الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hypertension is the root cause of many organ failure in human body, so it is a major public health challenge globally and huge problem in both developed and developing countries. It is a leading preventable risk factor for heart disease, stroke, and kidney failure, and is a major contributor to premature death, dementia, disability, and healthcare costs.The global prevalence of hypertension was estimated to be 1.13 billion in 2015 and is expected to be 1.5 billion by 2025. Most human societies have changed from having agrarian diets and active lives to taking fast foods and sedentary habits. Associated with increasing tobacco use, all these changes have led to increase the prevalence of obesity, diabetes, hypertension, cardiovascular diseases (CVD) and dyslipidemia.
Aim of the study:
The study was conducted to assess hypertension-management behaviors and readiness to change among outpatients attending Alexandria Main University Hospital using the trans theoretical model and to examine relationships between the stages of change of hypertension management behaviors, other constructs of transtheoretical model and some socio- demographic factors.
Target population and study sampling:
To achieve the aim, a Cross-sectional descriptive study was performed on a sample of 380 of hypertensive adult patients who were attending the internal medicine clinic in Alexandria Main University Hospital. A systemic random sample was selected based on the hypothetical assumption that average rate of staying and maintaining healthy behavior = 55.5% with precision of 5% at 95% confidence level.
Tools of the study:
A structured interview questionnaire was used to collect data about:
Socio demographic data.
Health related data.
Assessment of smoking, physical activity, weight control, adherence to medications, follow up and stress management behaviors.
Assessment of stage of change of smoking, physical activity, weight control, adherence to medications, follow up behaviors.
Assessment of processes of change, decisional balance and self-efficacy of physical activity and weight control behaviors.
Results:
The results of the present study can be summarized as follows:
a. Sociodemographics:
About two fifths (37.4 %) of studied sample were aged 65 years or more, 58.7% were males and about one third of them (33.9%) were illiterate. As regard socioeconomic level, more than half of sample (54.7%) was belonging to moderate socioeconomic level.
b. Health related data:
More than half of sample (56.8%) was obese while only 10.3% had normal weight. About two thirds of the samples (63.9%) were uncontrolled, more than the half of sample (56.6%) had the disease since less than 10 years and only 12.1% had the disease for 20 years or more. Cardio vascular complications were the most frequent self-reported complications about 27.4% of the sample suffered from them.
c. Assessment of the behaviors:
More than two thirds of the sample (68.7%) were nonsmokers, 13.7% of them were ex-smokers and the current smokers represented about 17.6%. Regarding physical exercising more than half of sample (58.2%) is not active, one third of the sample (33.7%) was walking at least 150 minutes per week and about 13.4% practiced at least 150 minutes moderate activity but only 3.2% did at least 75 minutes vigorous activity. About two thirds of the sample (61.9%) followed moderately healthy pattern while the majority of the sample (83.9%) were good adherent to medications. As regard follow up and stress management behaviors the main percent (47.6%, 56.3%) belonged to the poor categories respectively.
d. Assessment of stage of change:
Regarding smoking behavior, the highest percent (43.6%) were in maintenance stage and about one third of them (33.6%) were in pre contemplation stage. The remaining behaviors showed that the majority of the sample was in pre contemplation stage except in adherence to medication behavior the majority was in maintenance stage.
e. Decisional balance:
About one half of the patients (46.1%, 48.4%) had high pros and low cons of physical exercising respectively. It was also found in weight management behavior (55.3%, 45.8%).
f. Self-efficacy:
The highest percent of the sample had low self-efficacy to do regular physical activity and manage their weight (50.8%, 40%) respectively.
g. Relation between stage of change and other constructs of the theory and some socio demographic factors:
It was found that there were significant relation between gender, educational level and stage of change of both behaviors( physical activity& weight management). Also other constructs of the theory were significantly associated with the stage of change.
Based on the findings of the present study many recommendations are suggested and summarized as follows:
• Management of hypertension needs multidisciplinary approach with greater involvement of patients in managing their conditions. It should be adopted to promote better adherence to prescribed medication regime and healthy lifestyle. Firstly individuals’ self-care activities in addition to medication adherence should be assessed followed byeducational sessions.
• Improve physicians counseling skills and education of nursesto teach patients about hypertension, medication adherence and healthy lifestyle behaviors.
• The policy makers need to focus on community level intervention through integration with the open door health extension program.