EFFECTIVENESS OF INTEGRATED HEALTH LITERACY AND SELF-MANAGEMENT MODEL FOR HYPERTENSION CONTROL IN URBAN COMMUNITY, NAKHONRATCHASIMA PROVINCE, THAILAND

Abstract

Background: Hypertension (HT) response a half of death from heart disease and stroke due to poorly-controlled hypertension. Many strategies have been approached poorly-controlled HT. The integrated health literacy and self-management model led care on poorly-controlled HT in urban area were few on reviewing. This study aimed to determine effectiveness of integrated program for poorly-controlled HT in urban community, Nakhorn Ratchasima, Thailand in experimental group comparing with usual care. Methods: This was a quasi-experiment during January 2017- March 2018 of The catchment areas of two primary care unit (PCU) in urban area of Nakhorn Ratchasima, Thailand were selected to be one as an experimental group, and another one was a control group. Poorly-controlled HT patients were separately randomized 67 patients for each arm.. There were 63 and 60 poorly-controlled hypertensive patients who enrolled into experimental and control groups consecutively. Experimental group got the integrated program based on 20-items health literate care model (HLCM) and self-management (SM). Control group received usual care. Data was collected by valid and reliable interviewing questionnaire at baseline, 3-months, and 6-month and morning home blood pressure by village health volunteers for 7 days was applied to measure systolic home blood pressure (SHBP) and diastolic home blood pressure (DHBP) at baseline, 3-months, and 6-month. Biochemistry levels were tested at baseline and 6-month. Data analysis used descriptive statistic, and baseline comparison was analyzed by Chi-square, Fisher’s Exact test, independent-t test and, Wilcoxan-Mann-Whitney test. Comparing the mean differences change of outcomes between experiment and control groups by confounders adjusting was analyzed by multiple linear regression. Results: The experimental group which received the integrated health literacy and self-management model led care for 6 month resulting in reduction of SHBP 9.6 (95% CI; 5.2, 14.0) mmHg, DHBP 6.2 (95% CI; 4.0, 8.2) mmHg, and BMI 0.8 (95% CI; 0.4, 1.2) kg/ m2 comparing with the control group significantly (P<.001). The mean score of self-management behaviors in experimental group increased 0.4 (95% CI; 0.3, 0.4) comparing with the control group significantly (P-value <.001). The mean score of drug and appointment adherence 0.6 (95% CI; 0.2, 1.0) comparing with the control group significantly (P-value .004). The mean score of health literacy for chronic disease: experience sharing and self-observation significantly increased by 1.0 (95% CI; 0.6, 1.4) and 1.0 (95% CI; 0.5, 1.5) with (P-value <.001) both values. Whereas LDL in experimental group reduced 23.8 mg/dL comparing with control group significantly (P-value <.001). Conclusion: The integrated health literacy and self-management model may effect to decrease blood pressure for poorly-controlled HT in urban community in experimental group comparing with control group by increase health literacy for chronic disease, self-management behaviors, and drug and appointment adherence.