Assessment of a Health Promotion Model on Obese Turkish Children.

BACKGROUND: Studies of childhood obesity have shown that fostering healthy life behaviors is more important than losing weight. However, studies reporting this result did not use a theoretical nursing model, which offers a systematic approach and scientific basis for studying the concepts and principles of nursing practice. PURPOSE: The aim of this study was to determine the effects of an intervention that is based on Nola J. Pender's Health Promotion Model (HPM) on the healthy life behaviors and self-confidence of obese children. METHODS: This quasi-experimental study enrolled 86 obese children and their parents (48 in the experimental group and 38 in the control group) as participants. The data collection tool was composed of an adaptation of a Pender's model-based evaluation form and the "Piers-Harris Self Confidence Scale." The experimental group received HPM-based individual and group education, whereas the control group received routine follow-up only. Whereas qualitative data were analyzed using content analysis, quantitative data were analyzed using a paired t test and Mann-Whitney U or Wilcoxon test. RESULTS: At the end of the education and follow-up program, experimental group participants showed a significant increase in healthy eating habits such as noting food portions (Z = 5.231, p < .001) and choosing water instead of sugary drinks (Z = 4.130, p < .001) and spent significantly less time per day in front of a television or computer (Z = 5.085, p < .001). Furthermore, after the intervention, experimental group participants had reduced their total body mass index standard deviation score (Z = 6.031, p < .001) and had an average self-confidence score that differed significantly from the control group (Z = 3.796, p < .001) and that was significantly higher than the average preintervention score (Z = 5.971, p < .01). CONCLUSIONS: Health professionals must recognize the physical, psychological, and social risks of obesity in children and focus on these problems to identify appropriate solutions. It is recommended that education and nursing follow-up programs be developed based on nursing models. This study found that patient education based on Pender's HPM increased healthy life behaviors (e.g., healthy nutrition and increased exercise time) and decreased sedentary activity substantially in the experimental group. This study further suggests that, although Pender's HPM has not been tested on obese children, this model offers effective guidelines for nursing activities that are targeted on developing healthy life behaviors in children.

The assessment of adherence of hypertensive individuals to treatment and lifestyle change recommendations.

OBJECTIVE: Most of studies about adherence in hypertension highlight the adherence to the medical treatment but do not include the adherence to the other recommendations, such as lifestyle modifications. The factors effective on adherence to each type of recommendation may differ. Accordingly, we aimed in this study to show that nonadherence to each recommendation should be assessed individually. METHODS: The study, which was designed as cross-sectional and descriptive, included 150 patients who were followed by the outpatient clinics for at least one year. A data collecting form with 44 questions was prepared by the investigators, and the patient adherence was assessed in five categories: medicine-related adherence, diet-related adherence, exercise-related adherence, measurement-related adherence and smoking related adherence. The face-to-face interview method was used to collect data. Statistical analysis was accomplished by Chi-square test and logistic regression analysis. RESULTS: Of 150 subjects included in the study, 94 (63%) were female and mean age was 56+/- 12 (20-81) years. Mean duration of drug use was 6.5+/- 6.5 years and the mean number of drugs used was 1.6+/- 0.8. The adherence to recommendations of medication, diet, exercise, home-blood measurement and smoking were 72%, 65%, 31% , 63% and 83%, respectively. Each patient was adherent to at least one recommendation, while 11% of patients were adherent to one recommendation, 23% - to two, 29% - to three, 24% - to four and 13% - to five. According to the regression analysis, factors effective on each type of adherence were found to be different from others. The presence of three or more types of adherence was related to income level (OR= 0.297; 95%CI - 0.132-0.666; <0.001) and presence of any other chronic disease (OR=2.329; 95% CI - 1.114-4.859; p=0.002). CONCLUSION: The rates of adherence to medicine and life-style changes were generally found to be low in hypertension. The cause of nonadherence is different according to the type of adherence. Each recommendation should be assessed individually in terms of adherence.