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    Please use this identifier to cite or link to this item: https://tkuir.lib.tku.edu.tw/dspace/handle/987654321/122772


    Title: A web-based self-care program to promote healthy lifestyles and control blood pressure in patients with primary hypertension: A randomized controlled trial
    Authors: Ting-Yu Chen;Chi-Wen Kao;Shu-Meng Cheng;Yue-Cune Chang
    Keywords: diet;hypertension;physical activity;self-care;self-efficacy;web-based;weight management
    Date: 2022-06-08
    Issue Date: 2022-06-14 12:10:19 (UTC+8)
    Publisher: Wiley
    Abstract: Background: Hypertension is a major risk factor for cardiovascular diseases, which
    contributes to the worldwide mortality rate. Successful blood pressure control requires
    adherence to medications and lifestyle modifications. However, motivating
    patients with primary hypertension to change and sustain behaviors long-term
    is
    challenging. A web-based
    self-care
    program centered on self-efficacy
    theory could
    provide feedback for effective control of blood pressure.
    Purpose: To examine the effect of a web-based
    self-care
    program for patients with
    primary hypertension on cardiovascular risk-factors
    (pulse pressure and lipids), self-efficacy,
    and self-care
    behaviors (medication adherence and lifestyle).
    Design: A two-armed
    randomized controlled trial with 3-month
    and 6-month
    follow-ups.
    Setting and Participants: A total of 222 patients with primary hypertension were recruited
    between February 2017 and August 2018 at a cardiology clinic of a medical
    center in Taipei, Taiwan.
    Methods: Eligible patients were randomized by permuted block randomization into
    the intervention group (n = 111) and control group (n = 111). Patients in the intervention
    group received a 6-month
    web-based
    self-care
    program, based on the theory of
    self-efficacy,
    while patients in the control group received usual care. Baseline and outcome
    measures (3 and 6 months) included self-efficacy,
    evaluated with the Chinese
    version of the 6-item
    Self-Efficacy
    for Managing Chronic Diseases (SEMC6), self-care,
    using subscales of the Hypertension Self-Care
    Activity Level Effects Scale (H-SCALE)
    for lifestyle and medication adherence, and blood pressure and serum lipid data,
    collected through web-based
    self-reports
    and chart review. Generalized estimating
    equations evaluated the effects of the intervention.
    Findings: At baseline, the control group had higher scores on the SEMC6, and lower
    cholesterol (HDL) compared with the intervention group (t = −2.70, p < 0.05; and
    t = 1.76, p < 0.05, respectively). Pulse pressure decreased significantly (β = −20.30,
    95% CI −23.76, −16.83), and serum triglycerides and low-density
    lipoprotein cholesterol
    levels were significantly lower compared with controls at 6 months (all p < 0.001).
    At 6 months, the intervention group had significantly higher mean scores for the
    SEMC6 compared with the control group (β = 21.84, 95% confidence interval [CI]
    19.25, 24.42) and H-SCALE
    subscale for medication adherence, diet, weight management,
    and physical activity compared with controls at 6 months (all, p < 0.001).
    Conclusions and clinical relevance: The greatest benefit of this program was allowing
    participants to immediately consult with the researchers about self-care
    issues
    via the website. Lifestyles vary from person to person; therefore, the individuality
    of each participant was considered when providing feedback. We provided devising
    interventions for participants that would increase their confidence in self-care
    for
    hypertension and ultimately achieve home blood pressure control. We encourage incorporating
    this program into standard clinical care for patients with hypertension.
    Relation: Journal of Nursing Scholarship 54(6), p.678-691
    DOI: 10.1111/jnu.12792
    Appears in Collections:[Graduate Institute & Department of Mathematics] Journal Article

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