Background
Self-efficacy is a widely applied psychosocial concept that is commonly used in association with management of chronic diseases, including hypertension. The aim of this study was to assess self-efficacy of hypertension management and patient-physician communication, as well as the factors associated with self-efficacy and patient-physician communication among patients with hypertension in Palestine.
Methods
We conducted face-to-face, questionnaire-based interviews using validated instruments to assess self-efficacy in managing hypertension (Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C)) and patient-physician communication (Perceived Efficacy in Patient-Physician Interaction Questionnaire (PEPPI)) in patients with hypertension at the three main primary healthcare centers in Nablus district in northern West Bank, Palestine. We also performed a multiple linear regression analysis to determine the variables independently associated with PEPPI and SES6C scores.
Results
We enrolled 377 participants with hypertension in this study. The average age (measured in years) was 56.8 with a standard deviation of 11.6. The mean PEPPI and SES6C scores were 20.0 (SD 4.4) and 41.1 (SD 10.6), respectively. In a multiple linear regression model, subjects who were city dwellers (B=3.597, p=0.004), and subjects with high education levels (B=4.010, p=0.001) achieved higher PEPPI scores, whereas subjects in the normal weight category (B=5.566, p<0.001) and those with higher PEPPI scores (B=0.706, p<0.001) achieved higher SES6C scores.
Conclusions
We found that impairment in self-efficacy was linked to overweight and obesity, as well as lower patient-physician communication. Moreover, our results showed that lower patient-physician communication was independently associated with low education level as well as non-city residency types. We recommend making the appropriate changes by both the policy-makers and the health care providers to improve the health facilities and its services, especially outside the cities. We also suggest holding specific counseling and training session on the management and control of hypertension.
Background
Hypertension is considered a serious and frequent source of morbidity and mortality [1]. Moreover, it is one of the most common chronic illnesses in the world [2]. In fact, it is the number one cause of mortality and the third most common cause of disability-adjusted life years [3]. In Palestine, hypertension prevalence was estimated at 3.7% [4], and it was ranked the fifth leading cause of death, accounting for 8% of all deaths in 2016, at about 21.8 deaths per 100,000 population [5]. However, the rates of awareness, treatment, and control of hypertension were found to be low [6]. As an initial approach to hypertension management, patients are encouraged to make healthy changes in their lifestyle including more physical activity, weight reduction, smoking cessation, and stress control. They are also encouraged to follow a modified diet (salt restriction, potassium supplement, avoiding alcohol, and multi-factorial diet control).
In Palestine, the health-care providers have developed specific guidelines for hypertension management that comply with the international recommendations, while also take the Palestinian context in account [7]. Maintaining adherence to the medication used in treatment is considered as important as initiating the treatment [8]. Yet, a wide range research has found hypertension control to be poor and that preventive behaviors and management of risk factors are the main issues in treatment [9]. Therefore, many methods are needed for patients to strengthen the self-management of their treatment. Self-efficacy is a psychosocial concept that is commonly used in association with the ability to manage chronic diseases [6]. It was proved to play an important role in various areas including health-related behavior (such as relapse of smoking cessation), experience and management of pain, eating and weight control, successful recovery from myocardial infarction, and adherence to programs related to preventive health. Data also emphasize the important role of perceived self-efficacy as a cognitive factor that has an impact on health [6]. Several studies have investigated the pattern of self-efficacy and self-management behaviors in hypertensive patients worldwide [8,9,10,11,12].
Although several studies have been conducted in Palestine among hypertensive patients [13,14,15,16,17,18,19], none addressed self-efficacy among patients with hypertension. Therefore, there is no sufficient data to compare the characteristics of patients’ self-management in the Palestinian healthcare system to those of healthcare systems elsewhere. Cardiovascular disorders pose a major and increasing challenge to the health of the Palestinian population in Palestine [7, 20]. The proportions of awareness treatment and control of hypertension in Palestine were low [16]. The aim of this study was to assess self-efficacy of hypertension management and patient-physician communication, as well as the factors associated with self-efficacy and patient-physician communication among patients with hypertension in Palestine. The rationale behind this assessment is to provide the bases for the efforts aimed at giving patients the necessary tools to achieve self-efficacy, developing educational sessions to improve self-efficacy practices among patients with hypertension, and implementing thorough programs that engage the families of these patients, which will ultimately improve treatment outcomes.