Introduction.
The chosen HP 2030 Leading Health Indicator (LHI) for this analysis is cigarette smoking in adults. One of the LHI’s main objectives is to reduce the current use of cigarette smoking among adults. Cigarette smoking is one of the leading causes of morbidity and mortality across all age groups around the world. According to Ahmed et al. (2021), cigarettes are estimated to be the most widely abused drug due to the presence of tobacco, which is highly addictive as it contains a large percentage of nicotine. Cigarette smoking in adults is an important and relevant LHI from the HP 2030 objectives as it seeks to improve the health and well-being of the general public by significantly reducing the use of cigarettes.
Analysis of the Research Study.
The selected study for this analysis is “An application of the theory of planned behavior to self-care in patients with hypertension” by Pourmand et al. (2020). This study’s main purpose was to employ a behavioural model based on the theory of planned behaviour to examine the factors that determine self-care behaviours necessary for controlling hypertension. Pourmand et al. (2020) conducted their research to verify the strong evidence that suggests that self-care management approaches have a significant effect on hypertension control. According to Pourmand et al. (2020), the Joint National Committee-8 (JNC-8) recommended that there are eight practices individuals with hypertension can practice to control the disease. These practices include weight loss, alcohol cessation, stress and anxiety control, smoking cessation, physical activity, low salt or dash diet, home blood pressure control, and proper use of antihypertensive drugs.
The study’s objective is relevant to cigarette smoking as an LHI from HP 2030, as smoking is one of the topics analyzed in relation to the control of hypertension. As the researchers seek to investigate the various variables that affect self-care behaviour in hypertension control, the study findings strive to highlight appropriate ways that can be used to reduce smoking (Pourmand et al., 2020). Through the study, information on the factors that influence smoking cessation can be gathered in order to establish how the objectives of cigarette smoking as an LHI from HP 2030 can be achieved.
Description of the Study.
The behavioural model used by Pourmand et al. (2020) is the Theory of Planned Behavior (TPB). TPB is a behavioral model intended to explain that all behaviors exhibited by individual have result from intentions, which are influenced by subjective norms, attitudes, and perceived behavioral control (PBC). According to Ajzen and Schmidt (2020), attitudes towards behavior focuses on emotions and the actual beliefs that a person holds. Subjective norms, on the other hand, are social pressures that include both perceived expectations of an individual, and how these expectations are valued by the individual (Ajzen and Schmidt, 2020). Every group of individuals has expectations hence there are relevant subjective norms. PBC, on the other hand, refers to how individuals feel while performing a certain behavior. PBC affects individuals’ intentions to behave in a particular manner. Lim and Weissmann (2023) state that when individuals feel that they have significant control over a situation, their intention to perform it also grows. According to PBC, higher control is exhibited by a high level of resilience and desire to succeed while performing a specific behavior.
Pourmand et al. (2020) use TPB to establish the various factors that influence self-care behaviours in the control of hypertension. According to Ajzen and Schmidt (2020), the behavioral model is also used to estimate the likelihood of performing the desired self-care behavior and the level of the patient’s knowledge. The application of TPB in the study begins during the data collection process where questionnaires are designed based on the TPB and self-care behaviors highlighted in JNC-8. Four types of data are collected in line with TPB behaviors in the following sections: Attitude towards behavior, subjective norms, perceived behavioral control, and behavioral intention. During data analysis, the researchers use Structural Equation Modelling (SEM) to develop and specify the TPB model with the aid of AMOS software. The TPB model developed after the analysis links the three components of TPC to intention to perform self-care behaviors.
Methods of Intervention of the Study.
The research adopted a cross-sectional study design between April 2016 and August 2017. Across the study period, consecutive sampling approach was embraced where 514 patients from the heart clinic of Sinai University Hospital were invited to participate. 14 of the participants opted out of the research due to health concerns as well as emerging disinterest to participate. The eligibility criteria required that participants should have at least a one-year history of diagnosed hypertension. In addition, participants were also required to have been coming for regular check-up at the Sinai University Hospital for them to be invited to participate in the study. Majority of the participants selected were from low and middle socioeconomic strata.
Data collection was conducted using questionnaires based on the TPB as well as the self-care behaviors highlighted in JNC-8. The questionnaires were organized into four main parts. The first part of the questionnaires covered questions relating to attitudes, subjective norms, and perceived behavioral control and behavioral control. A Likert scale was used in this first part of the questionnaires to score TPB questions. The second part of the questionnaires covered the status of different self-care behaviors mentioned in JNC-8 questions among the participants. This second part also highlighted questions regarding the behavior of the different groups highlighted in JNC-8. Part 3 of the questionnaire was focused on general and demographical information relevant to the participants. The final part of the questionnaire contained self-administered questions to ensure that the participants understood the earlier sections.
Further, descriptive statistics were used for the analysis of the study’s independent variables and self-care behaviors. An example of descriptive statistics used by the researchers is the Confirmatory Factor Analysis (CFA). This method was used to score the exogenous factors relating to TPB, such as attitudes, subjective norms, and PBC. Through CFA scores of participants’ exogenous factors were represented as loading scores. Another descriptive statistic used by the researchers was the Structural Equation Modelling (SEM), which was used to create the TPB model.
Results and Conclusion.
One of the study’s findings is that younger patients possess a more in-depth knowledge of self-care behaviors. Half of the study’s participants were over the age of 62. Those below that age showed significant possession of knowledge of self-care behaviors. In addition, the study also found that there is a significant correlation between the duration of hypertension and age. Older participants demonstrated longer durations of the disease compared to their younger counterparts. Additionally, the study findings suggest that individuals’ perception of having control over ceasing smoking and alcohol consumption is linked to their intention and self-care behavior. This finding by the researchers suggests that those who perceive to be more in control of their smoking and alcohol intake behavior are more likely to exhibit desired behavior. Subjective norms are also identified by the researchers as important determinants of intention among younger patients than older patients.
These findings are highly relevant to cigarette smoking in adults as an LHI from HP 2030. A key aspect that the findings reveal is the limitations across all age groups. As the study findings reveal, the younger generation possesses more knowledge of self-care behaviors to control hypertension. Therefore, improving the knowledge of self-care tips among the older generation could help control the disease. (Tan et al., 2021). Among the practices that the older generation should adopt is quitting smoking. By quitting smoking, these individuals could avoid contracting hypertension while also achieving the HP 2030 objectives. Quitting smoking, as identified by the researchers, is an appropriate way of avoiding hypertension while also positively contributing to the reduction of smoking among adults.
Additionally, the study findings highlight some strategies that can be adopted to encourage desired behavior. One of these strategies is to encourage individuals to be more in control of their situations. As the findings suggest, individuals exhibit more intention to engage in a certain positive behavior when they perceive that they are in control. There are various methods that can be employed to enhance individuals’ perception of control of their behavior. An example of these methods is enhancing their self-awareness. Self-awareness is vital for individuals’ perception of control as it can help in self-evaluation, which is necessary for aligning personal behavior with values (Moeller et al., 2020). Individuals who are self-aware are more capable of correctly understanding how they are perceived by others.
Encouraging individuals to talk with their loved ones is an example of the strategies that can be implemented to improve the self-awareness of individuals who smoke cigarettes. When these individuals are more self-aware, they become cognizant of the factors that influence their smoking behavior (Moeller et al., 2020). As PBC states, when these individuals identify the triggers of their behaviors, they are more likely to perform the behavior of interest.
Discussion of the Model’s Usefulness to Study and Practice.
Application of the Research Findings to Nursing/ EMS Practice. How Could the Educator Apply he Research Findings.
The study findings highlight certain key aspects that could be useful to nursing/EMS practice. An example of these key aspects revealed by the findings is the importance of subjective norms in determining intention among younger patients. Healthcare professionals in nursing and EMS practice are able to understand the value of subjective norms when dealing with the younger generation. For instance, when attempting to reduce cigarette smoking among young adults, these healthcare professionals could rely on convincing them to quit the behavior as it is considered the undesirable by the larger society. Relying on subjective norms allows nurses to help in the realization of the HP 2030 goal of reducing cigarette smoking among adults (Lim & Weissmann, 2023).
Another key aspect identified by the study is the duration of hypertension disease. The researchers find that there is a correlation between age and duration of the disease. Educators could use these findings to help enhance the self-awareness of adults who smoke cigarettes. When adults suffering from hypertension realize that smoking cigarettes derails their progress as they age, they are likely to resort to desired behaviors such a quitting smoking to lessen the duration of disease. Using the study findings can help educators can equip adults with the necessary information needed to control their hypertension while also achieving the HP 2030 objective of reducing smoking.
Application of Behavioral Model to Nursing/EMS Practice. How Could the Educator use the Behavioral Model.
TPB is useful to nursing and EMS practice in various ways. One way that the nurses could use TPB is to determine the appropriate interventions for smoking cessation. As revealed by the study, TPB allows for the collection of data across three main components: attitudes, subjective norms, and PBC. Collecting this information allows nurses to identify areas of weaknesses among patients and identify an appropriate approach to address them (Bastable, 2023). TPB can particularly be useful during complex situations where it is difficult to understand a patient’s behavior.
Educators, on the other hand, could assess the aspects that influence subjective norms. Assessing factors that affect subjective norms allows educators to tailor the best approaches that lead to desired behavior. Factors such as institutional values have the ability to influence subjective norms. Assessing institutional values may help educators address certain issues, such as smoking, which may be propagated by inappropriate values (Bastable, 2023). Assessing TPB components such as subjective norms is vital for educators to adopt necessary changes in practice that foster improved outcomes.
Conclusion.
In summary, the research by Pourmand et al. (2020) identifies effective ways that can be used to achieve the HP 2030 LHI of reducing smoking among adults. Smoking is a major cause of morbidity and mortality as it causes diseases such as hypertension. Pourmand et al. (2020) apply the TPB to assess the factors that influence self-care behaviors for the control of hypertension. Their cross-sectional study highlights findings that could be useful for nurses and educators in their efforts to reduce smoking among adults. An example of a major finding highlighted by the researchers is that younger generations possess better knowledge on self-care approaches. Using such findings allows nurses and educators to develop appropriate strategies useful in various unique situations.
References.
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Ajzen, I., & Schmidt, P. (2020). Changing behavior using the theory of planned behavior. The handbook of behavior change, 17-31.
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Lim, W. M., & Weissmann, M. A. (2023). Toward a theory of behavioral control. Journal of Strategic Marketing, 31(1), 185-211.
Moeller, S. J., Kundu, P., Bachi, K., Maloney, T., Malaker, P., Parvaz, M. A., … & Goldstein, R. Z. (2020). Self-awareness of problematic drug use: Preliminary validation of a new fMRI task to assess underlying neurocircuitry. Drug and alcohol dependence, 209, 107930.
Pourmand, G., Doshmangir, L., Ahmadi, A., Noori, M., Rezaeifar, A., Mashhadi, R., Aziminia, R., Pourmand, A. and Gordeev, V.S., 2020. An application of the theory of planned behavior to self-care in patients with hypertension. BMC Public Health, 20, pp.1-8.
Tan, F. C. J. H., Oka, P., Dambha-Miller, H., & Tan, N. C. (2021). The association between self-efficacy and self-care in essential hypertension: a systematic review. BMC family practice, 22, 1-12.
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