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Self-management and blood pressure control in China: a community-based multicentre cross-sectional study
  1. Zhan Qu1,
  2. Monica Parry2,
  3. Fang Liu1,
  4. Xiulin Wen3,
  5. Jieqiong Li3,
  6. Yanan Zhang4,
  7. Duolao Wang5,
  8. Xiaomei Li1
  1. 1School of Nursing, Xi’an Jiaotong University, Health Science Center, Xi’an, Shaanxi, China
  2. 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  3. 3The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
  4. 4School of Public Health, Xi’an Jiaotong University, Health Science Center, Xi’an, Shaanxi, China
  5. 5Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  1. Correspondence to Xiaomei Li; roselee8825{at}163.com

Abstract

Objectives This study explored the relationship between self-management and blood pressure (BP) control in China.

Design A cross-sectional study.

Setting Eight community health centres from four cities in the Northeast (Shenyang), Northwest (Xi’an), Southwest (Chengdu) and South (Changsha) of China.

Participants A total of 873 adults with hypertension, including 360 men and 513 women. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg.

Outcome measurements BP control was the primary outcome variable. This was categorised as good control if individuals with hypertension reduced their BP to <140/90 mm Hg, otherwise, it was categorised as poor control. Secondary outcomes included self-management, defined as: (1) context or condition-specific factors or physical/social environments (eg, age, sex, marital status, education, personal income and health insurance) and (2) process or knowledge/beliefs, self-regulation skills/abilities and social facilitation (eg, treatment, diet, exercise and risk factor management). Data were analysed using logistic regression models using SPSS V.20.

Results A total of 67.1% (n=586) participants had poor BP control. Limited outpatient care benefits in mainly rural residents (OR 2.26, 95% CI 1.06 to 4.81) and longer disease duration (OR 1.03, 95% CI 1.01 to 1.04) were associated with poor BP control. Self-management practices reduced the odds of having poor BP control (OR 0.98, 95% CI 0.97 to 0.99).

Conclusions The individual and family self-management theory can serve as an effective theory for understanding the key contexts, processes and outcomes essential for BP control in China. Future research should evaluate the effect of a self-management intervention (eg, self-monitoring, medication adherence, regular and routine doctor visits, and social supports) for BP control in China using a multisite cluster randomised controlled trial. Sex and gender difference, cost and patient-reported outcomes should also be examined.

  • hypertension
  • self-management
  • community care
  • sex
  • gender

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors XL was a major contributor in project administration, research design, organising the fieldwork, giving advice on the manuscript writing and supervision. ZQ and MP were major contributors in data analysis, manuscript writing and revision. ZQ, FL, XW and JL were involved in community nursing training in blood pressure measurement, providing patient-centred questionnaire instructions, collecting data and inputting results into the database. ZQ, MP, YZ and DW analysed and interpreted all patient data. All authors have read and approved the final manuscript.

  • Funding This work was supported by China Medical Board, Grant Number (11-085).

  • Competing interests None declared.

  • Ethics approval This study was approved by the Ethics Committee of Xi’an Jiaotong University Health Science Center (Approval No. 2014-008).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Obtained.

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