| BackgroundThe prevention and treatment of hypertension have been an important public health issue of rural area in the underdeveloped regions. And the hypertension control is affected by various aspects of complicated biologic-psychological-social factors, which mainly come from patients, medical staff and health administrators. The standardized intervention protocol for hypertension factor(SIPHF) is theoretically regarded as a feasible method to address the hypertension issue in rural area of China, which include the early identification of patients, the stratification and evaluation of the patients based the related guidelines, pharmacy therapy and non-pharmacy intervention to patients by follow-up. In practice, evidence from home and abroad shows that the SIPHF plays an important role in improving the healthy status of patients, modifying their unhealthy life style, enhancing their control rate. However, most of researches on SIPHI are conducted in the developed communities of rural and urban area, but have not been carried out in rural area of the underdeveloped rural regions in China.Objectives1.To identify the modified risk factors that affecting the effect of SIPHF in the underdeveloped rural area.2.To design and implement the SIPHF according to the local status of health resources based on the risk factors related to the intervention effect.3.To evaluate the intervention effect of SIPHF, including the indicators on the knowledge, belief and behavior related to hypertension intervention.4.To evaluate the overall intervention effect of SIPHF, including disease burden, clinical outcome, life quality and patients' satisfaction.5.To comprehensively analyze the affecting factors on intervention effect, in order to provide evidence-based suggestions for SIPHF improvement and policy-making in the underdeveloped rural area of China.MethodsMinqin County in Gansu Province was selected as the experimental field, and clinical trial was conducted for the whole process of research design. Firstly, based on literature review and qualitative surveys, the modified risk factors that affecting the effect of hypertension management in the underdeveloped rural area were identified, the specific questionnaire and SIPHF were developed, and the first cross-sectional study was conducted. Secondly, the surveyed population were then divided into intervention group and control group, and periodic health education and following up were conducted to the intervention group for six months; Thirdly, the second cross-sectional study was conducted to evaluate the effect of intervention by qualitative and quantitative survey, the indicators include the knowledge awareness rate and the right belief rate for hypertension control, and the behavior prevalence related to hypertension intervention, the disease burden, the life quality and clinical outcomes resulted from hypertension, the dynamic tendency of blood pressure and the patients' satisfaction. And the factors related to the effect of hypertension management was evaluated; Finally, SWOT analysis was conducted to evaluate the factors affecting the intervention process and effect, based on the results of qualitative and quantitative surveys on the factors related to effect of the intervention, and to provide evidence-based suggestions for SIPHF improvement and policy-making in the underdeveloped rural area in China.ResultsAfter disequilibrium of baseline information was modified, the statistics tests for information of final survey showed that the intervention group had better awareness than the control group, including the normal blood pressure, the normal salt intake amount each day for an adult, the coronary heart diseases resulting from hypertension, the knowledge related to hypertension prevention and control. The intervention group had better belief than the control group, including measuring blood pressure each year for the person above 35 years old, too much salt intake and other factors leading to hypertension, quitting drug therapy when the pressure becomes normal and the uncomfortable feeling disappears. The intervention group had better behavior prevalence than the control group, including measuring blood pressure periodically, drug therapy compliance, reasonable diet and mental balance, controlling weight, quitting smoking, restricting drinking, and the score of drug compliance, psychological health status and life quality. The intervention group had less amount of disease burden than the control group, including the direct medicine cost, days lying-in-bed and unable to work. And the intervention group had higher blood control rate than the control group.During the follow-up period, the tendency of blood pressure of intervention group showed an increasing decline in general, but there is a bit rising during the third and fourth interview. There was no statistical difference between the intervention group and control group for the BMI and Relative Risk of cardiovascular and cerebrovascular events, and 99.28% of the intervention group showed quite satisfaction and satisfaction for the intervention. The qualitative survey among doctors and intervened patients testified authenticity of the above results, but showed there were some other effect achieved, including improving relationship between doctors and patients, the chronic disease management ability of the medical staff.The multi-variable analysis showed such factors related to the control rate, including the score of health belief, the baseline information of systolic pressure, whether being intervened or not, the score of drug compliance and the combined usage of drugs. The factors related to drug compliance including the score of health belief, the type of labor, the intake amount of animal oil, the awareness of side-effect of the drug, the awareness of the names of doctors in charge of following up, whether being intervened or not. The qualitative survey showed there were some other factors related to the effect of intervention, including the economy status of patients, the social and cultural circumstance of patients and human resource of medical staff.ConclusionsThe major contribution of the study include:1.The intervention measures had a significant effect on improving the awareness rate of related knowledge, the right belief rate, and had favorable impact on improving the proportion of measuring blood pressure periodically, the drug compliance, the mental balance, decreasing hard physical labors, but had little impact on the change of smoking, drinking, and various meal intake.2.The intervention measures had significant effect on decreasing the disease burden, improving the quality life and control rate, making the blood pressure decline steadily, but had little impact on the overweight and obesity. All these results showed that the active following up and health education, conducted by medical staff of township hospitals, directed by the SIPHF, can produce significant effect.3.The factors that affecting the control effect and drug compliance in that area were found by qualitative and quantitative surveys, including the health belief, the life style, social-cultural-economic factors of the patients, and the health care service and intervention measures, and the corresponding suggestions were then put forward, based on the identified issues.4.Combined with the effect and related factors summarized in above sections, SWOT analysis was finally conducted to evaluate the strength, weakness, opportunities and threats of developing the intervention for hypertension patients' risk factors in rural area, and the corresponding suggestions for the policy making were then put forward.This study is the first one in China to carry out the SIPHF and effect evaluation for risk factors intervention of hypertension patients, and one series of complete intervention protocol and evaluating indicator system framework was established for SIPHF in the underdeveloped rural area. This study is also the first one in China to analyze the factors attribute to the effect of SIPHF in that area, and the evidence-based suggestions to strengthen the hypertension management in underdeveloped rural area were then put forward.
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