KNOWLEDGE OF HYPERTENSION AMONG ADULTS IN OWERRI SENATORIAL ZONE OF IMO STATE NIGERIA.

Abstract

The study was conducted  to ascertain the knowledge  of hypertension  among adults in  Owerri senatorial  zone  of  Imo  state,  Nigeria.  Eight  specific  objectives  were  formulated  with  eight corresponding research questions and four null-hypotheses were also postulated to guide the study. The descriptive survey research design was used for the study. The population for the study was three hundred and fifty five thousand, four hundred and fifty three adults while the sample for the study consisted  of four  hundred  and  thirty two  adults.  A five  sectioned researcher  designed questionnaire was the instrument for data collection. The instrument was validated by five experts from the Department of Health and Physical Education, University of Nigeria. Split half method using Cronbach Alpha statistic was utilized to establish the internal consistency of the instrument and had a reliability index of .76. Percentages using a slightly modified version of Okafor’s (1997) of Ashur’s (1977) criteria for describing level of knowledge were utilized for answering research questions. Analysis of Variance (ANOVA) and Student t-Test statistic were used to analyze the data obtained and testing of the hypotheses. The results of the study showed that:  adults’ had high level of knowledge regarding the concept of hypertension; there was moderate level of knowledge regarding the signs and symptoms of hypertension among adults; adults’ exhibited  high level of knowledge regarding risk factors of hypertension and there was high level of knowledge regarding preventive  measures  of hypertension.  Adults  aged  35-  45  and  45-55  years  had  high  level  of knowledge of the various dimensions  of hypertension except that of signs and symptoms in which the level of knowledge was moderate level of knowledge according to age. Female adults’ level of knowledge was high for KCH, KRFH and KPMH while that of males were moderate for the same dimensions. Both male and female adults’ level of knowledge for KSSH was moderate.  The level

of knowledge for various dimensions of hypertension KCH, KRFH and KPMH was high for urban adults and moderate for KSSH while it was high for rural adults in KCH, KRFH and moderate in KPMH.  Adults  with  no  formal  education  had  moderate  level  of  knowledge  in  the  various dimensions of hypertension except that of signs and symptoms in which the level of knowledge was low while adults with primary education possessed moderate level of knowledge for KCH and KRFH, and low level of knowledge for KSSH and KPMH. Furthermore, adults with secondary education possessed moderate level of knowledge while  adults with tertiary education possessed high  level  of  knowledge  in  the  various  dimensions  of hypertension.  There  was  significant difference in the level of knowledge of hypertension among adults’ according to age. However, there was significant difference in the level of knowledge of various dimensions of hypertension between male and female adults. There was significant difference on the level of knowledge of various  dimensions  of hypertension  between  urban  and  rural  adults.  There  was  significant difference  in  the  level  of  knowledge  of  hypertension  among  adults  according  to  level  of education.  Based on  the  findings,  recommendations  were made.  Government  and  voluntary health agencies should sponsor intensive enlightenment campaign   through  print  and  electronic media in order to sustain the knowledge level of adults on hypertension and its complications.

Background to the Study

CHAPTER ONE Introduction

Hypertension remains a major global public health challenge that has been identified as the leading  risk  factor  for  cardiovascular  morbidity  and  mortality  (Kearney,  Whelton,  Reynolds, Muntner,  Whelton  &  He,  2004).  It  increases  hardening  of  the  arteries,  thus  predisposing individuals to heart diseases, peripheral vascular diseases, stroke, heart failure and kidney failure. Hypertension is the commonest non-communicable disease in the world and all races are affected with  variable  prevalence.  Castelli  (2004)  explained  that  its  prevalence  is  on  the  increase  in developing countries where adoption of western lifestyle and stress of urbanization, both of which are expected  to increase  morbidity associated  with  unhealthy  lifestyle  are not on the decline. Andreoli, Carpenter, Grigs and Loscalzo (2004) were of the opinion that hypertension produces disruptions in health, disability and death in the adult population worldwide. Ejike, Ezeanyika and Ugwu (2010) stated that hypertension causes one in every eight deaths worldwide, making it the third leading killer disease in the  world. They also estimated that about one billion adults, the world over, had hypertension in the year 2010 and the number is expected to rise to 1.56 billion in the year 2025 if positive  intervention programme is not made. Aram, George, Henry, Williams, Lee,  and  Joseph  (2003)  indicated  that  fifty  million  Americans  have  high  blood  pressure, approximately one in three adults.

In United States of America, approximately twenty eight (28) to thirty one per cent  of adults have hypertension (Fields, Burt & Cutler (2004). Of this population, 90 to 95 per cent have primary hypertension (high blood pressure related to unidentified cause). The remaining five to ten per cent   of this group   have   secondary hypertension (high blood   pressure related to identified cause).   In  China, almost 130 million  people  aged 35-74 years  are estimated to be hypertensive

(Camel & Delene, 2006). Similarly in Ghana, studies revealed a hypertension  prevalence  of  forty per cent among rural dwellers and eight per cent to thirteen per cent in the urban areas. In sub- Saharan Africa, it is the most rapidly rising cardiovascular disease and affecting over 20 million people  (Kadiri,  2005).  He  also  stated  that  in  Nigeria,  hypertension  is  the  commonest  non- communicable disease with over 4.3 million Nigerians above the age of fifteen years classified as being hypertensive.

Hypertension,  also known as high blood pressure  is the persistent  blood pressure in  the

arteries above ninety millimeters of mercury (mmHg) between the heart beats (diastolic) or over

140 millimeters of mercury (mmHg) at the beats (systolic) (Aquilla, 2008). According to Hyman and Parlik (2003),  hypertension  is the persistent  raised  levels of blood pressure  in  which  the systolic pressure is above 140 mmHg and diastolic pressure above 90 mmHg. The normal blood pressure  is below  120/80  mmHg;  blood  pressure  between  120/80  and  139/89  is  called  ‘Pre- hypertension,  and a pressure of 140/90 or above is considered  high (abnormal) blood pressure. According to Expert Committee on Non-Communicable Diseases (1993), blood pressure of 120/80 mmHg is considered  normal for a 30 year old person,  while blood pressure of 140 mmHg is considered  high  for  such a person.  Similarly,  blood  pressure  of 150/90  mmHg  is considered normal for a 60-year old person, while blood pressure of 160/100 mmHg is high for such a person. Hypertension  is  sometimes  called  “the  silent  killer”  because  people  who  have  it  are  often symptom-free.  In this study,  hypertension is perceived as a systolic blood pressure greater than

140 mmHg and a diastolic blood pressure greater than 90 mmHg among adults. The top number which is the systolic pressure corresponds to the pressure in the arteries as the heart contracts and pumps  blood  forward  into  the  arteries.  The  bottom  number  which  is  the  diastolic  pressure represents the pressure in the arteries as the heart relaxes after contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed. Blood pressure is normally measured at the brachial artery with a sphygmomanometer (pressure cuff) in millimeters of mercury (mmhg) and given as systolic over diastolic pressure. Hypertension is classified into two namely; primary and secondary hypertension.

According  to  Stanler  (2004),  hypertension  is  categorized  into  primary  and  secondary hypertension.  Primary hypertension  has an unknown cause and accounts for  ninety per cent to ninety five per cent of all hypertension cases (Chris, 2009). This type of hypertension is strongly associated  with lifestyle. Usually, the patients do not have many signs and symptoms but may experience  frequent  headache,  tiredness,  dizziness  or  nose  bleeds.  Although  the  cause  is  not known,  obesity,  smoking,  alcohol,  diet  and  heredity  play  a  role  in  essential  or  primary hypertension.

Secondary hypertension has a known cause and accounts for five per cent to ten per cent of all hypertension  cases. Chris (2009) maintained  that the most common cause of  secondary

hypertension is an abnormality in the arteries supplying blood to the kidneys. Other causes include airway obstruction during sleep, stress, diseases and tumors of the adrenal glands, lifestyle, spinal cord  injury,  hormone  abnormalities  (oral contraceptive  estrogen  replacement),  thyroid  disease, toxemia  of  pregnancy,   renal  problems  such  as  vascular   lesion  of  renal  arteries,  diabetic neuropathy, pains as well as anxiety and hypoglycemia. There are some factors which predispose adults to hypertension.

The risk factors of hypertension are genetic factor which can be inherited from parents,

age which when the body does not retain the amount of elasticity as it used to in the early years of life, obesity which is an increase in weight of over ten per cent above normal body index due to generalized  deposition of fat in the body, excessive salt intake which increases  blood pressure, stress   which   produces   chemical   substances   that   cause   generalized   vasoconstriction,   oral contraceptive  which contains  estrogen that causes  salt retention  that    increases  the volume of blood, sedentary lifestyle which has the tendency of increasing body weight and directly raises blood  pressure,  elevated  levels  of  plasma  lipids  particularly  cholesterol,  excessive  alcohol consumption which increases blood pressure  and  tobacco use (cigarette smoking)  that contains nicotine which causes constriction of the blood vessels.

The signs and symptoms of hypertension recognized by Thatch and Schultz (2004) include occipital headache, dizziness, restlessness, failing vision, shortness of breath, and rapid increased heartbeat. Adults should possess the knowledge of risk factors in order to prevent hypertension. This will help them recognize and prevent or treat hypertension when these signs occur.

Knowledge  is  used  to  cover  such  related  terms  as  facts,  information,  understanding, awareness, insight, wisdom, reasons, comprehension, meaning, concept and experience (Albelum,

1987). It is an organized  body of knowledge  shared  by people.  Nnachi (2007)  conceptualized knowledge  as the ability to understand  or comprehend  phenomena,  the  acquisition of positive information by the exercise of some capacity which humans presumably have in common. Health knowledge could be said to mean putting into reality the art of mobilization of resources by an individual,  intellectually,  physically and  emotionally.  Hamburg and Russell (2000) opined that health knowledge  and understanding  of related  factors  have  a favourable  effect  on quality of overall well-being. They went further to state that one’s exposure to proper health knowledge will influence positively the person’s health attitude and practice, and thus, one could rightly say that knowledge is the  key to optimum well-being. Umaru (2003) pointed out that knowledge comes about as a result of learning through cognitive, affective and psychomotor domains. In this study, knowledge is referred to as all understanding and familiarity gained by learning and experience that will enable adults to recognize  risk factors as well as recognizing  and use  of preventive measures  of  hypertension.  Knowledge  of  hypertension  is  an  important  prerequisite  for  an individual  to  implement  desirable  behavioural  practices  towards  its  prevention.  Lack  of such

knowledge  will lead to aggravated  health problems.  Adults should therefore,  possess  adequate knowledge of risk factors of hypertension in order to prevent the disease.

Risk factors are defined by Lothar, Gottfried and Heide (2011) as individual characteristics which affect the person’s chances of developing a particular disease or group of diseases within a defined future time period. According to Lucas and Gilles (2003), risk factor is anything that has been  identified  as  increasing  an  individual’s  chances  of  getting  a  disease  or  developing  a condition. They will be considered to be at risk of developing hypertension, those with habits or characteristics which increase the likelihood of developing hypertension. Risk factors in this study, refers to the characteristics, conditions or behaviors such as excess salt intake and smoking which increase the probability of hypertension to occur. When risk factors are related to hypertension, they are known as risk factors of hypertension. Risk factors of hypertension are of two types: those ones that can be changed and those that cannot be changed. The risk factors that can be changed are  obesity,  excess  salt  intake,  smoking,  environmental  stress,  oral  contraceptives,  sedentary lifestyle,  elevated levels of plasma lipids and unregulated secretion of aldosterone. Risk factors that cannot be changed are genetic predisposition,  age and gender.  Adults should have adequate knowledge of the risk factors to be able to prevent hypertension.

Preventive measures are interventions directed to avert the emergence of specific disease, reducing their incidence and prevalence in population. Starfield, Hyde, and Gervas (2007) defined preventive measures as all measures that limit the progression of a disease  at any stage of its course. In this study, preventive measures is referred to as all the activities whose primary purpose is  to  promote,  restore  and  maintain  health,  and  those  practices  which  are  directed  towards preventing hypertension among adults. There are two types of preventive measures; primary and secondary. Primary prevention is the intervention that averts the occurrence of a disease or actions taken prior to the onset of disease which removes  the  possibility that a disease  will occur. It signifies  intervention  in the pre-pathogenesis  phase  of a disease or health problem.  It may be accomplished by measures designed to promote general health and well-being, and quality of life of adults (health promotion) or by specific  protective measures (specific protection). Secondary prevention is action which slows the progression of a disease at its incipient stage and prevents complication. Salama (2011) opined that the specific intervention in secondary prevention is early detection of hypertension which involves screening test. It attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place especially among adults.

Adulthood is the longest period of a man’s life. Hornby (2001) defined an adult as a person who has grown to full size or strength, intellectually and emotionally mature, and legally a person old enough to vote or marry. Ebiringa and Nwagbo (1997) defined an adult as someone who has reached the age of maturity, who covers his nakedness, who lives on his own, who can answer a

village call and who is taxable.  They went further  to state that an adult is someone who  has developed a sense of perspective, more balanced in thinking, and is responsible for his own actions and that of others. Samuel (2006) defined  adulthood  as the period whereby an  individual  has acquired all the adolescent developmental tasks, reached accepted age bracket and is responsible for his actions without parental or social restrictions. Samuel (2006) also categorized adults into three stages; young adulthood (21- 40), middle adulthood (41-65) and older adulthood (65 years and above). Young adulthood which commences at around 21 to 40 years is the period when full physical fitness is generally experienced. It is a stage of critical transition. Adults in this age group are filled with vitality and enthusiasm. Middle adults falls within the ages of 41 to 65 years which is a period of pleasant plateau (Ejifugha, 2003). Adults within this group are at a stage of physical and psychological development.  Adults in this group tend to eat too much and may fail to take regular exercise. Many are  overweight and actually obese. Psychological stress causes adults in this group to smoke,  drink and abuse drugs. Older adults are between the ages of 65 years and above.  The  factors  in  ageing  set  in  to  influence  the  individual  gradually  which  may  cause cardiovascular diseases like hypertension. In this study, an adult is referred to as an individual who has reached the age of maturity and falls within the age bracket of thirty five years and above.

There  are  many variables  that may impinge  on knowledge  of hypertension.  Literature shows that studies on knowledge  of hypertension  examined  socio-demographic  factors of age, race, level of education, parity, gender, income, location, occupation and marital status (Hamdan, Saeed,  Kutbi,  Choudhry  &  Nooh,  2010).  However   the  present   study  is  concerned   with demographic factors of age, gender, location, and level of education.

Age has been identified as a strong factor that that can limit the ability of adults to acquire adequate knowledge of hypertension. Age determines growth, development, maturity and death. Age brings about maturity and maturity puts one in a position to rationalize, concretize, accept or reject concept, information,  habit, attitude and practice (Ejifugha,  2003). It is believed that the more one add years to life, the more knowledge he acquires and the more exposed to situations that  can  cause  health problems  including  hypertension.  Adults  because  of their  exposure  and experience must have come to understand the concept of hypertension, signs and symptoms, risk factors and preventive measures of hypertension and because of lack of exposure or experience may not adequately acquire the knowledge of diseases (Bagunyoke, 2003) such as hypertension.

Gender  has  influence  on knowledge  of  hypertension.  Akinkugbe  (2003)  observed  that women  have  more  hypertension   than  men.  However,   after  menopause,   the   incidence  of hypertension due to arteriosclerosis  in women rapidly increases than in men  and even become higher in old age. From adolescence through 54 years, men have a much greater risk of developing hypertension  compared  with women of the same  age. The  reverse  is the case after 54  years.

Women then are seen to have more incidence of hypertension due to the disappearance of female stronger hormone that provides protective effect against hypertension.

Location is an environmental factor which may limit the ability of adults to seek adequate knowledge  of hypertension.  Hamdan,  Saeed, Kutbi, Choudhry and Nooh (2010) indicated  that hypertension was significantly associated with age, gender, geographical location. Similarly, Lech and Piotr (2009), stated that hypertension was more frequently diagnosed among rural than urban adults. The adults in urban areas have more opportunities and access to attend seminars, health talks, workshops  and medical check ups on  hypertension  (accessibility  to health information). Unfortunately, those in the rural areas may not have such opportunities as such programmes may not exist in the rural areas. These programmes are in most cases accessible to a smaller privileged group in the society, who are living in well developed towns, at the expense of greater majority who wallow up in diseases and ignorance in rural areas.

Studies have indicated that level of education is associated with knowledge, which may include the risk factors and preventive measures of hypertension. According to  Hamdan, Saeed, Kutbi, Choudhry and Nooh (2010) observed that adults who were more knowledgeable adopted positive  lifestyles,  while  the  iliterate  adults  adopted  unhealthy   lifestyles.  The  higher  the educational attainment, the higher the acquisition of knowledge, attitude and behaviour, while the lower the level of education, the lower increase in knowing risk factors and prevention measures of hypertension. Similarly, Myo, Thaworn, Janthila, Nongluk  ,  Suchart  ,  Wilawan  ,  Phatchanan  , Puangpet,  Nara  , and  Apiradee (2012) reported  that those with primary school education were likely to be aware of hypertension than those who did not have primary school education. The variables of age, gender, location and level of education were examined in the study. Knowledge of hypertension by adults will surely influence their health behaviour. Therefore, some behaviour change theories will be applied to explain knowledge of hypertension.

This study was anchored on three theories. These are the critical knowledge theory, health belief model, theory of reasoned action. According to Diagnam (1992), Critical knowledge theory states that when an individual  is ignorant  or holds a belief  about  a  health matter, the health educator attempts to change or ascertain the individual’s level of knowledge towards the health matter or concept through questioning the respondent.

The health belief model has its focus on explaining and predicting preventive health behaviour  by focusing  on  the  attitudes  and  beliefs  of  individuals  (Rosenstock,  Strecher  and Beckar, 1999). This is useful because the model examined the perceptions, beliefs and behaviours of adults and to provide information on the lifestyle practices related to preventing hypertension. Adults who believe that certain lifestyles such as excess salt intake and inactivity can predispose them to hypertension will achieve good health by avoiding such lifestyles.

Theory  of  reasoned  action  show  how  attitude  impacts  on behaviours.  It  states  that  a person’s attitude towards a particular behaviour is influenced by belief outcome of the behavior. Adults  who  develop  positive  attitude  towards  high  salt  intake,  excess  alcohol  and  inactivity consumption  are  likely  going  to  develop  hypertension;  conversely,  those  who  have  negative attitude may not get hypertension.  The study was carried out in Owerri Senatorial Zone of Imo

State.

Owerri senatorial zone is in Imo state located in the South Eastern part of Nigeria.  The senatorial zone covers around 1,700sqkm and shares common boundaries with Abia State by the east, and Rivers State by the south. It also shares common boundaries with Ohaji Egbema, Orlu, Obowo, Ihitte-Uboma, and Mbano local government areas all of which are in Orlu and Okigwe zones of Imo State. There are nine local government areas which make up Owerri Senatorial Zone (see Appendix A). The inhabitants are engaged in agriculture, businesses and civil service works. These activities occupy much of their time with little or no time left for them to have rest and take care of their health, and they undergo lots of stress which can lead to hypertension. Furthermore, there are places which serve as tourist attractions in the zone such as Mbari exhibition centre, Imo Concorde hotel and lots of hotels and guest houses where people come for relaxation. These places expose adults to excessive alcohol consumption. Owerri Municipal which is the major urban area is cosmopolitan being the Imo State Capital and commercial nerve centre. These activities made the location to qualify for the study.

Hypertension has been shown to have series of consequences, and adequate knowledge of risk factors can help in the prevention of hypertension. Therefore, adults in Owerri Senatorial Zone need to have the knowledge of hypertension to reduce the prevalence  of  hypertension disease, improve health and optimum well-being. But it is likely that adults in the area may or may not have adequate knowledge  of hypertension.  Evidence  regarding  the  knowledge  of hypertension does not seem to exist. Therefore, this study on knowledge of hypertension becomes necessary.

Despite effective therapies and lifestyle interventions, optimal prevention of hypertension remains very health challenge to health professionals especially in most developing countries like Nigeria. Kadiri (2005) noted that 4.3 million Nigerians are suffering from this silent killer disease called hypertension. The inability to adequately prevent or manage hypertension in Nigeria can be attributed to inadequate knowledge of hypertension. Thus reaching the healthy people vision 2020 objective  may be difficult  if necessary actions  are not taken to prevent this disease.  If health promotion programmes  are to be  appropriate  and effective, adults’  knowledge  of hypertension need to be identified. Therefore, the researcher was motivated to determine the level of knowledge of hypertension possessed by adults in Owerri senatorial zone of Imo state. This became necessary against the backdrop that identification of gaps in adults’ knowledge of hypertension is capable of aiding the development of adequate information to enhance the knowledge of hypertension.

Statement of the Problem

It  is  expected  that  adults  should  practice  healthy  lifestyles  such  as  regular  exercise, maintaining weight at 15 per cent or less of desirable weight, management of stress, moderation of alcohol consumption,  avoidance of   tobacco smoking, increase intake of  fruits  and vegetables, increase  intake  of  low-fat  diary  products  and  reduction  of  excessive  salt  intake  to  prevent hypertension  and  improve  optimum  wellbeing.  Adults  should  have basic  knowledge  of these healthy lifestyle  behaviours  while  growing up  through  health education  to be able to prevent cardiovascular diseases such as hypertension.

Regrettably,  most  adults  due  to  ignorance  of  risk  factors  and  preventive  measures  of hypertension engage in unhealthy lifestyles such as excessive consumption of alcohol, sedentary lifestyle, excess consumption of sodium intake, tobacco and cigarette smoking, obesity, reduced intake  of  fruits  and  vegetables,  stress  and  consumption  of  foods  rich  in  cholesterol.  These unhealthy lifestyle practices have increased the prevalence of hypertension in the world including Nigeria,  which  culminates  into  high  cases  of  deaths.    Hypertension  is  one  of  the  problems affecting especially a great portion of the adult population and currently causes one in every eight deaths worldwide, making it the third  leading killer disease in the world. Ejike, Ezeanyika and Ugwu (2010) estimated that about one billion adults had hypertension in the year 2010, and the number  is  expected  to  rise  to  1.56  billion  in  the  year  2025.  In addition, hypertension is the commonest non-communicable  disease in Nigeria with  over  4.3  million  Nigerians  classified  as being  hypertensive.  In Nigeria,  many people  lose  their  lives  to  hypertension.  This  is  not  an acceptable  situation,  considering  the  fact  that  hypertension  is preventable  and  manageable  to reduce its impact on the health and lives of people in Nigeria.

However, some studies have been conducted on the knowledge of hypertension in many parts of the world including Nigeria. The literature reviewed  showed  that related  studies were conducted among pregnant women, workers in banking industry, hypertensive  patients, primary care patients, urban elderly and in rural communities, and in different countries. Incidentally, there are no  studies,  to the best knowledge  of the researcher  that  have been carried  out in Owerri Senatorial Zone of Imo state to determine the level of knowledge of hypertension among adults. In view of the above, the need arose to determine if adults in Owerri senatorial zone of Imo state have adequate knowledge of hypertension. This was the task of the present study.

Purpose of the Study

The  purpose  of  the  study  was  to  determine  the  level  of  knowledge  of  hypertension possessed by adults in Owerri Senatorial Zone of Imo State. Specifically,  the  study was set to determine the level of knowledge of:

1.         concept of hypertension possessed by adults;

2.         signs and symptoms of hypertension possessed by adults;

3.         risk factors of hypertension possessed by adults;

4.         preventive measures of hypertension possessed by adults;

5.         hypertension possessed by adults according to age;

6.         hypertension possessed by adults according to gender;

7.         hypertension possessed by adults according to location;

8.         hypertension possessed by adults according to level of education;

Research Questions

The following research questions were posed to guide the study.

1.    What is the level of knowledge of concept of hypertension possessed by adults?

2.    What  is  the  level  of  knowledge  of  signs  and  symptoms  of  hypertension  possessed  by adults?

3.    What is the level of knowledge of risk factors of hypertension possessed by adults?

4.    What  is  the  level  of  knowledge  of  preventive  measures  of  hypertension  possessed  by adults?

5.    What is the level of knowledge of hypertension possessed by adults according to age?

6.    What  is  the  level  of  knowledge  of  hypertension  possessed  by adults  according  to gender?

7.    What  is  the  level  of  knowledge  of  hypertension  possessed  by adults  according  to location?

8.   What is the  level of knowledge  of hypertension  possessed  by adults according  to  level of education?

Hypotheses

The following null hypotheses postulated guided the study and were tested at .05 level of significance.

1.        There is no significant difference in the level of knowledge of hypertension among adults based on age.

2.        There is no significant difference in the level of knowledge of hypertension between male and female adults.

3.        There is no significant difference in the level of knowledge of hypertension between urban and rural adults.

4.        There is no significant difference in the level of knowledge of hypertension possessed by adults according to level of education.

Significance of the Study

The results  of this study may be useful to  health  educators,  medical  and  paramedical officers,  public  health officers,  counselors,  media  educators,  researchers,  curriculum  planners, government and adults in many ways. The study may help to develop a positive regard towards hypertension.  The  ministry  of  health  may  benefit  from  the  study  by  discovering  a  gap  in knowledge of the population, and emphasize strategies to  teach the adult population on how to prevent the risk factors. It may also be useful to other researchers to carry out this study in areas where disease prevention measures and health promotion are needed with regards to hypertension.

The anticipated results from the study of knowledge of signs and symptoms of hypertension will generate  new knowledge relating to the effectiveness of health education  and intervention programmes to improve the knowledge of signs and symptoms associated with hypertension for adults. It may likely be useful to health educators on the need to create awareness on the signs and symptoms of hypertension.

The results generated from the study on knowledge of risk factors of hypertension revealed those risk factors that have been in existence over the years, which have been predisposing people to hypertension.  The results  may be useful to health educators,  media  educators  and medical officers in sensitizing community members through awareness campaigns in the form of seminar to alert people on the risk factors of hypertension.

The results generated from the study on knowledge of preventive measures of hypertension revealed  the preventive  measures that may promote health and well-being.  The  results may be useful  to  health  educators,  medical  and  paramedical  officers  and  centre  for  disease  control agencies  in  organizing  orientation  endeavours  to  raise  level  of  awareness  of  the  masses  on measures of preventing hypertension. The health and allied  educators may use the results of the study to educate adults and encourage them to practice healthy lifestyles that will promote their health and be conscious of their health.   The results may be useful to health care providers and health educators who may want to embark on  further  enlightenment  campaigns on preventive measures of hypertension and also plan hypertension intervention programmes.

The results generated from the study on the knowledge of hypertension according to age revealed those measures that will help in the prevention of hypertension for various age groups. It may be useful to health educators, individuals, media and administrators in creating awareness on the preventive measures of hypertension to the various age groups that will be  mostly affected. The health educators may direct their teachings to the age group that is negatively affected by risk factors of hypertension. The results of the study may also provide useful information needed by health  administrators  in planning  appropriate  intervention  against  the  increasing  trend  of  the disease in the society. It may serve as a reminder to individuals on the possible measures for the

prevention  of  hypertension.  Health  and  allied  educators  may  find  the  results  of  this  study beneficial, and they will be armed with adequate information on how to prevent hypertension for different segments of the population.

The anticipated results that will be generated from this study will reveal data on knowledge of hypertension among male and female adults. Health counselors may utilize  the results of the study to counsel the segment of adults that are affected by undesirable knowledge and practices, and encourage segments of adults that engage in healthy lifestyles. Public health educators may use the results of the study to organize seminars and workshops to give the correct information in order to  encourage  positive  lifestyles  to improve  health  and well-being  of adults that will be mostly affected.

The  anticipated  results  to  be  generated  from  this  study  will  reveal  knowledge   of hypertension between urban and rural adults. The results may be useful to health educators, Centre for  disease  control,  health  administrators   and  health  related  organizations.   Health   related organizations will encouraged to introduce hypertension campaigns in both urban and rural areas. This will go a long way to enlighten  the populace  generally on  hypertension  disease.  Health educators may be better armed to conduct group discussions with the segment of the population that persistently practice negative lifestyles. Health administrators and centre for disease control may use the results of the study to teach and plan preventive strategies for the affected segment of the adults to improve on positive healthy lifestyles for optimum health and well-being. The result may  likely motivate  health  related  organizations  in providing  basic  needs  that  will motivate healthy living and prevent cases of diseases.

The results generated from the study revealed knowledge of hypertension of among adults based on level of education. The results may likely be useful to health educators, federal ministry of health, counselors, ministry of information and curriculum planners. Health educators may find the results of this study useful in teaching  the literate and illiterate  adults on how to prevent hypertension and other cardiovascular diseases. They may also organize health talks and seminars for adults to adopt healthy lifestyles. It may likely guide the federal ministry of health in policy formulation  and decisions.  The information  generated  from this study may likely be useful to ministry of Information in disseminating health information and policies for the prevention, early detection  and  prevention  of  hypertension.  The  counselors  may use  the result  of the  study to counsel illiterate adults on why they should adopt healthy preventive measures of hypertension. Similarly  curriculum  planners  may also  find  the data useful in incorporating  some aspects of information on the methods of preventing the disease in the academic curriculum at various levels. The results  may be useful  to  health educators  and  administration.  They will use it  to  mount hypertension intervention programmes in order to help the less educated adults to adopt positive

healthy  lifestyles;  and  the  educated  will be encouraged  to  continue  with  those  lifestyles  that promotes health.

The study is significant  in the sense that some theories such as the critical  knowledge theory, the health belief model, theory of reasoned  action, which was reviewed  to investigate knowledge of hypertension. It is assumed that adults will achieve better health if their knowledge of  hypertension  will  be  taken  into  consideration.  Adults’  motive  of  knowing,  adopting  and maintaining  health behaviour  as key issues  that  relate  to  knowledge of hypertension  requires behavioural change in achieving its goals. Reviewing the theories or models of health behaviour in explaining the process of behavioural change may be used to identify an appropriate model to guide the present research. These theories  were  anchored  whereby the result of the study was intended to help to verify the relevance of those theories with regard to knowledge of hypertension among adults in Owerri senatorial zone of Imo state, Nigeria.

Scope of the Study

The study covered all the local government areas in Owerri Senatorial Zone of Imo State. There were nine (9) local government areas in the senatorial zone. The study was  restricted to adults between the ages of thirty five years and above, and who were found within the urban and rural areas. The study was concerned with determining the level of knowledge of hypertension among adults. This consisted of the concept of hypertension, signs and symptoms, risk factors and preventive measures of hypertension. The demographic factors of age, gender, location and level of education as they relate to knowledge of hypertension were all explained.

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