Assessment of Clinical Barriers Factors to Healthy Lifestyles amongst Hypertensives in Communities of Idoma Tribe of Benue State, Nigeria

Background


I N T R O D U C T I O N
People who lead healthy lifestyles, also known as self-care, perform or practice actions on their own behalf to safeguard their own safety and promote wellbeing. (1) High body mass index (BMI), poor eating patterns, high sodium intake, low physical exercise, and excessive alcohol consumption have all been linked to hypertension. In order to control high blood pressure, the Joint National Committee on the Prevention, Diagnosis, Assessment, and Treatment of High Blood Pressure suggests six self-care practices: following medication regimens; engaging in physical activity; eating a healthy, low-fat, low-salt diet, similar to the dietary approaches to stop hypertension (DASH); and maintaining a healthy weight. In addition, a number of studies have found that good self-care practices are crucial for regulating blood pressure. (2) To improve one's health, one needs make use of their intellect, problemsolving abilities, upbeat attitudes, excitement, courage, and optimism. As a result, self-care entails adopting a healthy behavioral pattern and accepting responsibility for one's own health. This behavioral pattern may include actions taken by the person and caregiver for themselves, their children, and their families to stay active, maintain good physical and mental health, meet social and psychological needs, avoid disease or injuries, and preserve health and well-being by treating minor illnesses and chronic conditions after an acute illness or hospital discharge A descriptive analysis of 1,039 people from community health clinics in the New York metropolitan region with poorly managed HTN was conducted by researchers. The effectiveness of evidence-based multilevel, multi-component systems was investigated. We collected and looked through infor-mation on demographics, clinical, psychological, and behavioral traits. According to the statistics, the majority of patients (79.7%) had comorbidities, which were linked to improper eating habits and poor physical health. Diabetes was found to be the co-morbidity that was most common (35.8%). According to this study, co-morbidities have a substantial impact on lifestyle and should be looked into in relation to issues with physical activity and low-sodium diet adherence.
Despite the fact that some of the descriptive demographics may be similar to those of other African American populations, the study's location in an urban setting is limited compared to the HTN population in rural eastern North Carolina. It's important to consider how common co-morbidities are in HTN patients. Due to the aggravated condition, there is a financial cost as well as a health cost. Treatment plans from different pharmaceutical classes and types of therapy frequently overlap while treating co-morbidities. This causes problems for both professionals and patients. HTN is not the only condition in which many co-morbidities and their effects interact but they can also cause problems with medical regimens that have an impact on one's capacity to lead a healthy lifestyle and control one's own health, such as problems with medication compliance, exercise compliance, and food compliance. Diuretics, betablockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, alpha blockers, and vasodilators are routinely prescribed to patients with HTN and other comorbidities. It's essential to track early gains in clinical criteria because different drugs have different clinical profiles and adverse effects, which makes it difficult to prevent serious side effects. Electrolytes and renal function must be assessed before and during treatment. This is particularly valid for those who have many comorbid conditions. Any reduction in renal mass, for instance, interferes with the renal vasculature's ability to regulate itself. Changes that are gradual and minor are necessary, or such medications may need to be stopped altogether. Serum potassium and creatinine levels can rise when the renin-angiotensin system is disrupted. (3) Few studies have examined the condition-specific characteristics of laboratory data during times of HTN therapy stability or transition. Although not statistically significant, the Framingham Heart Study found that serum potassium levels of 5.2 mEq/L or 4.0 mEq/L increased the incidence of HTN. There was no connection between the blood's salt content and the existence of HTN in the sample. Previous research has linked hyperkalemia to an increased risk of cardiovascular death, including the National Health and Nutrition Examination Survey and the British Regional Heart Re-portResearchers examined the relationship between serum potassium and sodium levels and the occurrence of HTN in a Chinese community-based sample. (4) The researchers concluded that higher serum potassium may increase the risk of HTN and renal function may have an impact on the amount of blood potassium since potassium and sodium are essential in the maintenance of cellular activities. In contrast to the link between blood potassium and HTN risk, which was demonstrated to be independent of renal function, there was no association between serum sodium and HTN risk. Researchers looked at the connection between serum potassium and sodium levels and the prevalence of HTN in a community of Chinese people.
The researchers came to the conclusion that raising serum potassium may raise the risk of HTN and that renal function may affect the amount of potassium in the blood since potassium and sodium are necessary for cellular activity. While blood potassium and HTN risk were shown to be linked in a way that was unrelated to renal function, the association between serum sodium and HTN risk was discovered to be independent of renal function.

M E T H O D S
All of the participants in this study are hypertensives from Idoma areas. Sample: To include hypertensives in the study, a multistage cross-sectional simple random sample procedure was adopted. Instrument: Participants' demographic and social lifestyle behavior information was gathered using a structured data collecting instrument that includes a questionnaire and a profoma interview/discussion guide. Study design: Between 2019 and January 2023, 1660 hypertensives from a population of around 4 million persons underwent a community-based cross-sectional mixed technique study. Procedure: Information was gathered from each of the eight local governments of the Idoma tribe using a standard questionnaire that had been pretested among hypertensives. Free hypertension drugs were also given out following consultation with the team's doctor. The researcher assistants received training and orientation so they could conduct questionnaire administration and record group discussions and interviews. Data analysis: After being entered into Excel, the data was transferred to SPSS version 20.0. Tables were created with descriptive analyses utilizing frequency and %. The project received ethics board approval from Lincoln University College Malaysia and Benue State permission from Makurdi Health Management Board. The gate keepers in each community had to provide their approval before anyone could enter. Participants' written consent was gained after being informed of their purpose and advantages. No names were used, and the data were protected from illegal access by lock and key. This ensured confidentiality. Every technique was carried out in accordance with the institutionally authorized guideline.

R E S U L T S
Objective 1. To determine clinical factors acting as barriers to each of the eleven (11) healthy lifestyles (self-management) practices amongst hypertensives in communities of Idoma tribe, Benue state. Clinical factors barrier to medication adherent are not having any symptom 85.1%, fear of side effect of drugs 84.4%, difficulty in obtaining refill 83.2%, feel well 78.7%, high medication cost 78.7% of physician dosing 77.3%, number of anti HBP 73.1% and feel better 72.9%. Others are perceived BP uncontrolled 72.4% poor participation of patient/physician to patient management 71.6% amongst others. Presence of multiple comorbidities 55.3% and health care provider sources of motivation 50.6% were all clinical barriers factors to medication adherence   There are 61.2%, 61% 59%, 58.2% and 55.5% respondents said when you feel better, perceive BP uncontrolled, delivery system design, illness of family member, presence of multiple co-morbidities were clinical factor barriers to dash diet adherent When you do not have any symptom 91%, feel better 80.9%, perceived BP uncontrolled 76%, poor participation of patients/ physician (care giver) in patient management 72.4% and when you feel well 64.9% were clinical barriers to salt adherent. Other respondents asserted that non educating of physician on patients' clinical condition 51.7%, Patient health outcome 51.6% and low BMI 50.6% were clinical barriers to low salt adherent. Weight management non adherent as a result of clinical factors revealed that 86%, 74.2%, 73.1%, 73%, 67.6%, 65.7% and 63.5% of respondents stated that feel better, being overweight, when not having symptoms, multiple treatment regime, poor participation of patient/physician (care giver) in patient management, stroke and poor commitment between health care personnel and patients were responsible respectively. When you feel well 75.7%, feel better 72.6%, decision support 64.1%, poor commitment between health personnel and patients 52.6% etc., determine clinical barrier factor on non-adherent to moderation in alcohol. As for clinical barrier factor to nonsmoking adherence, only feel better 58.4% stated it as barrier. Most respondent, stated that patient health outcome 53.7%, duration of HBP 53.6% and educating of patient by physician on patients 50.4%, clinical condition were clinical factor barriers to stress control adherent. Use of health services. Feel better 83%, un-improvement in quality of health care 83%, perceived BP uncontrolled 68%, co-morbidity 64.9% non-availability of health services 64%, presence of multiple comorbid 63.7%, feel worse 63%, when you do not feel symptom 62.7%, prior experiences to disease 58%, when feel well 56.6%, patient health outcome. Along the stated barriers are also patient health outcome 58.5%, stroke 55.7%, prior ex-posure to disease 55.3%, perceived Bp uncontrolled 53.5%, complications 52.4%, presence of multiple co-morbidities 51.7% and feel worse were all said to be clinical barrier factors to follow prescribed treatment plan.

D I S C U S S I O N S
Objective: To determine clinical factors acting as barriers to the eleven (11) healthy lifestyles (self-management) practices amongst hypertensive in communities of Idoma tribe Benue State Nigeria.
The barriers, in order of priority, are: lack of symptoms, fear of side effects, difficulty getting a refill, feeling well, high medication costs, physician dosing, delivery system design, number of anti-HBP, feeling better, perception that BP is not under control, poor physician (care giver) involvement in patient management, taking other medications, and the healthcare system. drug makes you weary, duration of HBP, many medications, treatment plans, patient health outcome, past exposure to disease, number of visits to doctor or healthcare provider, drug makes you dizzy, when concerned about taking drug for rest of your life, a lack of commitment between the patient and the medical staff, the use of two or more different medications, a stroke, a doctor's failure to inform patients of their clinical conditions, the availability of medical facilities, the repeated use of a drug, the presence of multiple co-morbidities, and the source of motivation for the medical staff are all factors. As can be seen from the foregoing, clinical barriers to hypertensive individuals leading healthy lifestyles are multifactorial and all genuine when taking into account the economic, social, security, environmental, spiritual, and psychological environments in which Nigerians and people around the world found themselves. These results are consistent with research conclusions from Nigeria and other nations, including the ones listed below. (5)(6)(7) In terms of physical activity, doctors did not recommend it when a patient had co-morbid conditions like diabetes, took two or more medications, was overweight and felt worse, was present or had access to sporting facilities, or had sick family members. (7)(8)(9)(10)(11) Participating in moderate physical activity helps hypertensives enhance their heart health and build up their community. Determine the proper workout for them based on their age and blood pressure level. Yan and co. (2022). Walking, yoga, handclapping, cycling, and other forms of exercise reduce people's time spent sitting still, enhance muscle oxygen absorption, reduce sympathetic excitation, and boost verbal stimulation. These effects reduce peripheral resistance and blood flow. Yoga can efficiently lower blood pressure by stimulating the parasympathetic nervous system and depressing the sympathetic nervous system, which in turn reduces tension and anxiety. Aquatic sports and football training are among these workouts because they can alter nerve regulation and vasoactive chemicals, especially in moderate-intensity and emotional regulation, as demonstrated by Yoga. The aforementioned statement makes it clear that devising methods to encourage physical activity among this demographic is necessary because doing so will cause hypertension to adapt neurohumorously, vascularly, and structurally.
Chemotherapy was found to be a barrier to exercise, as well as to other health concerns. (12) Unfamiliarity with blood pressure monitoring, the perception that blood pressure is out of control, when you feel good, patient health outcomes, strokes, and the frequency with which patients see doctors are clinical factors that specifically function as barriers to self-BP monitoring. According to an extensive analysis of self-BP monitoring conducted by Tucker et al, self-BP monitoring might be suggested as one component of a comprehensive strategy for treating hypertensive individuals who also have co-morbidities connected to hypertension. (13) Krowish et al. noted similarities in cost, patient ability, procedural testing ability, use of BP equipment, and time. (14) A key component of preventing hypertension complications is personal hypertension management. As noted in the current study discovered delays in patients' communication with doctors and a lack of detailed conversation. (14) Self-BP monitoring is essential for preventing high blood pressure-related fatalities from cardiovascular and cerebrovascular disease. Clinical factors that made the DASH diet difficult to follow were low BMI, swallowing problems, decision assistance, family member illness, being overweight, and diverse prescription regimens. They also highlighted related findings from the research of other scholars. Vegetables can be grown and used in the garden, according to several participants in the preceding studies. (15,16) The respondent claims that obstacles to consuming less salt include clinical issues, low BMI, feeling better, and other clinical considerations. Other researchers touched on the challenges of dining with others, the flavor, the lack of variety while dining out, and the lack of knowledge about salt. (17) A obstacle is the lack of knowledge about the sodium content of various foods as well as the tradition of salting food. Clinical factors that interfere with weight management include: being overweight, having a low BMI, visiting the doctor frequently, the patient's health status, the source of the multivation in the health care system, and the doctor's education of the patient regarding the clinical condition. Exercise, diet, and other interventions must be compatible with the patient's clinical, cultural, and personal strategies in order to bring their hypertension under control because obesity or overweight is a significant risk factor for hypertension.
According to the findings of the investigation, doctors' dietary recommendations lacked consistency. (18) He believed that regular use of weight reduction, medications, and referral to auxiliary services, along with regular counseling and nutritional counseling, would improve weight management. Barriers to moderation in alcohol consumption; When you feel good, feel better, a lack of commitment on the part of healthcare professionals and patients, poor decision-making assistance, and lack of patient education by doctors about their clinical conditions were cited as hurdles by respondents. Alcoholism is a very common condition worldwide, and stigmatization is the main obstacle because others in the community view the person as a failure in life. The obstacles vary on the person's condition and quantity or kind of alcohol consumption. A barrier is the doctor's failure to address alcohol problems during routine exams and the patient's lack of knowledge about potential treatment alternatives. (19) Feeling well is one of the clinical barriers to stopping smoking according to 58.4% of survey participants. Those who smoke native snuff, which is breathed through the mouth and nose, are a small minority in this society. They asserted that it inspires them to work harder and stay awake while on the farm; p6. Anxiety, irritation, and sensitivity are the most frequent reactions to smoking, according to the literature. A psychological educational intervention aimed at altering unfavorable beliefs about quitting smoking, anxiety, and sensitivity may be a promising therapeutic emphasis. Even those who want to stop struggle because of the drawbacks of doing so. They hypothesized that giving up smoking would make it harder to tolerate drinking. (19) Feeling worse, receiving several medical treatments, having multiple co-morbidities, and a lack of commitment on the part of medical staff and patients are clinical factors that hinder the control of stress. complications, patients' health outcomes, the length of HBP, and the doctor's education of patients of their clinical condition. Acute stress responses enhance cardiac output, heart rate, and peripheral resistance by activating the sympathetic nervous system and the hypothalamicpituitary-adrenoceptor axis. On the other hand, persistent stress is thought to clinical hurdles to stress management include worsen-ing symptoms, various medical conditions being treated, the existence of many comorbidities, and a lack of commitment on the part of medical staff and patients. complications, patients' health results, the length of HBP, and patient education by the doctor regarding patients' clinical status. Acute stress responses enhance cardiac output, heart rate, and peripheral resistance by acting on the hypothalamic-pituitary-adreno-ceptor (HPA) axis and the sympathetic nervous system, respectively. Contrarily, persistent stress is thought to Clinical factors that prevented this population from using health services included: feeling better, increased access to high-quality healthcare, the number of HBP medications, decision-support tools, stroke, delivery system design, co-morbidities like diabetes, the availability of health facilities, not having any symptoms, prior exposure to a disease, not feeling sick, patient health outcomes, multiple medical treatment regimens, and patient education by doctors about their clinical conditions. Time constraints, lengthy wait times, a lack of knowledge, financial constraints, a provider's unfavorable attitude, traveling from a distance, and socio-cultural factors are all mentioned.
Patients who live in rural locations are disproportionately more likely than those who do not to have trouble reaching their doctor. High health expenses, out-of-pocket expenses, policies, and a lack of information regarding the care facility.
Feel better, no symptoms, poor caregiver and patient management, poor commitment between patient and caregiver, lack of decision support, duration of HBP, health system design, physician education on patient clinical outcome, multiple medical treatment regimems, patient health outcome, stroke, prior exposure to disease, number of times patient visit health care provider, complications, and presence of multiple diseases were clinical factor barriers on following prescribed treatment plan. Treatment compliance is frequently subpar, especially in developing nations. This is due to a variety of factors, including patient resistance to implementing prescribed treatments, a lack of information and beliefs, time constraints, financial issues, and a lack of specialized people.

C O N C L U S I O N
These were conclusion from a social and cultural study Chan et al, that were relevant to the current investigation. (12) Understanding these elements should help establish the theoretical framework for efforts to enhance professional practice and patient outcomes. According to Health S, without patient access to care, the health care industry cannot offer care, patients cannot develop a relationship with their providers, and patients cannot attain overall patient wellness. (20) Despite this significance, patient care access is not a reality for many patients in many different nations due to difficulties getting to clinic offices, scheduling conflicts, and other access-related problems. In their study by Muhorakeye et al, which some ways differ from this study's findings, those highlighted in rural areas included gossip and stigma, finances, resources, low service quality, unfavorable views about services, mistrust, and a limited number of skilled employees. (21) Suggestion Develop intervention to overcome these barriers.

F U N D I N G
Partial scholarship from Lincoln University College Malaysia. Partial support from University of Jos by way of study leave with salary payment.