Analysis of Factors Related to Self Management Behavior (SMB) in Hypertensive Patients

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1 8th Iteratioal ursig Coferece (IC 2017) Aalysis of Factors Related to Self Maagemet Behavior (SMB) i Hypertesive Patiets Ilkafah urul Augrah Ridwa ursig Program, Medical Faculty, Hasauddi Uiversity Makasar, Idoesia ilkafah@uhas.ac.id ursig Program, Medical Faculty, Hasauddi Uiversity Makasar, Idoesia Titi Iswati Afelia ursig Program, Medical Faculty, Hasauddi Uiversity Makasar, Idoesia Abstract- Hypertesio is kid of chroic ad risk disease cause the disease complicatios, to avoid the complicatios required the ability to self-maagemet behavior such as lifestyle chages icludig blood pressure cotrol, diet modificatio ad physical activity. This research aimed to determie the factors related to selfmaagemet behavior (SMB) i the patiets with hypertesio i the workig area of Batua Makassar. This study was a quatitative study desig usig aalytical survey. Samplig used i this study was purposive samplig techiques, the umber of respodets as may as people. The results showed that most respodets educatio level were high school, the major respodets were wome, more tha half of respodets aged years with a average age of 56 years, ad most of respodet had BMI scale 25 with the average value of respodets BMI were 25.5, the average respodet had suffered from hypertesio for.1 years ad most do ot experiece complicatios. From chi-square aalysis test was obtaied sigificat relatioship betwee kowledge, family support, ad self-efficacy with SMB i the patiets with hypertesio i Batua Makassar with p-value (0.001, 0.000, 0.000). Self-efficacy is the most domiat factor related to SMB of hypertesive patiets. There is a relatioship betwee kowledge with the SMB i hypertesive patiets, ad there is a relatioship betwee family support ad self-efficacy with the SMB i hypertesive patiets i the workig area of Batua Makassar. Where the better level of kowledge, family support ad selfefficacy, the better SMB of the patiets will be. Therefore, it is expected to self-maagemet Behavior (SMB) ca be made as a health promotio program to improve kowledge ad the patiet's ability to perform SMB. Keywords: Hypertesio, self-maagemet behavior, self efficacy, family support I. ITRODUCTIO Hypertesio is persistet blood pressure where the systolic pressure is above 10 mmhg ad diastolic pressure is above 90 mmhg[1]. Hypertesio has bee became the world health problem ad a major health problem i developed coutries (Aster, 2015). Based o data from World Health Orgaizatio (WHO) i 2012, there were 9 millio cases of hypertesio, is estimated will icrease to 15 billio i 2025 or approximately 29% of the world populatio. Accordig to the data of health statistical of the world i hypertesio accouted for 9. millio deaths worldwide[2]. The results of basic medical study (Riskesdas) i 201 showed the prevalece of hypertesio i Idoesia i 201 as much as 28.1%. Secodary data were obtaied from the health departmet of Makassar, the umber of cases of hypertesio i South Sulawesi i 201 were cases with 272 deaths due to complicatios of hypertesio ad icreased i 2015 as may as 7.20 cases of hypertesio. High rates of hypertesio have a impact o the icreased icidece of complicatios (such as cardiovascular disease, stroke, kidey failure ad eurological disorders), there should be a effort to prevet disease complicatios. Carter et al (2008) cited i Rigsby (2011) asserts that as a result of hypertesio experieced by over 70 millio people i the Uited States ca icrease the risk factor for cardiovascular disease ad kidey disease[]. Itervetio i order to lowerig blood pressure is hadled pharmacologically ad o-pharmacologically. Maagemet of hypertesio cosists of two mai approaches i.e. lifestyle modificatio ad pharmacological. Study shows that pharmacological treatmet is less effective to cotrol blood pressure without o-pharmacological therapy[]. Caadia Hypertesio Educatio Program (2011) recommeds o-pharmacological maagemet of hypertesive patiets such as modifyig lifestyle (icludig dietary modificatio, BB cotrol, stress maagemet, smokig, blood pressure moitorig, exercise, medicatio adherece ad iteractio with health workers). The implemetatio is called Self-Maagemet Behavior (SMB) i patiets with hypertesio[5]. SMB i hypertesive patiets is a corerstoe for the patiets to be able to cotrol ad prevet complicatios occurrece. The effective SMB ca help improve the health status ad icrease the idepedece of hypertesive patiets[6]. SMB i patiets with hypertesio i the workig area of Puskesmas Batua geerally has bee carried out but the implemetatio of the SMB are less effective, it proved by the obtaied cases of hypertesio from Batua i the last two years there was a icrease i 201 as may as 199 cases, while i 2015 the umber of cases of hypertesio icreased as may as 2,026 cases ad mostly occur i the age of 0-6 years. SMB i patiets with hypertesio ca be iflueced several factor. Oe of the factors that ca affect SMB is kowledge, kowledge of patiets o hypertesio will icrease cofidece Copyright 2017, the Authors. Published by Atlatis Press. This is a ope access article uder the CC BY-C licese ( 192

2 ad belief to the therapy coducted, aother factor is selfefficacy, the patiet's belief to therapy coducted[6]. Accordig to Badura i Komalasari, Wahyui, & Karsih (201) that a perso who has a high efficacy teds to work hard ad persevere util the task is completed, from the theory it ca be cocluded that patiets who have a high efficacy ca improve self-motivatio of patiet to carry out the therapy. A study coducted by Mulyati, Yetti, & Sukmarii (201) idicated that there were three factors that have a sigificat relatioship with self-maagemet behavior that is selfefficacy, social support ad the ability commuicate with health care providers. While the level of educatio, kowledge ad duratio of pai is ot related to self-maagemet behavior i hypertesive patiets. Aother study coducted by Crowley et al (201) about the factors associated with o-compliace with the use of proper medicatio, diet ad exercise o the behavior of self maagemet i patiets with hypertesio showed that there are two factors related with the poor adherece to behavioral self-maagemet of hypertesio i.e. lack of kowledge ad belief to therapy factor. I additio, factor of family support also affects the behavior of patiets with hypertesio. Family support is divided ito istrumetal support, emotioal, iformatioal ad appraisal support. This is accordig to study coducted by Putry (2016) which stated that there was a relatio of family support o the treatmet of hypertesio patiet i Jelbuk, Jember. Aother study coducted by Fly, et al (201) i Africa Americas showed that hypertesive patiets have may barriers to self-care maagemet, so that the self-maagemet efforts is less effective i patiets with hypertesio. I additio, this study also showed that the role of the family is very importat i self-maagemet, icludig providig assistace to the selectio of food ad help patiet with hypertesio to adhere the treatmet ad lifestyle modificatios recommeded by health professioals. hypertesio, icludig risk factors ad hypertesio. Measuremet of self-efficacy usig questioaires adapted from Prasetyo (2012) which cosists of statemets about selfefficacy i hypertesive patiets. To measure the level of family support respodets i this study usig a questioaire adapted from Putri (2016) which cotais statemets about the family support of hypertesive patiets which divided ito four such as emotioal support, istrumetal support, iformatioal support ad appraisal support. III. RESULTS This study was coducted i Batua, Makassar. Retrieval of data was coducted over twelve (12) days from October 21st ovember 2d, The data were obtaied usig 5 questioaire i.e. demographic data, kowledge about hypertesio, family support, self-efficacy, ad selfmaagemet behaviors give to the respodets who met the iclusio criteria. Researcher idetified the data to determie the respodets who would be ivolved ad the give the research explaatio to the respodets. Researcher asked permissio to the Respodet to sig the iformed coset form that icluded with istrumet sheets. The collected data is processed ad aalyzed i uivariate that icludes frequecy distributio characteristics of respodets, the level of kowledge, family support, self-efficacy,ad self-maagemet behavior of the respodet. The bivariate aalysis icludes the idepedet variable relatioship with the depedet variable is the relatioship betwee kowledge, family support, self-efficacy o self-maagemet behavior (SMB) i patiets with hypertesio i Batua Makassar. The results of the study as follows: Characteristics of respodets (Table 1), the level of kowledge of hypertesive patiets (Table 2), family support (Table ), self-efficacy (Table ), self-maagemet behavior (Table 5), ad the relatioship betwee kowledge, family support, self-efficacy o self-maagemet behavior (SMB) i patiets with hypertesio i Batua Makassar. TABLE I. II. METHODS The method used was quatitative study usig aalytical survey desig with cross-sectioal approach which is the study desig observe or collect the depedet variable ad idepedet variables while at the same time. The study took place i Batua Makassar. The samplig techique used was purposive samplig, the sample met the criteria to be the respodet ad obtaied sample as may as respodets. Data collectio i this study was coducted by fillig out the questioaire. The questioaire i this study cosists of five istrumets, amely the demographic data of respodets, kowledge about hypertesio, family support, self-efficacy, ad hypertesio self-maagemet behavior questioaire (HSMBQ) used i measurig the self-maagemet behavior (SMB) of the respodets. SMB measuremets coducted by usig the istrumet of Hypertesio Self-Maagemet Behavior Questioaire (HSMBQ) adapted from Akher (2010) which has bee tested for validity ad reliability. Kowledge of hypertesio i this study was measured by usig questioaire adapted from Prasetyo (2012) which cosist of statemets about DISTRIBUTIO CHARACTERISTICS OF RESPODETS BY AGE, GEDER, LEVEL OF EDUCATIO, BMI, BLOOD PRESSURE, DURATIO OF ILLESS, COMPLICATIOS, AD SMOKIG STATUS I BATUA, MAKASSAR, DURIG OCTOBER-OVEMBER 2016 ( = ).. Variable Age Geder Male Female BMI 17,0-18,5 18,5-2,9 25,0-29,9 0 Last Educatio o school Elemetary. Juior high school. Seior high school 5.Diploma Presetatio 7,6, ,2 62, , 60,2,8,8 25, 28,9 2,5,6 19

3 6. Bachelor.. 5. Blood Pressure Grade 1 of Hypertesio: Systolic mmHg ad diastolic 90-99mmHg Grade 2 of Hypertesio: Systolic 160 mmhg ad Diastolic 100 Legth of illess 2 years > 2 years Complicatio oe Diabetic Stroke Kidey disease Others Smokig status Smokig o Smokig TABLE V. DISTRIBUTIO OF SELF MAAGEMET BEHAVIOR (SMB) I HYPERTESIVE PATIETS I BATUA, MAKASSAR DURIG OCTOBEROVEMBER 2016 ( = ),8 5 65,1 29,9 7,6, , 15,7 7,2 2, 8, ,5 79,5 TABLE II. DISTRIBUTIO OF RESPODETS BY THE LEVEL OF KOWLEDGE OF HYPERTESIVE PATIETS I BATUA, MAKASSAR DURIG OCTOBER-OVEMBER 2016 ( = ) Kowledge Presetatio TABLE III. DISTRIBUTIO OF FAMILY SUPPORT OF HYPERTESIVE PATIETS I WORKIG AREA OF PUSKESMAS BATUA MAKASSAR DURIG OCTOBER-OVEMBER 2016 ( = ) Family Support Presetatios TABLE IV. ISTRIBUTIO OF SELF-EFFICACY OF HYPERTESIVE PATIETS I BATUA MAKASSAR, DURIG OCTOBER-OVEMBER 2016 ( = ) Self-efficacy Presetatio Both Self maagemet behavior (SMB) Presetatio 7.6. TABLE VI. DISTRIBUTIO OF THE RELATIOSHIP BETWEE KOWLEDGE, FAMILY SUPPORT AD SELF EFFICACY WITH SELF MAAGEMET BEHAVIOR (SMB) OF HYPERTESIVE PATIETS I BATUA MAKASSAR DURIG OKTOBEROVEMBER 2016 (=) Self maagemet behavior (SMB) Variable % % % 56,7 26, 60 1, , ,7 1, 28 Self-efficacy 1 2,6 2 76, 5 92,1 7, ,,6 95,6, 5 Kowledge Family support P Value OR (CI 95%) 0,001 6,56 (0,8252,) 0,000 5,91 (0,6,8) 0,000 89,1 (1,26) * Uji chi-square. Table 6 shows that of the 60 respodets who have a good kowledge there were respodets (56.7%) showed good SMB ad 26 respodets (.%) showed poor SMB. Of the 2 respodets who have less kowledge there were three respodets (1.0%) showed a good SMB ad 20 respodets (87.0%) showed poor SMB. Based o the aalysis results chisquare test obtaied value p = < (α = 0.05). This meas that there is a relatioship betwee kowledge with the SMB i patiets with hypertesio. The results obtaied by aalysis of OR value is This meas that someoe who has a high kowledge have the opportuity to perform SMB 6.5 times with good tha the respodets who have poor kowledge. Of the 28 respodets who have good family support, there were 2 respodets (85.7%) showed good SMB, ad respodets (1.%) showed poor SMB. Of the respodets who have poor family support, there were 1 respodets who idicate the good SMB ad 2 respodets (76.%) showed poor SMB. Based o the aalysis of chi-square test obtaied value p = <(α = 0.05). This meas that there is a sigificat relatioship betwee family support with the SMB i patiets with hypertesio i Batua Makassar. The aalysis also obtaied OR value as much as 5.9 This meas that respodets who have good family support have the 19

4 opportuity to perform SMB 5.9 times with good tha the respodets who have poor family support. Of the 8 respodets who have high self-efficacy there were 5 respodets (91%) showed good SMB ad respodets (7.9%) showed poor SMB. Of the 5 respodets who have poor self-efficacy there were two respodets (.%) showed good SMB ad respodets (95.6%) showed SMB. Based o the results of chi-square aalysis obtaied value of p = 0,000> (α = 0.05). This meas there is a sigificat relatioship betwee self-efficacy with SMB i patiets with hypertesio i Batua Makassar. The aalysis also obtaied the value of OR is This meas that respodets who have good self-efficacy have opportuities times to perform SMB well tha the respodets who have poor self efficacy. IV. DISCUSSIO Results of study o the respodets characteristic features of hypertesive patiets at Batua Makassar with the umber of respodets as may as people, it is obtaied almost half of patiets with hypertesio amely people (.6%) aged 566 years with a average age of patiets was 5.8 years. It is proved that the icreasig of perso's age, the greater the risk of hypertesio. Hypertesio is a disease that ca occur at ay age, but the results were obtaied almost half of hypertesive patiets aged 56-6 years. It is due to lack of physical activity (exercise) of the respodets ad poor healthy lifestyle, thus triggerig the occurrece of hypertesio. The Results is i lie with the study coducted by Aggra & Prayityo (201) at Telaga Muri, West Cikarag showed the results of study that the majority of respodets by age, at most 0 years, i.e. 19 people (.9%). Study o geder obtaied more tha half of the respodets were female as may as 52 people (67%). The result showed that the average respodet i this study were female. The results also foud a icrease i blood pressure i wome respodets ofte due to uhealthy behaviors icludig the cosumptio of fatty foods ad lack of physical activity, as well as stress factors. The Results of study is i lie with the study coducted by Aisa, Wahiduddi, ad Asar (201) at Pattigaloag Makassar city showed that of the 10 samples cotaied 8 people (6.6%) were wome. Study o BMI obtaied the majority patiets had BMI scale at 25.0 to 29.9 as may as 50 people (60.2%). The results also obtaied by the average value of BMI i hypertesive patiets were This meas that average respodets i this study were excessive weight (overweight). Someoe with excessive weight (overweight) ad obesity ted to be more at risk of developig hypertesio because of high levels of cholesterol serum i the body that will affect the risk of icreased blood pressure[7]. Obesity icreases cardiac work ad oxyge requiremets ad cotribute to a passive lifestyle. Excessive body fat (especially abdomial obesity) ad the ieffectiveess of physical activity will cause isuli resistace which will lead to the occurrece of hypertesio[8]. Research is i the study coducted by Ilkafah (2016) i the Batua, Makassar showed that more tha the majority of respodets (57%) were icluded i the overweight of BMI. Based o a study of the respodets' educatio level obtaied more tha a small umber of respodets (5%) had a high school educatio level, (.8%) had a Diploma ad (.8%) had a bachelor's degree of higher educatio. This meas that almost half of respodets have a high level of educatio. Accordig otoatmodjo (2007) level of educatio also determies a perso's ability to uderstad the kowledge acquired, i.e. the higher the perso's level of educatio the easier the perso receivig the iformatio provided. I this study, the respodets who had diploma levels, bachelor ad most of which have high levels of educatio middle ad high school show good level of kowledge, while those respodets who have o school ad half of the respodets who have elemetary levels of educatio showed poor kowledge. This ca mea that educatio ad kowledge is directly proportioal, which meas that the higher the level of perso s educatio, the better kowledge will be. The results were obtaied more tha half (.%) of patiets with hypertesio at Batua suffered hypertesio more tha 2 years. Based o the test results mea value obtaied the average respodets i this study have experieced hypertesio for.1 years. Hypertesio is a chroic disease that lasts a lifetime ad caot be cured. Progressio of the disease will cotiue to ru for life ad ca cause a variety of acute ad chroic complicatios[1]. The results were obtaied most of the respodets who have a good level of kowledge is a respodet who has bee sufferig from hypertesio more tha 2 years. This meas that the loger a perso had hypertesio the the kowledge of the disease hypertesio will also be gettig better because respodets who had bee sufferig from hypertesio more tha two years was likely to kow more about hypertesio from experiece ad iformatio that obtaied earlier from health professioals. Study o the complicatios of hypertesio disease obtaied that most of the respodets i this study do ot have ay complicatios of the disease ad proved from respodets (66.%) without ay complicatios. The results also showed that less tha a small umber of respodets i this study had diabetes. The result also obtaied a average of respodets who have complicatios of hypertesio is the respodet who has bee sufferig from hypertesio more tha 2 years. This proves that the loger a perso has hypertesio, the higher risk of complicatios of hypertesio will be who are uable to cotrol the blood pressure. Study o smokig status was obtaied less tha a small umber of respodets i this study that have smokig habitual showed from respodets there were 17 respodets (20.5%) who smoke. The results also obtaied all the respodets who smoke were male. This happeed because wome have a egative stigma, whe smoke, they are see as bad wome. Smokig is a risk factor for hypertesio because of the compoets toxis i cigarettes such as icotie ito the blood vessel, causig a buildup of plaque i blood vessels will cause costrictio of the blood vessels ad vasocostrictio of blood vessels that lead to the occurrece of hypertesio. Smokig habits i a perso ca cause the adreergic system ad icrease blood pressure ad vulerable to atherosclerosis disease. I additio, icotie ca icrease blood clottig ad blood vessel[9]. 195

5 The results of chi-square obtaied aalysis test obtaied value of p = <0.05 (α). This meas it ca be cocluded that there is a sigificat relatioship betwee the level of kowledge of the SMB i hypertesive patiets, where the better a perso's level of kowledge of the better SMB show ad vice versa. It ca be see from respodets majority of respodets already kow about the defiitio, sigs ad symptoms as well as treatmet of hypertesio but kow less about the risk factors of hypertesio as well as kow less about the therapy that ca be coducted to alleviate the blood pressure but drug therapy. The results are cosistet with the SMB show by the majority of hypertesive patiets that SMB respodets are still poor because of the lack of kowledge of the risk factors of hypertesio ad therapies that ca alleviate the patiet's blood pressure. betwee family support with the treatmet of hypertesive patiets i the Jelbuk,Jember regecy. Kowledge is the result of kowig ad happeed after someoe did sesig of a particular object. Kowledge is the extet to which a perso uderstads iformatio. Kowledge or cogitive domai is very importat i shapig a perso's behavior[10]. Self-efficacy is a factor that affects the SMB of patiets because this factor ca determie whether a patiet ca survive eve i the implemetatio there are difficulties ad failures (Friedma & Schustack, 2008). The study showed the majority of respodets who have a good self-efficacy showed a good SMB. From the results it ca be cocluded that there is a relatioship betwee self-efficacy with SMB i hypertesive patiets. This is i lie to research coducted by Mulyati, Yetti & Sukmasari (201) idicate that there is a sigificat relatioship betwee self-efficacy with SMB i hypertesive patiets. Basically behavior based kowledge teds to be better tha the behavior that is ot based o kowledge[11]. The domiat factor ifluecig copig with hypertesio is the level of kowledge. About the SMB is a basic kowledge of the behavior, the level of oe's kowledge will have a impact o behavior or lifestyle. This is accordig to study coducted by Taukhit (201) which showed that there is a relatioship betwee the levels of kowledge with behavioral prevetio of complicatios of hypertesio. This study cocluded that the higher oe's educatio, the better prevetio behavior of complicatios of hypertesio. Based o the chi-square aalysis obtaied p Value =0.000 <0.05 (α) it ca be cocluded that there is a relatioship betwee family support with SMB of hypertesive patiets, where the better the level of support the respodet's family the better respodet would show SMB. Based o the study of family support also affects the SMB of hypertesive patiets. This is proved from 28 respodets who have good family support there were (85.7%) of respodets who expressed good SMB, ad of the respodets who have poor family support there were (76.%) of respodets who experieced poor SMB. The family is a group of two or more idividuals who have a special relatioship that ca be boud by blood or legal relatioship. The role of the family i chagig the lifestyle ad behavior of people is very importat i improvig the compliace of idividuals to make healthy lifestyle behaviors[9]. The result showed that the average respodet had good emotioal support ad appraisal support. But the respodets get lack istrumetal support ad iformatioal support. Support from family is a importat elemet i helpig idividuals to resolve the problem, good family support will grow the high self-cofidece ad self-motivatio i resolvig a problem[12]. Family support is divided ito four istrumetal support, iformatioal support, emotioal support, ad appraisal supports[10]. The study i lie with the study coducted by the Wome (2016), which showed that there is a relatioship Self-efficacy has sigificat relatioships o SMB i hypertesive patiets at Batua Makassar. The results of chisquare aalysis test obtaied p Value= <0.05 (α), it proves that there is a relatioship betwee self-efficacy with SMB i hypertesive patiets. Where the better level of respodets self-efficacy, the better SMB will be. Self-efficacy is a perso's belief i the ability to orgaize ad implemet treatmets to achieve the goals set. Badura (1997) cited i Komalasari, Wahyui, & Karsih (201) that the Self-efficacy is belief that grows i a perso that is based o the existece of motivatio ad a strog will, ad will be evideced i the form of attitudes ad behavior. Self-efficacy ca be used as a cotrol mechaism of chroic diseases ad is used as a basis to make lifestyle chages. The results were obtaied the majority respodets who have good self-efficacy showed good ad quite good SMB, ad the patiets who have poor self-efficacy showed poor SMB. The patiet's Self-efficacy is formed from experiece i cotrollig blood pressure, kowledge, selfefficacy also ca arise from what people see ad ecouragemet from others. The study, is i lie with the research coducted by Prasad (201) idicate that there is a sigificat relatioship betwee self-efficacy with self-care maagemet i patiets with hypertesio. This study cocludes a perso who has high selfefficacy will perform with good self-care maagemet. V. COCLUSIO AD RECOMMEDATIO The coclusio i this study is a sigificat relatioship betwee kowledge, family support ad self efficacy agaist SMB patiets with hypertesio i the workig area of Puskesmas Batua Makassar. Self efficacy is the most ifluetial factor to SMB hypertesive patiets. The results of this study suggest for urses to Self Maagemet Behavior (SMB) ca be used as a health promotio program to improve kowledge ad the patiet's ability to perform SMB. REFERECES [1] [2] [] S. C. Smeltzer ad B. G. Bare, Buku Ajar Keperawata Medikal Bedah Bruer & Suddarth, 8th ed. Jakarta: Buku Kedoktera EGC. R. R. Dhugaa, A. R. Padey, B. Bista, S. Joshi, ad S. Devkota, Prevalece ad Associated Factors of Hypertesio: A CommuityBased Cross-Sectioal Study i Muicipalities of Kathmadu, epal, It. J. Hypertes., vol. 2016, pp. 1 10, May B. D. Rigsby, Hypertesio improvemet through healthy lifestyle modificatios., ABF J., vol. 22, o. 2, pp. 1,

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