Dennison Cheryl R, Peer Nasheeta, Steyn Krisela, Levitt Naomi S, Hill Martha N
Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Room 419, Baltimore, MD 21205, USA.
Ethn Dis. 2007 Summer;17(3):484-91.
To examine determinants of hypertension (HTN) care and control among peri-urban hypertensive Black South Africans.
Cross-sectional, descriptive.
Public and private primary care sites in three townships near Cape Town, South Africa.
403 hypertensive Black patients (183 men, 220 women), ages 35-65 years.
The Precede-Proceed Model guided the study. Self-report sociodemographics, medical history, health behaviors, health service utilization, quality of life, social support, and exposure to life threats and illness were assessed. Blood pressure (BP) was measured and height and weight recorded.
Mean BP (mm Hg) was 151/99 for men, 142/88 for women with BP controlled (<140/90 mm Hg) among 33% of men, 44% of women. Patient-related barriers to HTN care included limited HTN-related knowledge, poor quality of life and stressors such as family death. An unhealthy lifestyle involving smoking cigarettes, physical inactivity and using alcohol excessively was common. In regression models of select socioeconomic, lifestyle risk and HTN care variables, significant predictors of lower SBP and DBP or BP control included: fewer antihypertensive medications, better compliance to HTN recommendations, younger age, female, higher education level, not using alcohol excessively, and private sector healthcare.
This study identified a high level of barriers to HTN control and the need for comprehensive multilevel interventions to improve HTN care and control in this high-risk population. Furthermore, the data illustrate that the Hill-Bone compliance scale can be a practical tool in primary healthcare settings to identify patient-related factors and guide counseling to improve adherence in HTN care.
研究南非城市周边地区高血压黑人患者高血压护理及控制的决定因素。
横断面描述性研究。
南非开普敦附近三个城镇的公立和私立初级保健机构。
403名年龄在35 - 65岁之间的高血压黑人患者（183名男性，220名女性）。
采用“教育-环境诊断与评价-综合行为和环境策略（Precede-Proceed）模型”指导本研究。评估了自我报告的社会人口统计学、病史、健康行为、卫生服务利用、生活质量、社会支持以及生活威胁和疾病暴露情况。测量了血压（BP），记录了身高和体重。
男性平均血压（mmHg）为151/99，女性为142/88；33%的男性和44%的女性血压得到控制（<140/90 mmHg）。高血压护理中与患者相关的障碍包括高血压相关知识有限、生活质量差以及诸如家人死亡等压力源。不健康的生活方式很常见，包括吸烟、缺乏体育活动和过度饮酒。在选定的社会经济、生活方式风险和高血压护理变量的回归模型中，收缩压和舒张压较低或血压得到控制的显著预测因素包括：服用的抗高血压药物较少、对高血压建议的依从性较好、年龄较小、女性、教育水平较高、不过度饮酒以及接受私立医疗保健。
本研究发现高血压控制存在高水平障碍，需要采取全面的多层次干预措施来改善这一高危人群的高血压护理和控制。此外，数据表明希尔 - 博恩依从性量表可以作为初级医疗保健环境中的实用工具，用于识别与患者相关的因素并指导咨询，以提高高血压护理中的依从性。
