Purpose
Hypertension is prevalent in Uganda and achieving treatment goals remains a challenge. Our aim was to assess the impact of a bundled nurse‐led intervention on hypertension physiologic measures and lifestyle modification, and to explore perceptions of the interventions to enhance sustainability.
Design and setting
We employed a sequential explanatory mixed‐method design. The study was conducted at a large urban private hospital in Uganda from September 2018 to May 2019.
Sample
Participants were clinic patients with hypertension currently under care. A total of 54 participants were enrolled in two study groups. Two focus groups with 16 participants and 2 nurse‐educator interviews were conducted.
Methods
Blood pressure and weight were measured at baseline, three, six, and nine months. The Self‐Care of Hypertension Inventory was used to assess lifestyle modification. Monthly education and group‐support with text‐message follow‐up were implemented. Two focus‐groups and nurse‐educator interviews were conducted to assess perceptions post‐implementation. The analysis included descriptive statistic, multivariate analysis and qualitative analysis for themes and subthemes.
Findings
Overall, participants had a mean weight loss of 7.7 kg (p = 0.001) and a mean reduction in systolic blood pressure (SBP) of 9.5 mm Hg (p = 0.001). Improvement in biometric outcomes was associated with lifestyle modification such as taking medicine as prescribed (p = 0.008), eat lots of fruit and vegetables (p = 0.043), and control your body weight (p = 0.015). Thematic analysis yielded the following themes: Knowledge and understanding, Attitude change, Adherence—a real struggle, and Adapting to what suits us. Participants found group support, shared learning, and knowledge reinforcement enhanced their knowledge and self‐efficacy. Nurse educators were motivated by the patients’ favorable responses to the Bundled Education and Support with Text (BEST) intervention.
Conclusion
Findings support the use of nurse‐led interventions to enhance the achievement of hypertension treatment goals. To sustain the achieved lifestyle modification and blood pressure outcomes, participants expressed a desire for continued support, information access, and inclusion of patients as champions for knowledge dissemination. Future studies need to explore the provision of enabling structures to support nurse‐led interventions in routine non‐Communicable disease (NCD) care.
Clinical relevance
Hypertension knowledge‐gaps exist among patients and may reflect missed opportunities for patient engagement and education for behavior change. Bundled nurse‐led hypertension interventions can significantly improve lifestyle modification and enhance hypertension outcomes. Persons supported and empowered with knowledge can act as conduits to wider communities in championing knowledge dissemination.