Out of the total 482 respondents, 480 participated in the study, yielding a response rate of 99.6%. The mean age of the respondents was 55.4 (SD±11.2) years. More than half (55.6%) of the respondents were male and most 394(82.1%) of the respondents were married. About 396 (82.5%) of respondents were Follower of Orthodox religion. Nearly all (99%) of the respondents were Amhara in ethnicity. About 293(61%) of respondents had no formal education and 314(65.4%) of the respondents resided at urban (Table 1).
Health profile of respondents
From the total respondents 228(47.5%) participants had family history of HTN and more than half of the participants 258(53.7%) were over weighted and obese. About 216 respondents (45%) have uncontrolled HTN. About 231(48.1%) respondents have co morbidity in addition to HTN. Nearly one third 160(33.3%) of respondents have treatment duration of 5 years and above. About 130(27.1%) of respondents miss their follow up visit from health institutions (Table 2).
Source of information of HTN self-care practice findings
More than half of respondents 295 (61.5%) were heard about the non-medical management of HTN. From these 253 (85.8%) respondents’ get the information from health workers. During their follow up time, 198 (41.3%) of the study participants were not get any information towards the non-medical management of HTN (Table 3).
Individual related findings
About 282 (58.8%) of the participants have good knowledge about HTN self-care practice and 243 (50.6%) of the participants had favorable attitude towards HTN self-care practice. More than half 279(58.1%) of participants have good self-efficacy and 227(47.3%) have poor social support (table 4).
Level of hypertension self-care practices
The median score for self-care practice was 72 with maximum score of 133. Out of the total respondents, 245(51.0%) patients had poor self-care practice with 95% CI (46.56%, 55.51%). The median score for medication adherence was 21 with the maximum score of 24. About 214(44.6%) of respondents practiced poor adherent to antihypertensive medications. The median score for good practice to diet was 10 with maximum score of 57. Most of the participants 444(92.5%) practiced low diet quality, 32(6.7%) practiced medium diet quality and 4(0.8%) practiced good diet quality. The median score for physical activity was 4 with the maximum score of 14. About 398 (82.8%) respondents’ poor practiced to physical activity. The median score of weight management practice of the participants were 38 with the maximum score of 50. More than half of respondents 300 (62.5%) had poor weight management practice. Few number of participants 16 (3.3%) were smokers and 47(9.8%) were drunk alcohol (Figure 1).
Factors associated with self-care practice
From all 26 variables, 4 variables (treatment duration, source of information, information per follow up visit, information clearness in follow up visit) were not included in regression analysis due to system missing and Multicollinearity problems. The final multivariable logistic regression analysis revealed Educational level, co morbidity, BP control status, attitude and social support were independent factors for self-care practices of HTN Patients. Patients who cannot read and write were 3.153 times more likely practice poor self-care (AOR = 3.153, 95% CI: 1.674-5.939) as compared to those patients having grade12 and above educational level. Individuals with uncontrolled BP state were 2.141times more likely to practice poor self-care (AOR = 2.141, 95% CI: 1.271- 3.609) as compared to those who had controlled state of BP. Patients who had no co-morbidity were 58.2% times less likely to practice poor self-care (AOR = 0.418, 95% CI: 0.263-0.663) as compared to those with co-morbidity. Patients who had unfavorable attitude were 3.193 times more likely to practice poor self-care (AOR= 3.193, 95% CI: 1.951-5.225) as compared to those patients with favorable attitude. On the other hand, hypertensive patients with poor social support were 2.587 times more likely to practice poor self-care practice (AOR = 2.587, 95% CI:1.544-4.334) as compared to patients with good social support (Table 5).
A total of fourteen in-depth interviews were conducted until the data saturation was attained. All participants have HTN for at least two years. Nine of the participants were female. All respondents were between the age of 30 and 80 years, and seven of them were married. With regard to their educational back ground, one has attended college, three had secondary education, one could write and read only and nine of them were not read and write. Among the participants, 13 were orthodox religion and one was Muslim religion followers. After all in-depth interviews completed we categorized in to 3 thematic areas. The first theme explores barriers to participating in the self-care practice activities. The second theme explores challenges of sustaining self-care management activities. The third theme describes effect of HTN on lifestyle.
Theme 1: Barriers to participating in the self-care practice activities
Family meal preparation habits were identified as a barrier for self-care practice as expressed by the respondents:
‘’ it is so challenging to prepare food separately for me out of my family. Even my family feels unhappy when they prepare without salt…’’ 34-year-old male respondent
Inadequate information on HTN and its self are practice by the doctor at follow up visit were recognized as barriers; as stated by a respondent:
“...... I've stopped taking medication for 1 year. I don't do anything special right now. I drink coffee, I use salt, I don't know what BP control is.... ” 55-year-old female respondent"
...after I take pills for BP, my BP became normal and after that no need of taking drugs...'' 65 year old man.
The inconvenience working environment also mentioned as barrier which well explored by the respondents
“....Even if I was committed to regular exercise, it is not convenient. There is no place to exercise....” 60-year-old man.
Theme 2: Challenges of sustaining self-care management activities
Pressure during social events, sharing food during social gathering in Ethiopia is considered a way of expressing respect and affection to one another and refusing is unacceptable; as stated by a respondent:
“...When I go to Senbete and Mahiber (social event in Ethiopia).With pleasure, I take what they offer me because it's not necessary to deny. That's why I eat what they have prepared. A social life for us is important........” 45-year-old male participant.
It was difficult to prepare individual meals for one person in a family. Ethiopian culture does not allow men to engage in the preparation of food. As mentioned by a respondent, a man with HTN must eat whatever is served to the family:
“...I eat what my wife and children eat. It is difficult to prepare a separate meal just for myself; you know it just is not convenient....” 76-year-old male participant.
The patients recognized that negligence and poor self-efficacy to practice self-care activity was also challenges; as stated by a respondent:
".....poor controlling of my BP is the problem of me that I am not giving attention for life styles....."60 year-old male participant.
“I don’t exercise regularly. I walk sometimes on the street when I have the time but scheduled sport is not practiced....” 34-year-old women.
“Exercise at my age?! I cannot think it. It is difficult . . .” 77-year-old women.
Theme 3: Effect of HTN on lifestyle
The patients believed that the diagnosis of HTN had profound effect on their lifestyle; change of lifestyle after diagnosis of HTN requires discipline and motivation; as stated by a respondent:
''....I can't eat as much as I want. I have a lot of family work load to prepare food...." 51-year-old female participant.
"....It is challenging to cope with very challenging life, difficult to work hard due to pain and selective way of diet consumption for HTN management....."36-year-old female participant.