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Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

All human being needs to be safe and feel safe, both physically and

psychologically because it is one of the fundamental needs which is safety. Everyone of

us protect ourselves within the changing environment by functioning as healthy

individuals who make decisions in reasonable manner.

Disease prevention includes measures not only to avoid the incidence of

disease, like risk factor reduction, but also to apprehend its development and lessen its

consequences once established. Disease prevention is sometimes used as a

corresponding term along with health promotion. Although there is frequent overlap

between the content and strategies, disease prevention is defined separately. Disease

prevention in this context is considered to be action which usually emanates from the

health sector, dealing with individuals and populations identified as exhibiting

identifiable risk factors, often associated with different risk behaviors (adapted from

Glossary of Terms used in Health for All series. WHO, Geneva, 1984).

Health promotion is the condition of information and/or education of individuals,

families, and communities that would support family unity, community commitment, and

traditional spirituality that make positive contributions on their health status.

Furthermore, health promotion upholds nourishing thoughts and concepts to motivate

individuals to adopt healthy behaviors

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In an era of the 20th century, it is sensible to say that health promotion has

already accomplished its peak with the evolution of health promotion from being just a

concept to becoming a specialization and a profession in most of the countries

worldwide. Various organizations committed in the promotion of health of the people

such as World Health Organization, Australian Health Promotion Association, and

Canadian Public Health Association had made significant contributions that catapulted

the concept of Health Promotion into a whole new level, making health the priority and

the business of every human being. Over the past two decades, explosion of interest

and participation in health promotion and wellness activities (Murray, 2009) became an

extensive as evidenced by more people engaging in health-promoting activities such as

exercise, proper diet, and healthy lifestyle.

One of the most renowned definitions of Health Promotion comes from the World

Health Organization which is the “process of enabling people to increase control over,

and to improve, their health (Ottawa Charter, 1986)”. Unknown to the knowledge of

many, health promotion is a concept distinct from the terms health education and health

maintenance in such a way that health promotion conveys an umbrella effect on the

other two terminologies and focuses on the improvement of health, its goodness and

wellness and enhancing the people’s capacities for living (McKenzie, et al, 2005),

regardless of any impairment on their physical, mental, social, environmental, and

spiritual condition. Health promotion pushes a person forward towards the optimum goal

of health. If health maintenance refers to those activities that avoid illnesses, disabilities,

etc. (Murray, 2009), health promotion pertains to activities that aims to empower the

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individuals to seek for better health. These actual behaviors that individuals perform in

seeking better health refer to Health Promotion Practices.

Health Promotion refers to the efforts to promote positive health (Naidoo, 2005).

It also represents a comprehensive and social political progress; it does not only

embrace actions directed as strengthening the skills and capabilities of individuals, but

also actions towards changing social, environmental and economic conditions so as to

alleviate their impact on public and individual health. Health promotion is a method that

enables the people to raise their awareness over the determinants of health and hereby

their health. Participation is necessary to sustain health promotion action.

Background of the Study

Is hypertension a serious problem? Hypertension kills! Also referred to as high

blood pressure, it is a medical condition that increases the patient’s risk of having

serious heart problems such as stroke and heart attack. A person can have

hypertension for a long period of time without exhibiting symptoms. Eventually, almost

everyone will be affected by hypertension because high blood pressure becomes

common as a person ages (http://www.wazzupmanila.com/hypertension/1760).

According to Department of Health, the study found the following:

If uncontrolled, causes damage to various organs in the body resulting to other

diseases. The organs usually affected are the following.   

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     1.  Heart – leads to heart attack and heart failure

    2.  Brain – leads to stroke and internal bleeding

     3.  Kidneys – leads to renal failure and the need for dialysis

    4.  Eyes – leads to blindness

    5.  Peripheral Blood Vessels – leads to peripheral vascular  diseases

Left untreated, the disease will progress and will eventually lead to death.

 Is hypertension a big problem in the Philippines?  

 Yes! The latest local data (1998) shows a 21% prevalence.

Death from heart disease rank first as cause of death in the century

With a projected population of 78.4 million by year 2000, roughly 8.6

million Filipinos are hypertensive

About 59% have target organ damage – heart attacks (myocardial

infarction) in 3.4%, stroke in 11.5% and kidney damage in 53%

Since hypertension causes minimal or no symptoms at all, only 13.6% of

hypertensives are aware of their condition. This results to chronic

uncontrolled states and progressive organ damage leading to death. 

Thus, it is important to know your blood pressure and how to manage it.   

  

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   What is blood pressure?  

Blood pressure (BP) is the force created as your heart pumps your blood and

moves it through the blood vessels. This continuous blood flow provides your

body with the oxygen and nutrients it needs. In short, it keeps you alive.

Blood pressure is measured through a device called sphygmomanometer. A BP

reading consists of two numbers – the top number (systolic BP) is the

measurement of BP while your heart is pumping, while the bottom number

(diastolic BP) is the measurement of your BP while your heart is at rest.

  Normal BP is a level below

             Systolic          140 mmHg

             Diastolic          90 mmHg 

BP normally fluctuates depending on the time of day, body position (sitting or

lying down), mental stress and level of physical exertion. Thus, BP determination

is standardized – at the left arm, sitting position, after 5 – 10 minutes of rest. Two

or three BP levels are taken and the average is considered the final BP value. 

You are HYPERTENSIVE if your blood pressure taken two or three times in a

two-week period is consistently . . . 

            Systolic          140 mmHg and above

            Diastolic          90 mmHg and above  

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 What dangers await hypertensive patients?

Individuals with high BP rarely have symptoms. Few complain of headache,

nape pains or dizziness, which are usually mild and tolerable.

Thus, hypertension is treated not only to relieve symptoms, but to prevent the

development of target organ damage, which occur in those with chronic

untreated, elevated blood pressure.

  Dangerous Complications of Uncontrolled Hypertension

Stroke results when arteries in the brain burst (bleeding) or become blocked

(thrombosis). Part of the brain dies and the patient becomes paralyzed

Heart Attack occurs when coronary arteries in the heart are blocked. The

heart muscle dies, and may stop beating. Patient dies as a consequence

Heart Failure results when the heart pumps too hard for too long, trying to

keep blood flowing through the body. Eventually, the heart weakens. The

patient now tires easily and is always out-of-breath

Kidney Failure happens when tiny vessels in the kidneys are blocked. The

kidneys malfunction are unable to clean the body of wastes. Patient is slowly

poisoned, becomes weak and bloated. Unless “dialyzed”, the patient will die

of poisoning from his own body wastes

Blindness or Impaired Vision occurs when tiny blood vessels in the eye

rupture or become blocked, damaging the surrounding eye tissues

(www2.dov.gov.ph/common_disease/hypertension.htm)

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This study will be conducted in Brgy. 454 Lardizabal, Sampaloc, Manila City,

where the researchers are currently studying at University of Sto. Tomas, taking up post

- medicine.

Brgy. 454 is one of the 241 barangays of Sampaloc, 4th district of Manila, with a

total population of 395, 111 (2007 Census of Population). This is the first time that the

said barangay has accommodated medical students having their research to be

conducted that concerns their community health promotion practices with hypertension.

No other studies have been conducted in and about the said barangay. Due to the lack

of appropriate records of the barangay that can supposedly be used to further describe

the community with regards on their health promotion practices; this raised a question in

the mind of the researchers, “Are the health promotion practices of the residents of

Brgy. 454 Lardizabal still applicable up to this day especially with those who have

hypertension?”

This scenario prompts the researchers to conduct a study on the current health

promotion practices of the residents of Brgy. 454 Lardizabal. With the introduction of

modern technology and the rise of new health-related breakthroughs and discoveries,

an assessment of their health promotion practices is needed to determine the timeliness

and effectiveness of these practices. At the same time, the researchers are also

motivated to improve the health status of the said urban community, following the

human perspective in health promotion as stated by Lucas (2005) in his book Health

Promotion Evidence and Experience that the starting point in health promotion is the

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“desire to improve the quality of people’s lives without necessarily adopting disease

prevention as a primary aim”.

“An assessment should produce both needed change and increased

empowerment (Homan, 2008)”. This study entitled, “An Assessment to Health

Promotion Practices among the Residents of Brgy. 454 with Hypertension”. It is

thus in this light that the present study will find out the common barriers to health

promotion lifestyle of these residents and to and the results of which will serve as a

basis for designing and developing an appropriate health education programs that will

address the current need of the community.

Theoretical Framework

The theoretical framework of this study was the Health Promotion Model by Dr.

Nola J. Pender. The health promotion model (HPM) proposed by Nola J Pender (1982;

revised, 1996) was intended to be a “complementary counterpart to models of health

protection.” It defines health as a positive dynamic state not merely the absence of

disease. Health promotion is focused at increasing a client’s level of well being. The

health promotion model shows the multi dimensional nature of persons as they act

together within their environment to pursue health. The model focuses on following

three areas:

 Individual characteristics and experiences

 Behavior-specific cognitions and affect

 Behavioral outcomes

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The health promotion model explains that each person has a unique personal

characteristics and experiences that affect subsequent actions. The set of variables for

behavioral specific knowledge and affect have important motivational significance.

Health promoting behavior is the desired behavioral outcome and is the end point in the

HPM. Health promoting behaviors should be used to improved health, enhanced

functional ability and better quality of life at all stages of development. The final

behavioral demand is also influenced by the immediate competing demand and

preferences, which can derail an intended health promoting actions

(http://currentnursing.com_theory/health_model.htm).

Figure 1 Health Promotion Model

This model works on the premise that individual characteristics, including prior

related behavior, personal factors, and biopsychosocial factors have a direct effect on

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the desired health-promoting behavior. At the same time, these individual

characteristics also affect the feelings and perception of the individual. All these

combined affect an individual’s commitment to a plan of action and the performance of

the health-promoting behavior (Murray, 2009). The researchers believe that the

individual characteristics of the residents of Brgy. 454 such as the age, gender, civil

status, educational attainment, occupation, and spiritual beliefs affect their health

promoting practices. Although the researchers will not give much attention on the

feelings and perception of the individual, the totality of this study under the Health

Promotion Model will serve as a reference in determining the compliance of the

residents of Brgy. 454 to the Health Promotion Program that will be implemented later

on as the outcome of this study.

Research Paradigm

INPUT PROCESS OUTPUT

Figure 2 Research Paradigm

Residents of Brgy. 454 Lardizabal

Age Gender Civil Status Educational

Attainment Occupation Spiritual beliefs

Data Analysis on Health Promotion Practices in terms

of: Health

Responsibility Interpersonal

Relations Nutrition Physical Activity Spiritual Growth Stress Mgmt.

Health Promotion Program focus on

Hypertension

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Figure 2 explains the interrelationship of Input-Process-Output of the study which

focuses on the research on the common health promotion practices of the residents of

Brgy, 454.

The input for this study refers to the profile of the residents of Brgy. 454 in terms

of their age, gender, civil status, educational attainment, occupation, and spiritual

beliefs. These variables will be used to further understand the background of the

respondents. The pursuit for understanding will be done through the process stage,

wherein data analysis on health promotion practices in terms of Health Responsibility,

Interpersonal relations, Nutrition, Physical Activity, Spiritual Growth, and Stress

Management would be evaluated. The last is output stage, wherein it will produce

recommendations of health promotion programs based on the findings.

Statement of the Problem

The study aims to assess health promotion lifestyle program through the

identification of the common health promotion practices done by the residents of Brgy.

454 Lardizabal with hypertension.

Specifically, this study seeks to find answers on the following questions:

1. What is the demographic profile of the residents of Brgy. 454 Lardizabal in terms of:

1.1. Age

1.2. Gender

1.3. Civil Status

1.4. Educational Attainment

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1.5. Occupation

1.6. Spiritual beliefs

2. What are the health promotion practices of the residents of Brgy. 454 Lardizabal ?

3. What are the common barriers to health promoting lifestyle among the

respondents?

Significance of the Study

The result of this study will be of importance to the following:

To the Residents of Brgy. 454 Lardizabal may find the result of the study as an

approach to raise their consciousness on how to promote positive health and their

unique behavior as residents of Brgy. 454. This will provide a solid and scientific

description of the health promotion practices they perform thereby strengthening their

exclusive identity. This can also provide an opportunity to re-evaluate their own

practices in enhancing health and identifying their weaknesses thus the creation of

programs that can address the needs of Brgy. 454.

To the Community Health Workers of Brgy. 454 and in Samaploc, Manila will

benefit from the study and acknowledge the necessity to give a concrete and scientific

description of the common practices done by the residents in the said barangay thereby

increasing their personal knowledge. This description will provide an accurate

knowledge of the client and serve as the foundation where programs designed to

improve the health of the community can be built upon.

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To the Medical Students will find the outcome of the study to further enhance

their knowledge on health promotion practices and ways to help implement these acts.

Other Researchers – This study will serve as an invitational research agenda for

further research and development in response to the continuous search for

contemporary approaches to further understand of concerns parallel to this work.

Scope and Limitations of the Study

The focus of this study is the heath promotion practices commonly done by the

residents of Barangay 454 in terms of Health Responsibility, Interpersonal Relations,

Nutrition, Physical Activity, Spiritual Growth, Stress Management.

The researchers chose Brgy. 454 as a convenient place to conduct the study

since the researchers were familiar with this community. Therefore, the data to be

utilized in this study is readily available and accessible to the researchers. Moreover,

the researchers believe that urban communities like Brgy. 454 would yield more

significant results that can contribute to the substance of the study.

The subject of the study will be the long-time residents of Brgy. 454. Thirty-two of

the said barangay will be selected as respondents of this study. Data gathering

techniques will be limited to observation and distribution of survey questionnaires.

The time frame for this study is from November to December 2010 covering the

data gathering period and January – February 2011 for processes and analysis, writing

up for the report and final dissertation. Thus, any or all developments that occurred

thereafter are deemed excluded.

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Definition of Terms:

1. Barriers – refers to objects or individuals that inhibited a process or event

from occurring (Pender, Murdaugh, & Parsons, 2002).

2. Health – refers to a state of complete physical, social, and mental wellbeing,

and not merely the absence of disease of infirmity (WHO)

3. Health Education – refers to “any planned combination of learning

experiences designed to predispose, enable, and reinforce voluntary behavior

conducive to health in individuals, groups, or communities (Green and

Kreutuer, 2005)”.

4. Health Promotion – refers to efforts to improve the health status of an

individual and enhance his capacity to achieve health.

5. Health Promotion Practices – also known as Health Promotion Behaviors;

refers to the actual behaviors performed by an individual in order to improve

health.

6. Health Maintenance – refers to the desire of an individual to actively avoid

the occurrence of illness or disease.

7. Health Protection – refers to behaviors that protect a person from acquiring

an illness or disease.

8. Hypertension – defined as a chronic, common, asymptomatic to

symptomatic, disorder characterized by a persistently elevated blood

pressure exceeding 140/90 mm Hg (Mosby, 1994). Hypertension has the

potential to be uncontrolled (the systolic blood pressure 140 mm Hg or

greater and/or the diastolic blood pressure is 90mm Hg or greater) or

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controlled (blood pressure below 140/90 mm Hg due to antihypertensive

medication, diet, or exercise).

9. Interpersonal Relations – refers to social relationship of an individual. It

includes the kind of communication done by an individual to fulfill his personal

and intimate needs.

10.Nutrition – refers to the selection and consumption of food of an individual

11.Physical Activity – refers to an individual’s participation in light, moderate, or

vigorous activity (Walker, S., 1996).

12.Spiritual Growth – refers to the ability of an individual maximize human

potential through searching for meaning, finding a sense of purpose, and

working towards goals in life (Walker, S., 1996). It also refers to the belief of

an individual to a higher form of being.

13.Stress Management – refers to the coping mechanisms done by an

individual to reduce tension or manage stress.

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Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

Through the review of related literature and related studies, researchers were

provided the knowledge and background on the topic or subject being studied. A

collection of extensive related literature is an essential part of a research paper in a way

that it serves as the framework of the study to make it substantial, credible, and reliable.

It serves as the feet of a research study so it can stand on its own and make it strong

enough for future researches to build upon.

The researchers gathered all literatures, both foreign and local, that are deemed

important to the topic at hand.

Foreign Literature and Journals

The growth of interest and activity in health promotion has been accompanied by

many attempts to examine the nature of health concept in particular cultures. It is

argued (Pender, 1996, Katz et al, 2002, Tones and Green, 2004) that health promoters

such as hospital nurses are unlikely to improve health and to bring about change unless

they have adequate understanding of the meaning of health and its determinants. Thus,

if people’s health is to be promoted effectively, the concept of health needs to be

explored culturally. To this end, there is a need to establish a theoretical background

about the meaning of health itself before any attempt to examine health promotion

related issues.

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Health Concept: Meaning and Development

When health related literature is reviewed it becomes obvious that the concept of

health is still one of the most frequently reported concepts. Health has not only been

associated with people’s health behaviour (Paxston et al, 1994, Ogden et al, 2002,

Hjelm et al, 2005) but also with the population’s mortality, morbidity, life satisfaction,

happiness, health policy, sexual health, education and economy (Buchanan, 2000,

Davey et al 2000, Helman, 2000, McPake, et al, 2002).

The concept of health however is contested and has diverse and sometimes

conflicting meanings that are both socially and culturally constructed. The concept of

health was derived from the old English word “hoelth” which means being safe, sound

and whole (Pender, 1996,). Historically, physical wholeness was of major importance for

acceptance in social groups. Physical power and nature were frequently linked together.

Those people suffering from disease or malformation were ostracised from society. The

reason was not only because of the fear of contagion from physically obvious disease

but also according to Blaxter (2001) there was repulsion at grotesque appearances. In

light of this, it is not unexpected that the review of literature found that being healthy

was constructed as natural in a certain environment or in harmony whereas unhealthy

was constructed as unnatural or contrary to nature (Davey et al, 2001).

Health was defined by the WHO (1946) as:

“ The state of complete physical, mental, and social wellbeing’ and not only the

absence of disease and infirmity”.

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This definition has proved to be robust and it is frequently cited in the literature in

particular within nursing and health promotion contexts, and it would be worth reviewing

its effectiveness and applicability. The definition was revolutionary as it consists of three

aspects of health including physical, mental and social well-being. It has many

advantages, which were recognized by many authors (Bunton and Macdonald, 2002,

Katz et al, 2002, Lee and Newberg, 2005). This is not surprising as it is postulated

(Pender, 1996, Bowling 2005) that the WHO’s definition reflects concern for the

individual as a total person rather than the sum of parts. In addition, the definition places

health within the environmental context rather than a disease focus. Recently, health

promotion authors go further to contend that the WHO’s definition is well acknowledged

in the literature not only because its positive reference to well-being but also it is useful

to be adapted at a political level centering on equity and empowerment and asserting

that health is a standard of living (Tones and Tilford, 2001, Tones and Green, 2004).

Although they did not offer obvious guidance about how to incorporate these ideas into

practice, their suggestions might demonstrate that the WHO’s definition of health can be

used as a framework for promoting health at both the individual and political level.

Medical writers, on the other hand, advocate to lesser extent that the WHO’s definition

can be deemed as a milestone to distinguish between positive health such as well-being

and negative aspects of health which exclusive emphasis on disease prevention

(Downie et al, 1991).

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On this basis, the WHO’s definition made a significant addition to the literature by

arguing that health is beyond the disease-linked issues and it is rooted in the

individuals’ social life.

The WHO’s definition is totally unrealistic and too idealistic. This is because it

assumes that someone somewhere can achieve a 100% state of health. This implies a

misunderstanding of the meaning of health as a complex qualitative experience shaped

by an individuals’ context (Katz et al, 2001). It could also lead to a central confusion

about the meaning of “complete” or “incomplete health”. For example, is the health of a

person with a physical disability complete or incomplete?

To add to the problem, the definition is based on the assumption that people’s

views of “the state of health” are alike. Such an assumption has been discredited by

considerable evidence. Earlier studies have shown that people define the state of health

in many different ways such as fitness, energy, sexual activity and even wealth (Young,

1996, Davey, 2001, Davey et al, 2001, Hjelm et al, 2005).

Likewise, Ewles and Simnett (2004) expressed their concerns about the quality

of the WHO’s conceptualization of health which implies a static position whereas life

and living are anything but static. This indicates a misunderstanding of the fact that

health in its holistic facets (e.g. physical, mental, spiritual) is in a state of continuous

change.

Young (1996) acknowledges the advantages of the WHO’s definition but she

points out other problems as below:

“….. Such a wide ranging definition can sometimes make it difficult to determine

things which are not covered by the heading “health concern”…could we, for

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example, consider a woman experiencing relationship difficulties with her

husband and family “ unhealthy”? (p:242).

As indicated above it seems that the too broad a definition of health makes it

difficult to specifically address the needed health interventions to achieve the desired

outcomes. This raises significant concerns, which could lead to misinterpretations

among health care providers themselves.

A further weakness of the WHO’s definition of health stems from the possibility of

linking its meaning with health promotion. Whilst it could be used as a framework for

health promotion (Tones and Green, 2004), adopting the WHO’s definition as a

guideline for promoting people’s health might produce not only ineffective heath

promotion activities but also unrealistic expected outcomes such as a “ 100% complete

health status”.

Thus, health care providers need to acknowledge that the aims of maintaining

health should be within realistic boundaries and reasonable expectations.

Health Promotion: Historical Background

Health Promotion dates back up to the time when religion and superstition

influenced people’s belief on health and illness. The Babylonians, the Greeks,

Egyptians, Palestinians, Romans, and the Chinese have laid down the foundation of

most of the health promotion practices that we enjoy today. Concepts on hygiene and

sanitation were introduced to civilization by the Greeks whose belief in health and

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illness was mandated by their gods and goddesses; the quarantine practices that

benefit people of today especially in communicable diseases can be traced back during

the Palestinian times under the Mosaic Code which emphasized the importance of

segregation by separating what is clean from the unclean. The public health sanitation

like street cleaning, building construction, ventilation, heating, and water sanitation that

we enjoy today are some of the accomplishments of the Romans and Egyptians

(Murray, 2009). Even during that time, health was already considered of prime

importance and its enhancement was necessary, some for the purpose of achieving

balance of the mind, body and spirit and some as a form of luxury and personal

indulgence. Whatever the purpose may be, these ancient practices bear the underlying

fact that an individual, even in the earliest times, is always in search of activities that

can prolong life and improve the quality of life (Marks, et al, 2005).

As Health Promotion gains popularity, myriad of definitions rose and overlap with

one another. Oftentimes, the term health promotion is used interchangeably with health

education, health maintenance, and health protection. The leading organization in

managing health, the World Health Organization (WHO) defined Health Promotion as

“the process of enabling people to increase control over, and to improve their health.

(WHO, 1986)”.

During this definition’s inception, five key strategies were also identified namely -

building healthy public policy, creating physical and social environments supportive of

individual change, strengthening community action, developing personal skills such as

increased self-efficacy, and Reorienting health services to the population and

partnership with patients (Ottawa Charter, 1986). This definition coincides with the

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definition of Marks, et al (2005) which is “any event, process, or activity that facilitates

the protection or improvement of the health status of individuals, groups, communities,

or populations.” It targets a wider range of population as it intends to focus on the

community level which includes environmental interventions such as “targeting the built

environment (e.g. fencing around dangerous sites) and involve legislation to safeguard

the natural environment (Marks, et al, 2005)”. It encompasses a broader scope as it

“represents a comprehensive social and political process” and with actions “directed

towards changing social, environmental, and economic conditions so as to alleviate

their impact on public and individual health (Health Promotion Glossary, WHO, 1998).

Definition of Health Promotion

A more individualistic approach on Health Promotion is reflected on the definition

of Pender, et al. (2006) which states that “Health Promotion is the behavior motivated

by the desire to increase well-being and actualize human health potential”. This

definition, on the other hand, includes the behavioral approach of health promotion,

which “focuses on secondary and primary prevention to improve health status through

lifestyle and behavior changes of individuals (Leddy, 2006)”.

These behavioral interventions are “primarily concerned with the consequences

of individual’s actions whose focus is on the concept of empowerment (Marks, et al.,

2005)”. The objective of this approach is to generate changes in the behavior of an

individual towards health, so that independence and self-reliance can be fostered. This

can be achieved by increasing the awareness and knowledge of an individual on health

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and ways on how to improve it through health education. Health Education is defined

as “any planned combination of learning experiences designed to predispose, enable,

and reinforce voluntary behavior conducive to health in individuals, groups, or

communities (Green and Kreutuer, 2005).

Using Travis’s Illness-wellness Continuum, movement in the direction of wellness

state must begin with awareness, followed by education, then growth (Kozier, 2008).

Therefore, health Education capitalizes on awareness and knowledge in initiating

behavioral change in an individual. This insight reflects the difference between health

promotion and health education, where health education serves as a tool in

implementing health promotion. To further operationalize the definition of health

promotion, Breslow stated on his commentary on health promotion in JAMA, 1999 “that

each person has a certain degree of health that may be expressed as a place in a

spectrum.

From that perspective, promoting health must focus on enhancing the people’s

capacities for living. That means moving them toward the health end of the spectrum,

just as prevention is aimed at avoiding disease that can move people toward the

opposite end of the spectrum”. For this reason, Health promoting behaviors must be

geared towards the High-Level Wellness of Travis’s Illness-Wellness Continuum.

Another definition of Health Promotion deals with the actions done to promote

health. Health behavior refers to the actual actions performed by an individual to

improve health. Health behavior alone is defined as “any activity undertaken by an

individual regardless of actual or perceived health status, for the purpose of promoting,

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protecting, or maintaining health, whether or not such behavior is objectively effective

toward that end (WHO, 1998)”.

Health Promotion: Theories and Models

There are a number of theories proposed in the literature that attempt to guide

the work of health promotion as well as health education. Although no one theory is

sufficient to fully explain health promotion behaviours, practitioners need to understand

their implications for practice (Naidoo and Wills, 2000). Behavioural change theories are

examined first because hospital health providers’ roles in health promotion is guided by

their ideologies as explored in this chapter (Maidwell, 1996, Furber, 2002, Cross, 2005,

Casey, 2007).

Models of health related behavioural change are often derived from

sociopsychology (Cole, 1995). This field examined the link between effective health

promotion interventions and the social influence process (Mittelmark, 1999).

Sociocognitive or “social learning” theory was used as a means to explain health

behaviours and to focus on the social context of behavioural change and its underlying

cognitive process (MacDonald, 2000). Thus, it is driven by the notion that behaviour is

guided by expected consequences. It indicates that health related behaviours are a

result of the interaction between patients’ beliefs and environmental elements (e.g. lung

problems and pollution) (Tones and Green, 2004). Despite this, however, socio-

cognitive theories are based on a preventive health framework and thus sit more

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comfortably with traditionally defined health education as opposed to a wider reaching

health promotion ideology operating at social and economic levels (Clark, 1998, Cullen,

2002). Therefore, these theories attempt to examine patients’ reactions to the threat of

illnesses and thus seek actions to minimize or eliminate this threat through health

education. However, changing individuals’ behaviour is a problematic and complex task.

Not only might it lead to victim blaming but also to “cognitive dissonance” (Festinger,

1958). This is based on the concept that when clients face a situation when the

delivered health education message is in conflict with their current beliefs and attitudes,

they react in a manner that could create dissonance (e.g the belief that smoking would

reduce stress) (Festinger, 1958).

The theory contradicts to some extent the rational empirical theory that assumes

that clients will make rational decisions based on view of information given to them

(Baird, 1998).

Although the above theories are ideologically different, they link together health

related actions, individuals’ beliefs and indeed their agendas. The most developed

models and theories in health promotion are based on psychosocial theories and are

threatened by their limitations. The theory of reasoned action (Ajzen and Fisherbein,

1980) indicates that intentions to perform an action are determined by the individuals’

attitudes towards the behaviour and the social norm. Thus, their beliefs are predictors of

intentions that, in turn, predict actual behaviour.

Likewise, Pender’s (1987) health promotion model explains the link between

individuals’ beliefs and their behaviours but fails to consider the impact of

26

socioeconomic issues. Instead the model “views the environment as it relates to

behaviour rather than how it relates to health”(King, 1994, p.214).

On the other hand, the health belief model (Becker, 1974), is largely guided by a

preventive health approach as opposed to socio-economic and political approach to

positive health. More recent socio-cognitive models did not give indications on how they

might be operationalised in practice (Niven, 2000, Stuifbergen et al, 2000) or were too

complex to use especially in a limited resourced setting (Whitehead, 2001a). The last

two models have not yet been validated and thus their effectiveness is questioned.

Health Promotion Practices

Health Promoting Practices or Behaviors of an individual differ from one person

to another. Pender (2006) stated it best that “each person has unique personal

characteristics and experiences that affect subsequent actions”. There are five levels

that affect a person’s behavior (Sharma, 2008). First, are the individual factors, like the

attitude of a person. If a person believes that a healthy body will permit him to perform

more challenging tasks, then engaging in health promotion activities would come

naturally.

According to Fawcett (2005), “Environment, culture, family background, work

ethic, educational level, social standing, and gender may contribute to the individual’s

perception of heath and illness”. Then personal view and understanding on the concept

of health and illness also falls on this level. In the earlier times, if a disease is believed

27

to be caused by an entry of an evil spirit, holes are bored into the skull of the patient to

release these spirits.

In the Philippines, if illness or disability is caused by nunu sa punso or aswang,

people immediately visit an “arbolaryo” and submit the patient to a “tawas” to detect the

spirit believed to cause the disease.

In addition to this, an individual’s environment also play a crucial role in his health

promotion practices as stated in an article from the Global Health Promotion (Jul, 2010)

entitled “How does socio economic position link to health behaviour?

Sociological pathways and perspectives for health promotion” by Weyers S., et

al. The study showed that the “characteristics of the neighbourhood environment

influence health behaviour of its residents above and beyond their individual

background”. Therefore, the physical environment also determines the health promotion

practices of an individual. Also included in the individual factors are the age, civil status,

spiritual beliefs, occupation, and educational attainment of the individual.

Second level is the Interpersonal factors where an external factor affects the

behavior, example of which is a spouse requesting for a healthy breakfast.

Third level refers to organizational factors which include policies that contribute to

a better health like a company that allots 1 hour of exercise for employees every

morning. Fourth level is community factors, such as the physical environment an

individual is surrounded with. For example, if the person needs to fetch water every day

from the communal faucet that is 1 kilometer away from his house, then that activity can

be considered as a vigorous form of exercise. Last is the role of public policy factors.

For example, if a memorandum coming from the Mayor mandates the cleaning of

28

suspected breeding and resting sites for Dengue mosquitoes three times a week, then

that memorandum compels the residents to do such (Sharma, 2008).

In this study, the factors that are taken into consideration are the 6 dimensions of

health-promoting lifestyle identified in the Health Promotion Lifestyle Profile II (Walker,

et al., 1996). These are the Spiritual Growth, Interpersonal Relations, Nutrition, Physical

Activity, Health Responsibility, and Stress Management. Health Promotion Lifestyle

Profile II is used to measure the health promoting behavior of an individual.

Lifestyle, according to Pender (2006), is defined as “discretionary activities that

are regular and part of one’s daily pattern of living and significantly influence health

status”. In this study, the term lifestyle is synonymous with Health Promoting Behaviors.

Spiritual growth or health is defined as the “ability to develop one’s inner nature to its

fullest potential which includes the ability to discover and articulate one’s basic purpose;

to learn how to experience love, joy, peace, and fulfillment (Pender, et al., 2006, p.

104)”.

Spiritual health is essential in assessing the heath promoting practices because

this “affects the client’s interpretations of life events and health (Chuengsatiansup, 2003

as cited in Pender, et al. 2006)”. Numerous studies have been done supporting this

significant correlation of spirituality and health experiences. One of these is a study

entitled “Spiritual health, clinical practice stress, depressive tendency and health

promoting behaviours among nursing students by Hsiao Y. et al. (2010) wherein

Spirituality was positively associated with health-promoting behaviors. This relationship

will contribute to the holistic approach in assessing the health promotion practices of an

individual.

29

Interpersonal Relations, likewise, is also vital in assessing health promotion

practices as this reflects the social relationship an individual posses. According to Lucas

(2005), positive social relationships “stimulate the production of a health promoting

hormone and block the production of hormones usually related to stress”. Positive social

relationships offer a venue for verbalization of feelings of the individual which is

necessary for the individual to get in touch with their feelings and emotions and enables

the individual to select the most appropriate strategy in dealing with stress through

feedbacks from others.

This dimension is related to the third dimension of the HPLP II which is Stress

Management as “high levels of social support have also been linked to positive affect,

and may thus protect against distress from life events associated with high stress

(Lucas, et al., 2005 p. 130)”. Stress is defined as anything that may threaten the

physical and psychological well-being of a client. Assessment of how an individual

handles these stresses may serve as a better predictor of his health promoting

practices.

Fourth and fifth dimensions of the HPLP II are the Nutrition and Physical Activity,

respectively. Nutrition involves the way an individual selects and consumes foods that

are essential in promoting a health well-being. Their selection of food must be

consistent with the guidelines provided by the Food guide Pyramid. Physical Activity, on

the other hand, “involves regular participation in light, moderate, and/or vigorous activity

(Walker, et al., 1996).

Assessment of physical activity is important since “sedentary lifestyle, for many

individuals, begins with childhood and continues until adulthood (Pender, et al., 2006, p.

30

102)” and lack of physical exercise has been directly related with the occurrence of

cardiovascular diseases.

Last, but not the least, is the dimension on Health Responsibility, which involves

“an active sense of accountability for one’ own well-being (Walker, et al., 1996)”. This

includes paying attention to one’s health through education and exercise of informed

consumerism. As Pender, et al., (2006) mentioned, “individuals play a significant role in

the determination of their own health status because self-care represents the dominant

mode of health care in our society”.

Like breathing, no one else can take care of one’s health than the person owning

that health. The desire to enhance health and well-being must come from within.

One must bear in mind that human health promotion is a moral endeavor. In the

individual level, health promotion provides services that will assist humans in their

functioning taking into consideration their particular circumstance.

Therefore, a need to include the factors that influence a person’s health status

like mental, physical, spiritual, and environmental factors in the assessment of an

individual is a must (Edelman, et al., 2006). This will only be possible if thorough

assessment will be done on the health promotion practices of the respondents.

Prolonging life and improving its quality is the objective of Health Promotion

(Marks, et al., 2005). In order to achieve this goals, health promotion must concentrate

more on enhancing the physical, psychological, and emotional well-being of an

individual instead of focusing on reducing the risk of acquiring diseases. A more positive

approach to promote health is needed to stimulate in individuals the desire to enhance

the quality of life.

31

Local Literature

The need for health promotion in the Philippines goes back to the time of the

Ramos Administration, when the Administrative Order No. 341 entitled Implementing

Philippine Health Promotion Program through Healthy Places was created. It was

written along with the belief that there is a “need to undertake more health promotion

and disease prevention measures as a result of the reported increase in the incidence

of preventable diseases in Asia and in the country (AO No. 341, 1997)”. The PHPP

gives priority to women, and children, adolescent youth, workers, elders, disabled and

chronically ill persons, ethnic minorities, rural people, and urban poor (Palaganas,

2003).

Time went on and health promotion was given a renewed interest as a result of

the association of degenerative diseases with the lifestyle of an individual. In 2002,

Mortality statistics showed that 7 of the 10 leading causes of deaths in the country are

associated with the unhealthy lifestyle of the client: tobacco smoking, physical inactivity,

and an unhealthy diet (Cuevas, et al., 2007). This rise in the occurrence of degenerative

and lifestyle diseases called for a need to take on a new approach to health promotion

that will go beyond the interaction between the client and a physician. Hence, the

creation of the National Policy on Health Promotion (Administrative Order No. 58 s.

2001).

This Administrative Order promotes the utilization of a “socio-ecological

approach” to health promotion that would include the environment and other sectors

that affect the over-all well-being of a person. The vision for Health Promotion, “By the

32

year 2010, Filipinos are managing their own health” serves as the framework for health

promotion.

This study will contribute to the attainment of the said goal through the creation of

appropriate health promotion programs/strategies that can change the lifestyle of the

target population by starting with proper assessment of their current health promotion

practices. This fulfills a fraction of the health sector’s responsibility to “build capacity for

policy development, leadership, health promotion practice, knowledge transfer and

research, and health literacy (Anden, 2010)”.

“Without sincere efforts directed towards achieving socio-economic

transformation no lasting improvements are expected in the field of health (Palaganas,

2003, p. 90)”. Health Promotion may sound easy to say but it is very much harder to do,

especially if the community is underdeveloped. Brgy. 454 is an urban community

wherein there are depressed areas situated in Sampaloc, Manila.

As Palaganas (2003) puts it, “many mistaken practices result from ignorance and

superstition”. It can be drawn that the health promotion practices of the community may

still be possibly linked with the practices and beliefs of the past, which are no longer

applicable today. At the same time, there is also a lack of medical professionals that

would correct their current practice and provide them with the correct ones.

33

Synthesis

After reading and compiling the relevant literatures above, one idea remains –

that for a health worker to come up with a program that will meet the needs of the

community in terms of health promotion, a thorough, accurate assessment of their

health promotion practices is of supreme importance. It is the responsibility of the health

worker/provider to gather all the information that she can get in order to come up with

a program/plan that is specifically designed according to the specific needs of Brgy.

454, Sampaloc, Manila. This includes the consideration of all the factors that may

influence the health promotion practices of the individual such as the individual

characteristics as these may affect the way a person takes care of his health as

reflected in the 6 dimensions stated in the Health Promotion Lifestyle Profile II.

The readings in this chapter will help the researcher to further describe and

analyze the health promotion practices of the residents of Brgy. 454. These literatures,

both foreign and local will enlighten the researcher with the what, why and how of the

health promotion practices that the residents perform and will be used as a stepping

stone in the creation of the intended output of this study.

34

Chapter 3

RESEARCH METHODLOGY

            This chapter presents the methodology of the study. Specifically, it discusses

the research design, population, sample, and sampling techniques, instrumentation,

data gathering procedures, data analysis.

Research Design

This study is observational in nature which utilizes a cross-sectional design which

is commonly used in conducting a health promotion research (Crosby, et al, 2006).

According to John Creswell (2005), a cross sectional study examines the current

attitudes, beliefs, opinions or practices of a certain group or community. To further

examine the target population, a survey research was utilized to understand the

characteristics of the population and estimate the levels of knowledge about any given

health threat or health protective behavior; and health-related attitudes, beliefs,

opinions, and behaviors (Crosby, et al, 2006).

Therefore, this study will utilize a cross-sectional survey design as it determines

the common health promotion practices done in Brgy. 454 Lardizabal Sampaloc,

Manila.

35

Population, Sample, and Sampling Techniques

The respondents of this study will be fifty residents of Brgy. 454, mostly aged 30-

40 years old. This selection is based on the belief of the researcher that individuals in

the specified age group are mature enough to involve themselves in the improvement of

their health and capabilities. Moreover, people in this age group would represent those

who mostly engaged in activities that may negatively affect their health situation such as

alcohol abuse, smoking, and lack of physical exercise.

Therefore, their health promotion practices call for further investigation. The

respondents were selected using the purposive sampling technique where the

researcher selected those individuals who could provide richer and more significant

information about the study. Purposive sampling is a technique where the “researcher

intentionally select individuals and sites to learn and understand the central

phenomenon (Creswell, 2005)”.

Instrumentation

The researcher utilized the Health Promotion Lifestyle Profile II, an instrument

used to measure the health promoting behavior of an individual, focusing on the six

domains of health responsibility, physical activity, nutrition, spiritual growth,

interpersonal relations, and stress management. These dimensions are reflected in the

following items:

36

1. Health-Promoting Lifestyle 1 to 52

2. Health Responsibility 3, 9, 15, 21, 27, 33, 39, 45, 51

3. Physical Activity 4, 10, 16, 22, 28, 34, 40, 46

4. Nutrition 2, 8, 14, 20, 26, 32, 38, 44, 50

5. Spiritual Growth 6, 12, 18, 24, 30, 36, 42, 48, 52

6. Interpersonal Relations 1, 7, 13, 19, 25, 31, 37, 43, 49

7. Stress Management 5, 11, 17, 23, 29, 35, 41, 47

This instrument, based on the Health Promotion Model of Nola J. Pender, was

originally produced in 1987 by Susan Walker, Professor Emeritus of University of

Nebraska, College of Nursing. This 52-item examination used a 4-point Likert Scale to

determine the behavior of the individual with a format of “Never”, “Sometimes”, “Often”,

and Routinely”.

In order to accommodate the level of education of the residents of Brgy. 454, the

instrument was translated into the Filipino language. Considering the translation made,

this study will also serve as mean in measuring the appropriateness of the HPLP II tool

in the Philippine setting.

No pilot study is needed since the instrument to be used has been tested and

validated as evidence by the number of studies that utilized the said survey tool.

37

Data Gathering Procedure

In order to obtain the much-needed data, the researchers followed a series of

steps. First is to talk to the Barangay Captain if they can conduct a survey and present a

letter explaining about their study. Once permission is granted, the researcher will

begin the data gathering.

To select the respondents, the researcher will obtain a list of names of the

residents from their office, together with their addresses. The researchers will personally

visit the selected respondents and will ask if they have hypertension. If yes, the

researchers would provide them with the questionnaire. Beforehand, a letter asking for

their participation will be given to the participant. They participants have the right to

refuse involvement in the said study.

Collection of the questionnaire will follow afterwards for the collation and analysis

of data. Necessary statistical treatment will be applied in order to come up with the

results needed for the study.

Data Analysis

The HPLP II survey’s data was coded and analyzed by the researchers. The

descriptive statistics were calculated using mean. The researcher examined the

demographic survey by evaluating percentage of subjects who responded to the

questions with a particular answer. Percentages also were used to evaluate the sample

characteristics.

38

The researchers used Pearson’s r to statistically examine the HPLP II scores and

the average systolic and diastolic blood pressure measurements for correlations. The

researcher had hoped to discover significant correlations between the six dimensions of

the HPLP II survey and the average blood pressure measurements. The six categories

are health responsibility, physical activity, nutrition, spiritual growth, interpersonal

relations, and stress management. The health-promoting lifestyle is the seventh

category and it includes all 52 questions. Health-promoting lifestyle category contains all

six dimensions under one title. By looking at the six dimensions individually, the

researcher actually broke down the health-promoting lifestyle category for a more

thorough analysis.

Statistical Treatment of Data

The data that will be obtained in this study will be statistically treated with the

necessary formulas to facilitate the analysis and interpretation of findings. The Health

Promotion Lifestyle Profile II, the instrument used by the researcher, already has a

proposed method of scoring the results.

The score for the over-all health promoting lifestyle will be obtained by computing

the Mean of the individual’s responses. Likewise, the scores for each subscale will be

obtained using the same computation. The mean, denoted by an x, is the most sensitive

measure of center since it takes into account all scores in a distribution when it is

calculated (Bordens, 2007). The formula for the mean is:

39

x = n

Where: Ex is the summation of scores

n is the number of scores in the distribution.

To answer question number 4, PEARSON PRODUCT-MOMENT ‘

CORRELATION COEFFICIENT will be utilized. This is a measure of association that

provides an index of the direction and magnitude of the relationship between two sets of

scores (Bordens, 2007).

Where: N no. of cases

XY sum of the products of x and y

X sum of the x’s

Y sum of the y’s

X2 sum of the squares of x’s

Y2 sum of the squares of the y’s

40

To test the significance of the computed r

Where: n the number of respondents

r the computed coefficient of correlation

41

Chapter 4

PRESENTATION OF FINDINGS, ANALYSIS & INTERPRETATION OF DATA

This chapter presents the results and discussion of data gathered based on the

following: a) to know the demographic profile of the residents of Brgy. 454 Lardizabal, b)

to illustrate the health promotion practices of the residents of Brgy. 454 Lardizabal, and

c) to specify common barriers to health promoting lifestyle among the respondents. The

study was conducted using Health Promotion Lifestyle Profile II.

RQ1: What is the demographic profile of the residents of Brgy. 454 Lardizabal

in terms of:

The ages of the subjects ranged from 30 years old to 50 years old or older.

Estimated sixteen percent (N=5) were between the ages of 30 to 35 years old, twenty-

two percent (N=7) were between the ages of 36 - 40 years old, twenty-five percent

(N=8) were between the ages of 41 to 45 years old, and thirty-eight percent (N=12)

were ages 46 to 50 years old. Majority of the subjects were married. Of the thirty-two

subjects, estimated sixty-nine percent (N=22) were married, sixteen percent (N=5) were

separated, nine percent (N=3) were widowed, and six percent (N=2) were single. For

most, highest level of education was high school. Estimated forty-seven percent (N=15)

had attended high school, thirty-four percent (N=11) had attended grade school and

nineteen percent (N=6) had attended tertiary. The rest of the variables were also

illustrated on the table below.

42

Table 1 Demographic Profile of the Respondents

  Characteristic Total Sample

n=32 Percentage

Gender Male 25 78.13

Female 7 21.88

Age 30 to 35 5 15.63

36 to 40 7 21.88

41 to 45 8 25.00

46 to 50 12 37.50

Marital Status Single 2 6.25

Married 22 68.75

Separated 5 15.63

Widow 3 9.38

Educational Attainment None 0 0.00

Primary 11 34.38

Secondary 15 46.88

Tertiary 6 18.75

Occupation Employed 17 53.13

Unemployed 15 46.88

Spiritual beliefs Catholic 16 50.00

Iglesia ni Kristo 6 18.75

Born Again 2 6.25

Others 8 25.00

A few questions asked about medications, home blood pressure monitoring,

transportation, living conditions, employment, and help at home. Eighty-four percent

(N=27) of the subjects took all medications as prescribed. Thirty-four percent (N=11) of

the subjects measured their blood pressures at home on a regular basis, while sixty

43

percent (N=19) had a blood pressure machine at home. Ninety-four percent (N=30) of

the subjects had transportation available for their primary care appointments. Seventy-

five percent (N=24) had someone at home to help with health needs and twenty-five

percent (N=8) did not have help at home. Nevertheless, seventy-eight percent (N=25)

reported living alone and nineteen percent (N=6) did live with someone. Sixty-nine

percent (N=22) did not believe money was a barrier in controlling blood pressure

RQ2: What are the health promotion practices of the residents

of Brgy. 454 Lardizabal?

A summary of the HPLP II survey responses is located in Table 2. All fifty-two

questions from the HPLP II and all blood pressure measurements were examined using

Pearson’s Correlation Coefficient. The following categories had significant results:

interpersonal relations, spiritual growth, health responsibility, and stress management.

Table 2 Summary of Health Promotion Practice

44

R3: What are the common barriers to health promoting lifestyle among the

respondents?

45

Interpersonal Relations was analyzed with the average blood pressure

measurements and yielded several moderately significant correlations. The results for

Interpersonal Relations are located in Table 3. First, an inverse correlation with

moderate significance was found (r= -0.398, p=0.024, p<0.05) between systolic blood

pressure measurements and praising other people easily for their achievements.

Secondly, a moderate correlation (r=-0.355, p=0.046, p<0.05) was found between

systolic blood pressure measurements and discussing my problems and concerns with

people close to me. Thirdly, a moderate correlation was discovered between systolic

blood pressure measurements and maintaining meaningful and fulfilling relationships

with others. Lastly, a moderate correlation (r=-0.374, p=0.035, p<0.05) was discovered

between systolic blood pressure measurements and touching and being touched by

people I care about.

46

\

]

Spiritual Growth was analyzed with the average systolic blood pressure

measurement. Three questions from the survey correlated significantly with the average

systolic blood pressure measurement. The questions were as follows: look forward to

the future (r=-0.363, p=0.041, p<0.05), work toward long-term goals in my life (r=-0.393,

p=0.026, p<0.05), and find each day interesting and challenging (r=-0.369, p=0.037,

p<0.05).

Health Responsibility had only one question that resulted in a moderately

significant correlation with systolic blood pressure. The significant correlation was noted

between discuss my health concerns with health professionals and the average systolic

blood pressure measurement(r=-0.412, p=0.019, p<0.05).

Table 3. Interpersonal Relations

Number of Subjects

Systolic r=Correlation p=Significance

Diastolic r=Correlation p=SignificanceQuestion

Discuss my problems andconcerns with people close to me. N=32

r= - 0.355** p= 0.046

r=- 0.269 p= 0.137

Praise other people easily for their achievements. N=32

r= - 0.398** p= 0.024

r= 0.008 p= 0.965

Maintain meaningful and fulfilling relationships with others. N=32

r= -0.428** p= 0.015

r= 0.129 p= 0.481

Spend time with close friends. r= -0.269 p= 0.136

r= 0.051 p= 0.783

Find it easy to show concern, love, and warmth to others. N=32

r= - 0.130 p= 0.478

r= -0.123 p= 0.502

Touch and am touched by people I care about. N=32

r= -0.374** p= 0.035

r= 0.110 p= 0.551

Find ways to meet my needs for intimacy. N=32

r= -0.315 p= 0.079

r= 0.090 p= 0.626

Get support from a network of caring people. N=32

r= -0.320 p= 0.074

r= -0.249 p= 0.169

Settle conflicts with others through discussion and compromise. N=32

r= 0.130 p= 0.477

r= -0.146 p= 0.426

47

Stress Management had two moderately significant results. The average systolic

blood pressure and take some time for relaxation each day was correlated (r=-0.353,

p=0.048, p<0.05). The second correlation was between the question, balance time

between work and play, and systolic blood pressure (r=-0.353, p=0.048, p<0.05).

Among the different categories of the HPLP II, only one category provided a

correlation with elevated diastolic blood pressure. Under Stress Management, an inverse,

moderate correlation was discovered between subjects getting enough sleep and diastolic

blood pressure (r=-0.505, p= 0.003, p<0.05). In other words, subjects who claimed to get

enough sleep had lower diastolic blood pressures.

48

Chapter 5

SUMMARY AND CONCLUSIONS

This chapter summarizes the study on the research made in assessment to

health promotion lifestyle of the residents of Brgy. 454 with hypertension. The

conclusions given were drawn from the outcomes of the research and observations on

the impact made. Recommendations were based from findings and conclusions of the

study.

Summary

This study would perform the concept of the Health Promotion Lifestyle Profile II

to assess residents’ health promotion practices and to discover common barriers to

health promoting lifestyle with hypertension.

Existing literature was reviewed to determine if any prior studies had been done

to assess health promotion practices in relation to hypertension that provides this

information. It was discovered that many studies had been done by health educators

and professionals on what they perceived to be important in developing healthy

promotion program that would greatly affect the lifestyles of the respondents in a

community. Knowing residents of Brgy. 454’s perceptions based on their evaluation

could help health providers better understand the needs of their community and design

a specific program intended for the residents with hypertension.

The method of research to be used in this study is observational in nature which

utilizes a cross-sectional approach to determine the health promotion practices of age’s

49

30-to-50-year-old respondents. Survey research was conducted in Brgy. 454 Sampaloc,

Manila with purposive sampling.

The HPLP II survey’s data was coded and analyzed by the researchers. The

descriptive statistics were calculated using mean. The researcher examined the

demographic survey by evaluating percentage of subjects who responded to the

questions with a particular answer. Percentages also were used to evaluate the sample

characteristics.

The researchers used Pearson’s r to statistically examine the HPLP II scores and

the average systolic and diastolic blood pressure measurements for correlations. The

researcher had hoped to discover significant correlations between the six dimensions of

the HPLP II survey and the average blood pressure measurements.

Conclusion

The following conclusions have been drawn based on the findings presented:

1. The demographic data provided great insight into the type of sample population

obtained for this study. The sample population mostly consisted of high school

educated, married, Caucasian males, who were between the ages of 66 to 75

years old. All 32 subjects were hypertensive and uncontrolled. The subjects

(N=32) had at least two blood pressure readings (consecutively) that were

greater than 140/90 mmHg.

2. Several categories of the HPLP II had moderately significant results that were

inversely correlated. The Interpersonal Relations category revealed that having a

relationship with others affects systolic hypertension. Interpersonal relations did

50

not affect diastolic blood pressures. A moderately strong correlation was

discovered between “discussing my problems and concerns with others” and

systolic blood pressure measurements, indicating that not discussing concerns or

problems with others increases systolic blood pressure. In addition, a stronger

correlation was found among systolic blood pressure and “praising other people

easily for their achievements”, indicating that not praising others increases

systolic blood pressure. Lastly, “maintaining meaningful and fulfilling relationships

with others” had the strongest correlation in the category. Maintaining meaningful

and fulfilling relationships decreases systolic blood pressures.

3. Spiritual Growth had a significant impact on systolic blood pressures, but not on

diastolic blood pressures. A correlation was found between “looking forward to

the future” and systolic blood pressure, signifying looking forward to the future

decreased systolic blood pressure. Another health behavior in this category,

“working toward long-term goals and finding each day interesting/challenging”,

was correlated with systolic blood pressures. Not having long-term goals or not

finding each day interesting increased the systolic pressure.

4. Health Responsibility and Stress Management had significant correlations with

systolic blood pressures. In Health Responsibility, the statement “discuss my

health concerns with health professionals” was moderately correlated to systolic

blood pressure. This result indicated that “discussing problems with health

professionals”, such as nurses or providers, decreased an elevated systolic

blood pressure. One statement from the Stress Management category, “take

some time for relaxation each day” was correlated to systolic blood pressures,

51

signifying that not taking some time for relaxation and not balancing time

between work and play may increase systolic blood pressures.

5. The other categories from the HPLP II, such as Nutrition and Physical Activity,

did not significantly correlate to systolic or diastolic blood pressures.

6. Hypertension has been deemed as the most notable disease among Filipinos.

In hopes to contribute for a better health program, the purpose of this study

was to discover the barriers to a health-promoting lifestyle among the

residents of Brgy. 454. The results significantly show that stress

management, interpersonal relationships, spiritual growth, and health

responsibility effects systolic blood pressure, either negatively or positively.

The problems with stress management, interpersonal relationships, spiritual

growth, and health responsibility can be considered barriers to controlled

hypertension.

52

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