Impact of the virtual anti-hypertensive educational campaign towards knowledge, attitude, and practice of hypertension management during the COVID-19 pandemic

Table 1 Schedule for virtual anti-hypertensive educational campaign

No.	Sessions	Subjects	Duration
1	Session 1	Hypertension awareness campaign, definition and how to measure home blood pressure monitoring, understanding the silent killer of hypertension: dangerous effect towards cardiovascular diseases	2 h
2	Session 2	Healthy lifestyle: focusing on health diet, physical activity, and avoiding stress. Health benefits of the DASH eating plan and why DASH eating plan works	2 h
3	Session 3	Dietary recommendation for hypertension: getting started on DASH (live demo)	2 h + 2 h of live demo
4	Session 4	Tips to reduce salt and sodium intake (live demo: weigh salt before cooking)	2 h + 2 h of live demo
5	Session 5	Meal plans, measure each ingredients and oil products for cooking (live demo)	2 h + 2 h of live demo
6	Session 6	Living with the DASH eating plans. How to choose grains, fruits, vegetables, low fat and non-daily product (live demo)	2 h + 2 h of live demo
7	Session 7	How to educate others about dispelling misinformation in the healthy diet	2 h

Table 2 Distribution of characteristics in hypertensive subjects following a virtual anti-hypertensive educational campaign

Characteristics	Intervention, n = 55	Control, n = 55	P value
Sex
Male	22 (40.0)	19 (34.5)	0.23
Female	33 (60.0)	36 (65.5)
Age group, yr
< 20	0	1 (1.8)	0.33
20-29	3 (5.4)	4 (7.2)
30-39	12 (21.8)	10 (18.2)
40-49	19 (34.5)	20 (36.4)
50-59	16 (29.1)	16 (29.1)
60-69	4 (7.2)	2 (3.6)
> 70	1 (1.8)	2 (3.6)
Marital status
Single	2 (3.6)	1 (1.8)	0.35
Married	30 (54.5)	29 (52.7)
Widowed	23 (41.8)	25 (45.4)
Religion
Muslim	42 (76.4)	47 (85.5)	0.28
Christianity	9 (16.4)	5 (9.1)
Others	4 (7.2)	3 (5.4)
Educational degree
Not attending	4 (7.2)	4 (7.2)	0.41
Elementary school	16 (29.1)	18 (32.7)
Junior high school	8 (14.5)	5 (9.1)
Senior high school	20 (36.4)	19 (34.5)
Diploma	5 (9.1)	4 (7.2)
Undergraduate	2 (3.6)	4 (7.2)
Graduate (magister)	0	1 (1.8)
Occupation
Civil servants	2 (3.6)	3 (5.4)	0.38
Police	1 (1.8)	0
Laborers	7 (12.7)	4 (7.2)
Entrepreneurs	5 (9.1)	7 (12.7)
Private workers	5 (9.1)	4 (7.2)
Housewives	25 (45.5)	29 (52.7)
Retired	10 (18.2)	8 (14.5)
Antihypertensive drugs
ACE-inhibitor	17 (30.9)	15 (27.3)	0.27
ARBs	2 (3.6)	1 (1.8)
Beta blocker	3 (5.4)	2 (3.6)
CCBs	31 (56.4)	29 (52.7)
Diuretics	2 (3.6)	8 (14.5)
Baseline systolic BP	153 ± 15 mmHg	151 ± 15 mmHg	0.49
Baseline diastolic BP	96 ± 13 mm Hg	91 ± 13 mm Hg	0.42

Data are presented as n (%) or mean ± SD. Comparative study used independent t-test for normally distribution data and Mann-Whitney U test for data that did not follow normal distribution. ACE: Angiotensin-converting enzyme; ARBs: Angiotensin II receptor blockers; CCBs: Calcium channel blockers; BP: Blood pressure.

Table 3 Results of the knowledge section evaluated with a 22-item Hypertension Knowledge Level Scale before and after virtual anti-hypertensive educational campaign

No.	Item	Subjects answered true		P value
		Before intervention, n = 110	After intervention, n = 109
1	Increased diastolic blood pressure also indicates increased blood pressure	65 (59.1)	81 (74.3)	< 0.001
2	High diastolic or systolic blood pressure indicates increased blood pressure	71 (64.5)	84 (77.1)	< 0.001
3	Drugs for increased blood pressure must be taken every day	76 (69.1)	99 (90.8)	< 0.001
4	Individuals with increased blood pressure must take their medication only when they feel ill	44 (40.0)	77 (70.6)	< 0.001
5	Individuals with increased blood pressure must take their medication throughout their life	43 (39.1)	75 (68.8)	< 0.001
6	Individuals with increased blood pressure must take their medication in a manner that makes them feel good	83 (75.5)	89 (81.6)	0.042
7	If the medication for increased blood pressure can control blood pressure, there is no need to change lifestyles	99 (90.0)	103 (94.5)	0.120
8	Increased blood pressure is the result of aging, so treatment is unnecessary	96 (87.3)	103 (94.5)	0.042
9	If individuals with increased blood pressure change their lifestyles, there is no need for treatment	17 (15.5)	59 (54.1)	< 0.001
10	Individuals with increased blood pressure can eat salty foods as long as they take their drugs regularly	78 (70.9)	96 (88.1)	< 0.001
11	Individuals with increased blood pressure can drink alcoholic beverages	107 (97.3)	107 (98.2)	0.420
12	Individuals with increased blood pressure must not smoke	103 (93.6)	105 (96.3)	0.270
13	Individuals with increased blood pressure must eat fruits and vegetables frequently	108 (98.2)	108 (99.1)	0.440
14	For individuals with increased blood pressure, the best cooking method is frying	107 (97.3)	106 (97.2)	0.490
15	For individuals with increased blood pressure, the best cooking method is boiling or grilling	98 (89.1)	101 (92.7)	0.120
16	The best type of meat for individuals with increased blood pressure is white meat	31 (28.2)	99 (80.7)	< 0.001
17	The best type of meat for individuals with increased blood pressure is red meat	103 (93.6)	105 (96.3)	0.270
18	Increased blood pressure can cause premature death if left untreated	46 (41.8)	91 (83.5)	< 0.001
19	Increased blood pressure can cause heart diseases, such as heart attack, if left untreated	87 (79.1)	108 (99.1)	< 0.001
20	Increased blood pressure can cause strokes, if left untreated	61 (55.5)	106 (97.2)	< 0.001
21	Increased blood pressure can cause kidney failure, if left untreated	57 (51.8)	91 (83.5)	< 0.001
22	Increased blood pressure can cause visual disturbances, if left untreated	39 (35.5)	59 (54.1)	< 0.001

Data are presented as n (%). Comparative study used paired sample t-test and Wilcoxon signed rank test.

Table 4 Results of the attitude section evaluated with principal components of the items of the questionnaire to measure adherence in patients with primary hypertension

No.	Likert item	Average Likert scale		P value
		Before intervention, n = 110	After intervention, n = 109
1	Have you taken the medications according to the frequency indicated in the formula provided by the physician?	38 (34.5)	61 (55.9)	< 0.001
2	Have you taken the medications according to the dosage indicated by the physician?	82 (74.5)	87 (79.8)	0.035
3	Have you taken the medications according to the schedule indicated by the physician?	45 (40.9)	64 (58.7)	< 0.001
4	Have you taken the medications for a long period without interruptions, according to indications provided by the physician?	32 (29.1)	35 (32.1)	0.032
5	Have you taken the medications according to indications by the physician, without increasing or diminishing the dosage?	82 (74.5)	87 (79.8)	0.035
6	Have you continued taking the medications even if you don’t have symptoms of hypertension?	38 (34.5)	61 (55.9)	< 0.001
7	Have you forgotten to take your medications?	72 (65.5)	49 (44.9)	< 0.001
8	Have you suspended the medications when you have felt that symptoms have improved?	73 (66.4)	59 (54.1)	< 0.001
9	Have kept using the medications in spite of feeling that the symptoms have worsened?	37 (33.6)	60 (55.0)	< 0.001
10	Have you complied with a low-salt diet?	32 (29.1)	81 (74.3)	< 0.001
11	Have you complied with a low-fat diet? Reducing consumption of fried preparations, sauces, dressings, sausages (cold cuts - Mortadella - fast foods in general)	28 (25.5)	67 (61.5)	< 0.001
12	Have you complied with a low-cholesterol diet? Reducing consumption of red meats, chicken skin, eggs, sauces (mayonnaise - tomato sauce - industrial vinaigrettes), oil, lard and butter)	45 (40.9)	71 (65.1)	< 0.001
13	Have you diminished consumption of sugar and sweets?	18 (16.4)	31 (28.4)	< 0.001
14	Have you increased consumption of fiber? Such as papaya, pineapple, soursop, peaches, pears, and apples; also cereals, like oats, quinoa and bran	29 (26.4)	47 (43.1)	< 0.001
15	Have you increased consumption of fresh vegetables?	71 (64.5)	89 (81.6)	0.006
16	Have you increased consumption of fresh fruits?	36 (32.7)	70 (64.2)	< 0.001
17	Have you increased consumption of grains? Including beans, chickpeas, lentils, peas. Besides dry nuts, like peanuts and almonds?	28 (25.5)	47 (43.1)	< 0.001
18	Have you increased consumption of low-fat dairy products?	28 (25.5)	67 (61.5)	< 0.001
19	Have you diminished the consumption of coffee?	63 (57.3)	70 (64.2)	0.028
20	Have you limited consumption of alcoholic beverages?	106 (96.4)	107 (98.2)	0.440
21	Have you stopped smoking?	13 (11.8)	28 (25.7)	< 0.001
22	Have you performed physical exercise at least five times per week?	17 (15.5)	32 (29.4)	< 0.001
23	When performing physical exercise, have you dedicated at least 30 min to it?	12 (10.9)	25 (22.9)	< 0.001
24	Have you been able to control the amount of food you consume?	63 (57.3)	68 (62.4)	0.032
25	Have you maintained your body weight under control?	59 (53.6)	61 (55.9)	0.280
26	Have you set aside daily time for relaxation for yourself?	14 (12.7)	26 (23.8)	< 0.001
27	Have you recurred to some forms to relieve stress or tension?	17 (15.5)	18 (16.5)	0.240
28	Have you controlled yourself emotionally in light of sudden events?	51 (46.4)	59 (54.1)	0.012

Data are presented as n (%).

Table 5 Item structure of the 8-item Morisky Medication Adherence Scale rotation of the initial factor extraction using the principal component method

No.	Items	Subjects answered “yes”		P value
		Before intervention, n = 110	After intervention, n = 109
1	Do you sometimes forget to take your hypertensive pills?	47 (42.7)	39 (35.8)	0.160
2	People sometimes miss taking their medications for reasons other than forgetting. Thinking over the past two weeks, were there any days when you did not take your hypertensive medicine?	70 (63.6)	65 (59.6)	0.310
3	Have you ever cut back or stopped taking your hypertensive medication without telling your doctor, because you felt worse when you took it?	23 (20.9)	19 (17.4)	0.180
4	When you travel or leave home, do you sometimes forget to bring along your hypertensive medication?	49 (44.5)	47 (43.1)	0.380
5	Did you take your hypertensive medicine yesterday?	96 (87.3)	97 (89.0)	0.430
6	When you feel like your hypertension is under control, do you sometimes stop taking your medicine?	81 (73.6)	65 (59.6)	< 0.001
7	Taking medication every day is a real inconvenience for some people. Do you ever feel hassled about sticking to your hypertensive treatment plan?	51 (46.4)	49 (44.9)	0.390
8	How often do you have difficulty remembering to take all your medications? (likert scale: 1 = never; 2 = seldom; 3 = sometime; 4 = frequently)	3.1 ± 0.8	2.3 ± 0.6	< 0.001

Data are presented as n (%). Response choices are “yes” or “no” for items, except Likert scale for item number 8.