The effect of self-management program with tele-nursing based on the Roper-Logan-Tierney model on self-care of hypertensive patients: a randomized controlled trial

Hypertension (HT) is a chronic disease that affects 1.39 billion people worldwide, and its prevalence increases with age [1]. The Turkish Heart Disease and Risk Factors in Adults study, the most comprehensive study conducted in our country, reported that its prevalence was high (33.7%) and 1 out of every three individuals had HT [2].

For a healthy society, individuals must make efforts to protect their health. The individual should have the necessary knowledge and skills to maintain self-care. Patients who need to be adequately informed Show adequate compliance and adverse health outcomes. With effective self-care management, hypertension control will be achieved, hospital admissions will decrease, side effects will be limited, quality of life will increase, and health expenditures will decrease [3]. Nurses who spend more time with patients than other healthcare professionals are healthcare team members responsible for continuity of care and patient education [3]. The independent roles of nurses include protecting and improving the health of society, improving the quality of life, coping with the problems arising from the disease, and providing counseling on self-care. Nurses’ essential duties and responsibilities are to monitor individuals with chronic diseases, provide them with education and counseling, and ensure that they develop the necessary care skills [4].

Nursing care in hypertension includes BP control and prevention of complications. Symptoms such as anginal pain, dyspnea, nosebleeds, visual changes, and dizziness should be evaluated. The patient and family should be informed about BP measurement and lifestyle changes (weight control, salt restriction, exercise, stress management, healthy diet, smoking and alcohol cessation) [5].

Nurses have benefited from models and theories that provide a systematic approach to care, improve the nurses' perspective, and increase the quality of care in their services to individuals, families, and society [6]. One of these models, the Life Model developed by Roper Logan and Tierney, aims to recognize the individual as a whole, to identify and solve the problem, and to provide care to the individual with a holistic and humanistic approach, which is the basic philosophy of nursing [7]. In this model, it is emphasized that health is only possible by performing daily life activities independently. Therefore, nurses will provide a conceptual framework that can increase independence by evaluating patients as a whole with the Life Model. Nurses should ensure that hypertension patients receive effective education to meet their basic needs and that they can be independent, self-sufficient, and integrated with society in their future lives [8]. The use of these technological approaches in studies targeting education and behavior change facilitates the equal delivery of health resources and access to health services to everyone, including groups disadvantaged in accessing health services due to their place of residence or economic reasons [9].

Telehealth is a telehealth method that can effectively provide healthcare services to patients and give an advantage to face-to-face education.

Telehealth can be beneficial for people with mobility limitations, living in remote and rural areas, and people with chronic conditions (such as hypertension) [10]. In addition, telehealth can effectively provide medical consultations and shared learning, improve access to health services, reduce health inequalities, and ultimately lower health costs [7].

Self-care and self-care management are essential in increasing or progressing chronic diseases. For this reason, the importance of interventions in managing the disease process or increasing compliance with treatment is rising. Self-care practices include many factors, such as ensuring compliance with treatment, performing and managing disease-related life activities, regular use of medications, exercise, and diet compliance [11, 12].

Özdelikara et al. stated that many factors will affect compliance with the disease and self-care in individuals with chronic disease. Therefore, patient assessment should be multidimensional; issues affecting the patient's self-care and compliance with the disease should be determined, and education should be given about the patient's deficient issues. They also stated that individuals' compliance may increase or decrease over time and that nurses should evaluate patients with specific periods [12]. Therefore, this study was conducted to evaluate the level of self-care of hypertension patients with self-management support provided by tele-nursing.

The study’s findings, which examined the effect of telenursing and self-management programs based on the Roper-Logan-Tierney Model on the self-care of hypertension patients, are given below.

In the intervention group, 43.3% of the patients were 36–50 years old, 50% were female, 80% were married, 60% were primary school graduates, 53.3% were not working, 40% had been diagnosed with HT for 25 months or more, 66.7% used one blood pressure medication, 40% used blood pressure medication for 25 months or more, 80% used hypertension medications regularly, and 63.3% did not smoke.

In the control group, 50% of the patients were 61 years of age or older, 60% were female, 80% were married, 66.7% were primary school graduates, 73.3% were not working, 50% had been diagnosed with HT for 25 months or more, 56.7% used one blood pressure medication, 53.3% used blood pressure medication for 25 months or more, 73.3% used hypertension medications regularly, and 76.7% did not smoke. Chi-square analysis results showed that the intervention and control groups were similar in terms of sociodemographic variables (p > 0.05) (Table 1).

The mean scores of the "Self-protection" sub-dimension of the intervention group were 45.47 ± 7.29 in the pre-test, 48.82 ± 7.11 in the mid-test, and 49.55 ± 8.65 in the post-test. The mean score of the "Social Protection" subscale of the intervention group was 49.58 ± 7.12 in the pre-test, 49.13 ± 8.20 in the mid-test, and 51.37 ± 8.45 in the post-test. The mean score of the intervention group in the "Self-Care Management in Chronic Diseases Scale" was 95.05 ± 8.37 in the pre-test, 97.95 ± 11.98 in the mid-test, and 100.92 ± 12.98 in the post-test.

The mean scores of the "Self-protection" sub-dimension of the control group were 44.52 ± 6.11 in the pre-test, 45.27 ± 8.03 in the mid-test, and 41.16 ± 6.52 in the post-test. The mean score of the "Social Protection" sub-dimension of the control group was 48.97 ± 5.52 in the pre-test, 45.48 ± 7.25 in the mid-test, and 47.61 ± 6.22 in the post-test. The mean score of the "Self-Care Management Scale in Chronic Diseases" of the control group was 93.48 ± 6.92 in the pre-test, 90.76 ± 11.93 in the mid-test, and 88.97 ± 7.42 in the post-test.

When the in-group mean scores of the intervention group were compared, it was determined that the difference between the mean scores of the "Self Protection" sub-dimension pre-test, mid-test, and post-test was statistically significant (p < 0.05). It was determined that the difference between the mean scores of the "Self Protection" sub-dimension was due to the difference between the pre-test—mid-test and pre-test—post-test. It was determined that there was no statistically significant difference between the "Social Protection" sub-dimension pre-test, mid-test, and post-test mean scores of the intervention group (p > 0.05). There was a statistically significant difference between the pre-test, mid-test, and post-test mean scores of the "Self-Care Management Scale in Chronic Diseases" of the intervention group (p < 0.05). It was determined that the difference between the mean scores of the "Self-Care Management Scale in Chronic Diseases" of the intervention group was due to the difference between pre-test and post-test and mid-test and post-test.

When the mean scores of the control group were compared for the group, it was determined that the difference between the pre-test, mid-test, and post-test mean scores of the "Self-Protection" sub-dimension was statistically significant (p < 0.05). It was determined that the difference between the mean scores of the "Self Protection" sub-dimension was due to the difference between the pre-test and the mid-test post-test. The difference between the "Social Protection" sub-dimension pre-test, mid-test, and post-test mean scores of the control group was statistically significant (p < 0.05). It was determined that the difference between the mean scores of the "Social Protection" sub-dimension was due to the difference between the pre-test—mid-test and mid-test—post-test. The difference between the pre-test, mid-test, and post-test mean scores of the "Self-Care Management Scale in Chronic Diseases" of the control group was not statistically significant (p > 0.05).

When the comparison of the mean scores between the groups was examined, it was determined that the difference between the "Self-protection" sub-dimension pre-test mean scores of the intervention and control groups was not statistically significant (p > 0.05). The difference between the "Self-protection" sub-dimension mid-test mean scores of the intervention and control groups was not statistically significant (p > 0.05). The difference between the "Self-protection" sub-dimension posttest mean scores of the intervention and control groups was statistically significant (p < 0.05).

The difference between the "Social protection" sub-dimension pre-test mean scores of the intervention and control groups was not statistically significant (p > 0.05). The difference between the intervention and control group's "Social protection" sub-dimension mid-test mean scores was not statistically significant (p > 0.05). The difference between the posttest mean scores of the "Social protection" sub-dimension of the intervention and control groups was statistically significant (p < 0.05).

The difference between the pre-test mean scores of the intervention and control groups on the "Self-Care Management Scale in Chronic Diseases" was not statistically significant (p > 0.05). The difference between the intervention and control group's "Self-Care Management in Chronic Diseases Scale" midtest mean scores was statistically significant (p < 0.05). The difference between the posttest mean scores of the "Self-Care Management Scale in Chronic Diseases" of the intervention and control groups was statistically significant (p < 0.05) (Table 2).

This study's findings, which examined the effect of tele-nursing and self-management programs based on the Roper-Logan-Tierney Model on the self-care of hypertension patients, were discussed in light of the literature.

When the self-management levels were compared between the intervention and control groups, it was determined that there was no significant difference between the groups in the pre-tests, and the self-care management levels were at an intermediate level (Table 2). Similarly, Kurt and Gürdoğan (2022) and Runa and Bahar (2023) reported that the self-care power of patients with hypertension was at an intermediate level in different studies [17, 18]. This indicates that both groups had similar needs for self-care management at baseline and provides an appropriate basis for evaluating the effect of the self-care management program to be applied to the intervention group. These results highlight the importance of self-care management programs and indicate that self-care management should be improved, especially by using innovative approaches such as tele-nursing. Moderate levels of self-care management suggest that these patients require more support and guidance in their care process. In this context, tele-nursing practices can improve patients' self-care management. Especially during the pandemic, tele-nursing practices can be used when face-to-face health services are limited.

When the post-test self-management levels of the intervention and control group patients were compared, it was determined that after 12 weeks of tele-nursing training based on the Roper, Logan, and Tierney model, the self-care power of the intervention group patients increased significantly, while the self-care power of the control group patients decreased significantly (Table 2). Kurt et al. determined that self-care management support given to hypertension patients significantly increased self-care management and treatment compliance levels [17]. Zhu et al. found that the nurse-led hypertension management model, which includes decision support, clinical information, and self-management support in hypertensive patients, significantly improved patients' hypertension-related self-care behaviors [19]. Similarly, Yatim et al., Ozoemena et al., Darrat et al., and Saldana et al. reported that training for hypertensive patients increased their self-care levels [20‐23]. Rujiwatthanaokorn et al. examined the effect of a hypertension self-management program on self-care. The program positively and significantly affected patients' hypertension-related self-care knowledge and ability [24]. Özdelikara et al. stated that many factors will affect compliance with the disease and self-care in individuals with chronic disease. Therefore, patient assessment should be multidimensional; issues affecting the patient's self-care and compliance with the disease should be determined, and education should be given about the patient’s deficient issues. They also stated that individuals' compliance may increase or decrease over time and that nurses should evaluate patients at specific intervals [25]. In addition, Runa and Bahar stated in their study that nurses working with hypertension patients should assess the patients at particular intervals [18]. Research has shown that self-management support increases medication adherence, motivates individuals to manage the disease, and provides individual self-confidence [23, 26‐28].

It is seen that the studies in the existing literature are in parallel with the results of this research. According to the research results, tele-nursing is an application that improves nursing practice and facilitates patients' access to health services. This method saves time and resources and can contribute to protecting and promoting health by addressing the self-care needs of patients and healthy individuals. Telenursing practices based on the Roper, Logan, and Tierney model offer a structure that facilitates patients' access to health services by improving nursing practice. This model guides patients in identifying their health needs and creating customized care plans to address them. Tele-nursing methods offer opportunities to regularly monitor patients' health status, provide education, intervene remotely, and optimize intervention plans by analyzing data. The integration of the Roper, Logan, and Tierney model in this context explains how the self-management support offered by tele-nursing contributes to patients' self-care skills. The model guides nurses in developing patients' self-care skills and enables effective management of this process. This approach also increases the efficiency of health services by saving time and resources. Focusing on the self-care needs of patients and healthy individuals can make essential contributions to protecting and promoting health.

Although randomization was employed to minimize bias, it cannot fully account for residual confounders such as variability in participants' adherence to the intervention and differences in baseline characteristics. These factors could have impacted the outcomes. Future studies should aim to monitor adherence more closely and include strategies to control for baseline differences to enhance the reliability of findings. Addressing these factors will ensure more robust conclusions and further validate the effectiveness of tele-nursing interventions in improving self-care management.