1.The prevalence of hypertension in the Stonechurch Family Health Centre (S.F.H.C.) was 18%. This is higher than the prevalence of 15% for Ontario (p-value <0.05).22 Using logistic regression analysis, age was highly significant (p-value <0.0001), while sex was not (p-value = 0.584). Another 10% had raised B.P. readings. While no patient had hypertension under the age of 30, the prevalence of hypertension rose dramatically to approximately 50% at age 70. 2. 34% of patients with diagnosed hypertension (and receiving medication) were not controlled. This is higher than values reported in other studies (27% & 19%).32,38 3. The controlled rate for treated patients 60 and older (64%) was higher than the rate for untreated patients 60 and older (22%) (p-value = 0.025). In particular, 80% of women under 60 were controlled compared with 53% for those 60 and older (higher, p-value = 0.046). 88% of the uncontrolled hypertension in the 60 and older group, was isolated systolic hypertension (I.S.H.). It appears that the clinic did not have a consistent policy for the management of I.S.H. in the elderly. Women were particularly affected. 4. 80% of women under 60 were controlled, compared to 57% for men under 60 (higher, p-value = 0.108). Strategies for improved surveillance and management are needed for men under the age of 60. 5. The implementation of health maintaining interventions for men appears problematic. 75% of women attended at least once in 1994, compared to only 64% of men (higher, p-value <0.05). Women attended much more (83%) during their child-bearing and child-rearing age. They visited more often, 3.9 visits/year compared to 2.9/year for men (higher, p-value< 0.05). During child-rearing age, the rate was 4.7 for women. While women attend for health maintenance (e.g. breast examinations, Pap smears, and contraception), there are no significant gender specific interventions for men. 6. 19% of men never had their B.P. taken, compared to only 8% of women (higher, p-value < 0.05). Using logistic regression analysis, both age and sex were highly significant (p-value < 0.0001). In the previous five years, at age 20, 54% of men and 18% of women, did not have their B.P. taken. 7. In the previous year only 44% of the practice had their B.P. taken (within two years: 61%; and five years: 80%). The clinic's 44% coverage for B.P. readings is lower than the 70-75% reported by others.29,32,33 Dunn reported that 83% of patients who visited their doctor in two years had their B.P. taken.34 8. While 82% of Canadians reported visiting a G.P. in the previous year, 70% of the S.F.H.C.'s patients visited in a year.22 There is a turnover of 84% in two years and 96% in five years. Therefore in general, opportunistic interventions could be run at two or five year cycles (coverage of 84% and 96% respectively). 9. 70% of patients used 100% of the services (visits) in a 1994. 27% of patients accounted for 70% of all visits to the S.F.H.C. 10. Recommendations are made to improve both provider and patient compliance. A Hypertension Flow Chart with accompanying management protocols derived from the Canadian Consensus on Hypertension Management 1984-1992, and a Coronary Artery Disease Risk Prediction Chart, are provided.25 It is an accessible up-to-date instrument for consistent and effective management. Family physicians are in the best possible position for on-going population surveillance, opportunistic intervention, early diagnosis, and management of hypertension. / Thesis / Master of Science (MS)

An educational module, based on evidence-based practice (EBP) guidelines by the 8th Joint National Committee (JNC 8) and the American College of Cardiology (ACC), was created and implemented to determine if its implementation would impact the knowledge of clinic staff regarding current EBP guidelines about self-management of hypertension (HTN). The module has the potential to contribute to the resolution of patient noncompliance on HTN treatment and management by increasing nursing staff proficiency in knowledge transfer to patients on effective self-management of their health condition. The creation of the module was guided by the concept of need or asset assessment and the theory of planned behavior. The module was composed of 2 short lecture presentations on HTN, current EBP guidelines on lifestyle modifications, and proper blood pressure measurement. The module also included pre- and postlecture surveys to evaluate knowledge and practices of staff, and reiterated the current guidelines and approaches presented in the lectures. Survey data were analyzed using McNemar’s test for paired and binary data. Results showed the agreement of all the staff in recognizing the utility of the module in standardizing their knowledge of current EBP guidelines on lifestyle modifications and blood pressure measurement procedures. The results also showed the enhancement of staff proficiency which might lead to efficient education of patients on effective HTN treatment and management protocol. This pathway has the potential to bring about social change by decreasing the incidence of patient noncompliance and improving patient health.

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Hypertension is a chronic non-communicable disease and a major risk factor for cardiovascular diseases, renal malfunction, disability, and premature death. One of the public health recommendations for the management of hypertension is the reduction of sodium/salt intake. There is need to develop and implement new evidence-based theoretical interventions to initiate and sustain behavior change in health education and promotion. Therefore, the quantitative cross-sectional method and design was used to investigate the adequacy of multi-theory model (MTM) constructs for the initiation and the sustenance of low sodium/salt intake behavior in hypertensive Nigerian adults. In addition, the impact of the MTM (initiation) constructs on actual salt/sodium intake was evaluated to validate self-reported behavior. A convenience sample of 149 consenting Nigerian adults with hypertension and of ages 20 to 60 years, self -administered the valid and reliable 39-item MTM instrument. The findings of confirmatory factor analysis showed construct validity of subscales for the initiation and sustenance model. All items loading for the two models were significant, p < 0.001. Multivariate regression analysis revealed 40.6% of the variance in initiating the consumption of low salt diets explained by advantages outweighing disadvantages, behavioral confidence, and changes in physical environment. About 41.8 % of the variance to sustain the intake of low salt diet was explained by emotional transformation, practice for change, and changes in social environment. The results justified the predictive role of MTM and adequacy of its utility to build evidence-based health education programs and interventions to address the health need of people with hypertension and contribute to social change in the country.