Adherence to Self-Care Practices and Associated Factors among Patients Diagnosed with Hypertension Visiting the Medical Outpatient Clinic at Kenyatta National Hospital DOI: https://dx.doi.org/10.4314/ajhs.v38i1.9

Abstract

Background: Self-care practices in hypertension describe proactive behaviours undertaken by patients to manage their condition and prevent complications. These include medication adherence, dietary changes, such as low-sodium intake and adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, regular physical activity, weight control, alcohol moderation, and smoking cessation. This study assessed adherence to self-care practices and associated factors among hypertensive patients attending the medical outpatient clinic at Kenyatta National Hospital (KNH), Kenya's largest national referral hospital.

Methodology: A hospital-based analytical cross-sectional study was conducted among 167 adult patients receiving antihypertensive treatment at KNH. Systematic random sampling was used, where every third eligible patient was selected after the first was chosen via lottery. Data were collected using an interviewer-administered structured questionnaire incorporating the validated Hypertension Self-Care Activity Level Effect (H-SCALE) and Hypertension Evaluation of Lifestyle and Management (HELM) scale. Data analysis was done using SPSS version 26. Descriptive statistics and binary logistic regression were used to determine associations between independent variables and self-care adherence.

Results: The mean age of participants was 43.4 years (SD±6.1). Only 34.7% demonstrated good adherence to self-care practices, while 65.3% had poor adherence. Among individual behaviours, smoking cessation had the highest adherence (92.7%), followed by medication adherence (86.5%) and alcohol moderation (57.8%). Lower adherence was observed for weight management (30.9%), physical activity (27.3%), and low-salt diet (15.1%). Sociodemographic characteristics were not significantly associated with self-care adherence. However, participants with good knowledge of hypertension were significantly more likely to adhere to self-care practices (OR = 3.20, 95% CI: 1.64–6.24, p = 0.001), indicating that knowledge is a key independent predictor.

Conclusion and Recommendations: Adherence to self-care among hypertensive patients remains low, especially in dietary salt reduction and physical activity. While sociodemographic factors were not significant, adequate knowledge of hypertension markedly improved self-care adherence. This underscores the importance of structured, culturally sensitive health education in outpatient settings. Programmes should focus on diet and physical activity, use interactive approaches, and involve family support to sustain long-term behavioural change.