Association Between the Improvement of Knowledge, Attitude and Practice of Hypertension Prevention and Blood Pressure Control-A Cluster Randomized Controlled Study

Abstract

Background Hypertension-related knowledge, attitude and practice (KAP) of hypertensive patients can affect the awareness, treatment and control of hypertension. However, little attention has been paid to the association between the change of hypertension preventive KAP and blood pressure (BP) control in occupational population using longitudinal data. We assess the effectiveness of a workplace-based multicomponent hypertension intervention program on improving the level of KAP of hypertension prevention, and the association between improvement in KAP and BP control during intervention. Methods From January 2013 to December 2014, workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20) using a cluster randomized control method. All employees in each workplace were asked to complete a cross-sectional survey to screen for hypertension patients. Hypertension patients in the intervention group were given a 2-year workplace-based multicomponent hypertension intervention for BP control. The level of hypertension prevention KAP and BP were assessed before and after intervention in the two groups. Results Overall, 3331 participants (2658 in the intervention group and 673 in the control group) were included (mean [standard deviation] age, 46.2 [7.7] years; 2723 men [81.7%]). After 2-year intervention, the KAP qualified rate was 63.2% in the intervention groups and 50.1% in the control groups (odds ratio = 1.65, 95% CI, 1.36∼2.00, P < .001). Compared with the control group decreased in the qualified rate of each item of hypertension preventive KAP questionnaire, all the items in the intervention group increased to different degrees. The increase of KAP score was associated with the decrease of BP level after intervention. For 1 point increase in KAP score, systolic blood pressure (SBP) decreased by .28 mmHg and diastolic blood pressure (DBP) decreased by .14 mmHg [SBP: β = -.28, 95%CI: −.48∼-.09, P = .004; DBP: β = −.14, 95%CI: −.26∼-.02, P = .024]. SBP and DBP was significantly in manual labor workers (SBP: β = −.34, 95%CI: −.59∼-.09, P = .008; DBP: β = −.23, 95%CI: −.38∼−.08, P = .003), workers from private enterprise, state-owned enterprise (SOE) (SBP: β = −.40, 95%CI: −.64∼−.16, P = .001; DBP: β = −.21, 95%CI: −.36∼−.06, P = .005) and a workplace with an affiliated hospital (SBP: β = −.31, 95%CI: −.52∼−.11, P = .003; DBP: β = −.16, 95%CI: −.28∼−.03, P = .016). The improvement of knowledge (SBP: β = −.29, 95%CI: −.56∼−.02, P = .038; DBP: β = −.12, 95%CI: −.29∼.05, P = .160), as well as attitude (SBP: β = −.71, 95%CI: −1.25∼−.18, P = .009; DBP: β = .18, 95%CI: −.23∼.59, P = .385) and behavior (SBP: β = −.73, 95%CI: −1.22∼−.23, P = .004; DBP: β = −.65, 95%CI: −.97∼−.33, P < .001) was gradually strengthened in relation to BP control. Conclusion This study found that workplace-based multicomponent hypertension intervention can effectively improve the level of hypertension preventive KAP among employees, and the improvement of KAP levels were significantly associated with BP control. Trial Registration Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.