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Keywords:

  • self-care;
  • behavior;
  • self-efficacy;
  • elderly women;
  • hypertension

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies

Objective

To identify correlates of self-care behaviors among elderly, low-income Korean women with hypertension.

Research Design

A secondary analysis of data from a community-based intervention trial for hypertension control.

Setting

Three community health posts in the Gangwon province, South Korea.

Participants

Two hundred thirty-four (234) low-income elderly women (age 60–93) who had previously participated in a community-based intervention trial for hypertension control.

Methods

The researchers collected data that included patient background characteristics, hypertension self-care behavior, self-efficacy of hypertension control, general knowledge of hypertension, and social support. The data were analyzed using descriptive and inferential statistics, including hierarchical regression analysis.

Results

The model explained 41.1% of the total variance in hypertension self-care behavior scores. Among elderly, low-income Korean women, the significant factors of their hypertension self-care behavior included: (a) self-efficacy of hypertension control (β = .62), (b) social support (β = .16), and (c) age (β = –.14). Hierarchical regression analysis showed that elderly Korean women that had higher self-efficacy of hypertension control, higher social support, and were younger were more likely to have higher hypertension self-care behavior scores.

Conclusions

The results highlight the need for interventions that focus on improving an individual's self-efficacy and social support to enhance hypertension self-care. The findings of this study can help nurses better understand hypertension self-care behavior in elderly, low-income Korean women.

Hypertension is a global health problem. According to the 2012 World Health Statistics report, one in three adults has hypertension worldwide (World Health Organization [WHO], 2012a). Hypertension causes almost one half of all deaths from stroke and heart disease among middle-age to older adults, and the prevalence of hypertension generally increases with age (WHO, 2012a). Nearly 70% of people in the United States, 49% of people in China, and 61% of people in Korea age 65  and older are diagnosed with hypertension (Centers for Disease Control and Prevention, 2011; Ministry of Health, Welfare and Family Affairs [MHWFA], 2011; Zhang et al., 2009). The prevalence of hypertension among Korean women age 65  and older is much higher than that of Korean men of the same age (67.8% and 50.5%, respectively) (MHWFA, 2011). In Korea, hypertension combined with cardiovascular disease is the second leading cause of death due to disease, and the mortality rate for hypertension related diseases is higher in Korean women than in Korean men (Statistics Korea, 2011). The Korea National Health Insurance Corporation (2012) reported that the expense of treating cardiovascular diseases accounted for 13.8% of all medical costs in the 2011 fiscal year, and that the economic burden of hypertension-related diseases among the elderly population will continue to increase.

Researchers have emphasized that compliance with hypertension self-care guidelines such as weight reduction, smoking cessation, a low-sodium diet, and physical activity can contribute substantially to regulating blood pressure (King, Mainous, Carnamolla, & Everett, 2009; Kojuri & Rahimi, 2007; Logan et al., 2012; Y. H. Park et al., 2011). In spite of the clear benefits of self-care behavior, the rates of self-care behavior among hypertensive adults are relatively low (Kressin et al., 2007; Morgado, Rolo, Macedo, Pereira, & Castelo-Branco, 2010). Ethnic disparities also appear to affect self-care behavior among women with hypertension. For example, Zhao and colleagues (2008) reported significant ethnic variation in adopting hypertension self-care behaviors among women in the United States, and also found that Asian women had the lowest percentage of three healthy lifestyle behavior adaptations, namely physical activity, weight control, and alcohol consumption. Similarly, Sanchez-Vaznaugh, Kawachi, Subramanian, Sanchez & Acevedo-Garcia (2009) indicated that 39.5% of Asian women and 27.2% of Asian men did not exercise on a regular basis. In a study of 4,165 elderly Koreans, Y. Lee et al. (2012) showed that only 11.7% of elderly people adhered to all four recommended self-care behaviors.

Women with higher levels of social support engaged in more frequent self-care behaviors than women with lower levels.

Ample evidence supports that healthier lifestyles and behavioral changes are essential to managing hypertension (King et al., 2009; Kojuri & Rahimi, 2007; Logan et al., 2012; Y. H. Park et al., 2011). Hypertensive patients must adjust their behavior to control blood pressure and prevent hypertensive complications. However, hypertension control is not just an individual problem; it demands a community-based, multidisciplinary, and culturally relevant approach. A better understanding of self-care behaviors among hypertensive women is needed to determine what factors enable and inhibit self-care behaviors in these women. A useful first step for developing strategies to promote self-care behavior and hypertension management would be to explore factors associated with hypertension self-care behaviors in elderly Korean women. Currently, very little is known regarding hypertension self-care behaviors and their correlates among Korean elderly women. This study was undertaken to address this knowledge gap. The results of this study could inform future interventions to improve outcomes in ethnically diverse, hypertensive elderly women.

Conceptual Framework

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies

Social cognitive theory provided the framework for examining the correlates associated with self-care behaviors in elderly, low-income Korean women with hypertension. Social cognitive theory, which is used to describe the interactions between personal, behavioral, and environmental factors in health and chronic disease management, is recognized as a useful framework for understanding an individual's self-care behavior (Eccles et al., 2012; J. E. Lee et al., 2010; Martin et al. 2008). Social cognitive theory has been widely utilized in previous studies to understand behaviors in various health-related situations such as physical activity, healthy diet, hypertension, and cardiovascular disease (J. E. Lee et al., 2010; Martin et al., 2008; Martin et al., 2007; Roche et al., 2012). In an attempt to understand self-care behaviors based on social cognitive theory, researchers have posited that personal factors such as cognitive, emotional, and biological variables (e.g., self-efficacy, knowledge) and environmental factors (e.g., social support) influence an individual's behavior (e.g., self-care behavior) (Choi, Wilbur, Miller, Szalacha, & McAuley, 2008; J. E. Lee et al., 2010; White, Wójcicki, & McAuley, 2012). In this study, the factors influencing hypertension self-care behaviors of women include personal factors (age, marital status, BMI, years of having hypertension, self-efficacy, and knowledge of hypertension) and environmental factors (social support).

Review of the Literature

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies

Personal Factors

Demographic and Health Variables

In general, age and marital status have been consistent correlates of hypertension self-care behaviors. Many studies have reported that older women were more likely to engage in hypertension self-care behaviors than younger women (J. E. Lee et al., 2010; Trivedi, Ayotte, Edelman, & Bosworth, 2008). Married women were found to be more likely to be adherent to medications when compared with unmarried women (Trivedi et al., 2008). Body mass index (BMI) and time since a diagnosis of hypertension have also been associated with self-care behaviors. Body mass index was negatively associated with healthy lifestyle behaviors (Pai, Chen, & Tsao, 2010), and a longer duration of hypertension was related to an increased adoption of hypertension self-care behaviors (J. E. Lee et al., 2010).

Hypertension Knowledge

Knowledge has long been known to be a vital factor that contributes to and enhances self-care behavior in the management of chronic diseases. Warren-Findlow and colleagues (2011) noted that knowledge had a positive impact on self-care behavior in African American families. Likewise, Heo et al. (2008) reported that a higher level of disease knowledge was related to better self-care behaviors in the United States. Zhang et al. (2009) also reported that familiarity with hypertension was associated with regular medication compliance and controlled blood pressure (BP) among 4,141 elderly urban Chinese individuals. In contrast, J. E. Lee et al. (2010) reported no association between knowledge of hypertension and hypertension self-care behaviors in Korean Americans.

Self-Efficacy of Hypertension Control

An increasing number of researches have demonstrated that self-efficacy, defined as one's perception of his or her ability to perform a specific task to successful completion, is an important predictor of self-care behavior among individuals with diverse chronic health conditions (J. E. Lee et al., 2010; Sharoni & Wu, 2012; Warren-Findlow, Seymour, & Brunner Huber, 2012). Sharoni and Wu (2012) demonstrated a positive relationship between self-efficacy and self-care behavior in Malaysian patients with type 2 diabetes. Martin et al. (2008) also noted that among hypertensive African American women in the United States, those with higher levels of self-efficacy were more likely to report greater efforts to be physically active. Additionally, among Korean Americans with hypertension, self-efficacy in managing symptoms was the most influential factor in facilitating self-care behavior (J. E. Lee et al., 2010).

Environmental Factors

Social Support

Social support from family and friends has been hypothesized to be a potential component of self-care behavior and has been found to directly affect an individual's ability to adapt to changes associated with chronic diseases (Kara & Alberto, 2007; Y. Song et al., 2012). However, previous studies that examined the relationship between social support and self-care behavior have presented conflicting conclusions. Kara and Alberto (2007) found that social support from family and friends was valuable for developing self-care behavior and that social support enabled self-care behavior in Turkish patients with chronic disease. Y. Song et al. (2012) indicated that a lack of social support was a strong predictor of inadequate type 2 diabetes self-care activities. In contrast, social support was not a significant predictor of self-care behavior in Korean Americans with hypertension (J. E. Lee et al., 2010) and in Chinese immigrants with hypertension (Li, Wallhagen, & Froelicher, 2008).

Summary and Purpose

Although many researchers have identified correlates of self-care behaviors, few investigators have specifically examined self-care behaviors in elderly hypertensive Korean women. Moreover, the age distribution in Korea is quickly shifting toward a more elderly society, and the burden of disease attributable to hypertension is considerable. This study was designed to address this gap in the literature by focusing on correlates of hypertension self-care behaviors among elderly, low-income Korean women.

Hypertension control self-efficacy was the most influential factor in hypertension self-care behaviors.

Research Objectives

The purpose of this study was to examine correlates of self-care behaviors among elderly, low-income Korean women with hypertension and to explore whether self-efficacy and knowledge (personal variables) and social support (environmental variable) are associated with self-care behavior in hypertensive individuals. Based on reviews of social cognitive theory and the existing literature, it was hypothesized that self-efficacy, knowledge, and social support would be positively related to self-care behavior after controlling for relevant confounders among elderly, low-income Korean women with hypertension.

Methods

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies

Design

A descriptive-correlational study was performed to explore factors associated with self-care behaviors among elderly, low-income women with hypertension in Korea. A secondary analysis was conducted using the baseline data of 234 elderly women (age 60–93) who participated in a community-based intervention trial for hypertension control. This study was funded by the Ministry of Health and Welfare and Gangwon province. The study was reviewed and approved by the Institutional Review Boards of the institute where the researcher is affiliated.

Participants

In the original study, trained visiting nurses affiliated with three community health posts used screening activities to recruit low-income older adults with hypertension. The inclusion criteria for entry into the study were (a) age 60 or older; (b) systolic BP ≥ 140 millimeters of mercury (mmHg) and/or diastolic BP ≥ 90 mmHg or, being on antihypertensive medication; (c) not having a diagnosis of serious mental illness (e.g., schizophrenia) or terminal illness (e.g., end-stage cancer, end-stage renal disease); and (d) living on public assistance. At the screening, individuals who met the study eligibility criteria were invited to participate. They were asked to examine the informed consent sheet that gave comprehensive information on the study, including its purpose, data collection procedures, contents of home visit services, potential risk involving confidentiality, and their rights to withdraw. They were also informed that secondary analysis might be performed. Of those who were eligible, 307 (78% response rate) who agreed to participate in the original study and consent to sendary analysis completed the baseline assessment (male: 73, female: 234). To explore factors associated with self-care behaviors among elderly, low-income women with hypertension, the baseline data obtained from the 234 women was used for this secondary analysis. A power analysis for this study using multiple regression analysis with seven independent variables, a medium effect size (f2 = .25), a 0.05 statistical significance level, and a power of 0.80 indicated that this study required 65 participants (Cohen, 1988). Thus, the sample of 234 was more than adequate for the planned statistical analysis.

Instruments

Demographic and Health Variables

The demographic and health items included personal information about age, marital status, height, weight, and duration of hypertension. Participant BMI was computed from self-reported weight and height as weight in kilograms divided by height in meters squared. Following the WHO (2012b) definitions participants were categorized as normal (24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (30 or more kg/m2).

Hypertension Knowledge

Knowledge of hypertension was measured using 18 items developed by Y. I. Park (1994). Hypertension knowledge scores were calculated by counting the number of items with correct responses to statements such as ‘‘There is a close relationship between hypertension and obesity,’’ or ‘‘Hypertension has a genetic factor.’’ Total scores ranged from 0 to 18, with higher scores representing greater knowledge of hypertension. The reliability coefficient of the Hypertension Knowledge Scale has been reported previously, with a Cronbach's alpha coefficient of 0.72 when used with patients with hypertension (Park, 1994), and the reliability coefficient of this study was determined to be 0.69. High scores on the Hypertension Knowledge Scale were significantly correlated with strong self-efficacy and self-care behavior in a sample of elderly community-dwelling Korean adults (H. J. Lee, 2004).

Self-Efficacy of Hypertension Control

Self-efficacy of hypertension control was measured using the Hypertension Self-efficacy Scale developed by Song, June, Kim, and Jeon (2004). This scale assesses how confident an individual is in managing hypertension in six categories. Each item is scored on a 4-point Likert-type scale, with 1 (not at all confident) to 4 (very confident). Higher scores indicate higher levels of self-efficacy. The reliability coefficient of the Self-efficacy of hypertension control has previously been reported with a Cronbach's alpha coefficient of 0.71 when used with elderly Korean adults (R. Song, June, Kim, & Jeon, 2004), and this study demonstrated a coefficient of 0.63. The construct validity of the scale was demonstrated through significant correlations with health behavior in elderly Korean adults (R. Song et al., 2004).

Social Support

Social support was measured using six items adapted from the Multidimensional Scale of Perceived Social Support (MSPSS) by Zimet, Dahlem, Zimet, and Farley (1988). Examples of items are “I can count on my friends when things go wrong, I can talk about my problems with my family,” and “There is a special person in my life who cares about my feelings.” Each item was scored on a 5-point Likert-type scale. Higher scores indicated increased levels of perceived social support. The construct validity of the Korean-language version of the MSPSS was previously tested with elderly Koreans (Shin & Lee, 1999) and was found to have a Cronbach's alpha coefficient of 0.89 and was 0.86 in this study.

Hypertension Self-Care Behaviors

Hypertension self-care behaviors were measured using an 18-item questionnaire for the self-care behavior of hypertensive patients developed by R. Song and colleagues (2004). The instrument uses a 4-point Likert-type scale (1 = never, 2 = sometimes, 3 = frequently, 4 = always) and includes five subscales of health responsibility such as diet behavior, exercise, stress management, and smoking habits. A higher score indicates greater self-care behavior performance. The reliability coefficients of this self-care behavior scale have been previously reported to have a Cronbach's alpha coefficient of 0.82 and 0.87, respectively, when used with elderly Korean populations (I. S. Park et al., 2010; R. Song et al., 2004), and the coefficient was 0.80 in this study.

Data Collection

The original study was conducted from May to October 2010. The original intervention study consisted of six parts: a baseline interview by trained visiting nurses from the community health post; weekly blood pressure monitoring; 30 minutes per week of psychobehavioral education, including hypertension risk factors and self-care behaviors; weekly exercise; 3 times per week of a tele-health service through messaging devices; and telephone counseling by a visiting nurse. The baseline data collection took place from May to June 2010. Potential participants were informed of the purpose and process of the study, the components of the intervention program, the potential risks and benefits of participation, and the confidentiality of the study. They were also informed that they could chose to withdraw from participation in the study at any time. Written consent was obtained from all participants and a home visit was arranged to interview participants using structured questionnaires. The interviews for the baseline evaluation lasted an average of 30 minutes and were conducted by trained visiting nurses. During the interview, the trained visiting nurses collected physiologic data, including BP, weight, and height, and demographic and psychological data were obtained via self-reporting.

Data Analysis

Descriptive statistics were used to summarize sample characteristics and study variables, and the correlation between each variable in the study was assessed. Hierarchical regression analysis was used to identify significant correlates of hypertension self-care behaviors in participants by entering independent blocks of predictors with personal factors (age, marital status, BMI, duration of hypertension, hypertension knowledge, and self-efficacy of hypertension control) and an environmental factor (social support). Analyses were performed to ensure that there was no violation of the assumptions of multicollinearity, normality, and homoscedasticity. Intercorrelations among study variables and variance inflation factors (VIF) were assessed to determine multicollinearity. A normal probability plot of the regression standardized residuals, a normal P–P plot, and the standardized residuals histogram were used to determine normality and homoscedasticity. There was no indication that the assumptions of multicollinearity, normality, or homoscedasticity were unfounded. To examine the relative contribution of each group of variables in explaining the dependent variable, only personal factors were entered in the first step. In the second step, social support was added as an environmental factor. Statistical analyses were performed with SPSS, version 19.0. All analyses are two-tailed with an alpha level of 0.05.

Nurses that work with elderly hypertensive Korean women need to monitor self-care behaviors such as exercise regularity, weight control, and a low-sodium diet.

Results

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies

Participant Characteristics

The characteristics of the participants are summarized in Table 1. Participants’ ages ranged from 60 to 93 years, with a mean age of 74.5 years (SD = 6.8). Of the participants, 17 (7.2%) were divorced or widowed, 64 (27.4%) were married, and 6 (2.6%) lived alone. A slight majority were normal weight (57.5%), with an overall mean BMI of 24.8 (SD = 3.9). The range of time since a diagnosis was 1 to 43 years, with a mean of 10.4 (SD = 8.1) years. The mean score of hypertension knowledge was 13.5 (SD = 2.3). The mean score of self-efficacy of hypertension control was 3.2 (SD = 0.5). The mean score of social support was 3.4 (SD = 1.0). The mean score of hypertension self-care behaviors among Korean women was 3.1 (SD = 0.5). The results of the ratings on the 18 items of hypertension self-care behaviors are shown in Table 2. Items with lower scores were regular exercise (2.0), weight checking (2.3), reducing stress (2.7), and following a low salt diet (2.8).

Table 1. Characteristics of Participants (N = 234)
 n (%)
Age
60–6956 (23.9)
70–79122 (52.1)
≥ 8056 (23.9)
Marital status
Married64 (27.4)
Divorced17 (7.2)
Widowed147 (62.8)
Single6 (2.6)
Body mass index (BMI)
Normal131 (57.5)
Overweight79 (34.6)
Obese18 (7.9)
Table 2. Hypertension Self-Care Behavior Estimates from the Participants (N = 234)
ItemMean (SD)
Note
  1. Scale: 1 = never, 2 = sometimes, 3 = frequently, 4 = always. Item mean = 3.1 (SD =.5), minimum = 2.0, maximum = 4.0.

1Taking medication at the designated time3.7 (0.6)
2Taking medication at the designated frequency3.8 (0.6)
3Taking the recommended dosage3.8 (0.5)
4Checking blood pressure regularly3.1 (0.9)
5Checking body weight regularly2.3 (1.0)
6Seeing a doctor at the scheduled times3.6 (0.7)
7Doing exercise regularly, quite vigorously2.0 (1.0)
8Walking frequently2.8 (1.0)
9Doing stretching regularly2.3 (1.0)
10Eating meals at the same time3.4 (0.8)
11Following a low-fat diet3.3 (0.8)
12Following a low-salt diet2.8 (0.9)
13Quitting smoking all day3.6 (1.0)
14Avoiding smoking areas2.9 (1.2)
15Refraining from a craving for tobacco3.3 (1.2)
16Reducing worry or anxiety in life2.9 (0.9)
17Discussing worries with friends or families2.6 (1.0)
18Reducing stress2.7 (1.0)

Correlates of Hypertension Self-Care Behavior

Relationships among study variables are presented in Table 3. Higher levels of hypertension self-care behavior were significantly correlated with younger age, hypertension control self-efficacy, and social support (p < .01). The findings from the hierarchical regression analysis are summarized in Table 4. The regression model explained 39.4% of the variance in the first step. The results indicated that those who were younger and had higher hypertension control self-efficacy were more likely to report better self-care behaviors. In the second step, social support added 1.7% of the variance in self-care behavior and was a significant predictor of hypertension self-care behavior. Evaluation of individual independent variables revealed that hypertension control self-efficacy contributed most significantly to the model and yielded the largest standardized regression coefficient (β) of .618, followed by social support (β = .160) and age (β = –.138). The final model was able to explain 41.1% of the total variance in hypertension self-care behavior (p < .05 for the final regression model).

Table 3. Correlations of the Variables
Variables12345678
Note
  1. *p < .05. **p < .01. ***p < .001.

Age1       
Marital status−.256***1      
Body mass index (BMI)−.299***.0531     
No. years having hypertension.119−.008.0281    
Hypertension knowledge−.167*.017−.025.1211   
Hypertension self-efficacy−.076.062.014.008.194**1  
Social support−.036.097−.018−.047−.037.438***1 
Hypertension self-care behavior−.173**.053.070.010.127.609***.407***1
Table 4. Hierarchical Regression Analysis Predicting Self-Care Behavior (N = 234)
Note
  1. Marital status coding: married = 1, others = 0. *p < .05. **p < .01. ***p < .001.

Step/independent 
variableSelf-care behavior
  bSE bβ
Step 1Age−.009.004−.138*
 Marital status.003.056.003
 Body mass index.001.006.005
 No. years having hypertension.001.003.020
 Hypertension knowledge−.006.011−.030
 Hypertension self-efficacy.582.051.618***
 Adjusted R2.394  
 F24.586***  
Step 2Social support.075.028.160**
 Adjusted R2.411  
 F22.743***  

Discussion

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies

An important finding was that hypertension control self-efficacy was the most significant influential factor of hypertension self-care behaviors. After controlling for relevant confounders, the results indicate that higher levels of self-efficacy were associated with more self-care behaviors. These findings are comparable with findings reported in earlier literature, and many researchers have demonstrated that self-efficacy is a powerful predictor of behavioral change and maintenance (Kroll et al., 2012; J. E. Lee et al., 2010; Martin et al., 2008). Therefore, it is recommended that nursing interventions to improve self-efficacy should be provided to improve self-care behaviors in hypertensive patients.

One interesting finding was that although the participants had moderate-to-high scores of self-care behaviors, the mean scores of regular exercise (2.0), weight checking (2.3), and adherence to a low-sodium diet (2.8), which is recommended for hypertensive patients, were relatively low. M. J. Kim et al. (2011) reported that weight control was the behavior that was adhered to the least among Korean Americans with hypertension. A possible explanation for these results may be that Koreans tend to think that medication is the sole solution to disease. Han et al. (2007) also noted that Korean Americans might believe that weight control and regular exercise are not as important as taking medications for the control of high blood pressure. A study on disparities in lifestyle choices among hypertensive patients showed that Korean Americans made less effort to reduce salt in their diets than non-Hispanic Whites or African Americans (M. J. Kim, Ahn, Chon, Bowen, & Khan, 2005). Koreans traditionally eat salty foods such as kimchi, fish preserves, and soy sauce. Because of these cultural influences, Koreans may have difficulty adapting to a low-sodium diet. In one study among Korean Americans, the authors showed that more than one third of the sample reported eating salty food all or most of the time (Han et al. 2007). Based on the results of this study, nursing interventions for blood pressure control should encourage behaviors such as regular exercise, weight control, and a low-salt diet in Korean or ethnically similar populations.

We found that knowledge of hypertension was not significantly associated with hypertension self-care behavior. This finding was inconsistent with the results of earlier studies that reported that patients with higher hypertension knowledge reported statistically significant higher self-care scores (Peters & Templin, 2008; Warren-Findlow et al., 2011). However, these findings are largely consistent with other studies that show that knowledge has no statistically significant effect on self-care behaviors (Ciampa et al., 2012; J. E. Lee et al., 2010). Other researchers have mentioned that knowledge itself does not ensure good health behavior compliance, and that health providers should also focus on psychosocial variables such as social support and self-efficacy to enhance self-care behavior (Kara & Alberto, 2007). J. E. Lee et al. (2010) noted that the effect of knowledge on self-care behavior might not be as substantial when more powerful variables such as self-efficacy are included.

In this study, a positive relationship was observed between social support and self-care behavior in elderly women with hypertension, which is consistent with other studies (Kara & Alberto, 2007; Trivedi et al., 2008). This finding implies that patients with hypertension with greater levels of social support would be more likely to perform more self-care behavior. Researchers have suggested that the involvement of family members, friends and health care providers can help reduce patients’ burden in managing chronic diseases (Kara & Alberto; Sharoni & Wu, 2012). In Korean culture, which has a long Confucian tradition, a strong moral obligation exists for adult children to take care of their parents. Traditionally, most elderly Korean adults lived with their sons and daughters-in-law and were supported by their children. However, because of rapid economic growth and social change, the family function of caring for the elderly has been weakened (Y. B. Kim, 2009). Currently, in industrialized and urbanized Korea, the majority of adult children no longer live with their parents.

According to a national survey of the living conditions and welfare needs of elderly Koreans (MHWFA, 2012), most elderly individuals (72.7%) do not live with their adult children; instead they live alone (19.6%) or with their spouses (48.5%). Thus, elderly adults may need more social support because of the decrease in family support. Furthermore, in the context of the patriarchal culture of Korea, women often provide social support to their spouses or children (J. K. Lee & Smith, 2011). A recent study among first-generation Korean Americans with type 2 diabetes showed a gender difference in the primary source of social support. These researchers found that men were more likely to receive support from their spouses, whereas women tended to look for support from other sources, and the level of unmet need for support was higher for women than men (Y. Song et al., 2012). Based on a review of the existing literature and on cultural backgrounds, we predict that elderly Korean women may need more social support from health care providers in regards to hypertension self-care than their male counterparts. Therefore, the unique social support required by elderly Korean women should be assessed in order improve hypertension self-care behavior.

The results also indicated that age was inversely associated with hypertension self-care behaviors. This finding was inconsistent with previous findings that older age was significantly associated with better self-care behaviors (J. E. Lee et al., 2010; Trivedi et al., 2008). One possible explanation for this difference may be that the abovementioned studies included a wider age distribution (e.g., range: 25–92 years) or a greater number of younger participants (e.g., range: 40–64 years) than this study (range: 60–93 years). In one study of women age 60  or older with heart disease, researchers reported that older age might be related to a natural decline in physical ability for self-care in elderly women (Clark & Dodge, 1999). Other studies have reported that older women may be more likely to experience a decline in their ability for self-care (M. Lee, 1999; Wang & Laffrey, 2001). As discussed above, the relationship between age and self-care behavior has been inconsistent (Gallant, 2003), and more research is needed to clarify the role of age in hypertension self-care behavior among more diverse populations.

Several limitations were identified in this study. First, the study population was recruited using a purposive sampling method in one geographic area of Korea; therefore, the findings might not be generalizable to the general population. Second, the cross-sectional design of this study does not allow for determination of a cause-and-effect relationship between the variables. Finally, because self-reporting was used for all of the data with the exception of blood pressure and body weight, a bias in data measurements may have been present. Other researchers have indicated that self-reporting methods may be inaccurate because of social desirability bias or recall difficulties (C. Kim & Beckles, 2004; Macabasco-O'Connell et al., 2011). We attempted to reduce this potential bias by assuring the participants of the confidentiality of the collected data and by explaining the importance of the accuracy of responses.

Conclusion

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies

This study provides valuable information regarding the correlates of hypertension self-care behavior among elderly, low-income women in Korea and demonstrates the importance of hypertension control self-efficacy, which was the most significant influential factor of hypertension self-care behaviors. The results highlight the need for interventions that focus on improving an individual's self-efficacy and social support in order to enhance hypertension self-care. Nurses and health care providers should emphasize self-care behaviors such as regular exercise, weight control, and the benefits of a low-sodium diet when designing self-care interventions for Koreans with hypertension.

REFERENCES

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies
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Biographies

  1. Top of page
  2. ABSTRACT
  3. Conceptual Framework
  4. Review of the Literature
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. REFERENCES
  10. Biographies
  • Soon-Ok Yang, PhD, MPH, RN, is a professor at Hallym University, Division of Nursing, Chuncheon, Korea.

  • Geum Hee Jeong, DNSc, RN, is a professor at Hallym University, Division of Nursing, Chuncheon, Korea.

  • Shin-Jeong Kim, DNSc, RN, is a professor at Hallym University, Division of Nursing, Chuncheon, Korea.

  • Seung Hee Lee, PhD, MPH, RN, is an assistant professor at The University of Ulsan, Department of Nursing, Ulsan, Korea.