone, Southern Ethiopia, 2023   8/12/2023 By Dejene M. 14

15. METHOD AND MATERIALS Study Area and Period The study area was Dilla town in Gedeo Zone, SNNPR, and Ethiopia. It is located 356 km from Addis Ababa and 86 km from Hawassa . In Dilla town, there are two public health centers and one general hospital . 8/12/2023 By Dejene M. 15

16. Study Design An institutional based cross sectional study was conducted among hypertensive patients at DURH. Population Source Population All hypertension patients who was on hypertension follow up in DURH. Study Population The study population was all randomly selected hypertension patients who was on hypertension follow up during study period in DURH 8/12/2023 By Dejene M. 16

17. Eligibility Criteria Inclusion criteria All hypertensive patients’ age ≥ 18 years was included in the study Exclusion criteria Patients who was severely ill and not able to communicate 8/12/2023 By Dejene M. 17

18. Sample size Determination   Sample size was determined using single population proportion formula by considering proportion of practice recommended lifestyle modifications similar study with the value of P value equal to 27.3% taken from study done in ,south Ethiopia in addition by taking marign of error (d) as 5 % and 95% CI n = ( 1.96) 2 (0.273)(0.727) =205 ( 0.05) 2 A n additional 10 % was added to the sample size as a contingency for non-response . correction formula was used then the final sample size will be 237 8/12/2023 By Dejene M. 18

19. SAMPLE TECHNIQUE Systematic sampling method was employed to get desired samples. Sampling interval (K) was 4. Through 1 to 4, 1 was randomly selected and first comer patient in the beginning day of data collection was taken as a first sample and then taking every 4 th patients was carried out until getting the desired sample size   8/12/2023 By Dejene M. 19

20. STUDY VARIABLES Dependent variables Life style modification Practice.( good /bad ) Independent variables Socio demographic factors Age, sex, marital status Income, Educational status Occupational status Health profile factor Co-morbidity Time since diagnoses BMI Personal factors Knowledge , attitude ,source of information   8/12/2023 By Dejene M. 20

21. OPERATIONAL DEFINITION Lifestyle modification is a practice which was recommended by JNC 7 as non-pharmacological managements of hypertension measured using physical exercise, low salt diet, and moderation of alcohol intake, stop smoking, and maintaining health weight ( M. Smachew , et al ) Good lifestyle modification Practice : when patients respond the mean or above the mean score on practice questions ( Abiy Tadesse et al). Good k nowledge when patients respond above the mean score on k nowledge questions ( Abiy Tadesse et al). . 8/12/2023 By Dejene M. 21

22. Data Collection Technique and procedures Data was collected by using semi- structured questionnaire through face to face interview and pretested Amharic language was conducted throughcollect the data The questionnaire was prepared in English then translated into Amharic language and was be back translated into the English language by another person to check its consistency 8/12/2023 By Dejene M. 22

23. Data Quality Assurance. The questionnaire was pre-tested in 5% of total eligible patients in yirgacheffe hospital for their accuracy and consistency prior to actual data collection Data Processing and Analysis data consistency was checked and entered into tSPSS version 27 for analysis descriptive statistics was described using frequencies, mean and standard deviation and presented by tables, figures, and texts 8/12/2023 By Dejene M. 23

24. Cont …. To identify factors associated with life style modification practice binary logistic regression analysis was used . In bivariate analysis each independent variables was tested against dependent variables and those with p-values < 0.25 was considered for multivariate analysis. 8/12/2023 By Dejene M. 24

25. Cont …. Finally for those statistically significant variables whose p- value <0.05 in the multivariate analysis Adjusted odds (AOR) ratio with 95% confidence interval(CI) was estimated and interpreted Ethical consideration Permission to undertake the study was obtained from the office of institutional review board of DURH college of medicine and health science, Before data collection Verbal consent was also obtained from the institution and study participants 8/12/2023 By Dejene M. 25

26. Result A total of 210 eligible clients were participated , with the response rate of 100%. The study consisted of 121(56.8%) males. The mean age of the respondents was 48( SD –(+) 13.39) years Out of the respondents 99(34.6%) attended collage and above and 49 (23.0%) respondents were governmental employed . About 145(68.1 ) were live in urban and 130(61%) were live with their family. 11/30/2023 quantitative result by pHO students 26

27. Variable   Catagories Frequency(out 0f 210) Percent( out of 100%) Age in year 18-39 69 32.4 40-59 87 40.8 >=60 54 25.4 Sex   Male 121 56.8 Female 89 41.8 Occupation Governmental employee 55 25.8 Private employee 41 19.2 Merchant 50 23.5 Daily worker 12 5.6 Housewife 24 11.3 Farmer 9 4.2 Retried 15 7.0 Other 4 1,9 11/30/2023 quantitative result by pHO students 27 Table Socio-demographic Characteristics among diagnsised hypertensive follow up patients at DURH Gedeo Zone southern Ethiopia 2023. Educational level   Not formally educated 43 20.5 Primary school 58 27.6 Secondary school 49 23.3 Collage and above 60 28.6 Marital status Married 161 76.7 Single 33 15.7 Divorced 6 2.9 Widowed 10 4.8 Religion Orthodox 68 32.4 Protestant 98 46.7 Muslim 25 11.9 Catholic 13 6.2 Other 6 2.9 Monthly income <1000 17 8 1000-2999 23 11 >3000 170 81

28. Health and individual related factors: from the total patients, 122(58.1%) have another chronic illness, , About 82 (39%) patients have duration of illness more than or equal to five years, Majority of participants 163 (77.6%) have no family history of hypertension . out of 210 respondent 151(71.9%) were have source of information about life style modification practice and their source of information was mostly health profession which is 77 (36.7%) respondents 11/30/2023 quantitative result by pHO students 28

29. Table 3; shows Health and individual related factors among diagnsised hypertensive follow up patients at DURH Variable Catagories Frequency Percent Do have you others chronic illness Yes 122 58.1 No 88 41.9 Family history of hypertension ? Yes 46 51.4 No 163 77.6 Duration of illness since diagnosis (in year) <2year 66 31.4 2-4 year 62 29.5 >=5year 82 39 have you source information about life style modification practice ? Yes 151 71.9 No 59 28.1 what was your source of information Health profession 77 36.7 Different media 21 10 Friends 25 11.9 Family 15 7.1 Others 7 3.3 11/30/2023 quantitative result by pHO students 29

30. Knowledge of lifestyle modification practices The finding showed that 123(58.6%) of participants were have poor knowledge about lifestyle modification practice. F rom total 118(56.1 %)of the respondent were know way of life or behaviour of an individual has effect on their blood pressure. One hundred forty four (68.6 %) didn`t understand that Eating diet high in saturated fat increases risk of high blood pressure, The study revealed 92 (44%) understood that; weight gain can worse their condition 11/30/2023 quantitative result by pHO students 30

31. Attitude of the patients towards life style modifications : Out of 210 participants 128 (61%) of the study participants agreed that dietary like fruits plays a positive role in health, From total113 (53.7%) patients were agreed for moderation of alcohol intake plays a positive role in hypertension, 91(43.3 %) of the respondent were disagreed that Sugar and sweet diets have a negative role in treatment of HTN.. 11/30/2023 quantitative result by pHO students 31

32. Table 5 attitude toward lifestyle modification practices .in hypertensive patients at DURH Gedeo Zone southern Ethiopia 2023 Variable Catigories Frequency Percent Dietary food like fruit and vegetables plays a positive role in treatment of HTN Agree 128 61 Disagree 82 39 . Physical exercises play appositive role in treatment of HTN. Agree 119 56.7 Disagree 91 43.3 Sugar and sweet diets have a negative role in treatment of HTN. Agree 119 56.7 Disagree 91 43.3 Limitations of alcohol intake plays appositive role in treatment of HTN. Agree 113 53.8 Disagree 97 46.2 Cigarette smoking cessation plays appositive role in treatment of HTN. Agree 116 55.1 Disagree 94 44.8 Limiting salt consumption play a positive role in treatment of HTN Agree 123 58.6 Disagree 87 41.4 11/30/2023 quantitative result by pHO students 32

33. Lifestyle modification practice According to the finding of these study, 102 (48 .6%) ( 95 % CI : 42.4, 55.2) of patients practice all recommended lifestyle modifications One hundred forty five (69%) of respondents were practiced limitation of alcohol intake 132 (62.9%) of them practices recommended low salt diet . majority of participants were not ever smoking 178(84.8%). Nearly half, 98 (46.7%) of study participants were practicing recommended health weight management 11/30/2023 quantitative result by pHO students 33

34. Table ;4 Lifestyle modification practice among diagnsised hypertensive follow up patients at DURH Gedeo Zone southern Ethiopia 2023   Variable Categories Frequency Percent do you change food eaten after the illness Yes 104 49.5 No 106 50.5 Do you control or reduce weight ? Yes 98 46.7 No 112 53.3 Do you limit salt salt consumption ? Yes 132 62.9 No 78 37.1 Do you do physical exercise for more than 30min per day or 150 min per week Yes 100 47.6 No 110 52.4 do you limit alcohol intake ? Yes 145 69 No 65 31 Do you smoking cigarettes?   Yes 32 15.2 No 178 84.8 11/30/2023 quantitative result by pHO students 34

35. 4.7.Factors associated with lifestyle modification practices in hypertensive patients The results of the bivariate analysis shows that ; age , Co-morbidity, time since diagnosis of Hypertension educational level , area of living , with whom they live and knowledge of lifestyle modification were become significant association with dependent Variable with p- value < 0.25 After controlling possible confounding effects of other covariates, 11/30/2023 quantitative result by pHO students 35

36. Cont …. , In multivariate analysis age , having source information , comorbidity and knowledge were significantly associated with my outcome variable with p-value < 0.05 The study showed that hypertensive patients age from 18-39 years old were 70% times less likely to practice recommended lifestyle modifications than age grater than 60 years old (AOR: . 0.30, , 95% CI: (0.113,0.78) Hypertensive patients who had good knowledge were 4.44 times more likely to practice recommended lifestyle modifications than who had poor knowledge (AOR: 4.44, 95% CI: (198,9.94) 11/30/2023 quantitative result by pHO students 36

37. patients who had source of information were 2.2 times more likely to practice recommended lifestyle modifications than who hadn`t source information (AOR: 2.2 ,95% CI (1.03,4.76 )). study also pointed as HTN patients who had other chronic illness were 69% times less likely to practice recommended lifestyle modifications than those who hadn`t .AOR; 0.31, 95% CI (0.15, 0.64). 11/30/2023 quantitative result by pHO students 37

38. Table 6 shows Factors associated with lifestyle modification practices at DURH .in hypertensive patients 11/30/2023 quantitative result by pHO students 38 Variable Catigories Practice COR(95% CI) AOR(95%CI) P – value Good Poor Age (year) 18-39 37 32 0.364(0.172, 0772)* 0.30(0.113,0.78)** 0.008 40-59 49 38 0.327(0,159,0,672)* 0.85(0.1,1.33 ) 0.003 >= 60 16 38 1 1 Educational level Not formally educated 26 17 0.258(0.113, 0,593)* 0.39(.21, 1.26) 0.48 Primary school 37 21 0.224( 0.103, 0.488)* 0.50(0.18,1.39) 0.218 Secondary school 22 27 0.485(0.219, 1.075) 0.61(0.22, 1.71) 0.142 Collage and above 43 27 1 1

39. Residence Urban 59 22 2.849(1.546, 5.25)* 1.75 (0.80, 3.8) 0.09 Rural 43 86 1 1 With whom you live Family 54 76 2.11(1.197,3.72)* 3.15(1.52, 6.5) 0.056 Alone 48 32 1 1 Heard information Yes 89 40 3.02(1.60, 5.70) 2.2(1.03,4.76) 0.036 No 62 19 `1 1 Knowledge Good 60 42 4.286(2.38,7.71)* 4.44(198,9.94)** 0.001 Poor 27 81 1 1 Duration since diagnosis (year) <2 38 28 0.67(0.35,0.97)* 0.62(0.27, 1.44) 0.251 2-4 25 37 1.24(0.689,2.61) 154(0.67,3.54) 0.243 >=5 39 43 1 1 Comorbidity Yes 62 43 0.43(0.25,0.56)* 0.31(0.15, 0.64)** 0.004 No 40 64 1 1 11/30/2023 quantitative result by pHO students 39

40. 5 . Discussion poor practice to healthy lifestyle is one of the reasons for serious complication and uncontrolled Hypertension in addition to wastage of health care resources . The study revealed that only 102(48.6%) of hypertensive patients in DURH practiced recommended lifestyle This finding was similar to studies in Jimma (42.5%) this is might be due to socio- cultural similarity [ Tesema S, et al , 2016 ]. 11/30/2023 quantitative result by pHO students 40

41. Cont …. This finding is higher when it is compared study done in Dessie and central Gonder ( Atsedemariam Andualem et al ,2020 , M. Smachew et al 2022 ) this is might be due to geographical and socio cultural variation , 11/30/2023 quantitative result by pHO students 41

42. Cont …. This finding is lower than when compared with study from Canada where 57% to 89% and USA where 56% patients initiated to practice recommended lifestyle modifications [ Rechardi A et al,2014 ]. The discrepancy might be due to the fact that patients were from developed country with good access, good setup and can encourage patients to adopt good lifestyle modification practices 11/30/2023 quantitative result by pHO students 42

43. Cont …. In these study less than half of participants were Performing recommended physical exercise for 30 minute per day, which is lower when compared to similar studies results from India found (61%) [ Lipilekha Patnaik et al 2017 . ] The possible explanation could be related to low awareness, socio-economic variation and lack of organized setup in living areas in developing countries . 11/30/2023 quantitative result by pHO students 43

44. Cont.…. Age was significantly associated with lifestyle modification practice, age from 18-39 years old were 70% times less likely to practice recommended lifestyle modifications, (AOR: . 0.30, , 95% CI: (0.113,0.78 )). The study from kingdom of Saudi Arabia support this finding ,in that older age more likely in practicing recommended lifestyle modification [ ABUABKER et al 2015 ]. This is might be due to younger less educated and also less likely eager to control their blood pressure by practicing the lifestyle modification 11/30/2023 quantitative result by pHO students 44

45. Cont.…. Having source of information is also significantly associated, where patients who had source of information were 2.2 times more likely to practice recommended lifestyle modifications ( AOR: 2.2 ,95% CI (1.03,4.76 )). this finding is supported by similar study done in Mizan Tepi [ Abiy Tadesse et al 2019 ] this is might be due to a patient who have more information about health lifestyle could practice that and prevent HTN complication easily. 11/30/2023 quantitative result by pHO students 45

46. Cont.…. Knowledge is also significantly associated with healthy lifestyle modification. Knowledgeable hypertensive patients about healthy lifestyle were more likely practice recommended healthy lifestyle modifications. This is supported by the finding from the study in Ethiopia at the cardiac clinic of Ayder comprehensive specialized hospital [ Yirga Legesse et al, 2019 ]. Explanation might be as knowledge status increase practice and motivation of lifestyle modification practice will also increase . It may be due to access to information sources like fosters, leaflets and similar written material about hypertension managements and control 11/30/2023 quantitative result by pHO students 46

47. Cont.…. HTN patients who had Comorbidities were 69% times less likely to practice recommended lifestyle modifications than those who hadn`t .AOR; 0.31, 95% CI (0.15, 0.64). This finding is consistent with the study done in Addis Ababa Ethiopi a that showed patients without co-morbidity were more likely to practice lifestyle modification [ H abtamu Abera et al, 2016 ]. It might With the presence of co-morbidity is very difficult to control. Comorbidities can worsen the conditions of the patient and make them unable to practice lifestyle changes . 11/30/2023 quantitative result by pHO students 47

48. Strength of the Study Strength could be the high response rate. Regularly check up of my job by advicer’s experience of CBTP.   11/30/2023 quantitative result by pHO students 48

49. Limitation T he study didn’t include hypertensive patients who were attending follow up in private health facilities in study area Tight schedules of study period 11/30/2023 quantitative result by pHO students 49

50. CONCLUSION This study revealed lifestyle modification practice is low among the hypertensive patients. . Regardless of other indicated treatments, all hypertensive patients who need to control their blood pressure should be given advice and support to achieve and maintain lifestyle practices. Of the studied variables, age, having source of information , knowledge about lifestyle and comorbidity were factors significantly associated with health lifestyle modification practice. 11/30/2023 quantitative result by pHO students 50

51. RECOMMENDETION For DURH They should plan health education program for hypertensive paitents precisely in the management of HTN beyond pharmacological treatment . For policy maker; they should plan to provide training started from health post to higher levels about lifestyle modification practice . 11/30/2023 quantitative result by pHO students 51

52. For researcher s Use this research as base line further study. For health professional provide detail information for hypertensive patients about HTN management and its complication prevention 11/30/2023 quantitative result by pHO students 52

53. References H. Wakjira , “LIFESTYLE MODIFICATION PRACTICE AND Lifestyle Modification Practice and Associated Factors among Diagnosed Hypertensive Patients,” Haramaya Univ. , vol. 1, no. November, pp. 1–38, 2020. W . H. Day, “A global brief on Hyper ­ tension World Health Day 2013,” World Heal. Organ. , vol. 2, pp. 1–40, 2013 . A. Dan-jumbo, P. O. Dienye , N. O. Nnadi , and S. Uriah, “Lifestyle practices among hypertensive patients attending the Family Medicine Clinic in a tertiary hospital in Nigeria,” vol. 06, no. 02, pp. 50–60, 2021. 8/12/2023 By Dejene M. 53

54. Cont ….. B. T. J. Bollyky , T. Templin, M. Cohen, and J. L. Dieleman , “Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared,” vol. 11, no. 11, pp. 1866–1875, 2017 . I. Ru , “Modifiable Risk factors of Hypertension and Socio ‑ demographic Profile in Oghara , Delta State ; Prevalence and Correlates,” vol. 5, no. 1, pp. 71–77, 2015, doi : 10.4103/2141-9248.149793. 8/12/2023 By Dejene M. 54

55. ACKNOWLEDGMENT I want to start by expressing my gratitude to the Almighty God who assisted me in writing this research . Dilla University's college of health and medical science, and all of those who gave me the opportunity to work on it . Next, I would like to express my sincere gratitude to Mrs. Ever, S for her insightful comments made when this study proposal paper was being written. 11/30/2023 quantitative result by pHO students 55

56. 8/12/2023 By Dejene M. 56