Form and frequency of congnitive intervention : Impact on adherence and management of primary hypertension

Abstract

The exponential rise in the prevalence of hypertension and the resultant surge in cardiac emergencies highlight the urgent need for management of primary hypertension. Hypertension, being a chronic illness mandates high clinical adherence for effective management resulting in good prognosis. Optimizing adherence behaviour is possible through Cognitive Intervention. The purpose of Cognitive Intervention is to enhance knowledge and form a cognitive base about the seriousness of the disease and significance of its management. This in turn is expected to create a conviction and affect state that culminates in enhancing adherence behaviour. The research study examined the differential impact of the Cognitive Intervention modules varying in form and frequency on adherence and management of primary hypertension. Using a pretest-posttest control group quasi experimental design, five groups of patients were compared. Group 1 called ‗Direct Interaction Single Exposure Group‘ (DIS) received Cognitive Intervention through Direct Interaction (DI) mode, where a qualified doctor through a session exposed them to the functional knowledge on primary hypertension. Group 2 called as ‗Direct Interaction Double Exposure (DID)‘ received the same DI form of Cognitive Intervention twice with a gap of 15 days. Group 3 is referred to as ‗Audio Visual Single Exposure Group‘ (AVS) which received the Cognitive Intervention through Audio-visual recorded form (AV) without the physical presence of the doctor while group 4, referred to as ‗Audio Visual Double Exposure Group‘ (AVD) was given the same AV form twice with a gap of 15 days between them. All these four intervention groups were compared with group 5, called as Control Group (C) that was given mere standard medical care. A sample of 450 participants was sequentially assigned to the five groups in the order of DIS, DID, AVS, AVD and Control. The participants were assessed before and after intervention usingHypertension Knowledge Test, Hypertension Compliance Scale, Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support and Hypertension Self Efficacy Scale. To assess hypertension management, Blood pressure readings were recorded thrice before and thrice after the intervention with a gap of one week between the recordings. In a three month follow up the groups were compared on adherence and management before and after the intervention. ANCOVA results showed that cognitive intervention was successful in impacting the adherence and management of hypertension. Particularly the Direct interaction form when repeated had the highest impact on the adherence and management. The audio visual form when repeated proved counterproductive on management of hypertension. In addition, the Cognitive Intervention through direct interaction when repeated reduced the levels of depression compared to the control group. Cognitive Intervention also enhanced the levels of perceived social support land Hypertension specific self-efficacy. Further the study attempted to trace the pathway between the intervention and the management of hypertension. By means of pathway modeling using multiple regression analyses, pathways evolved for both the direct interaction modules (DIS and DID). The knowledge enhancements by the exposure to these modules enhanced self-efficacy. This in turn enhanced hypertension management through enhanced clinical adherence. Thus indispensability of integrating Cognitive Intervention into the hypertension care alongside standard medical treatment is the key conclusion. Implications, strengths and limitations of the study are also discussed.