Empowering patients with hypertension in a public health system towards enhanced self-care through psycho-education
Preston, Lynn Doreen
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The increased number of patients with multi-morbidities in the South African health system, implies that without adequate patient self-care, an additional burden on an already overstressed public health system is evident. Due to staff shortages and resource limitations, there is inadequate time for medical staff to provide acceptable and appropriate health education to patients. In the interim, psycho-education may potentially serve as a health promotion strategy to empower patients with hypertension towards implementing enhanced self-care. Psycho-education also creates a better understanding of the illness for both the patient and their family by encouraging self-reliance through self-care and promoting individual responsibility, rather than relying completely on the health system. The eco-systemic framework (Lindau, et al., 2016; Yardley, et al., 2015), the building blocks of functional health system (WHO, 2011), and the middle-range theory of self-care (Riegel, et al., 2012.) serve as theoretical underpinning for this study. Recruitment and data collection commenced after ethical clearance was obtained from the Health Research Ethics Committee (HREC) of the North-West University, and permission was granted by the North West Provincial Department of Health. Through a qualitative, explorative, interpretive descriptive, contextual design, the researcher recruited hypertensive adult patients, who were attending an out-patient clinic at a selected district hospital in the Dr Kenneth Kaunda district, North West province in South Africa, as participants (N=250). Through purposive sampling, the included participants were all diagnosed with chronic hypertension for at least six (6) months, with no restriction placed on gender, race, or age. Hospital management served as gatekeeper and the unit manager as the mediator. Participants were required to sign an informed consent declaration, which included permission to be digitally audio-recorded. A total of twenty-four (24) participants (n=24) were interviewed until data saturation was obtained. Data was collected by means of semi-structured, individual interviews, conducted on the hospital’s premises. The interviews were digitally voice-recorded and transcribed for data analysis. Firstly, a generic thematic analysis was performed (Thorne, 2008:141-162), after which a reasoning process followed. Coding led to a second level of analysis to describe the relationship between themes (Thorne, 2008:141-162). A consensus discussion was held with a co-coder and field notes were kept, and observations noted, which all added to the richness of the collected data. Credibility was ensured by applying the evaluation criteria of interpretative description (Thorne, 2016:232), by examining the assumptions about the nature of the knowledge and experiences of the patients. The sample facilitated representative credibility and prolonged engagement with the medical out-patient department, which led to the application of applied logic engendering truthful interpretation. Data analysis resulted in six (6) themes, namely, positive and negative organisational factors, patient-specific needs, patterns in health education, perceptions regarding hypertension, and the lack of support for elderly and frail patients. This study provides an understanding of how patients with hypertension experience the public health system’s care; view their own self-care and how they cope with hypertension. Consequently, it provided the researcher with relevant information to formulate applicable recommendations for psycho-educational interventions with the aim to empower hypertensive patients to implement enhanced and optimal self-care.
- Health Sciences