INTRODUCTION:

Hypertension is an important global health challenge with high contributions to burden of disease and morbidity.¹ According to the first comprehensive global analysis of trends in hypertension prevalence, detection, treatment and control, ² by Imperial College London and WHO on August 2021, the number of adults in the age group 30 to 79 years with hypertension has increased from 650 million to 1.28 billion in the last 30 years. Dietary approaches to stop hypertension is a dietary plan that reduces hypertension originated in 1990s³. NHLBI (National Heart, Lung, and Blood Institute) conducted a study that showed that blood pressures were reduced with a dietary plan that is low in saturated fat, cholesterol and total fat. It emphasizes on fruits, vegetables and fat free or low fat milk and milk products⁴. This eating plan known as DASH⁵eating plan also includes whole grain products, fish, poultry and nuts. It is reduced in lean red meat, sweets, added ⁶ sugar containing beverages compared to typical American diet.

MATERIALS AND METHODS:

Research approach: Quantitative approach.

Research design: Quasi experimental⁷one group pretest post test design.

Target population: Hypertensive patients.

Accessible population: Hypertensive patients admitted in selected wards (cardiology and nephrology) of JMMC AND RI, Thrissur.

Inclusion criteria:

Patients:

· With hypertension (systolic >140 mmHg and diastolic >90 mm Hg)

· Aged > 40 years and other comorbidities

· Who are present during the study period

· Who are willing to participate for the study.

· Who are attending cardiology and nephrology wards of JMMC &RI, Thrissur

Exclusion criteria:

Patients:

· With any mental or physical disability that hinder the intervention, eg. mental retardation, hearing disability

· With isolated systolic hypertension, secondary renal or endocrinal hypertension

· Critically ill and disoriented patients

· Who are health professionals

· Who are not able to follow English/Malayalam

Sampling technique: Simple random sampling

Sample size: 40

Data collection procedure: Structured questionnaires

Data analysis: Descriptive statistics and Inferential statistics

Criteria measure: Knowledge on DASH (Dietary Approaches To Stop Hypertension) diet

RESULTS:

1. Distribution of hypertensive patients on socio demographic and clinical variables (n = 40)

Sl. No	Variables	Frequency (f)	Percentage (%)
	Socio demographic variables
1	Age
	a)41-50 years	10	25
	b)51-60 years	10	25
	c)61-70 years	6	15
	d)71-80 years	14	35
2	Gender
	a)Male	24	60
	b)Female	16	40
3	Occupation
	a)Daily Wage	3	7.50
	b)Government	6	12.50
	c)Private	6	15
	d)Self employment	6	15
	e)Nil	20	50
4	Dietary pattern
	a)Vegetarian	4	10
	b)Non vegetarian	4	10
	c)Both	32	80
	d)DASH	0	0
	Clinical variables
5	Family history of HTN
	a)Yes	23	57.60
	b)No	17	42.40
6	Duration of illness
	a) 1 to 20	37	92.50
	b) 21and above	3	7.50
7	On regular medications
	a)Yes	33	82.50
	b)No	7	17.50
8	Any other comorbidity
	a)Yes	31	77.50
	b)No	9	22.50
9	Previous knowledge
	a)Yes	3	7.50
	b)No	37	92.50

Table 1 shows that 14 (35%) of patients age were in the age group of 71-80 years old and 6 (15%) were in the age group of 61- 70 years. More than half 24 (60%) of patients were males and 16 (40%) were females. 20 (50%) of patients have no occupation, majority of them were following mixed dietary pattern 32 (80%), more than half of the patients had family history of hypertension 23 (57.60%), most of the patients having duration of illness within 1-20 years 37 (92.7%) and 33 (82.50%) were on regular medication.

2. To assess the level of knowledge on DASH diet among hypertensive patients in selected wards of JMMC & RI, Thrissur. (n = 40)

SL.No	Component	Inadequate		Moderate		Adequate
SL.No	Component	F	%	F	%	F	%
	Pretest
1	Introduction	25	62.5	14	35	1	2.5
2	Food unit	1	2.5	27	67.5	12	30
3	Guidelines	14	35	23	57.5	3	7.5
4	Overall	10	25	30	75	-	-
	Post test
5	Introduction	0	0	3	7.5	37	92.5
6	Food unit	0	0	3	7.5	37	92.5
7	Guidelines	0	0	5	12.5	35	87.5
8	Overall	-	-	5	12.5	35	87.5

Table 2 conveys that the overall distribution of samples showed the majority 30 (75%) of samples gained moderate knowledge in pre-test whereas 35 (87.5%) gained adequate knowledge in post -test. 25 (62.5%) of patients had inadequate knowledge on introduction in pre-test whereas 37 (92.5 %) had adequate knowledge in post-test. About food units, 1 (2.5%) had inadequate knowledge in pre-test whereas 37 (92.5%) had adequate knowledge in post-test. About guidelines, 14 (35%) of patients had inadequate knowledge in pre-test whereas 35 (87.5%) had adequate knowledge in post-test.

3. To determine the effect of planned teaching programme on DASH diet among hypertensive patients in selected wards of JMMC & RI, Thrissur. ( n= 40)

Sl.No	Component	Pre test		Post test		t value	df	p value
Sl.No	Component	Mean	SD	Mean	SD	t value	df	p value
1	Introduction	4.23	1.493	8.88	0.911	15.572	39	0.001***
2	Food unit	6.75	1.373	9	0.847	9.190	39	0.001***
3	Guidelines	5.13	1.556	9.00	1.155	11.092	39	0.001***
4	Overall	16.10	2.600	26.88	1.911	19.952	39	0.001***

***highly significant at p<0.001 level

Table-4

Sl. No	Variables	Inadequate		Moderate		Chi-square χ2	df	p value
		f	%	f	%
1	AgeLess than 60Greater than 60	1911	9555	19	545	6.533	1	0.004*
2	GenderMaleFemale	1812	78.370.6	55	21.729.4	0.034^ns	1	0.423
3	OccupationEmployed Unemployed	1516	73.776.2	55	26.323.8	0.01^ns	1	0.571
4	Dietary patternVegNon-vegBoth	2424	5010075	208	50025	2.66^ns	2	0.264
5	Family historyYesNo	1614	69.682.5	73	30.517.4	0.307^ns	1	0.293
6	Duration of illness1-20yrs21& above	288	75.766.7	91	24.333.3	0.01^ns	1	0.589
7	On regular medicationYes No	246	72.785.7	91	27.314.3	0.058^ns	1	0.428
8	Any comorbidityYesNo	228	75.972.7	73	24.127.3	0.01^ns	1	0.568
9	Previous knowledge
	Yes	2	66.7	1	33.4	0.01^ns	1	0.589
	No	28	75.7	9	24.3

*significant at p<0.05

Table 3 reveals that the mean pre-test knowledge score for introduction was 4.23 which was increased to 8.88 in the post-test. Mean knowledge score on food units was higher in the post-test (9) as compared to that in the pre-test (6.75). Mean knowledge score for guidelines was 5.13 which was raised to 9 in the post-test.It was evident from the results that the overall mean post-test score (26.88)was significantly higher than the mean pre-test knowledge (16.10)

4.To associate socio demographic and clinical data variables with pre-test level knowledge on DASH diet among hypertensive patients in selected wards of JMMC & RI, Thrissur.

The study findings shows that (table-4), age of the patients (χ2 = 6.533 and p = 0.004) was statistically associated with the pre-test level of knowledge at p<0.05 level. Gender, occupation, dietary pattern, family history of hypertension, duration of illness, on regular medication, any other comorbidity, previous knowledge about DASH diet had no association with pre-test level of knowledge at p<0.05 level. (n= 40).

Table 4 shows that there was significant association between age and pre-test level of knowledge. As the age increases, the level of knowledge decreases. There was no significant association in gender, occupation, dietary pattern, family history of hypertension, duration of illness, on regular medication, any other co-morbidity, previous knowledge about DASH diet.

DISCUSSION:

1. To assess the level of knowledge on DASH diet among hypertensive patients.

From the above study, majority of the samples (30) had moderate overall knowledge level and 25% of them (10) had inadequate overall knowledge level in pre-test whereas in the post test it was changed to 12.5% (5) with moderate knowledge and majority of them (35) with adequate knowledge.

2. To determine the effect of planned teaching programme on DASH diet among hypertensive patients in selected wards of JMMC & RI, Thrissur.

In the present study the mean pre-test knowledge score for introduction was 4.23 which was increased to 8.88 in the post-test. Mean knowledge score on food units was higher in the post-test (9) as compared to that in the pre-test (6.75). Mean knowledge score for guidelines was 5.13 which was raised to 9 in the post-test. It was evident from the results that the overall mean post-test score (26.88) was significantly higher than the mean pre-test knowledge (16.10). The calculated t value was 19.952. The differences between the pre-test and post-test mean knowledge score in aspect of guidelines t = 15.572 was found to be highly significant at p<0.001 level.

This finding is supported by a study by Suneesh PM⁸ in Unicare hospital at Rajkot. The study was to assess the effectiveness of STP on knowledge regarding DASH diet in controlling blood pressure among hypertensive patients⁸. The method of study was pre experimental one group pre-test post-test design with 40 samples. The mean pre-test knowledge score is 6.63 and the post-test knowledge score is 15.33. In this study, obtained ‘t’ value for the level of knowledge was 18.91 that was highly significant at p<0.001 level. It shows that most of the hypertensive patients had inadequate and moderate level of knowledge in pre-test and they improved to moderate and adequate level of knowledge in post-test. This shows the imperative need to understand the purpose of the STP regarding improving the knowledge about DASH diet in controlling blood pressure among hypertensive patients and it will improve the practice of DASH diet to control the blood pressure.

3. To associate the level of knowledge on DASH diet among hypertensive patients with socio demographic and clinical data variables.

Present study shows that socio-demographic and clinical data variables like gender, religion, education, occupation, monthly income, type of residence, dietary pattern, duration of illness, family history and other morbidity had no association with pre-test level of knowledge at p<0.05 level except age (χ2= 6.533 and p= 0.004).

These findings were supported by a cross-sectional study on “Health literacy in old age: results of a German cross-sectional study” by Dominique vogt⁹ in 2017 to assess health literacy of 475 respondents aged 65 years and above. Health literacy was assessed via computer assisted personal interviews using HLS – EU-Q47 on a representative population speaking German. From the study, overall 66.3% of all respondents aged 65 years and above had limited health literacy especially prevalent among respondents above 76 years of age (80.6%). People aged 76 and above had statistically significant lower health literacy scores than the younger respondents.

CONCLUSION:

The present study was conducted to assess the effect of planned teaching programme on DASH diet on knowledge among hypertensive patients. The current study proved that there was a significant increase in the level of knowledge regarding DASH diet after the planned teaching programme and a significant association between age and pre-test level of knowledge of hypertensive patients. Thus the researcher concluded that planned teaching programme is an effective educational intervention in improving the knowledge on DASH diet among hypertensive patients.

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Received on 24.05.2022 Modified on 29.11.2022

Int. J. of Advances in Nur. Management. 2023; 11(2):93-97.

DOI: 10.52711/2454-2652.2023.00021