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The Efficacy of a Comprehensive Reminder System to Improve Health Behaviors and Blood Pressure Control in Hypertensive Ischemic Stroke Patients: A Randomized Controlled Trial

Wan, Li-Hong, PhD; Zhang, Xiao-Pei, MSc; You, Li-Ming, PhD; Ruan, Heng-Fang, MSc; Chen, Shao-Xian, PhD

doi: 10.1097/JCN.0000000000000496
ARTICLES: Prevention

Background and Objective: The health behaviors of hypertensive stroke patients in China are not satisfactory. In this study, we tested the effect of a Health Belief Model Comprehensive Reminder System on health behaviors and blood pressure control in hypertensive ischemic stroke patients after occurrence and hospital discharge.

Methods: A randomized, parallel-group, assessor-blinded experimental design yielded participation of 174 hospitalized hypertensive ischemic stroke patients. The intervention consisted of face-to-face and telephone health belief education, a patient calendar handbook, and weekly automated short-message services. Data were collected at baseline and 3 months after discharge.

Results: Three months after discharge, the intervention group showed statistically, significantly better health behaviors for physical activity, nutrition, low-salt diet, and medication adherence. The intervention group also had statistically, significantly decreased systolic blood pressure and increased blood pressure control rate. Smoking and alcohol use behaviors were not affected.

Conclusion: At 3 months, use of the Comprehensive Reminder System based on the Health Belief Model, yielded improvement in most health behaviors and blood pressure control in hypertensive ischemic stroke patients. Continued implementation of this intervention protocol is warranted to determine the long-term effect. Smoking and alcohol use behaviors need to be targeted with a different intervention.

Li-Hong Wan, PhD, RN Associate Professor, School of Nursing, Sun Yat-sen University, Guangzhou, China.

Xiao-Pei Zhang, MSc, RN Head Nurse, Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.

Li-Ming You, PhD, RN Professor, School of Nursing, Sun Yat-sen University, Guangzhou, China.

Heng-Fang Ruan, MSc, RN Head Nurse, Department of Neurology and Stroke Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Shao-Xian Chen, PhD Professor, School of Nursing, Sun Yat-sen University, Guangzhou, China.

This study was funded by Guangdong Science and Technology Department, the Guangdong Special Program for Scientific Development, no. 2016A020215039 (L.H.W., PI), and by Guangzhou Special Program for Scientific Knowledge, no. 201609010050 (L.H.W., PI).

Author Contributions: L.H.W., L.M.Y., S.X.C., X.P.Z., and H.F.R. were responsible for the study design. L.H.W. and X.P.Z. participated in the intervention training of research nurses. L.H.W. wrote the first draft of the article. All authors read and approved the final manuscript.

The authors have no conflicts of interest to disclose.

Correspondence Shao-Xian Chen, PhD, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510089, China (chenshaoxian5@163.com).

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