Health Science

Communication

Biosci. Biotech. Res. Comm. 10(2): 258-263 (2017)

Changes in the body weight and subsequent physical

activity of hypertensive patients using BASNEF model

Rahim Baghaee,

Neda Khalediyan

* and Alireza Didarloo

Associate Professor, Department of Nursing Medical Surgical, School of Nursing and Midwifery, Urmia

University of Medical Sciences, Urmia, Iran

Master Nursing Education, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran

Associate Professor, Department of Health, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

ABSTRACT

Hypertension is a major public health issue. Lack of medication adherence in patients with hypertension can lead to

adverse outcomes. Therefore, patients need to be educated on how to control their blood pressure and increase their

behavioral preventive skills. Among the numerous models of health education, BASNEF model is the most com-

prehensive model used to study, identify and create new behaviors. This study aimed to determine the effect of an

educational intervention based on BASNEF model on the medication adherence in patients with hypertension. This

quasi-experimental study with pretest-posttest design conducted on 80 patients with hypertension referred to Health

Centers in Urmia, Iran, and met the eligibility criteria. They were selected using convenience sampling method and

then, randomly assigned to two groups as control and experimental. A 4-part questionnaire was used for collecting

the data. The collected data was analyzed by SPSS v.16 software using descriptive and inferential statistics (independ-

ent t-test, Mann-Whitney U test and Chi-square test). The results showed that the mean score of medication adher-

ence in patients with hypertension for a fundamental change in hypertension risk factors such as body weight and

subsequently physical activity in the experimental group was signi cantly more than the control group (P<0.001). It

seems that educational intervention based on BASNEF model has considerable advantages for a fundamental change

in hypertension risk factors such as body weight and subsequently physical activity and increases the medication

adherence in patients with hypertension signi cantly. Therefore, it is recommended to apply this educational model

as a key complementary factor to increases compliance of patients with hypertension.

KEY WORDS: HYPERTENSION, SMOKING, BODY WEIGHT, BASNEF, PHYSICAL ACTIVITY

258

ARTICLE INFORMATION:

*Corresponding Author: Urmia. neda.khaled22@gmail.com

Received 12

April, 2017

Accepted after revision 29

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

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Online Contents Available at: http//www.bbrc.in/

Rahim, Neda and Alireza

INTRODUCTION

Hypertension is an increase in systolic blood pressure

over 140 mmHg systolic or 90 mm Hg diastolic (Kasper,

Braunwald, Fauci, Longo, & Jameson, 2005) and is

one of the factors to increase the incidence of mortal-

ity in developing countries and in developed countries.

According to WHO reports, in 2013, 12 % of all deaths

globally are attributed to hypertension and because of

the importance of this disease was the motto of 2013 in

the World Health Organization “be serious about hyper-

tension” (Organization, 2013). According to 2014 World

Health Organization, the prevalence of hypertension in

people over 18 years was 22% (Organization, 2014). In

2008, in Iran prevalence of hypertension in persons aged

64-25 was about 25 % (Esteghamati et al., 2008, Ghem-

baza et al., 2014).

The impact of non-pharmaceutical treatments include

reducing salt in the diet, get the weight loss, increase

the physical activity, lack of alcohol consumption for

reducing hypertension has been approved ) (Okwuonu,

Ojimadu, Okaka, & Akemokwe, 2014). In a study con-

ducted in Iran shown that only 40 % of patients gen-

erally obey the medicinal diet for controlling hyper-

tension (Hadi, Rostamigooran, & Jafari, 2005) and in

America also speci ed that 30-60% of the patients with

hypertension do not obey the prescribed medicinal regi-

men (Chobanian et al., 2003).Adherence of treatment is

de ned by the World Health Organization: the extent

which a person takes medicine and follows his diet or

exercise and changes its lifestyle (Ghembaza, Senous-

saoui, Kendouci Tani, & Meguenni, 2014). Non-adher-

ence of treatment also is de ned as “the failure to obey

the recommendations of health behavior or treat” (Mas-

ror Roudsari, Dabiri Golchin, & Haghani, 2013). Dif-

 culty and complexity of the treatment regimen is a

factor related to treatment is considered as a possible

reason for low adherence to treatment. Repeat the dose,

the number of drugs that must be taken and the change

in antihypertensive medications are a number of fac-

tors that are involved in a dif cult regimen (Okwuonu,

Ojimadu, Okaka, & Akemokwe, 2014 and Ghajari,

Ghaderi, Valizadeh, Shakerinezhad, & Haghighizadeh,

2016).

In BASNEF model, unlike the behavior intention

model, the intention necessarily will not lead to behav-

ior, but enabling factors such as money, skill, precision

and facilities are between intention and behavior and in

the planning of this model should evaluate all enabling

factors on behavior (Didarloo A, 2013). Regarding the

mentioned issues, the authors decided to examine the

effect of education based on BASNEF to treatment in

patients with hypertension admitted to health centers of

Urmia University of Medical Sciences in 2015.

MATERIAL AND METHODS

In this experimental study, sample of study was obtained

among patients with hypertension referred to Health

Centers in Urmia, Iran. Using a list of patients referred

to the centers, based on quota random sampling and

lottery, 80 patients with hypertension were selected and

randomly divided into control and intervention groups.

The quota of health centers were included 40 patients

from the Tarzeloo health center, 20 patients from the 17

Shahryar health center and 20 patients from the Sho-

hada health center.

Informed consent was obtained from all participants.

Inclusion criteria included having a higher blood pres-

sure and equal to 140/90 mm Hg, 35-65 years of age,

the ability to read and write in the patient or one of his

family members and a willingness to participate in the

study and the exclusion criteria included three sessions

or more absence from training sessions, the patient’s

unwillingness to support the continuation of the study,

the patient’s hospitalization in the hospital and patient’s

death. The data collection instrument was a question-

naire that is designed according to the BASNEF model

and its reliability and validity were approved it. The

questionnaire included demographic information about

the opinion survey, questions related to the disease,

BASNEF model included four questions related to sec-

tion behavior, attitude, subjective norms and enabling

factors and Hill-Ben questionnaire for hypertensive

patients’ diet follow-up. Cronbach’s Alpha of discussed

structures was determined as follows:

Cronbach’s AlphaQuestionnaire Dimension

0.81Knowledge

0.96Attitude

0.93Subjective Norms

0.84Enabling factors

0.93Intention to behavior

0.90Adherence

Educational intervention based on BASNEF was done

only in the intervention group. Educational methods

were as lectures, distribution of educational package and

group discussion conducted on 6 session which each one

of them last 90 minutes. During the  rst, second and

third session to in uence the attitude of the patients,

topics included: an overview of hypertension and its

complications, the effect of disease on the interpersonal

relationship, the cost of treating the complications, the

effects of healthy diet among hypertensive patients and

the effect of physical activity to decrease hypertension.

In the fourth session, the participation of patients in

team therapy and family were taught to impact on the

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS CHANGES IN THE BODY WEIGHT AND SUBSEQUENTLY PHYSICAL ACTIVITY OF HYPERTENSIVE PATIENTS 259

Rahim, Neda and Alireza

dimensions of subjective norms. In the  fth and sixth

sessions, the use of low facilities, increase the skill and

precision in the control of disease, adherence of treat-

ment and follow up in order to affect the enabling fac-

tors were taught. As well as, educational pamphlet about

control of diseases were distributed in order to affect the

intention to behavior aspect.

In the present study, three-month follow-up was

considered to examine the impact of the training based

on BASNEF model. Finally, after the completion of the

period of follow-up, the intervention group and the con-

trol answered the questionnaire again and the results of

the impact of educational based on BASNEF model was

analyzed.

Independent and paired t-test-test and Chi-square

statistics were used for the analysis of the data using

the software SPSS version 16. The limitations of the

study include the lack of cooperation of the relevant

authorities and personnel, the lack of educational ses-

sions and the existence of multilingual individuals in

the city of Urmia. The necessary permissions from the

research and ethics committees and the relevant authori-

ties was acquired from Urmia University of medical sci-

ences (Rec.IR.UMSU.1394.246). Researcher undertaken

that any con dential speci cations will not be inserted

in the article.

RESULTS AND DISCUSSION

Gender, marital status, education level, employment sta-

tus, economic status, history of hypertension, history of

other diseases and sources of information between the two

groups had no signi cant difference (P>0.05) (Table 1).

There is a signi cant difference between the two

groups after the intervention in terms of the treatment of

hypertension and physical activity (P<0.05). Half of the

patients before the intervention had no physical activ-

ity, but after intervention, physical activity increased in

the intervention group than the control group. Also all

Table 1. The demographic information of patients in both intervention and control groups of subjects

P- Value

Intervention GroupControl GroupVariable

PercentFrequencyPercent

Frequency

P=0.999

208208Male

Gender

80328032Female

P=0.580

2.5100Single

Marital Status

85348534Married

5/125156Widow/Divorced

P=0.791

52.5216024Illiterate

Educational Level

22.5922.59Elementary

12.557.53Diploma

2.5100College

P=0.534

5200Employee

Occupation Status

52104Self-Employed

1047.53Unemployed

77.53177.531Household

5/2152Retired

P=0.784

1047.53Enough

Economic Status

52.5216024Somewhat Enough

37.51532.513Not Enough

P=0.066

72.5295020Yes

Hypertension

History

27.5115020No

260 CHANGES IN THE BODY WEIGHT AND SUBSEQUENTLY PHYSICAL ACTIVITY OF HYPERTENSIVE PATIENTS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Rahim, Neda and Alireza

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS CHANGES IN THE BODY WEIGHT AND SUBSEQUENTLY PHYSICAL ACTIVITY OF HYPERTENSIVE PATIENTS 261

aspects of the treatment of patients were observed after

treatment, including medication, nutrition and exercise

(Table 2).

Independent t-test showed that there was no signi -

cant statistical difference between the number of family

members and the body mass index before the interven-

tion (P = 0.225), but there was signi cant statistical dif-

ference after intervention between the body mass index

between the two groups, (P =0.019 (table 3).

High blood pressure is a major risk factor for devel-

opment of cardiovascular disease (Vrijens, Vincze,

Kristanto, Urquhart, & Burnier, 2008). The purpose of

this study was to determine the effect of education based

on BASNEF to treatment in patients with hypertension

admitted to health centers of Urmia University of Medi-

cal Sciences in 2015.In both groups, women formed the

majority of participants, that it’s more important for

women to refer the health centers. In the study of Rahaii

et al., in 2012, with the title “predictors of self-monitor-

ing of blood pressure based on the BASNEF in patients

with hypertension” (Rahaii et al., 2012) and in the study

of Naimii et al., in 2009 with the title “Knowledge and

Performance in Patients with high blood pressure “the

greatest of them were women (Naiimi, Malekzade, Had-

inia, Shari , & Mosavizade, 2008). The average age of

patients was 54.40 ± 10.85 years which is consistent with

the study of Izadirad et al., in 2012 (Izadirad, Masoodi,

& zareban, 2013).

Most subjects were married which is consistent with

the study of Hadi et al., in 2005 (Hadi, Rostamigooran,

& Jafari, 2005) .Most of the patients were illiterate and

only 2.5% were college educated people. In the study of

Naimii et al, more samples were illiterate (Naiimi, Male-

kzade, Hadinia, Shari , & Mosavizade, 2008). According

Table 2. Frequency distribution in terms of physical activity before and after the intervention in the subjects

P- Value

Intervention GroupControl GroupVariable

PercentFrequencyPercent

Frequency

P=0.278

27.51135141-3 times per week

Gender

Marital Status

1041563-5 times per week

7.53005-7 times per week

55225020None of them

P=0.009

351425101-3 times per week

Educational Level

2087.533-5 times per week

1562.515-7 times per week

30126526None of them

P=0.015

31.660015 minuteOccupation Status

63.212801630 minute

5.3120460 minute

000090 minute

P=0.007

3.617.7115 minute

Economic Status

39.31192.51230 minute

53.6150060 minute

3.610090 minute

Table 3. Comparison of average of BMI in two groups

P- value

intervention groupControl group

Variable

Mean± SDMean± SD

P=0.225

30.24±4.3731.27±5.14MBI after intervention

P=0.019

92.68±4.3723.15±5.44MBI before intervention

Rahim, Neda and Alireza

262 CHANGES IN THE BODY WEIGHT AND SUBSEQUENTLY PHYSICAL ACTIVITY OF HYPERTENSIVE PATIENTS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

to the results, most of the study subjects were house-

wives which is consistent with the study of Safai et al., in

2016 (M safaie sarnaghi, Hemmati Maslak Pak, Khadem-

vatan, & Alinejhad, 2016). Most patients had moderate

economic status which is consistent with the study of

Rahaii et al., in 2012 (Rahaii et al., 2012). According to

the results, the most of family had a history of hyperten-

sion. In the study of Jafarivarjoshani et al., with the title

‘impact of consultation = on the amount of blood pres-

sure in women with hypertension’, approximately half

of the participants had a history of hypertension (Jafari-

varjoshani, Anooshe, Ahmadi, & Namadian, 2004).

According to the obtained results of the intervention

and control groups in terms of the underlying variables,

there were no statistically signi cant differences and

were homogeneous. So the difference is meaningful in

the dependent variable after the intervention because of

the positive impact of the educational program based on

BASNEF model.

Regarding to the exercise, scores increased after the

intervention. Time of physical activity in the interven-

tion group signi cantly increased after intervention.

Chan et al., in 2009 found in their research that training

leads to more effective obedience in terms of activity

and exercise in patients (Chan, Lonsdale, Ho, Yung, &

Chan, 2009). The  ndings of the study of Hung et al., in

2014, was consistent with our study (Hung et al., 2014).

CONCLUSION

Education is one of the most effective ways to treat highly

effective. It also requires training models for the correct

way of doing that. This study utilizes BASNEF to educate

patients and increase compliance with treatment and help

them improve their life. Hopefully, nurses and health pro-

viders apply the results of this study to improve the health

of patients and their treatment process.

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