DR MOHD ANUAR BIN ABD RAHMAN 16 th National Public Health Colloquium 24 th -25 th November 2009 Berjaya Times Square

1. A CASE CONTROL STUDY ON FACTORSINFLUENCING NONCOMPLIANCE AMONG HYPERTENSIVE PATIENT AND IMPACTS ON THEIR QUALITY OF LIFE IN THE STATE OF PERLIS, MALAYSIA DR MOHD ANUAR BIN ABD RAHMAN 16th National Public Health Colloquium 24th-25th November 2009 Berjaya Times Square

2. INTRODUCTION • Hypertension – major public health problem in Malaysia (NHMS 3,2006) • It can cause a lot of serious complications likes strokes, kidney failure and heart attack and also lead to an sudden death

3. INTRODUCTION • The Prevalence (Hypertension among ≥ 30 yrs old) is estimated – 29.9% ( NHMS 2,1996 ) & 43% (NHMS 3,2006) • In Perlis, hypertension is the most common chronic disease • The prevalence of Hypertension is 33.87% (JKN,2005)

4. LITERATURE REVIEW • Hypertensive patient’s failure in obeying the treatment need can affect their quality of life and much tougher to be control and also inviting complications (Hassan NB et al.2005 ) • Hypertension have impacts on the quality of life the same level as diabetes, cancers and chronic respiration diseases (Hwee-Lin et al.2005 )

5. LITERATURE REVIEW • Increase the obedience level of hypertensive patient thus preventing complications and then decreasing morbidity and mortality (Kyngas,1998 )

6. Conceptual Framework SOCIODEMOGRAPHY FACTORS LIFE STYLES FACTORS INDIVIDUAL FACTORS NONCOMPLIANCE PATIENT LOW QOL • Smoking • Exercise • Alcohol Consumption • Gender • Race • Marriage • Educational Level • Income • Knowledge • Attitude • Practice of Traditional Medicine • Obesity • Blood Pressure Control • Health Services • Waiting Time • Transportation FIGURE 1 Conceptual Framework Showing Relationship Between Individual, Life Styles And Social Factors And Noncompliance Patient And Low Quality Of Life

7. GENERAL OBJECTIVE • To identify risk factors of noncompliance hypertensive patient and impacts on their quality of life in the state of Perlis

8. SPECIFIC OBJECTIVES • To identify characteristic of socio-demographic hypertensive patient • To identify risk factors associated with noncompliance hypertensive patient namely individual, life styles and social factors • To determine differences between noncompliance and compliance hypertensive patient in the scoring of quality of life • To determine relationship between the duration of hypertension against mental and physical component

9. HYPOTHESIS • Compliance is better among patient with good socio-demography factors compared to those with low socio-demography • Noncompliance is higher among patient with unhealthy life styles compared to those who have good life styles • Noncompliance is higher among patient with negative individual factors compared to those who have good in individual factors

10. HYPOTHESIS • Compliance patient is higher in scoring quality of life compared to those noncompliance • More longer the duration of hypertension , the scoring for mental and physical component is low

11. METHODOLOGY Design – Unmatched case control study Population Hypertensive patients who came for treatment at the government health clinic in Perlis Sample Unit Hypertensive patient who not complied with their treatment and follow-up (case) Hypertensive patient who complied with their treatment and follow-up (control) Sample Size- (Henneken et al.,1987) 200 pairs (400 respondents) Sampling Method Purposive

12. STUDY TOOL -Direct interview -Questionnaires build based on conceptual framework; 8 parts: 1.Selection as Cases or Control 2.Socio-demographic background 3.Health Measurement 4.Knowledge of the respondent on hypertension 5.Attitude of the respondent on hypertension 6.Practice of traditional medicine 7.Accessibility to health services 8.Quality of Life ( SF-36 ) Pre-tested

13. Sampling and Recruitment Hypertensive patient came to health clinic – purposive sampling Agree to join study Sample characteristics Fulfill Sample Characteristic Not Fulfill Sample Characteristic Case characteristics Fulfillcase characteristics – CASE Not Fulfillcase characteristics – CONTROL

14. OPERATIONAL DEFINITION • Case and Control Selection • Cases and Control were selected if they are meet the • following characteristics; • Essential Hypertension • Duration of having hypertension is at least 3 months at time of study • Age 40 and above • At least one and no more 3 on hypertensions medication • Agree to join study • Patient is under goverment health clinic follow-up

15. Exclusion criteria • Hypertension ; • Pregnant Mother • complicated with renal disease • complicated with liver disease • with Diabetes mellitus • with Coronary artery disease • with Cereberovascular Accident (CVA) • Asthma • COPD • Not agree to join study

16. RESULTS Finally: Sampling Size: 230 pairs ( 460 respondent ) 230 (Cases) and 230 (Control) with the ratio of cases to control 1:1

17. SOCIO-DEMOGRAPHIC CHARACTERISTIC Gender: Male (44.8%), Female (55.2%) Mean age: (Case=57.27 + 10.64 years, Control=57.58 + 11.05 years) Ethnicity: Malays - 89.2% Marital status: Married (87.2%) Academic level: Primary school (47.6%) Residency status: Owned (95.2%) Income status: Lower (76.3%)

18. Table 1: The risk factors associated with noncompliance hypertensive patient * p<0.05

19. Table 2: The risk factors associated with noncompliance hypertensive patient * p<0.05

20. Table 3: The risk factors associated with noncompliance hypertensive patient * p<0.05

21. Table 4: The risk factors associated with noncompliance hypertensive patient * p<0.05

22. TABLE 5:Crude and adjusted OR and their 95% CI for noncompliance hypertensive patient by selected factors (Logistic Regression Analysis) * p<0.05

23. Table 6: The differences case and control in physical and mental component * p<0.05 • 1. In physical components and mental components; - noncompliance are facing more problems in taking care of themselves especially in physical activities and emotional problems

24. Table 7: Relationship between the duration of hypertension against mental and physical component scores * p<0.05

25. Table 8: Quality of life score for noncompliance hypertensive patient (Physical component) * p<0.05

26. Table 9: Quality of life score for noncompliance hypertensive patient (Mental component) * p<0.05

27. CONCLUSIONS " Hypertension will tend to get worst with the existence of modifiable risk factor in life. With this risk factors many hypertensive patient were non-complied with their treatment. As a result, this caused reduction in their quality of life"

28. RECOMMENDATION 1.Strengthening the health promotion program in hypertension  2.Restructuring the appointment system - staggered appt. scheme, mobile hypertensive clinic 3.Surveillance of health quality services to be done annually 4.Increase awareness of quality of life in hypertension to health provider esp. doctors and medical assistant.

29. BENEFIT FROM THIS STUDY ….. • 1. The study had proven several modifiable factors that causing noncompliance hypertensive patient in Perlis • 2.The study had proven scientifically that quality of life among hypertensive patient is low. • 3. As a pilot study for QOL because there is no specific study for QOL among hypertensive patient in Perlis.

30. ACKNOWLEDGEMENT • Medical Research and Ethics Committee of Ministry of Health, • Perlis State Health Department • Kangar District Health Office • Medical Research Secretariat for short-term grant (FF-028-2007) for this study.

31. REFERENCES

33. THANK YOU