title: Metering Self-Reported Adherence to Clinical Outcomes in Malaysian Patients With Hypertension: Applying the Stages of Change Model to Healthful Behaviors in the CORFIS Study.
abstract: The CORFIS (Community-Based Cardiovascular Risk Factors Intervention Strategies) program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in CORFIS patients with hypertension. Based on submitted diet and exercise records (n = 209), adherence to sodium reduction, regular exercise, and increasing fruit and vegetable intake behaviors were quantified against weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) changes. Patients were categorized at 6 months into nonadherent/N-A (Precontemplation, Contemplation, and Preparation), newly adherent/NA (Action) and totally adherent/TA (Maintenance) groups. Self-reported adherence records did not meet recommended targets for healthful behaviors, but clinical benefits were achieved by adherent groups as indicated by effect size (Cohen's d) comparisons. SBP reduction was associated with adherence to sodium reduction in NA (d = 0.60, p < .001) and TA (d = 0.45, p < .001) compared to N-A (d = 0.13, p > .05). Marginally increasing fruit and vegetable consumption (Δ = 0.41 servings) resulted in sizeable reductions in weight for NA (d = 0.81, p < .001) > TA (d = 0.54, p < .001) > N-A (d = 0.21, p > .05) and in WC for NA (d = 0.68, p < .00) > TA (d = 0.53, p < .001) > N-A (d = 0.52, p > .05). Exercise behavior was least successful as pedometer counting was below 10,000 steps but sizeable weight and WC reductions were largest for NA (d = 0.71 and 0.79, respectively) > TA (d = 0.60 and 0.53, respectively) > N-A (d = 0.33 and 0.35, respectively). Patients reporting a shift to positive stages of change behaviors enjoyed clinically beneficial reductions in SBP, DBP, weight, and WC.
authors.affiliation: National University of Malaysia, Kuala Lumpur, Malaysia tilly_karu@yahoo.co.uk tilly@ukm.edu.my.
authors.forename: Tilakavati
authors.initials: T
authors.lastname: Karupaiah
authors.affiliation: National University of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Wong
authors.affiliation: University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Karuthan
authors.initials: K
authors.lastname: Chinna
authors.affiliation: National University of Malaysia, Kuala Lumpur, Malaysia International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Kanimolli
authors.initials: K
authors.lastname: Arasu
authors.affiliation: International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Winnie Siew Swee
authors.initials: WS
authors.lastname: Chee
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006266:Health Education; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology*; D012307:Risk Factors; D057566:Self Report; D012982:Sodium, Dietary; D015431:Weight Loss
chemical_list: D012982:Sodium, Dietary
keywords: adherence; diet; exercise; healthful behaviors; hypertension; stages of change