Abstract
Objectives
The aim of this study was to assess quality of life and associated factors among hypertensive patients attending in public hospital at Addis Ababa.
Methods and material
An institutional -based cross-sectional study was conduct among adults in Addis Ababa selected public hospitals. Systematic sampling technique was used to select 423 study participants after proportional allocation was made on each hospital. Data was collected by questionnaire adapted from WHO STEP wise approach to Surveillance on NCDs modified by the FMOH and EPHI. Data entry, cleaning by data exploration and analysis was done by using SPSS. Descriptive and logistic regression models were used for data analysis. The result was considered statistically significant at p < 0.05.
Result
The magnitude of high health-related quality of life in hypertensive patients was 53.6% (with 95% CI: 48.6-58.6). Having experienced any complications co morbidities HRQOL (AOR = 7.177; CI = 4.761–9.698), Starting treatment for hypertension below 3 years were (AOR= 3.029: CI=2.406-9.133, higher educational level (AOR=3.477: CI= 0.708-17.059), age 40 and above (AOR=3.216: CI= 1.073-9.643), having an income of <3000birr (AOR=1.75: CI= 1.14-2.68) were significantly associated with the dependent variable.
Conclusions and recommendation
This study showed the magnitude of low health-related quality of life in hypertensive patients is high. Having complications or co morbidities, starting treatment for hypertension below 3 years, being educated, older age, income of less than 3000 per month were factors associated to low health related quality of life in hypertensive patients.
BP
bodily pain
CVD
cardiovascular disorder
DASH
dietary approach to stop hypertension
HBP
high blood pressure
HRQOL
health related quality of life
MCS
mental component summary
MH
mental health
PCS
physical component summary
PF
physical functioning
QOL
quality of life
RE
role emotional
RP
role physical
SF
social functioning
SF-36
short form 36
TQOL
total quality of life
VT
vitality
WHO
world health organization
Introduction
Based on the average of two or more blood pressure readings obtained in two or more encounters with the healthcare provider following an initial screening, hypertension is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic blood pressure greater than 90 mm Hg over a sustained period. According to estimates, hypertension accounts for 4.5% of the world’s current disease burden and is just as common in many developing countries as it is in industrialized nations. It is an overwhelming global challenge and analysis of the global burden of hypertension revealed that over 25% of the world’s adult population had hypertension in 2000, and the proportion is expected to increase to 29% by 2025. Hypertension is the major modifiable risk factor for heart disease, stroke and kidney failure and it is the leading cause of death and the second leading cause of lost disability adjusted life-years worldwide.
Patients with chronic, disabling, or life-threatening diseases who live in hope of a cure, as well as those with conditions likely to affect their physical, psychological, and social wellbeing, are among those for whom it is critical to understand how healthcare interventions affect their lives rather than just their bodies. This recognition is growing. As a result, the healthcare sector has seen a significant development in quality-of-life measurement.
Approximately 17 million deaths worldwide are caused by CVD each year, making up nearly one-third of all deaths; complications from hypertension are responsible for 9.4 million deaths. As a chronic condition requiring lifelong medication and non-drug therapy, hypertension can directly affect a patient’s quality of life in a number of areas
Thousands of people with chronic illnesses now live longer thanks to medical advancements. While chronic illnesses may not be fatal, they can seriously impair a patient’s quality of life and require a significant amount of medical resources. In addition to postponing death, the ultimate goal of chronic illness is to improve quality of life and enhance health. It has also been found to be predictive of mortality and health service utilization.
The term “quality of life” was originally used in medicine in the 1970s to characterize the effects of chronic illness on both health and non-health outcomes. Along with measuring overall healthcare, it also measured the clinical and non-clinical consequences of physician interventions. New methods of measuring treatment effects—such as evaluating longevity (e.g., following a specific treatment) or the “quality” of life that was prolonged as a result of effective therapy—were closely linked to an interest in quality of life.
Widely accepted definition According to WHO, quality of life is defined as individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.
Quality of life has gained increased attention as an outcome measure of interventions and treatments in patients with established cardiovascular disease. For individuals at risk for developing CVD, quality of life measurement has been considered particularly useful because of two major reasons: While quality of life results might aid in the selection of therapeutic alternatives, morbidity or mortality alone are insensitive measures of the efficacy of therapy because these patients may be asymptomatic or have very modest symptoms for an extended period of time. Second, these people could find it challenging to recognize the significance of an asymptomatic illness and the advantages of receiving medical care, particularly if the side effects of medications could lower their quality of life.
Quality of life were measured using SF-36 survey instruments that was constructed to achieve two well-accepted standards of comprehensiveness: (1) representation of multidimensional health concepts; and (2) measurement of the full range of health states, including levels of well-being and personal evaluations of health.
Patient and medical facilities both suffer greatly from low health-related quality of life. In health facilities, low health-related quality of life raises the demand for professionals, infrastructure, and patient flow. Low HRQoL at the patient level also raises the risk of physical disability, psychological problems, hospitalization, income decline, and social relationships among patients.
Personnel who have chronic illnesses deal with a wide range of intricate symptoms and functional limitations that can significantly alter their daily lives and cause a seismic shift in how they view their health and quality of life as well as how they perceive themselves. The burden of multiple medical conditions may exacerbate the effects of a single disease. Furthermore, factors like age, gender, and socioeconomic status can either lessen or exacerbate the negative effects of chronic illnesses on a person’s quality of life.
The dramatic increase in mortality in middle age has drawn attention to the fact that longevity should be associated with improvements in health-related quality of life (HRQOL). Some researchers have shown that the increase in life expectancy leads to an increase in the proportion of people with poor health, which in turn burdens society and health services. The World Health Organization (WHO) summarized these concerns and stated that “adding years to life is a small victory without adding years to life” (WHO, 1998).
Wilson and Cleary’s studies show that physiological changes due to disease or treatment lead to symptoms, which in turn affect functional status or HRQOL. These associations are influenced by patient and environmental variables that may influence patient perception of symptoms and changes in HRQOL.
Another study reported that decreased HRQoL in hypertensive patients may be due to elevated blood pressure, adverse drug reactions, or other diseases rather than high blood pressure per se. Although hypertension is generally considered to be asymptomatic, especially in mild to moderate stages, its association with changes in health-related well-being and quality of life (HRQOL) remains a controversial issue. Studies of HRQOL in hypertensive individuals have been mixed, with some studies finding HRQOL worse in hypertensive patients than the general population, and some finding no effect of hypertension on HRQOL in some or all domains. The aim of the study was to assess quality of life and associated factors among hypertension patients attending at public hospitals in Addis Ababa city 2024.
Methods and materials
Study area and period
The study was conducted in Addis Ababa august 2024.
Study design
An institution Cross sectional study was conducted.
Population
The source and study population for this study was all hypertensive patients attending at public hospital Addis Ababa for follow up and hypertensive patients attending at selected public hospital during the study period, respectively.
Inclusion and exclusion criteria
Inclusion criteria
Age HTN patients whose age greater than18 years and has follow up in medical referral clinics.
Exclusion criteria
Patients who are too sick to be interviewed
Patients who have a disease like mental illness that impair their perception.
Sample size and sampling technique
The required sample size was calculated by using single Population proportions formula. The proportion of quality of life will take 50%, margin of error, significance level and non-response rate will assume to be 5%, 95% and 10%, respectively. Finally, 423 hypertensive patients was requited. Three public hospitals were selected by lottery method and the calculated sample was allocated proportionally for each Hospital based on monthly patient flow finally consecutive sampling was applied.
Data collection tools and procedures
Data was collected through a structured interview prepared to respond to all relevant variables by reviewing supporting documents using the patient’s chart after obtaining informed consent at discharge from clinical care. The data collection tool includes sociodemographic and behavioral practices of hypertensive patients. The questionnaires were adapted from the different literature of the respective studies. The tool 35 questions and the questionnaire have four sections about Socio–demographic factors. Clinical characteristics, compliance to the lifestyle modification regimen, patient satisfaction towards chronic illness clinic services and sf-36 questionnaire items. Data collectors were three nurses and two BSc Nurses who work in hospital for supervision activities. Training was given for data collectors and supervisor for about two days on method of extracting the needed information through interviewing, how to fill the information on a structured questionnaire and the ethical aspect in approaching the study participant which were in a polite and respectful manner. Data collectors will have enough information on the aim of study, procedures to be followed, as well as approach of client during interview. The technique for data collection was an interview method. Data collectors were only writing clients response without any modification. The interviewers collected the information based on the given guideline using a structured questionnaire. The supervisors were monitoring the data collection process of the interviewers and trying to solve problems by themselves and by informing the principal investigator.
Variables
Dependent variable
Quality of life poor/good
Independent variables
Socio-demographic variables like age, Sex, marital status, ethnicity, income, occupation,
Medical factors like duration of diseases, complication, comorbidity, side effect treatment, blood Pressure control, BMI
Behavioral factors like smoking, alcohol, physical exercise, diet
Operation definitions and terms of definition
Domain scores were calculated by summing up each item under each domain. Then each raw scale score was transformed from 0 to 100 (0–100 scale) by using the formula of transformed. Physical HRQoL (PCS) mean score was the arithmetic average of the transformed scores of physical functioning, role physical, bodily pain, and general health domains. Mental HRQoL (MSC) mean score was the arithmetic average of the transformed scores of social functioning, mental health, and role emotional, and vitality domains. Overall HRQoL mean score was the arithmetic average of the transformed score of the eight domains. Higher HRQoL was defined as participants who scored greater than or equal to the standardized mean value of 50. Lower HRQoL was defined as participants who scored less than the standardized mean value of 50.
Quality assurance techniques
The questionnaire was first developed in English and translated to Amharic and back translated to English by language experts to check its consistency. The trainees were responsible to handle the whole situation /process/ of the data collection and to check and correct questions to be raised by the respondents. Pre-test were conducted by taking 5% of the sample size to check the quality of the questionnaire then appropriate modification was made based on the gap identified to have the final version on population outside the study population.
Intensive training was given to data collectors and supervisors for two days and the data collectors and supervisors were fluent speakers on Amharic. A day to day on site supervision was done throughout the data collection period by supervisors and the principal investigator. The data was cleaned for incompleteness and inconsistency at the end of each day by the investigator and incomplete forms were turned back for completion.
Data analysis
After the data collection, data was checked manually for its completeness every day. The data was edited, coded, entered using Epi data version 3.1 on daily basis and after complete entry of data it was exported to SPSS version 27 for analysis. Data exploration was done to see the characteristics of data. Frequency distribution was done to check for outliers, inconsistencies and to identify missing values. Descriptive statistics such as frequencies, percentage, summary measures, tables and graphs were used to describe the results of the respondents according to the type of data. Then bivariable logistic regression at p value ≤ 0.25 was considered as candidate variables for multivariate determine the potential determinants of quality of nursing care. Then significant variables with p value ≤ 0.25 was considered as candidate variables for multivariable analysis. A statistically significant association was declared at p-value of <0.05. AOR with its 95% confidence level was used to identify quality of life.
Results
Socio-demographic characteristics of study participants
Out of 423 study participant 418 respondents participated in this study making a response rate of 98.8%. The mean age of the respondents were 61.10 years with standard deviation ±12.11. The minimum age of respondent is 32 and with the maximum of 90 years. Most participants of this study 82.3% (344) are above the age of 40 and above. Regarding the educational level of the participants, about 144(34.4%) was attended high school ( Table 1 ).
| Variable | Number | Percent | |
|---|---|---|---|
| Age | ≤ 39 years | 15 | 3.6 |
| 30 – 39 | 59 | 14.1 | |
| 40 and above | 344 | 82.3 | |
| Sex | Female | 188 | 45.0 |
| Male | 230 | 55.0 | |
| Marital status | Married | 264 | 63.2 |
| Single | 55 | 13.2 | |
| Divorced | 33 | 7.9 | |
| Windowed | 66 | 15.8 | |
| Occupation | Gov’t employee | 120 | 28.7 |
| Merchant | 58 | 13.9 | |
| Farmer | 11 | 2.6 | |
| House wife | 73 | 17.5 | |
| Daily labourer | 27 | 6.5 | |
| Other | 129 | 30.9 | |
| Educational level | Illiterate | 43 | 10.3 |
| Read and write | 42 | 10.0 | |
| Elementary | 63 | 15.1 | |
| High school | 144 | 34.4 | |
| Higher education | 126 | 30.1 | |
| Who covered the cost of the drug? | My self /Family | 241 | 57.7 |
| CBHI | 143 | 34.2 | |
| Employer organization | 25 | 6.0 | |
| Other | 9 | 2.2 | |
| Income per month | <3000 birr | 117 | 28.0 |
| 3000- 6000 birr | 148 | 35.4 | |
| 6001 – 9000 birr | 66 | 15.8 | |
| >9000 birr | 87 | 20.8 | |
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