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Appraise And Debate Below is the attached files. Please, open the attached article and the attached question below. Answer the question promptly. International Journal of Caring Sciences January-April 2021 Volume 14 | Issue 1| Page 392

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Original Article

Effect of Nursing Intervention on Knowledge and Practice of Salt and Diet
Modification among Hypertensive Patients in a General Hospital

South-West Nigeria

Ajiboye, Rachael Oluwafunmilayo

Senior Nurse Tutor, School of Nursing, Lagos State College of Nursing, Midwifery and Public Health,
Igando, Lagos, Nigeria

Okafor, Ngozi Antonia
Senior Lecturer, Department of Nursing, Babcock University, Ilishan-Remo, Ogun State, Nigeria

Olajide, Tayo Emmanuel
Lecturer II, Department of Nursing, Babcock University, Ilishan-Remo, Ogun State, Nigeria

Emmanuel Olayemi Tosin
Principal Nurse Tutor, School of Nursing, Lagos State College of Nursing, Midwifery and Public Health,
Igando, Lagos, Nigeria. yemmieonline@hotmail.com

Correspondence: Ajiboye, Rachael Oluwafunmilayo School of Nursing, Lagos State College of Nursing,
Midwifery and Public Health, Igando, Lagos, Nigeria. E-mail:braaf5@yahoo.co.uk

Abstract

Background: Hypertension is the most common non-communicable disease and the leading cause of
cardiovascular disease in the world. Current management of hypertension stressed the importance of salt and
diet modifications. Unfortunately, many hypertensive patients do not have proper knowledge of this, which
results to inadequate practice. Therefore, there is need to develop strategies that will help to improve knowledge
and practice of salt and diet modifications among hypertensive.
Objective: To determine the effect of nursing intervention on knowledge and practice of salt and diet
modifications among hypertensive patients.
Materials and Methods: A quasi experimental design was conducted using purposive sampling to select the
sample size of 38 participants. A researcher-developed questionnaire derived from the literature review and
Hypertension Self-Care Activity Level Effects (H-SCALE) adapted from Warren-Find low and Seymour (2011)
was used to measure knowledge and practice of salt and diet modification among the participants. Data gathered
from participants were expressed using tables and percentages while research questions were answered with
descriptive statistics of mean and standard deviation through statistical package for the social science software
version 21.
Results: the study revealed that higher percentage of the participants (81.6%) had poor of knowledge of salt and
diet modification pre-intervention, also 92.1% of the participants reported poor practice before intervention.
Intervention was given to the participants and results showed a positive change in knowledge and practice of salt
and diet practice post-intervention.
Conclusion: regular training should be given to hypertensive patients by nurses to improve their knowledge and
practice of salt and diet modification for effective blood pressure control.

Keywords: Hypertension, Knowledge, Practice, Salt and Diet modification, Nigeria

Introduction

The burden of hypertension and other non-
communicable diseases is rapidly increasing and
this poses a serious threat to the economic
development of many nations. Hypertension is a
global public health challenge due to its high

prevalence and the associated risk of stroke and
cardiovascular diseases in adults.

Globally, hypertension is implicated to be
responsible for 7.1 million deaths and about
12.8% of the total annual deaths (World Health
Organization (WHO), 2018). Africa, among

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other WHO regions was rated highest with
increased prevalence of high blood pressure,
estimated at 46% from age 25 years and above in
which Nigeria contributes significantly to this
increase (Okwuonu, Emmanuel, & Ojimadu
2014; Ekwunife, Udeogaranya, & Nwatu, 2018;
WHO, 2018). This is so in spite of the
availability to safe and potent drugs for
hypertension and existence of clear treatment
guidelines, hypertension is still grossly not
controlled in a large proportion of patients
worldwide.

Current national recommendations for the
prevention and treatment of high blood pressure
emphasized non-pharmacological therapy, also
termed “lifestyle modification” which includes
salt and diet modification. However, there is a
dearth of information on the knowledge and
practice of salt and diet modification among
hypertensive patients attending Nigeria’s health
institutions (Abubakar et. al, 2017). Hence, poor
knowledge of salt and diet modifications, and
inability to practice these were one of the
identified patient- related barriers to hypertension
control (Tesema et.al, 2016). This gap may also
be attributed to the type of information or
training programmes given to patients on salt and
diet modification.

Therefore, this study might help to improve the
knowledge of hypertensive patients on salt and
diet modification which in turn may affect its
practice thus reducing the death burden,
complications and economic cost of poorly
controlled hypertension among patients and in
the society.

Objective

The aim of the study was to determine the effect
of nursing intervention on knowledge and
practice of lifestyle modification among
hypertensive patients. The following research
questions were expected to be answered:

1. What is the pre-intervention knowledge
and practice of salt and diet modification among
hypertensive patients?
2. What is the post-intervention knowledge
and practice of salt and diet modification among
hypertensive patients?

Methods

It is a quasi-experimental study, which adopted
one pre-test-post-test design, conducted between
February and September 2019, at a secondary

health facility (General Hospital), South-west,
Nigeria. The study was carried out among
hypertensive patients attending medical out-
patients department (MOPD) in the general
hospital. The hospital was purposively selected
being the only secondary health facility located
in one of the densely populated communities in a
major commercial city of South-west, Nigeria.

Sample size and sampling procedure: Sample
size was calculated using Taro Yamane method
of sample size determination, n = calculated
sample size, Population size (N) = 42 based on
daily clinic attendance of hypertensive patients,
and margin of error = 0.05 with a confidence
level of 95% given a sample size of 38
participants. Inclusion criteria were male and
female patients who were ≥18 years of age,
diagnosed to be hypertensive and attending
medical out-patients department (MOPD),
available and willing to participate in the study,
who could communicate either in English or
Pidgin English. Exclusion criteria were other
patients at MOPD who were not diagnosed to be
hypertensive, or with any co-morbidity that could
interfere with participation in the training, and
have attended previous educational programme
on salt and diet modification. Participants were
selected based on the inclusion criteria using
purposive sampling.

Data collection tools and procedures: Data
were gathered using researcher-developed
questionnaire derived from the literature review
with the opinions of experts in the field to assess
participants’ knowledge of salt and diet practice
and modified Hypertension Self-Care Activity
Level Effects (H-SCALE) developed by Warren-
Findlow and Seymour (2011) to assess practice
of salt and diet modification among the
participants.The questionnaire consists of three
parts. The first part includes the demographic
characteristics of the participants with eight (8)
items; the second part assessed the participants’
knowledge of salt and diet modification. The
knowledge of salt and diet modification
questions includes twelve (12) items with
maximum and minimum scores of 12 and 0
respectively. Participants’ knowledge scores of
9-12 points indicate high knowledge, 6-8 points
indicate moderate knowledge and scores <6
points indicate poor knowledge. The third part
assessed the practice of salt and diet modification
among the participants with seven items which
were used to assess practices related to eating a
healthy diet, avoiding salt while cooking and

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eating, and avoiding foods high in salt content.
Responses were coded ranged from never (1) to
always (3). Responses were summed up creating
a range of scores from three (3) to twenty one
(21). Scores of eleven (11) and above indicates
that participants followed the low-salt diet and
was considered as having good low salt diet
practice while score 60 years 16 (42.1)

Total 38 (100.0)

Gender

Male 12 (31.6)

Female 26 (68.4)

Total 38 (100.0)

Educational Level

No formal education 11 (28.9)

Primary education 11 (28.9)

Secondary education 5 (13.2)

Tertiary education 11 (28.9)

Total 38 (100.0)

Occupation

Employed 8 (21.1)

Retired 10 (26.3)

Self employed 16 (42.1)

House keeper 4 (10.5)

Total 38 (100.0)

Duration of Hypertension

1-5 years 16 (42.1)

6-10 years 21 (55.3)

>10 years 1 (2.6)

Total 38 (100.0)

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Table 3: Summary of responses on knowledge and practice of salt and diet modification
pre-intervention

Knowledge Level n=38

Poor knowledge
(0-5 points)

Moderate knowledge
(6-8 points)

Good knowledge
(9-12 points)

Total

Pre-
intervention

31 (81.6%) 7 (18.4%) 0 (0.00%) 38 (100%)

Practice Level n=38

Poor practice (0-10
points)

Good practice (11-21
points)

Total

Pre-
intervention

35 (92.1) 3 (7.9) 38 (100%)

Table 4: Comparing pre – and post-intervention knowledge and practice of salt and diet
modification.

Knowledge and Practice Level n=38

Knowledge of salt
and diet
modification n=38

Poor knowledge
(0-5 points)

Moderate
knowledge (6-8
points)

Good
knowledge (9-12
points)

Total

Pre-intervention 31 (81.6%) 7 (18.4%) 0 (0.00%) 38 (100%)

Post-intervention 1 (2.6%) 0 (0.0%) 37 (97.4%) 38 (100.0%)

Practice of Salt and
Diet Modification

Poor practice (0-10
points)

Good practice (11-
21 points)

Total

Pre-intervention 35 (92.1) 3 (7.9) 38 (100%)

Post-intervention 4 (10.5) 34 (89.5) 38 (100%)

Table 3 summarily shows participants responses
on knowledge and practice of salt and diet
modification pre-intervention. 81.6% of the
participants had poor knowledge of salt and diet
modification, 18.4% had moderate knowledge
level and none of the participants had high
knowledge level (0.00%) of salt and diet
modification. Participants also demonstrated
poor practice of salt and diet modification as
92.1% of the participants reported poor practice,
while only 7.9% of the participants reported
good practice of salt and diet modification before
intervention. However, Table 4 reveals a positive
change in the participants’ level of knowledge
and practice of salt and diet modification after
intervention. Only 2.6% of the participants
demonstrated poor level of knowledge of salt and
diet modification post intervention as against
81.6% before intervention. While 97.4%
demonstrated high knowledge level post-

intervention training as opposed to none (0.00%)
before intervention. When comparing pre and
post intervention practice of salt and diet
modification, the practice of diet and salt
restriction was good (≥11) from 7.9% pre-
intervention to 89.5% post intervention. While
poor practice level (≤10) was reduced to 10.5%
from 92.1% after intervention.

Discussion

The study revealed that the pre-intervention
knowledge of participants about salt and diet
modification was poor (81.6%). This finding
corroborates the findings of a study done in India
in 2011 and South Ethiopia (2017) that majority
of the respondents have poor knowledge of salt
and diet modification (Subramanian et. al 2011;
Buda et.al, 2017). The finding is also in
agreement with Okwuonu, Emmanuel, and
Ojimadu (2014) that most hypertensive patients

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are not fully aware of the impact of unsaturated
oil, reduction in diary food, whole grains,
consumption of fruits and vegetables in the
control of blood pressure and salt reduction The
study also showed poor practice of salt and diet
modification (92.1%) among the participants
before intervention. This finding was a bit higher
compare with a similar study done in China that
about 70% of the participants had poor adherence
to modification practices (Lu, et. al, 2017). This
may be attributed to poor knowledge of salt and
diet modification which in turn affects its
practice among the participants. This agreed
with Babu, (2015) who said that the desired
changing level in patients’ attitude toward
knowledge and practice of salt and diet
modification was not achieved due to insufficient
information in relation to effect of salt and diet
modification on blood pressure control given by
the health care professionals. Hence, an intense
effort should be made by health care givers for
effective improvement.

According to the findings of the study, poor
knowledge and practice of salt and diet
modification as demonstrated by the participants
may affect effective blood pressure control
which may be attributed to poor health seeking
behavior on the part of patients or inadequate
information provided by the health personnel.
This is particularly supported by a group of
researchers who posited that targeted health
education strategies are obviously necessary to
enhance the knowledge level of hypertensive as
this will help to prevent adverse effect of poor
blood pressure control, and that health care
givers are needed to provide appropriate cost-
effective programmes on management of
hypertension with a lot of reinforcement and
motivation for effective practices (Gnanaselvam
et. al, 2016). In addition, patients need to be
taught the basic underlying principles behind
every part of their care for them to be motivated
and adopt any change of behavior. Therefore,
patient education should be strengthened on the
use of salt and different type of diets that are
suitable for prevention and effective control of
blood pressure (Okwuonu, Emmanuel, and
Ojimadu, 2014); Tesema et.al, 2016).

The study findings revealed a notable
improvement on knowledge and practice of salt
and diet modification after the intervention
training programme as shown by post-
intervention test score. This shows that
intervention programme was very effective as the

participants gained more insight salt and diet
modification in relation to blood pressure
control. This agreed with Babu (2015) that when
a structured instructional module is used to
divulge facts on salt and diet modification among
hypertensive patients this will in turn affect their
practice and thus lowered blood pressure.

The findings validate the report of a randomized
controlled clinical trial which states that increase
in knowledge about the role of lifestyle in the
occurrence of high blood pressure would cause
people to start modifying their lifestyles and
enhance their preventive behaviours (Jafari et.al,
2016). This was proven with the result of a meta-
analysis of 37 randomized controlled trials by
Aburto et. al, (2013) who demonstrates the
strong and consistent relationship that has been
observed between dietary sodium and blood
pressure that reduced sodium intake reduces
blood pressure in both non-acutely ill adults and
children. The largest controlled feeding study of
potassium supplementation effects on blood
pressure was conducted among Chinese adults by
Gu et. al (2013) the study demonstrated a
significant reduction in blood pressures that was
reproducible after an average of 4.5 years. Even
more encouraging are the results of magnesium
supplements decreasing systolic and diastolic
blood pressure 3 to 4 mmHg and 2 to 3 mmHg,
respectively, with greater dose-dependent effects
at supplementations >370 mg/day (Kupetsky-
Rincon & Uitto, 2012). In subgroup analyses
involving five trials conducted among
hypertensive, fiber intake significantly reduced
both systolic and diastolic blood pressure by 5.95
and 4.20 mmHg, respectively (Bazzano et.al,
2015). Buda et al. (2017) added that irrespective
of other treatments options, if all hypertensive
patients are given needed information and
support required in controlling blood pressure it
will assist in achieving and maintaining salt and
diet practices. Hence, educational programs are
essential in increasing knowledge, improving
self-management, and controlling dietary habits
that are detrimental to effective blood pressure
control (Beigi et. al, 2014)

Conclusion and Recommendation: The study
helped to validate that a nurse-led intervention
programme has significant effect in improving
knowledge and practice salt and diet
modification among hypertensive patients.
Therefore, it is recommended that nurses should
ensure adequate provision of such programme in
a continuous and intermittent way with accurate

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information while providing care for these
patients.
Limitation of the Study: There are other
variables that are effective in control of blood
pressure which were not included in the study
such as measurement of patients’ clinical
parameters like cholesterol level and
triglycerides due to financial constraints. Another
important limitation was follow-up time, hence,
future studies should be conducted given enough
time for follow-up.
Acknowledgements: The researchers show their
appreciation management of the health facility
used as well the State Health Service
Commission for permission to use their facility
for the study. Appreciation also goes to all
participants that took part in the study.

References

Abubakar, S., Muhammad, L. U., Ahmed, A., &Idris,
F. (2017). Knowledge, attitude, and adherence to …

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