Effects of Health Coaching on Self-Care Monitoring among Ghanaians with Hypertension Living in Southern California

Abstract

Hypertension (HTN) is a major health condition among Ghanaians both in Ghana and abroad. Hypertension management has remained problematic due to (a) decreased awareness, (b) inadequate self-monitoring, and (c) non-adherence to medication. The aim of the study was to improve the self-care monitoring practices of Ghanaians (living in Southern California) already diagnosed and being treated for hypertension who may or may not be adhering to a self-care monitoring program. Guided by the health belief model (HBM), this study used a quasi-experimental, pretest-posttest design. Health coaching is a collaboration between a health professional or a non-health professional and individuals with specific health conditions. The results of these collaborations are to promote self-care; this was grounded on the train-the-trainer (TTT) model (where a trained professional trained two lady elders of a church to become health coaches. The health-coaching intervention was comprised of a weekly teaching session for one month. Participants were educated on (a) HTN medication management, (b) diet (salt modification and weight management), and (c) physical activity. They were asked to (a) perform daily BP monitoring, (b) organize medications in a pill organizer, (c) take prescribed medications as directed, and (d) keep a blood pressure log for one month. SPSS version 28.0 was used for data analysis. Descriptive statistics were used to compare the pre-intervention and post-intervention scores on the HBM scales and its subscales of (a) perceived severity, (b) perceived susceptibility, (c) perceived benefits, (d) perceived benefits, (e) perceived barriers, and (f) cues to action. Pearson product moment correlations were used to examine the relationship between blood pressure medication adherence (as measured by the Morisky Medication Adherence Scale (MMAS-8) and the subscales of the HBM. The analytic sample included a total of 44 eligible participants in both the treatment group and the control group. There were 36 participants in the treatment group and eight participants in the control group. In the analysis for the treatment group, the mean age was 62.9 years (SD = 10.8, range from 37 to 85), with higher female representation (n = 22; 61.1%) than males (n = 14; 38.9%). A total of eight participants were included in the analysis for the control group; the mean age was 62.9 years (SD = 13.6, range = 51 to 90), with higher female representation (n = 7; 87.5%) than males (n = 1; 12.5%). For the treatment group: mean systolic blood pressure (SBP) was 142.9 (SD = 20.8) and mean diastolic blood pressure (DBP) was 87.2 (SD = 10.4). For the control group: mean SBP was 143.5 (SD = 12.2) and mean DBP was 88.6 (SD = 8.7). All subscales of the health belief model (HBM) had good to very good internal reliability. Based on independent samples t tests, the two groups differed significantly on (a) perceived susceptibility, t(33.3) = 4.04, p < 0.001; (b) perceived barriers, t(34.1) = 2.70, p = 0.011; and (c) cues to action, t(37.9) = 4.19, p < 0.001) at baseline. Mean MMAS-8 score for the full sample at baseline was 3.4 (SD = 2.5) and at Week 4 was 6.1 (SD = 2.0). Repeat measures ANOVA indicted a significant increase in MMAS-8 scores from baseline to Week 4 for all participants, F(1, 42) = 13.5, p < 0.001, η² = 0.24. The treatment group improved significantly more than the control group, F(1, 42) = 15.1, p < 0.001, η² = 0.26. The Hypertension Self-Care Profile (HBP SCP) Scale had three subscales: (a) self-efficacy, (b) motivation, and (c) behavior. There was a significant increase in the self-care profile self-efficacy scores from baseline to Week 4, F(1, 42) = 32.9, p < 0.001, η² = .44. Scores rose from an average 41.2 (SD = 10.4) before intervention to 53.5 (SD = 10.8) post-intervention. HBP SCP motivation scores increased significantly from a mean of 38.2 (SD = 8.9) pre-intervention to 50.7 (SD = 9.6) post- intervention, F(1, 42) = 36.2, p < 0.001, η² = .46. The treatment group increased significantly more than the control group, F(1, 42) = 16.9, p < 0.001, η² = .29. There was a significant effect of time (pre-treatment to post-treatment) on SCP behavior scores, with post-treatment scores (M = 64.3, SD = 16.3) significantly higher than pre-treatment scores (M = 43.1, SD = 16.0), indicating an increase in acting in ways that would be beneficial to blood pressure monitoring, F(1, 42) = 16.8, p < 0.001, η² = .29. There was also a significant interaction between time and treatment group for behavior, F(1, 42) = 21.1, p < 0.001, η² = .33; that is, the amount of change differed for treatment and control groups. All three scales had high reliability scores as measured by Cronbach’s alpha: behavior, 0.95; motivation, 0.87; and self-efficacy, 0.90. The results showed that health coaches can assist Ghanaians with HTN to achieve a positive change in blood pressure management by decreasing SBP and DBP. Further, the participants’ health beliefs and rate of medication adherence were positively influenced by health coaching. Health coaching intervention has been effective in the management of HTN among Ghanaians and can be implemented in a community church. Future studies with larger samples in the treatment and control groups is recommended, as well as a longer intervention period for Ghanaians and those from other African countries being treated for HTN.