Hypertension Beliefs Of Barrouallie, St Vincent And The Grenadines.

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 3 needed in the reduction of risky health behaviors but first these beliefs and behaviors need to be identified. The utilization of the health belief model is significant because it encompass the idea that it is necessary to understand an individual’s perception of their health circumstances to be able to cater to their specific needs. Under this model, it is believed that individuals will make a good recommended health decisions if all barriers are broken and they have the confidence to do so successfully, they will be able to prevent an unwanted condition or illness. The information generated from this purposed study will be useful to healthcare providers and policy makers in the formulation of specifically tailored strategies in preventative healthcare education, management and delivery. Section II: Research purpose and Research Question Research purpose The purpose of this study is to explore the association between the hypertension beliefs among hypertensives and non-hypertensives of a target sample of the rural community of Barrouallie, St Vincent. More specifically, the objective of this study is: 1. To identify the socio-economic demographic characteristics, hypertension knowledge and hypertension beliefs among the study participants. 2. To compare the socio-economic demographic characteristics, hypertension knowledge and hypertension beliefs among hypertensive and non-hypertension. 3. To compare the socio-economic demographic characteristics with hypertension knowledge and hypertension beliefs.

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 4. 4 To determine the relationship between hypertension knowledge and hypertension beliefs. Research Question 1. What are the socio- economic demographic characteristics, hypertension knowledge and hypertension beliefs among the study participants? 2. What are the socio-economic demographic characteristics, hypertension knowledge and hypertension beliefs among hypertensives and non-hypertensives? 3. What are the socio-economic demographic characteristics of hypertension knowledge and hypertension beliefs? 4. What is the relationship between hypertension knowledge and hypertension beliefs?

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 5 Chapter 2: Literature review In this section the researcher will review hypertension, hypertension in St Vincent and the Grenadines (SVG), non-modifiable risk factors, modifiable risk factors, behavioral modification in the prevention hypertension, main issues regarding hypertension prevention, the health belief model, instrument and the conceptual framework. Section I: Hypertension Hypertension (HTN), “pressure” as is colloquially referred to in SVG is also referred to as high blood pressure, raised blood pressure, arterial hypertension and the “silent Killer” due to the fact that some patients may not be aware that they have it until complications develop (Dumont & Hardware, 2009). HTN is said to be diagnosed when there is 2 or more prior blood pressure readings of 140 over 90 mm Hg and above (Carretero & Oparil, 2000). Of the two types of HTN, primary or essential is responsible for about 95% of cases and secondary HTN for about 5% (Weber et al, 2014). Primary HTN is said to be affiliated with lifestyle and heredity (Dumont & Hardware, 2009) and secondary HTN is as a consequence of pre-existing illnesses (Assarzadegan et al., 2013; Dumont & Hardware, 2009; Carretero & Oparil, 2000). While the etiology of primary HTN is unknown (Ford & Cooper, 1991) there are already identified risk factors that are associated with the possibility of succumbing to HTN. Obesity, Stress, family history, smoking, sedentary lifestyle, high sodium intake, alcoholism, advanced age, gender and sociodemographic factors are said to be contributory factors together with the access to healthcare and its’ facilities, promotional and preventative programs and hypertensive support (Joffres et al., 2013).

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 6 Section II: Hypertension in St Vincent and the Grenadines. In 2008, non-communicable diseases accounted for an estimated 77 per cent of all mortality, the most prevalent of which was cardiovascular diseases which accounted for 39 per cent of total deaths across all age groups in 2008, Commonwealth Health Online. According to the Saint Vincent and the Grenadines Pharmaceutical Country Profile (2012), communicable diseases is the leading cause of morbidity in SVG, followed by hypertension in the second place then a combination of hypertension and diabetes in third place with ischemic heart disease and hypertensive heart disease being the second and third cause of mortality respectively. Dietary risks, high body-mass index, and high blood pressure have been identified as the main risk factors, Global Burden of Disease (GBD) Profile: Saint Vincent and the Grenadines, 2010. Lifestyle-related diseases and illnesses seem to be the major contributory factor to disabilities for the elderly who are mainly affected by HTN which is most frequent in women than men, (Schmid & Vézina, 2007). HPN is the leading cause of clinic visits in all health districts representing almost one third (1/3) of total clinic visits. HTN clinic attendance among the genders has consistently demonstrated a two thirds (2/3) majority in favor of females over the past five (5) years, National Strategic Health Plan 2007-2012. It is important to note that in SVG there are 40 health centres and 5 district hospitals and several privately owned health centres and hospitals. A significant amount of the population seek healthcare privately while a small minority utilize natural and traditional medicine specifically plantderived medicine. There are little to no programs in existence to date but it is important to note that there are HTN support groups in existence in some districts where meetings may be held monthly. Teaching sessions are done at workshops and clinics mainly to educate and counsel

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 7 individuals on diet exercise and rest. At every clinic there is a special day reserved for blood pressure monitoring. HTN medications are available at all health centres to under 18 and over 60 free of cost and for others at a small fee of five eastern Caribbean dollars (XCD) or one dollar and eighty five cents USD. St. Vincent and the Grenadines National and Economic and Social Development Plan 2013-2025 stated that most of the resources are targeted at the treatment of such conditions while there has not been a full determination of the impact of non-communicable diseases on the society and the economy. Section III: Non-modifiable risk factors These are factors that cannot be change. These factors include age, gender, race and family history. As far as family history is concerned, there are genetic factors that are associated with the development of HTN (Beevers, Lip & O'Brien, 2001) and these genetic flaws may be at fault for causing HTN through the development of renal disease (Fuchs, 2011), studies have found it to be more prevalent in blacks (Fuchs, 2011), and the closer the blood relation is to a person who has it the more likely it will be to acquired. The human body undergoes many changes as it ages, both structural and functional and the apparition of hypertension can be attributed to loss of vasomotor function which occurs as a result of endothelial dysfunction (Seidel et al, 2011; Camici, 2009). Isolated or predominant systolic HTN occurs mainly in the elderly due to a stiffening of the aorta which occurs as one ages, this distinguished by high systolic pressures often with normal diastolic pressures (Weber et al, 2014). There are notable differences in gender with relation to the prevalence of HTN. Oparil and Miller (2005) states that the occurrences of HPN in younger women are lower than that of younger men and later on in life this becomes the opposite. As a woman becomes mature and then ages, changes occur in the reproductive system. They can be divided in the pre and post-menopausal stage, where (Dubey, Oparil, Imthurn, &

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 8 Jackson, 2002) suggested that ovarian hormones contribute to lower Bp in the premenopausal stage as compared to higher Bp in the post-menopausal period. Also, obesity and obstructive sleep apnea is associated with posmenopausal women and these factors make it possible to get HTN (Wolk, Shamsuzzaman, & Somers, 2003). Overall, women are more susceptible to HTN in the post-menopause because of changes that occurs during this period of life. Race is said to be a major influence in HTN, since there seem to be a higher prevalence of obesity and HTN among black people or rather, people of African descent. A Multi-Ethnic Study of Atherosclerosis by Kramer et al. (2004) suggested that there was a higher prevalence of HTN in African Americans when compared to whites. Section IV: Modifiable risk factors These are the same as modifiable factors and they are associated with the propensity of acquiring HTN. These factors have been identified in many studies to be obesity, high sodium intake, inadequate diet, alcohol and tobacco use, inactivity and stress. An inadequate diet represents an imbalance in the ingestion of necessary nutrients and minerals responsible for the daily activities of the body. In a healthy individual, the daily dietary requirement of sodium is less than 10 mmol per day (Flack et al., 2003). Since sodium is the main ion that determines the amount of fluid in the blood vessels by osmosis, high sodium intake is directly related to increases in blood pressure by causing fluid retention in the body. The disequilibrium between energy intake and its use results in obesity. Some researchers have identified obesity as a major contributory factor to HTN (Buttar, Li, & Ravi, 2005). Obesity is the same as having too much body fat. (Kang, 2013) identified the renninangiotensin-aldosterone system, the sympathetic nervous system, metabolic dysregulation and increased inflammatory cytokines as mechanisms by which obesity can be able to trigger HTN. It is said that in an obese patient, the heart increase in size to adapts to increased

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 9 arterial pressure, greater stroke work and higher cardiac output, as a result of the increased blood volume that is required to nourish tissues (Frohlich, Messerli, Reisin, & Dunn). Obesity is also closely related to insulin resistance which results in sympathetic adrenergic activity, endothelial dysfunction and peripheral vascular dilation (Wolk et al., 2003). Inactivity or sedentary lifestyle can result in obesity (Carretero & Oparil, 2000). Sedentary lifestyles are consistent with limited physical activity such as being indoors most of the time. This attribute to weight gain and an increased risk of attaining preventable diseases (Myers, 2003). In a systematic review of HTN in Sub-Saharan Africa by Addo, Smeeth and Leon (2007), they researchers found lifestyle differences to be a component in the explanation of a higher prevalence of HTN in urban areas than that of rural areas, stating that urban and rural patients tend to be different in dietary choices and daily physical activities. Alcohol raises blood pressure and is said to have damaging effects on the heart (Clark, 1985; Maheswaran, Gill, Davies, & Beevers, 1991). The alcohol beverage of choice does not determine whether or not blood pressure rises and there is about a 1mmHg blood pressure increase for every 10g of alcohol ingested (Puddey & Beilin, 2006). Tobacco smoking causes the narrowing of artery walls thus raising vascular resistance. The chemical compounds found in smoking causes structural and functional changes to the blood vessels, nicotine and carbon monoxide have hypertensive effects to individuals whether they actively practice smoking or is affected by it indirectly (Leone, 2011). Stress is another associated factor and with it the cortisol and adrenaline hormones are secreted into the blood stream stimulating vein constriction thus increasing blood pressure (Kulkarni, O'Farrell, Erasi & Kochar, 1998). A cross-sectional descriptive study by Owolabi, Owolabi, OlaOlorun, and Olofin (2012) found work stress to be strong contributory factor to

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 10 the presence of HTN, concluding that there was a strong association between high job strain and the presence of HTN with the prevalence of HTN among this group being at 42.4%. Gasperin, Netuveli, Dias-da-Costa, and Pattussi (2009) in a meta-analysis of cohort studies found that an individual who in stressful tasks experience high increases of blood pressure and who after such tasks experiences high blood pressure demonstrates a greater possibility of developing HTN. Cultural beliefs, socio-economic factors, access to healthcare and advice are among the predisposing factors (BeLue et al., 2009). Geyen (2012) found that African Americans consumed traditional foods that included large amounts of animal fat, salt, sugar and unhealthy seasonings, those foods which lacks these unhealthy ingredients are found to be undesirable and is considered not satisfying to their appetite. Some of these traditional foods had originated from slavery and for those with limited resources; salt was used for preservation purposes in the event that they did not have access to refrigeration. Geyen (2012) also stated that with relation to physical activities, African American women’s participation is less than their white counterparts and suggested that the reason is often because of the characteristics of their hair, making the point that moisture and their hair does not go well. The availability and quality of healthcare is often and without doubt a challenge to individuals who seek healthcare and advice. This is often so in developing countries where lack of resources and healthcare professionals serves as a barrier to prevention, promotion and treatment of illnesses. Khatib et al. (2014) in their study found that availability barriers included lack of resources and time, a high workload, knowledge and professional identity/agreement with guidelines on the providers part and for patients were those relating to beliefs,

HYPERTENSION BELIEFS OF BARROUALLIE, ST VINCENT AND THE GRENADINES 4 4. To determine the relationship between hypertension knowledge and hypertension beliefs. Research Question 1. What are the socio- economic demographic characteristics, hypertension knowledge and hypertension beliefs among the study participants? 2.