Original Article

The effect of education based on Leventhal's model on adherence to treatment and control of blood pressure in patients with hypertension


Background & Aim: Hypertension is a prevalent and significant health problem; moreover, lack of treatment adherence can cause precarious complications. The present study aims to determine the effect of education based on Leventhal's model on adherence to treatment and control of blood pressure in patients with hypertension.
Methods & Materials: This quasi-experimental study was performed on 59 patients with hypertension in Gonabad in 2020. The participants were selected based on convenience sampling; they were randomly assigned to the intervention and control groups. In addition to the routine treatment for hypertension, the patients in the intervention group received a training program based on Leventhal's model in 45-minute sessions and three times a week. In contrast, the patients in the control group received only the routine treatment for hypertension. A demographic and Hill-Bone Adherence Questionnaires were completed for the participants. Moreover, their blood pressure was recorded using the blood pressure record form. The data were analyzed in SPSS v.22 software, at the significance level of p<0.05.
Results: The two groups were homogeneous in adherence to treatment (P=0.63) before the intervention; yet, there was a substantial difference between the groups once the intervention was implemented (P<0.001). Besides, the average systolic and diastolic blood pressure was not significantly different between the two groups before the intervention. After the intervention, though, the difference was reported significant (p<0.05).
Conclusion: Education based on Leventhal's model caused an improvement in adherence to treatment and reduced blood pressure among patients with hypertension.

1. Najafi-Ghezeljeh T, Shahidi M, Ghiasvandian S, Haghani H. The effect of self-care educational program on quality of life in patients with hypertension. Cardiovascular Nursing Journal. 2015;4(1):40-7.
2. Sotodeh Asl N, Avazabadian M, Ghorbani R, Malek F. Quality of life in patients with hypertension and type 2 diabetes mellitus. Koomesh journal. 2020;22(2):263-8.
3. Mohamadinasab S, Ravari A, Mirzaei T, Sayadi A. The Effect of Aromatherapy with Essential Rose Oils on Blood Pressure in Hypertensive Patients. Journal of Medicinal Plants. 2019;18(72):202-14.
4. Najafi Ghezeljeh T, Nasr Esfahani M, Sharifian S. Comparing the effect of self-management training by mobile phone-based social network follow-up on blood pressure in people with hypertension. IJCN. 2017;6(1):22-31.
5. Muntner P, Hardy ST, Fine LJ, Jaeger BC, Wozniak G, Levitan EB, et al. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018. JAMA. 2020;324(12):1190-200.
6. Shafieyan Z, Qorbani M, Mehr BR, Mahboubi M, Rezapour A, Safari O, et al. Association between lifestyle and hypertension in patients referred to health care centers of Ilam city in 2014. Global Journal of Health Science. 2016;8(6):161.
7. Haghranjbar F, Shirzad M, Taghdisi MH, Sarami GR, Ahadi H. The Mediating Role of Subjective-Wellbeing in Terms of Perceived Stress and Hypertension. Iranian Journal of Health Education and Health Promotion. 2016;4(1):50-7.
8. Rodriguez-Iturbe B, Pons H, Johnson RJ. Role of the Immune System in Hypertension. Physiological Reviews. 2017;97(3):1127-64.
9. Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: A cross-sectional study. BMJ Open. 2013;3(8):e003423.
10. Keshvari M, Taleghani F, Shahriari M, Baghersad Z. The Relationship between Hypertension and Its Related Risk Factors in People Over 30 Years of Age in Isfahan. Community Health Journal. 2018;12(3):20-7.
11. Saffari M, Sanaeinasab H, Rashidi-Jahan H, Hajijafar-Namazi M-h, Sepandi M, Samadi M, et al. A Comparison Between Impact of a Health Education Program Using In-situ Training and Text-Messaging on Lifestyle and Blood Pressure in Military Personnel at Risk of Hypertension. Iran-J-Health-Educ-Health-Promot. 2019;7(1):74-83.
12. Mirshafiee A, Sadeghi A, Nazari F, Raei M. Survey of Body Mass Index and Blood Pressure among Personnel of a Military unit in 2019-2020. Journal of Military Health Promotion. 2020 Sep 10;1(2):94-103.
13. Maleki TE, Rezaei H, Hamishehkar H, Gharekhani A, Ghaffari S, Shaseb E, Pouriman B. The evaluation of hypertension control in patients with hypertension and concomitant cardiovascular disease. Depiction of Health. 2019 Sep 21;10(2):93-100.
14. Izadirad H, Masoudi GR, Zareban I, Poor MS, Haghshenas D. Effectivness of an educational program based on BASNEF model on blood pressure in hypertension. Payesh (Health Monitor). 2014 Aug 15;13(4):487-95.
15. Baghaee R, Khaledian N, Didarloo A, Alinezhad V. The effect of an educational intervention on the medication adherence in patients with hypertension: Based on basnef model. UNMF. 2016;14(9):811-21.
16. Mirkarimi A, Khoddam H, Vakili MA, Sadeghi MB, Modanloo M. Effect of life style modification on adherence to diet and hypertension in hypertensive patients. Koomesh. 2018;20(2):192-202.
17. Rahnama A, Shamsizadeh M, Salavati M, Mohammadi Y, Saheb Ekhtiari N. The Effect of Planned Education on Self-Efficacy of Patients with Hypertension: A Randomised Clinical Trial Study. Avicenna Journal of Nursing and Midwifery Care. 2018;26(2):91-102.
18. Ranjbar Ezzatabadi M, Mahdian M, Eslami H, Amini A. Patient Education Barriers from Nurses’ Opinions. Journal of Holistic Nursing and Midwifery. 2016;26(3):36-45.
19. Sadeh Tabarian M, Ghiyasvandian S, Haghani S. The effect of education based on Leventhal's model on perception of disease in diabetic patients. Iranian Journal of Nursing Research. 2019 Feb 10;13(6):76-82.
20. Taheri-Kharameh Z, Hazavehei SMM, Ramezani T, Vahedi A, Khoshro M, Sharififard F. The assessment of illness perception and adherence to therapeutic regimens among patients with hypertension. Journal of Education and Community Health. 2016;3(2):9-15.
21. Rakhshani M. Leventhal's Self-Regulation of Nursing Theory. Mashhad: Parastaranejavan; 2018.
22. Kim MT, Hill MN, Bone LR, Levine DM. Development and testing of the hill‐bone compliance to high blood pressure therapy scale. Progress in Cardiovascular Nursing. 2000;15(3):90-6.
23. Mousavizadeh SN, Ashktorab T, Ahmadi F, Zandi M. Evaluation of barriers to adherence to therapy in patients with diabetes. Journal of Diabetes Nursing. 2016;4(3):94-108.
24. Leventhal H, Phillips LA, Burns E. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. Journal of Behavioral Medicine. 2016;39(6):935-46.
25. Seyyedrasooli A, Parvan K, Rahmani A, Rahimi ZH. Effect of illness perception promoting interventions on treatment adherence in hemodialysis patients: A randomized controlled trial. Iran J Crit Care Nurs 2013;6(2):77-86.
26. Bernocchi P, Scalvini S, Bertacchini F, Rivadossi F, Muiesan ML. Home based telemedicine intervention for patients with uncontrolled hypertension:-a real life-non-randomized study. BMC Medical Informatics and Decision Making. 2014;14(1):52.
27. Zarea K, Nikbakht-Nasrabadi A, Abbaszadeh A, Mohammadpour A. Facing the challenges and building solutions in clinical psychiatric nursing in Iran: A qualitative study. Issues in Mental Health Nursing. 2012; 33(10): 697-706.
28. Beune EJ, Van Charante EPM, Beem L, Mohrs J, Agyemang CO, Ogedegbe G, et al. Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: cluster-randomized trial. PloS one. 2014;9(3):e90103.
29. Tang F, Zhu G, Jiao Z, Ma C, Wang B. Self-reported adherence in patients with epilepsy who missed their medications and reasons for nonadherence in China. Epilepsy & Behavior. 2013;27(1):85-9.
30. Khosravi A, Jozan M, Gharipour M, Rowzati M, Khosravi E, Sarrafzadegan N. The impact of workplace intervension on controling hypertension. Journal of Birjand University of Medical Sciences. 2013;19(6):10-6.
31. Saarti S, Hajj A, Karam L, Jabbour H, Sarkis A, El Osta N, et al. Association between adherence, treatment satisfaction and illness perception in hypertensive patients. Journal of Human Hypertension. 2016;30(5):341-5.
32. Chen J, Wu X, Gu D. Hypertension and cardiovascular diseases intervention in the capital steel and iron company and Beijing Fangshan community. Obesity Reviews. 2008;9:142-5.
33. Mohammadi MA, Dadkhah B, Sazavar H, Mozaffari N. The effect of follow up on blood pressure control in hypertensive patients. J Ardabil Univ Med Sci 2006; 6(2): 156-62.
34. Babaei-Sis M, Ranjbaran S, Mahmoodi H, Babazadeh T, Moradi F, Mirzaeian K. The Effect of Educational Intervention of Life Style Modification on Blood Pressure Control in Patients with Hypertension. Journal of Education and Community Health. 2016;3(1):12-9.
35. Haji Jafar Namazi M, Saffari M, Sanaei Nasab H, Sepandi M, Samadi M, Azad Marzabadi E, et al. The effect of healthy life style education through sending SMS on blood pressure among pre-hypertensive military personnel. EBNESINA. 2017;19(1):63-6.
IssueVol 8 No 4 (2021): Autumn QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v8i4.6709
Leventhal's model; adherence to treatment; hypertension; education

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Rajabloo M, Mohammadpour A, Sajjadi M. The effect of education based on Leventhal’s model on adherence to treatment and control of blood pressure in patients with hypertension. NPT. 8(4):333-344.