IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 7:No. 4 July/August 2020 SOCIODEMOGRAPHIC DETERMINANTS OF KNOWLEDGE, ATTITUDE AND PRACTICE ON LIFESTYLE PREVENTIVE MEASURES AGAINST HYPERTENSION AMONG FOUR SELECTED VILLAGES IN KUALA PILAH AND JEMPOL, NEGERI SEMBILAN *Suriani Ismail1, Huda Zainuddin1, Norliza Ahmad1, Muthiah Sri Ganesh1, Muhammad Hanafiah Juni1, Nor Afiah Mohd Zulkefli1, Suhainizam Muhamad Saliluddin1, Ahmad Iqmer Nashriq Mohd Nazan1, Noraliza Radzali2, Ariza Zainudin 3 1 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 2 Kuala Pilah District Health Office, Kuala Pilah, Negeri Sembilan, Malaysia 3 Jempol District Health Office, Jempol, Negeri Sembilan, Malaysia *Corresponding author: Suriani Ismail; email: [email protected] ABSTRACT Background: This study was aimed at determining the factors and predictors of knowledge, attitude and practice on lifestyle preventive measures against hypertension among residents in selected villages in Negeri Sembilan. Method: A self-administered questionnaire was used to collect respondents’ socio- demographic characteristics and their scores on knowledge, attitude and practice of lifestyle preventive measure against hypertension, in this cross sectional study. Body mass index (BM) was measured using calibrated measuring scales. Results: Among 787 respondents recruited, majority were of Malay ethnicity (60.2%), predominantly male (62.6%), aged between 31 to 55 years (44.2%), with normal BMI (63.4%). Significant associations were found between level of knowledge and age, (χ2 = 6.3, p= 0.043), ethnicity (χ2 = 12.1, p= 0.007), hypertensive status (χ2 = 11.25, p= 0.001), and BMI (χ2 = 17.578, p= 0.001). Factors found to be significantly associated with level of attitude were age (χ2 = 17.498, p= 0.001), hypertensive status (χ2 = 20.529, p= 0.001), and BMI (χ2 = 8.633, p= 0.035) while for level of practice, only age (χ2 = 25.09, p= 0.001). Significant predictors for good level of knowledge were older age group (p=0.021), ethnicity other than Malay, Chinese, or Indian (p=0.007), higher income (p=0.022), not being hypertensive (p <0.001) and lower BMI status (p<0.001), while for good level of attitude were older age group (p<0.001), and not being hypertensive (p<0.001). Significant predictors for good level of practice were older age group (p<0.001), ethnicity other than Malay, Chinese, or Indian (p=0.006), and not being hypertensive (p<0.001). Conclusion: Knowledge, attitude and practice among respondents were unsatisfactory and predicts by several factors studied. Key words: lifestyle preventive measure, hypertension, knowledge, attitude, practices Suriani et. al. 149 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 7:No. 4 July/August 2020 1.0 Introduction Hypertension is a global public health problem. Malaysia’s National Health and Morbidity Survey (2015) revealed that the commonness of hypertension (diagnosed and undiagnosed) among adults of 18 years and above was 30.3% (95% CI: 29.3, 31.2) and the survey also reported that it risen with age, from 6.7% (95% CI: 4.7, 9.4) in the 18-19 years age group, reaching a peak of 75.4% (95% CI: 70.5, 79.7) among the 70-74 years age group (1,2). There was variant between the different states, with the topmost prevalence in Kedah at 37.5% (95% CI: 33.5, 41.6), after that Sarawak at 37.3% (95% CI: 33.7, 41.1) and next Perak at 36.4% (95% CI: 33.2, 39.8). As for Negeri Sembilan, the state where this study was conducted, the prevalence was 32.5 % (95% CI: 28.2, 37.2). Overall in Malaysia, the prevalence was considerably higher in the rural areas at 33.5% (95% CI: 31.6, 35.4) contrasted to 29.3% (95% CI: 28.2, 30.4) in urban areas (1). Hypertension is defined as persistent elevation of systolic BP of 140 mmHg or greater and or diastolic BP of 90 mmHg or greater (3). Hypertension contributes toward many other diseases such as stroke, cardiovascular and kidney disease (4). It has been reported that the total direct cost of managing hypertension per person ranges between RM 1612 - 2718 per month while total indirect cost varies from RM 6654-8000 per month depending on the stage of the disease (5). The barriers against obtaining effective hypertensive care are inadequate knowledge on the dangers of untreated high blood pressure, poor attitude and practices towards treatment including lifestyle modification (6,7,8). Knowledge on lifestyle modifications such as performance of moderate physical activity, maintenance of normal body weight, reduction of dietary sodium intake, limitation of alcohol consumption and smoking cessation should be emphasised especially among people at risk of developing hypertension (9). Studies had shown that physical exercise and consumption of fruits and vegetables can reduce blood pressure, while elevated body mass index, salt intake and alcohol consumption are connected with an increase in blood pressure (10,11). Those who are pre-hypertensives or have a clear family history of hypertension should be offered these information as part of preventive efforts as well as management of hypertension. In Malaysia, there is a community-initiated program to help to reduce the prevalence of non- communicable disease including hypertension. The program is named Komuniti Sihat Pembina Negara (KOSPEN) which means ‘Healthy community, building the country’ (12). This program is aimed at transforming the community’s health and quality of life by involving the participation of the society in all health programs organised mainly by the government. Negeri Sembilan (the state of the study location) is one of the states in which KOSPEN is actively operating. However, the program might not reach all populations especially in the rural areas. In Malaysia, hypertension remains as a significant public health challenge and had caused a heavy economic burden on the healthcare budget. Effective lifestyle modification can lower blood pressure and could decrease the morbidity and mortality rates of hypertension. One of the purposes of selecting this rural setting was because NHMS 2015 had reported that the prevalence of hypertension was higher in the rural as compared to urban areas. The aim of this study is to look into the factors and predictors of knowledge, attitude and practice on lifestyle preventive measures against hypertension among residents in four selected villages in Kuala Pilah and Jempol districts, Negeri Sembilan. The information obtained can assist the planning Suriani et. al. 150 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 7:No. 4 July/August 2020 of future lifestyle preventive measures programs against hypertension specifically in rural Negeri Sembilan. 2.0 Methods This cross-sectional study was conducted in Kampung Serting Ilir, Taman Desa Melang, Taman Desa Aman and Kampong Gajah Mati in Kuala Pilah and Jempol Districts, Negeri Sembilan. Kampung Serting Ilir is about 56 km from Seremban (capital city of Negeri Sembilan state), Taman Desa Melang and Taman Desa Aman are about 35 km from Seremban while Kampong Gajah Mati is 30 km from Seremban. Sampling frame was the list of residents aged more than 18 years old and Malaysian citizens, while exclusion criteria were mentally and physically challenged and illiterate residents. Sample size calculated was 959. However, finally the distribution of respondents recruited according to study locations were 213 respondents from Kampung Serting Ilir, 259 respondents from Taman Desa Melang, 103 respondents from Taman Desa Aman and 212 respondents from Kampong Gajah Mati. Data was collected using a self-administered questionnaire. Content and face validation were carried out among villagers in a village near study location but not included as one of the selected study locations. Cronbach's alpha obtained was 0.94. The socio-demographic characteristics (age, gender, ethnicity, monthly household income and educational level) and status of hypertension were the independent variables in this study while the knowledge, attitude and practice on lifestyle preventive measure against hypertension were the dependent variables. The questionnaire consisted of 4 parts; Section A is to collect the respondents’ characteristics (information consists of age, gender, ethnicity, monthly household income, educational level and status of hypertension). Section B is to evaluate knowledge on lifestyle preventive measure against hypertension. This part consists of 8 items covering knowledge on lifestyle preventive measures of hypertension such as diet (including regarding healthy diet and salt intake), physical exercise, obesity, smoking, alcohol consumption. For each question 3 options was given (yes, no or don’t know). For every correct answer, 1 mark was given. The maximum score for knowledge is 8 and minimum score is 0. Section C assessed the attitude on lifestyle preventive measure against hypertension. This section also consists of 8 items and the responses used Likert’s scale made up of 5 option ‘strongly agree’, ‘agree’, ‘neutral’, ‘disagree’ and ‘strongly disagree’. The maximum score for knowledge is 40 and minimum score is 8. Section D assessed the self-reported practice on lifestyle preventive measure against hypertension. This consists of 9 items and it was also assessed using Likert’s scale, ‘always’, ‘most of the time’, ‘sometimes’ ‘seldom’ and ‘never’. The maximum score for knowledge is 45 and minimum score is 9. For attitude and practice statements, score was counted as 5 to 1 points for positive statements and score was reversed for negative statements. The knowledge, attitude and practise scores were then categorized into good and poor based on a cut-off point at median score. Scores above the median was considered as good level while equal and less were considered as poor. The weight and height were measured with measuring scale placed on a flat and firm surface and the respondents were instructed to remove any heavy clothing and belongings when measuring their weight and height.