1

Chapter 1
THE PROBLEM AND ITS BACKGROUND

Introduction

All human being needs to be safe and feel safe, both physically and
psychologically because it is one of the fundamental needs which is safety. Everyone of
us protect ourselves within the changing environment by functioning as healthy
individuals who make decisions in reasonable manner.
Disease prevention includes measures not only to avoid the incidence of
disease, like risk factor reduction, but also to apprehend its development and lessen its
consequences once established. Disease prevention is sometimes used as a
corresponding term along with health promotion. Although there is frequent overlap
between the content and strategies, disease prevention is defined separately. Disease
prevention in this context is considered to be action which usually emanates from the
health sector, dealing with individuals and populations identified as exhibiting identifiable
risk factors, often associated with different risk behaviors (adapted from Glossary of
Terms used in Health for All series. WHO, Geneva, 1984).
Health promotion is the condition of information and/or education of individuals,
families, and communities that would support family unity, community commitment, and
traditional spirituality that make positive contributions on their health status.
Furthermore, health promotion upholds nourishing thoughts and concepts to motivate
individuals to adopt healthy behaviors

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In an era of the 20th century, it is sensible to say that health promotion has
already accomplished its peak with the evolution of health promotion from being just a
concept to becoming a specialization and a profession in most of the countries
worldwide. Various organizations committed in the promotion of health of the people
such as World Health Organization, Australian Health Promotion Association, and
Canadian Public Health Association had made significant contributions that catapulted
the concept of Health Promotion into a whole new level, making health the priority and
the business of every human being. Over the past two decades, explosion of interest
and participation in health promotion and wellness activities (Murray, 2009) became an
extensive as evidenced by more people engaging in health-promoting activities such as
exercise, proper diet, and healthy lifestyle.
One of the most renowned definitions of Health Promotion comes from the World
Health Organization which is the process of enabling people to increase control over,
and to improve, their health (Ottawa Charter, 1986). Unknown to the knowledge of
many, health promotion is a concept distinct from the terms health education and health
maintenance in such a way that health promotion conveys an umbrella effect on the
other two terminologies and focuses on the improvement of health, its goodness and
wellness and enhancing the peoples capacities for living (McKenzie, et al, 2005),
regardless of any impairment on their physical, mental, social, environmental, and
spiritual condition. Health promotion pushes a person forward towards the optimum goal
of health. If health maintenance refers to those activities that avoid illnesses, disabilities,
etc. (Murray, 2009), health promotion pertains to activities that aims to empower the

3
individuals to seek for better health. These actual behaviors that individuals perform in
seeking better health refer to Health Promotion Practices.
Health Promotion refers to the efforts to promote positive health (Naidoo, 2005).
It also represents a comprehensive and social political progress; it does not only
embrace actions directed as strengthening the skills and capabilities of individuals, but
also actions towards changing social, environmental and economic conditions so as to
alleviate their impact on public and individual health. Health promotion is a method that
enables the people to raise their awareness over the determinants of health and hereby
their health. Participation is necessary to sustain health promotion action.

Background of the Study

Is hypertension a serious problem? Hypertension kills! Also referred to as high

blood pressure, it is a medical condition that increases the patients risk of having
serious heart problems such as stroke and heart attack. A person can have
hypertension for a long period of time without exhibiting symptoms. Eventually, almost
everyone will be affected by hypertension because high blood pressure becomes
common as a person ages (http://www.wazzupmanila.com/hypertension/1760).
According to Department of Health, the study found the following:
If uncontrolled, causes damage to various organs in the body resulting to other
diseases. The organs usually affected are the following.

4
1. Heart leads to heart attack and heart failure
2. Brain leads to stroke and internal bleeding
3. Kidneys leads to renal failure and the need for dialysis
4. Eyes leads to blindness
5. Peripheral Blood Vessels leads to peripheral vascular diseases
Left untreated, the disease will progress and will eventually lead to death.
Is hypertension a big problem in the Philippines?
Yes! The latest local data (1998) shows a 21% prevalence.

Death from heart disease rank first as cause of death in the century

With a projected population of 78.4 million by year 2000, roughly 8.6

million Filipinos are hypertensive

About 59% have target organ damage heart attacks (myocardial

infarction) in 3.4%, stroke in 11.5% and kidney damage in 53%

Since hypertension causes minimal or no symptoms at all, only 13.6% of

hypertensives are aware of their condition. This results to chronic
uncontrolled states and progressive organ damage leading to death.

Thus, it is important to know your blood pressure and how to manage it.

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What is blood pressure?
Blood pressure (BP) is the force created as your heart pumps your blood and
moves it through the blood vessels. This continuous blood flow provides your
body with the oxygen and nutrients it needs. In short, it keeps you alive.
Blood pressure is measured through a device called sphygmomanometer. A BP
reading consists of two numbers the top number (systolic BP) is the
measurement of BP while your heart is pumping, while the bottom number
(diastolic BP) is the measurement of your BP while your heart is at rest.
Normal BP is a level below
Systolic

140 mmHg

Diastolic

90 mmHg

BP normally fluctuates depending on the time of day, body position (sitting or

lying down), mental stress and level of physical exertion. Thus, BP determination
is standardized at the left arm, sitting position, after 5 10 minutes of rest. Two
or three BP levels are taken and the average is considered the final BP value.
You are HYPERTENSIVE if your blood pressure taken two or three times in a
two-week period is consistently . . .
Systolic

140 mmHg and above

Diastolic

90 mmHg and above

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What dangers await hypertensive patients?

Individuals with high BP rarely have symptoms. Few complain of headache,

nape pains or dizziness, which are usually mild and tolerable.

Thus, hypertension is treated not only to relieve symptoms, but to prevent the
development of target organ damage, which occur in those with chronic
untreated, elevated blood pressure.
Dangerous Complications of Uncontrolled Hypertension

Stroke results when arteries in the brain burst (bleeding) or become blocked
(thrombosis). Part of the brain dies and the patient becomes paralyzed

Heart Attack occurs when coronary arteries in the heart are blocked. The
heart muscle dies, and may stop beating. Patient dies as a consequence

Heart Failure results when the heart pumps too hard for too long, trying to
keep blood flowing through the body. Eventually, the heart weakens. The
patient now tires easily and is always out-of-breath

Kidney Failure happens when tiny vessels in the kidneys are blocked. The
kidneys malfunction are unable to clean the body of wastes. Patient is slowly
poisoned, becomes weak and bloated. Unless dialyzed, the patient will die
of poisoning from his own body wastes

Blindness or Impaired Vision occurs when tiny blood vessels in the eye
rupture or become blocked, damaging the surrounding eye tissues
(www2.dov.gov.ph/common_disease/hypertension.htm)

This study will be conducted in Brgy. 454 Lardizabal, Sampaloc, Manila City,
where the researchers are currently studying at University of Sto. Tomas, taking up post
- medicine.
Brgy. 454 is one of the 241 barangays of Sampaloc, 4 th district of Manila, with a
total population of 395, 111 (2007 Census of Population). This is the first time that the
said barangay has accommodated medical students having their research to be
conducted that concerns their community health promotion practices with hypertension.
No other studies have been conducted in and about the said barangay. Due to the lack
of appropriate records of the barangay that can supposedly be used to further describe
the community with regards on their health promotion practices; this raised a question in
the mind of the researchers, Are the health promotion practices of the residents of
Brgy. 454 Lardizabal still applicable up to this day especially with those who have
hypertension?
This scenario prompts the researchers to conduct a study on the current health
promotion practices of the residents of Brgy. 454 Lardizabal. With the introduction of
modern technology and the rise of new health-related breakthroughs and discoveries,
an assessment of their health promotion practices is needed to determine the timeliness
and effectiveness of these practices. At the same time, the researchers are also
motivated to improve the health status of the said urban community, following the
human perspective in health promotion as stated by Lucas (2005) in his book Health
Promotion Evidence and Experience that the starting point in health promotion is the

8
desire to improve the quality of peoples lives without necessarily adopting disease
prevention as a primary aim.
An assessment should produce both needed change and

increased

empowerment (Homan, 2008). This study entitled, An Assessment to Health

Promotion Practices among the Residents of Brgy. 454 with Hypertension. It is
thus in this light that the present study will find out the common barriers to health
promotion lifestyle of these residents and to and the results of which will serve as a
basis for designing and developing an appropriate health education programs that will
address the current need of the community.

Theoretical Framework
The theoretical framework of this study was the Health Promotion Model by Dr.
Nola J. Pender. The health promotion model (HPM) proposed by Nola J Pender (1982;
revised, 1996) was intended to be a complementary counterpart to models of health
protection. It defines health as a positive dynamic state not merely the absence of
disease. Health promotion is focused at increasing a clients level of well being. The
health promotion model shows the multi dimensional nature of persons as they act
together within their environment to pursue health. The model focuses on following
three areas:

Individual characteristics and experiences

Behavior-specific cognitions and affect

Behavioral outcomes

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The health promotion model explains that each person has a unique personal
characteristics and experiences that affect subsequent actions. The set of variables for
behavioral specific knowledge and affect have important motivational significance.
Health promoting behavior is the desired behavioral outcome and is the end point in the
HPM. Health promoting behaviors should be used to improved health, enhanced
functional ability and better quality of life at all stages of development. The final
behavioral demand is also influenced by the immediate competing demand and
preferences,

which

can

derail

an

intended

health

promoting

actions

(http://currentnursing.com_theory/health_model.htm).

Figure 1 Health Promotion Model

This model works on the premise that individual characteristics, including prior
related behavior, personal factors, and biopsychosocial factors have a direct effect on

10
the desired health-promoting behavior. At the same time, these individual characteristics
also affect the feelings and perception of the individual. All these combined affect an
individuals commitment to a plan of action and the performance of the health-promoting
behavior (Murray, 2009). The researchers believe that the individual characteristics of
the residents of Brgy. 454 such as the age, gender, civil status, educational attainment,
occupation, and spiritual beliefs affect their health promoting practices. Although the
researchers will not give much attention on the feelings and perception of the individual,
the totality of this study under the Health Promotion Model will serve as a reference in
determining the compliance of the residents of Brgy. 454 to the Health Promotion
Program that will be implemented later on as the outcome of this study.

Research Paradigm
INPUT

PROCESS
Data Analysis on
Health Promotion
Practices in terms
of:

Residents of Brgy.
454 Lardizabal

Age
Gender
Civil Status
Educational
Attainment
Occupation
Spiritual beliefs

OUTPUT

Health
Responsibility
Interpersonal
Relations
Nutrition
Physical Activity
Spiritual Growth
Stress Mgmt.

Figure 2 Research Paradigm

Health Promotion
Program focus on
Hypertension

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Figure 2 explains the interrelationship of Input-Process-Output of the study which
focuses on the research on the common health promotion practices of the residents of
Brgy, 454.
The input for this study refers to the profile of the residents of Brgy. 454 in terms
of their age, gender, civil status, educational attainment, occupation, and spiritual
beliefs.

These variables will be used to further understand the background of the

respondents. The pursuit for understanding will be done through the process stage,
wherein data analysis on health promotion practices in terms of Health Responsibility,
Interpersonal relations, Nutrition, Physical Activity, Spiritual Growth, and Stress
Management would be evaluated. The last is output stage, wherein it will produce
recommendations of health promotion programs based on the findings.

Statement of the Problem

The study aims to assess health promotion lifestyle program through the
identification of the common health promotion practices done by the residents of Brgy.
454 Lardizabal with hypertension.
Specifically, this study seeks to find answers on the following questions:
1.

What is the demographic profile of the residents of Brgy. 454 Lardizabal in terms of:
1.1. Age
1.2. Gender
1.3. Civil Status
1.4. Educational Attainment

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1.5. Occupation
1.6. Spiritual beliefs
2.

What are the health promotion practices of the residents of Brgy. 454 Lardizabal ?

3.

What are the common barriers to health promoting lifestyle among the
respondents?

Significance of the Study

The result of this study will be of importance to the following:

To the Residents of Brgy. 454 Lardizabal may find the result of the study as an
approach to raise their consciousness on how to promote positive health and their
unique behavior as residents of Brgy. 454. This will provide a solid and scientific
description of the health promotion practices they perform thereby strengthening their
exclusive identity. This can also provide an opportunity to re-evaluate their own
practices in enhancing health and identifying their weaknesses thus the creation of
programs that can address the needs of Brgy. 454.
To the Community Health Workers of Brgy. 454 and in Samaploc, Manila will
benefit from the study and acknowledge the necessity to give a concrete and scientific
description of the common practices done by the residents in the said barangay thereby
increasing their personal knowledge. This description will provide an accurate
knowledge of the client and serve as the foundation where programs designed to
improve the health of the community can be built upon.

13
To the Medical Students will find the outcome of the study to further enhance
their knowledge on health promotion practices and ways to help implement these acts.
Other Researchers This study will serve as an invitational research agenda for
further research and development in response to the continuous search for
contemporary approaches to further understand of concerns parallel to this work.

Scope and Limitations of the Study

The focus of this study is the heath promotion practices commonly done by the
residents of Barangay 454 in terms of Health Responsibility, Interpersonal Relations,
Nutrition, Physical Activity, Spiritual Growth, Stress Management.
The researchers chose Brgy. 454 as a convenient place to conduct the study
since the researchers were familiar with this community. Therefore, the data to be
utilized in this study is readily available and accessible to the researchers. Moreover,
the researchers believe that urban communities like Brgy. 454 would yield more
significant results that can contribute to the substance of the study.
The subject of the study will be the long-time residents of Brgy. 454. Thirty-two of
the said barangay will be selected as respondents of this study. Data gathering
techniques will be limited to observation and distribution of survey questionnaires.
The time frame for this study is from November to December 2010 covering the
data gathering period and January February 2011 for processes and analysis, writing
up for the report and final dissertation. Thus, any or all developments that occurred
thereafter are deemed excluded.

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Definition of Terms:
1. Barriers refers to objects or individuals that inhibited a process or event
from occurring (Pender, Murdaugh, & Parsons, 2002).
2. Health refers to a state of complete physical, social, and mental wellbeing,
and not merely the absence of disease of infirmity (WHO)
3. Health Education refers to any planned combination of learning
experiences designed to predispose, enable, and reinforce voluntary behavior
conducive to health in individuals, groups, or communities (Green and
Kreutuer, 2005).
4. Health Promotion refers to efforts to improve the health status of an
individual and enhance his capacity to achieve health.
5. Health Promotion Practices also known as Health Promotion Behaviors;
refers to the actual behaviors performed by an individual in order to improve
health.
6. Health Maintenance refers to the desire of an individual to actively avoid
the occurrence of illness or disease.
7. Health Protection refers to behaviors that protect a person from acquiring
an illness or disease.
8. Hypertension

defined

as a

chronic,

common,

asymptomatic

to

symptomatic, disorder characterized by a persistently elevated blood

pressure exceeding 140/90 mm Hg (Mosby, 1994). Hypertension has the
potential to be uncontrolled (the systolic blood pressure 140 mm Hg or
greater and/or the diastolic blood pressure is 90mm Hg or greater) or

15
controlled (blood pressure below 140/90 mm Hg due to antihypertensive
medication, diet, or exercise).
9. Interpersonal Relations refers to social relationship of an individual. It
includes the kind of communication done by an individual to fulfill his personal
and intimate needs.
10. Nutrition refers to the selection and consumption of food of an individual
11. Physical Activity refers to an individuals participation in light, moderate, or
vigorous activity (Walker, S., 1996).
12. Spiritual Growth refers to the ability of an individual maximize human
potential through searching for meaning, finding a sense of purpose, and
working towards goals in life (Walker, S., 1996). It also refers to the belief of
an individual to a higher form of being.
13. Stress Management refers to the coping mechanisms done by an
individual to reduce tension or manage stress.

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Chapter 2
REVIEW OF RELATED LITERATURE AND STUDIES

Through the review of related literature and related studies, researchers were
provided the knowledge and background on the topic or subject being studied. A
collection of extensive related literature is an essential part of a research paper in a way
that it serves as the framework of the study to make it substantial, credible, and reliable.
It serves as the feet of a research study so it can stand on its own and make it strong
enough for future researches to build upon.
The researchers gathered all literatures, both foreign and local, that are deemed
important to the topic at hand.

Foreign Literature and Journals

The growth of interest and activity in health promotion has been accompanied by
many attempts to examine the nature of health concept in particular cultures. It is
argued (Pender, 1996, Katz et al, 2002, Tones and Green, 2004) that health promoters
such as hospital nurses are unlikely to improve health and to bring about change unless
they have adequate understanding of the meaning of health and its determinants. Thus,
if peoples health is to be promoted effectively, the concept of health needs to be
explored culturally. To this end, there is a need to establish a theoretical background
about the meaning of health itself before any attempt to examine health promotion
related issues.

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Health Concept: Meaning and Development

When health related literature is reviewed it becomes obvious that the concept of
health is still one of the most frequently reported concepts. Health has not only been
associated with peoples health behaviour (Paxston et al, 1994, Ogden et al, 2002,
Hjelm et al, 2005) but also with the populations mortality, morbidity, life satisfaction,
happiness, health policy, sexual health, education and economy (Buchanan, 2000,
Davey et al 2000, Helman, 2000, McPake, et al, 2002).
The concept of health however is contested and has diverse and sometimes
conflicting meanings that are both socially and culturally constructed. The concept of
health was derived from the old English word hoelth which means being safe, sound
and whole (Pender, 1996,). Historically, physical wholeness was of major importance for
acceptance in social groups. Physical power and nature were frequently linked together.
Those people suffering from disease or malformation were ostracised from society. The
reason was not only because of the fear of contagion from physically obvious disease
but also according to Blaxter (2001) there was repulsion at grotesque appearances. In
light of this, it is not unexpected that the review of literature found that being healthy
was constructed as natural in a certain environment or in harmony whereas unhealthy
was constructed as unnatural or contrary to nature (Davey et al, 2001).
Health was defined by the WHO (1946) as:
The state of complete physical, mental, and social wellbeing and not only the
absence of disease and infirmity.

18

This definition has proved to be robust and it is frequently cited in the literature in
particular within nursing and health promotion contexts, and it would be worth reviewing
its effectiveness and applicability. The definition was revolutionary as it consists of three
aspects of health including physical, mental and social well-being. It has many
advantages, which were recognized by many authors (Bunton and Macdonald, 2002,
Katz et al, 2002, Lee and Newberg, 2005). This is not surprising as it is postulated
(Pender, 1996, Bowling 2005) that the WHOs definition reflects concern for the
individual as a total person rather than the sum of parts. In addition, the definition places
health within the environmental context rather than a disease focus. Recently, health
promotion authors go further to contend that the WHOs definition is well acknowledged
in the literature not only because its positive reference to well-being but also it is useful
to be adapted at a political level centering on equity and empowerment and asserting
that health is a standard of living (Tones and Tilford, 2001, Tones and Green, 2004).
Although they did not offer obvious guidance about how to incorporate these ideas into
practice, their suggestions might demonstrate that the WHOs definition of health can be
used as a framework for promoting health at both the individual and political level.
Medical writers, on the other hand, advocate to lesser extent that the WHOs definition
can be deemed as a milestone to distinguish between positive health such as well-being
and negative aspects of health which exclusive emphasis on disease prevention
(Downie et al, 1991).

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On this basis, the WHOs definition made a significant addition to the literature by
arguing that health is beyond the disease-linked issues and it is rooted in the
individuals social life.
The WHOs definition is totally unrealistic and too idealistic. This is because it
assumes that someone somewhere can achieve a 100% state of health. This implies a
misunderstanding of the meaning of health as a complex qualitative experience shaped
by an individuals context (Katz et al, 2001). It could also lead to a central confusion
about the meaning of complete or incomplete health. For example, is the health of a
person with a physical disability complete or incomplete?
To add to the problem, the definition is based on the assumption that peoples
views of the state of health are alike. Such an assumption has been discredited by
considerable evidence. Earlier studies have shown that people define the state of health
in many different ways such as fitness, energy, sexual activity and even wealth (Young,
1996, Davey, 2001, Davey et al, 2001, Hjelm et al, 2005).
Likewise, Ewles and Simnett (2004) expressed their concerns about the quality
of the WHOs conceptualization of health which implies a static position whereas life
and living are anything but static. This indicates a misunderstanding of the fact that
health in its holistic facets (e.g. physical, mental, spiritual) is in a state of continuous
change.
Young (1996) acknowledges the advantages of the WHOs definition but she
points out other problems as below:
.. Such a wide ranging definition can sometimes make it difficult to determine
things which are not covered by the heading health concerncould we, for

20
example, consider a woman experiencing relationship difficulties with her
husband and family unhealthy? (p:242).

As indicated above it seems that the too broad a definition of health makes it
difficult to specifically address the needed health interventions to achieve the desired
outcomes. This raises significant concerns, which could lead to misinterpretations
among health care providers themselves.
A further weakness of the WHOs definition of health stems from the possibility of
linking its meaning with health promotion. Whilst it could be used as a framework for
health promotion (Tones and Green, 2004), adopting the WHOs definition as a
guideline for promoting peoples health might produce not only ineffective heath
promotion activities but also unrealistic expected outcomes such as a 100% complete
health status.
Thus, health care providers need to acknowledge that the aims of maintaining
health should be within realistic boundaries and reasonable expectations.

Health Promotion: Historical Background

Health Promotion dates back up to the time when religion and superstition
influenced peoples belief on health and illness. The Babylonians, the Greeks,
Egyptians, Palestinians, Romans, and the Chinese have laid down the foundation of
most of the health promotion practices that we enjoy today. Concepts on hygiene and
sanitation were introduced to civilization by the Greeks whose belief in health and

21
illness was mandated by their gods and goddesses; the quarantine practices that
benefit people of today especially in communicable diseases can be traced back during
the Palestinian times under the Mosaic Code which emphasized the importance of
segregation by separating what is clean from the unclean. The public health sanitation
like street cleaning, building construction, ventilation, heating, and water sanitation that
we enjoy today are some of the accomplishments of the Romans and Egyptians
(Murray, 2009). Even during that time, health was already considered of prime
importance and its enhancement was necessary, some for the purpose of achieving
balance of the mind, body and spirit and some as a form of luxury and personal
indulgence. Whatever the purpose may be, these ancient practices bear the underlying
fact that an individual, even in the earliest times, is always in search of activities that
can prolong life and improve the quality of life (Marks, et al, 2005).
As Health Promotion gains popularity, myriad of definitions rose and overlap with
one another. Oftentimes, the term health promotion is used interchangeably with health
education, health maintenance, and health protection. The leading organization in
managing health, the World Health Organization (WHO) defined Health Promotion as
the process of enabling people to increase control over, and to improve their health.
(WHO, 1986).
During this definitions inception, five key strategies were also identified namely building healthy public policy, creating physical and social environments supportive of
individual change, strengthening community action, developing personal skills such as
increased self-efficacy, and Reorienting health services to the population and
partnership with patients (Ottawa Charter, 1986). This definition coincides with the

22
definition of Marks, et al (2005) which is any event, process, or activity that facilitates
the protection or improvement of the health status of individuals, groups, communities,
or populations. It targets a wider range of population as it intends to focus on the
community level which includes environmental interventions such as targeting the built
environment (e.g. fencing around dangerous sites) and involve legislation to safeguard
the natural environment (Marks, et al, 2005). It encompasses a broader scope as it
represents a comprehensive social and political process and with actions directed
towards changing social, environmental, and economic conditions so as to alleviate
their impact on public and individual health (Health Promotion Glossary, WHO, 1998).

Definition of Health Promotion

A more individualistic approach on Health Promotion is reflected on the definition

of Pender, et al. (2006) which states that Health Promotion is the behavior motivated by
the desire to increase well-being and actualize human health potential. This definition,
on the other hand, includes the behavioral approach of health promotion, which
focuses on secondary and primary prevention to improve health status through lifestyle
and behavior changes of individuals (Leddy, 2006).
These behavioral interventions are primarily concerned with the consequences
of individuals actions whose focus is on the concept of empowerment (Marks, et al.,
2005). The objective of this approach is to generate changes in the behavior of an
individual towards health, so that independence and self-reliance can be fostered. This
can be achieved by increasing the awareness and knowledge of an individual on health

23
and ways on how to improve it through health education. Health Education is defined
as any planned combination of learning experiences designed to predispose, enable,
and reinforce voluntary behavior conducive to health in individuals, groups, or
communities (Green and Kreutuer, 2005).
Using Traviss Illness-wellness Continuum, movement in the direction of wellness
state must begin with awareness, followed by education, then growth (Kozier, 2008).
Therefore, health Education capitalizes on awareness and knowledge in initiating
behavioral change in an individual. This insight reflects the difference between health
promotion and health education, where health education serves as a tool in
implementing health promotion. To further operationalize the definition of health
promotion, Breslow stated on his commentary on health promotion in JAMA, 1999 that
each person has a certain degree of health that may be expressed as a place in a
spectrum.
From that perspective, promoting health must focus on enhancing the peoples
capacities for living. That means moving them toward the health end of the spectrum,
just as prevention is aimed at avoiding disease that can move people toward the
opposite end of the spectrum. For this reason, Health promoting behaviors must be
geared towards the High-Level Wellness of Traviss Illness-Wellness Continuum.
Another definition of Health Promotion deals with the actions done to promote
health. Health behavior refers to the actual actions performed by an individual to
improve health. Health behavior alone is defined as any activity undertaken by an
individual regardless of actual or perceived health status, for the purpose of promoting,

24
protecting, or maintaining health, whether or not such behavior is objectively effective
toward that end (WHO, 1998).

Health Promotion: Theories and Models

There are a number of theories proposed in the literature that attempt to guide
the work of health promotion as well as health education. Although no one theory is
sufficient to fully explain health promotion behaviours, practitioners need to understand
their implications for practice (Naidoo and Wills, 2000). Behavioural change theories are
examined first because hospital health providers roles in health promotion is guided by
their ideologies as explored in this chapter (Maidwell, 1996, Furber, 2002, Cross, 2005,
Casey, 2007).
Models of health related behavioural change are often derived from
sociopsychology (Cole, 1995). This field examined the link between effective health
promotion interventions and the social influence process (Mittelmark, 1999).
Sociocognitive or social learning theory was used as a means to explain health
behaviours and to focus on the social context of behavioural change and its underlying
cognitive process (MacDonald, 2000). Thus, it is driven by the notion that behaviour is
guided by expected consequences. It indicates that health related behaviours are a
result of the interaction between patients beliefs and environmental elements (e.g. lung
problems and pollution) (Tones and Green, 2004). Despite this, however, sociocognitive theories are based on a preventive health framework and thus sit more

25
comfortably with traditionally defined health education as opposed to a wider reaching
health promotion ideology operating at social and economic levels (Clark, 1998, Cullen,
2002). Therefore, these theories attempt to examine patients reactions to the threat of
illnesses and thus seek actions to minimize or eliminate this threat through health
education. However, changing individuals behaviour is a problematic and complex task.
Not only might it lead to victim blaming but also to cognitive dissonance (Festinger,
1958). This is based on the concept that when clients face a situation when the
delivered health education message is in conflict with their current beliefs and attitudes,
they react in a manner that could create dissonance (e.g the belief that smoking would
reduce stress) (Festinger, 1958).
The theory contradicts to some extent the rational empirical theory that assumes
that clients will make rational decisions based on view of information given to them
(Baird, 1998).
Although the above theories are ideologically different, they link together health
related actions, individuals beliefs and indeed their agendas. The most developed
models and theories in health promotion are based on psychosocial theories and are
threatened by their limitations. The theory of reasoned action (Ajzen and Fisherbein,
1980) indicates that intentions to perform an action are determined by the individuals
attitudes towards the behaviour and the social norm. Thus, their beliefs are predictors of
intentions that, in turn, predict actual behaviour.
Likewise, Penders (1987) health promotion model explains the link between
individuals beliefs and their behaviours but fails to consider the impact of

26
socioeconomic issues. Instead the model views the environment as it relates to
behaviour rather than how it relates to health(King, 1994, p.214).
On the other hand, the health belief model (Becker, 1974), is largely guided by a
preventive health approach as opposed to socio-economic and political approach to
positive health. More recent socio-cognitive models did not give indications on how they
might be operationalised in practice (Niven, 2000, Stuifbergen et al, 2000) or were too
complex to use especially in a limited resourced setting (Whitehead, 2001a). The last
two models have not yet been validated and thus their effectiveness is questioned.

Health Promotion Practices

Health Promoting Practices or Behaviors of an individual differ from one person

to another. Pender (2006) stated it best that each person has unique personal
characteristics and experiences that affect subsequent actions. There are five levels
that affect a persons behavior (Sharma, 2008). First, are the individual factors, like the
attitude of a person. If a person believes that a healthy body will permit him to perform
more challenging tasks, then engaging in health promotion activities would come
naturally.
According to Fawcett (2005), Environment, culture, family background, work
ethic, educational level, social standing, and gender may contribute to the individuals
perception of heath and illness. Then personal view and understanding on the concept
of health and illness also falls on this level. In the earlier times, if a disease is believed

27
to be caused by an entry of an evil spirit, holes are bored into the skull of the patient to
release these spirits.
In the Philippines, if illness or disability is caused by nunu sa punso or aswang,
people immediately visit an arbolaryo and submit the patient to a tawas to detect the
spirit believed to cause the disease.
In addition to this, an individuals environment also play a crucial role in his health
promotion practices as stated in an article from the Global Health Promotion (Jul, 2010)
entitled How does socio economic position link to health behaviour?
Sociological pathways and perspectives for health promotion by Weyers S., et
al. The study showed that the characteristics of the neighbourhood environment
influence health behaviour of its residents above and beyond their individual
background. Therefore, the physical environment also determines the health promotion
practices of an individual. Also included in the individual factors are the age, civil status,
spiritual beliefs, occupation, and educational attainment of the individual.
Second level is the Interpersonal factors where an external factor affects the
behavior, example of which is a spouse requesting for a healthy breakfast.
Third level refers to organizational factors which include policies that contribute to
a better health like a company that allots 1 hour of exercise for employees every
morning. Fourth level is community factors, such as the physical environment an
individual is surrounded with. For example, if the person needs to fetch water every day
from the communal faucet that is 1 kilometer away from his house, then that activity can
be considered as a vigorous form of exercise. Last is the role of public policy factors.
For example, if a memorandum coming from the Mayor mandates the cleaning of

28
suspected breeding and resting sites for Dengue mosquitoes three times a week, then
that memorandum compels the residents to do such (Sharma, 2008).
In this study, the factors that are taken into consideration are the 6 dimensions of
health-promoting lifestyle identified in the Health Promotion Lifestyle Profile II (Walker,
et al., 1996). These are the Spiritual Growth, Interpersonal Relations, Nutrition, Physical
Activity, Health Responsibility, and Stress Management. Health Promotion Lifestyle
Profile II is used to measure the health promoting behavior of an individual.
Lifestyle, according to Pender (2006), is defined as discretionary activities that
are regular and part of ones daily pattern of living and significantly influence health
status. In this study, the term lifestyle is synonymous with Health Promoting Behaviors.
Spiritual growth or health is defined as the ability to develop ones inner nature to its
fullest potential which includes the ability to discover and articulate ones basic purpose;
to learn how to experience love, joy, peace, and fulfillment (Pender, et al., 2006, p.
104).
Spiritual health is essential in assessing the heath promoting practices because
this affects the clients interpretations of life events and health (Chuengsatiansup, 2003
as cited in Pender, et al. 2006). Numerous studies have been done supporting this
significant correlation of spirituality and health experiences. One of these is a study
entitled Spiritual health, clinical practice stress, depressive tendency and health
promoting behaviours among nursing students by Hsiao Y. et al. (2010) wherein
Spirituality was positively associated with health-promoting behaviors. This relationship
will contribute to the holistic approach in assessing the health promotion practices of an
individual.

29
Interpersonal Relations, likewise, is also vital in assessing health promotion
practices as this reflects the social relationship an individual posses. According to Lucas
(2005), positive social relationships stimulate the production of a health promoting
hormone and block the production of hormones usually related to stress. Positive social
relationships offer a venue for verbalization of feelings of the individual which is
necessary for the individual to get in touch with their feelings and emotions and enables
the individual to select the most appropriate strategy in dealing with stress through
feedbacks from others.
This dimension is related to the third dimension of the HPLP II which is Stress
Management as high levels of social support have also been linked to positive affect,
and may thus protect against distress from life events associated with high stress
(Lucas, et al., 2005 p. 130). Stress is defined as anything that may threaten the
physical and psychological well-being of a client. Assessment of how an individual
handles these stresses may serve as a better predictor of his health promoting
practices.
Fourth and fifth dimensions of the HPLP II are the Nutrition and Physical Activity,
respectively. Nutrition involves the way an individual selects and consumes foods that
are essential in promoting a health well-being. Their selection of food must be
consistent with the guidelines provided by the Food guide Pyramid. Physical Activity, on
the other hand, involves regular participation in light, moderate, and/or vigorous activity
(Walker, et al., 1996).
Assessment of physical activity is important since sedentary lifestyle, for many
individuals, begins with childhood and continues until adulthood (Pender, et al., 2006, p.

30
102) and lack of physical exercise has been directly related with the occurrence of
cardiovascular diseases.
Last, but not the least, is the dimension on Health Responsibility, which involves
an active sense of accountability for one own well-being (Walker, et al., 1996). This
includes paying attention to ones health through education and exercise of informed
consumerism. As Pender, et al., (2006) mentioned, individuals play a significant role in
the determination of their own health status because self-care represents the dominant
mode of health care in our society.
Like breathing, no one else can take care of ones health than the person owning
that health. The desire to enhance health and well-being must come from within.
One must bear in mind that human health promotion is a moral endeavor. In the
individual level, health promotion provides services that will assist humans in their
functioning taking into consideration their particular circumstance.
Therefore, a need to include the factors that influence a persons health status
like mental, physical, spiritual, and environmental factors in the assessment of an
individual is a must (Edelman, et al., 2006). This will only be possible if thorough
assessment will be done on the health promotion practices of the respondents.
Prolonging life and improving its quality is the objective of Health Promotion
(Marks, et al., 2005). In order to achieve this goals, health promotion must concentrate
more on enhancing the physical, psychological, and emotional well-being of an
individual instead of focusing on reducing the risk of acquiring diseases. A more positive
approach to promote health is needed to stimulate in individuals the desire to enhance
the quality of life.

31
Local Literature

The need for health promotion in the Philippines goes back to the time of the
Ramos Administration, when the Administrative Order No. 341 entitled Implementing
Philippine Health Promotion Program through Healthy Places was created. It was
written along with the belief that there is a need to undertake more health promotion
and disease prevention measures as a result of the reported increase in the incidence
of preventable diseases in Asia and in the country (AO No. 341, 1997). The PHPP
gives priority to women, and children, adolescent youth, workers, elders, disabled and
chronically ill persons, ethnic minorities, rural people, and urban poor (Palaganas,
2003).
Time went on and health promotion was given a renewed interest as a result of
the association of degenerative diseases with the lifestyle of an individual. In 2002,
Mortality statistics showed that 7 of the 10 leading causes of deaths in the country are
associated with the unhealthy lifestyle of the client: tobacco smoking, physical inactivity,
and an unhealthy diet (Cuevas, et al., 2007). This rise in the occurrence of degenerative
and lifestyle diseases called for a need to take on a new approach to health promotion
that will go beyond the interaction between the client and a physician. Hence, the
creation of the National Policy on Health Promotion (Administrative Order No. 58 s.
2001).
This Administrative Order promotes the utilization of a socio-ecological
approach to health promotion that would include the environment and other sectors
that affect the over-all well-being of a person. The vision for Health Promotion, By the

32
year 2010, Filipinos are managing their own health serves as the framework for health
promotion.
This study will contribute to the attainment of the said goal through the creation of
appropriate health promotion programs/strategies that can change the lifestyle of the
target population by starting with proper assessment of their current health promotion
practices. This fulfills a fraction of the health sectors responsibility to build capacity for
policy development, leadership, health promotion practice, knowledge transfer and
research, and health literacy (Anden, 2010).
Without

sincere

efforts

directed

towards

achieving

socio-economic

transformation no lasting improvements are expected in the field of health (Palaganas,

2003, p. 90). Health Promotion may sound easy to say but it is very much harder to do,
especially if the community is underdeveloped. Brgy. 454 is an urban community
wherein there are depressed areas situated in Sampaloc, Manila.
As Palaganas (2003) puts it, many mistaken practices result from ignorance and
superstition. It can be drawn that the health promotion practices of the community may
still be possibly linked with the practices and beliefs of the past, which are no longer
applicable today. At the same time, there is also a lack of medical professionals that
would correct their current practice and provide them with the correct ones.

33
Synthesis

After reading and compiling the relevant literatures above, one idea remains
that for a health worker to come up with a program that will meet the needs of the
community in terms of health promotion, a thorough, accurate assessment of their
health promotion practices is of supreme importance. It is the responsibility of the health
worker/provider to gather all the information that she can get in order to come up with
a program/plan that is specifically designed according to the specific needs of Brgy.
454, Sampaloc, Manila. This includes the consideration of all the factors that may
influence the health promotion practices of the individual such as the individual
characteristics as these may affect the way a person takes care of his health as
reflected in the 6 dimensions stated in the Health Promotion Lifestyle Profile II.
The readings in this chapter will help the researcher to further describe and
analyze the health promotion practices of the residents of Brgy. 454. These literatures,
both foreign and local will enlighten the researcher with the what, why and how of the
health promotion practices that the residents perform and will be used as a stepping
stone in the creation of the intended output of this study.

34
Chapter 3
RESEARCH METHODLOGY

This chapter presents the methodology of the study. Specifically, it discusses

the research design, population, sample, and sampling techniques, instrumentation,
data gathering procedures, data analysis.

Research Design
This study is observational in nature which utilizes a cross-sectional design which
is commonly used in conducting a health promotion research (Crosby, et al, 2006).
According to John Creswell (2005), a cross sectional study examines the current
attitudes, beliefs, opinions or practices of a certain group or community. To further
examine the target population, a survey research was utilized to understand the
characteristics of the population and estimate the levels of knowledge about any given
health threat or health protective behavior; and health-related attitudes, beliefs,
opinions, and behaviors (Crosby, et al, 2006).
Therefore, this study will utilize a cross-sectional survey design as it determines
the common health promotion practices done in Brgy. 454 Lardizabal Sampaloc, Manila.

Population, Sample, and Sampling Techniques

35

The respondents of this study will be fifty residents of Brgy. 454, mostly aged 3040 years old. This selection is based on the belief of the researcher that individuals in
the specified age group are mature enough to involve themselves in the improvement of
their health and capabilities. Moreover, people in this age group would represent those
who mostly engaged in activities that may negatively affect their health situation such as
alcohol abuse, smoking, and lack of physical exercise.
Therefore, their health promotion practices call for further investigation. The
respondents were selected using the purposive sampling technique where the
researcher selected those individuals who could provide richer and more significant
information about the study. Purposive sampling is a technique where the researcher
intentionally select individuals and sites to learn and understand the central
phenomenon (Creswell, 2005).

Instrumentation

The researcher utilized the Health Promotion Lifestyle Profile II, an instrument
used to measure the health promoting behavior of an individual, focusing on the six
domains

of

health

responsibility,

physical

activity,

nutrition,

spiritual

growth,

interpersonal relations, and stress management. These dimensions are reflected in the
following items:

1. Health-Promoting Lifestyle 1 to 52

36
2. Health Responsibility 3, 9, 15, 21, 27, 33, 39, 45, 51
3. Physical Activity 4, 10, 16, 22, 28, 34, 40, 46
4. Nutrition 2, 8, 14, 20, 26, 32, 38, 44, 50
5. Spiritual Growth 6, 12, 18, 24, 30, 36, 42, 48, 52
6. Interpersonal Relations 1, 7, 13, 19, 25, 31, 37, 43, 49
7. Stress Management 5, 11, 17, 23, 29, 35, 41, 47

This instrument, based on the Health Promotion Model of Nola J. Pender, was
originally produced in 1987 by Susan Walker, Professor Emeritus of University of
Nebraska, College of Nursing. This 52-item examination used a 4-point Likert Scale to
determine the behavior of the individual with a format of Never, Sometimes, Often,
and Routinely.
In order to accommodate the level of education of the residents of Brgy. 454, the
instrument was translated into the Filipino language. Considering the translation made,
this study will also serve as mean in measuring the appropriateness of the HPLP II tool
in the Philippine setting.
No pilot study is needed since the instrument to be used has been tested and
validated as evidence by the number of studies that utilized the said survey tool.

Data Gathering Procedure

37

In order to obtain the much-needed data, the researchers followed a series of

steps. First is to talk to the Barangay Captain if they can conduct a survey and present a
letter explaining about their study. Once permission is granted, the researcher will
begin the data gathering.
To select the respondents, the researcher will obtain a list of names of the
residents from their office, together with their addresses. The researchers will personally
visit the selected respondents and will ask if they have hypertension. If yes, the
researchers would provide them with the questionnaire. Beforehand, a letter asking for
their participation will be given to the participant. They participants have the right to
refuse involvement in the said study.
Collection of the questionnaire will follow afterwards for the collation and analysis
of data. Necessary statistical treatment will be applied in order to come up with the
results needed for the study.

Data Analysis

The HPLP II surveys data was coded and analyzed by the researchers. The
descriptive statistics were calculated using mean. The researcher examined the
demographic survey by evaluating percentage of subjects who responded to the
questions with a particular answer. Percentages also were used to evaluate the sample
characteristics.

38
The researchers used Pearsons r to statistically examine the HPLP II scores and
the average systolic and diastolic blood pressure measurements for correlations. The
researcher had hoped to discover significant correlations between the six dimensions of
the HPLP II survey and the average blood pressure measurements. The six categories
are health responsibility, physical activity, nutrition, spiritual growth, interpersonal
relations, and stress management. The health-promoting lifestyle is the seventh
category and it includes all 52 questions. Health-promoting lifestyle category contains all
six dimensions under one title. By looking at the six dimensions individually, the
researcher actually broke down the health-promoting lifestyle category for a more
thorough analysis.

Statistical Treatment of Data

The data that will be obtained in this study will be statistically treated with the
necessary formulas to facilitate the analysis and interpretation of findings. The Health
Promotion Lifestyle Profile II, the instrument used by the researcher, already has a
proposed method of scoring the results.
The score for the over-all health promoting lifestyle will be obtained by computing
the Mean of the individuals responses. Likewise, the scores for each subscale will be
obtained using the same computation. The mean, denoted by an x, is the most sensitive
measure of center since it takes into account all scores in a distribution when it is
calculated (Bordens, 2007). The formula for the mean is:

39
x =
n

Where:

Ex is the summation of scores

n is the number of scores in the distribution.

To

answer

question

number

4,

PEARSON

PRODUCT-MOMENT

CORRELATION COEFFICIENT will be utilized. This is a measure of association that

provides an index of the direction and magnitude of the relationship between two sets of
scores (Bordens, 2007).

Where:

N no. of cases
XY sum of the products of x and y
X sum of the xs
Y sum of the ys
X2 sum of the squares of xs
Y2 sum of the squares of the ys

40

To test the significance of the computed r

Where:

n the number of respondents

r the computed coefficient of correlation

41
Chapter 4
PRESENTATION OF FINDINGS, ANALYSIS & INTERPRETATION OF DATA

This chapter presents the results and discussion of data gathered based on the
following: a) to know the demographic profile of the residents of Brgy. 454 Lardizabal, b)
to illustrate the health promotion practices of the residents of Brgy. 454 Lardizabal, and
c) to specify common barriers to health promoting lifestyle among the respondents . The
study was conducted using Health Promotion Lifestyle Profile II.

RQ1: What is the demographic profile of the residents of Brgy. 454 Lardizabal
in terms of:

The ages of the subjects ranged from 30 years old to 50 years old or older.
Estimated sixteen percent (N=5) were between the ages of 30 to 35 years old, twentytwo percent (N=7) were between the ages of 36 - 40 years old, twenty-five percent
(N=8) were between the ages of 41 to 45 years old, and thirty-eight percent (N=12)
were ages 46 to 50 years old. Majority of the subjects were married. Of the thirty-two
subjects, estimated sixty-nine percent (N=22) were married, sixteen percent (N=5) were
separated, nine percent (N=3) were widowed, and six percent (N=2) were single. For
most, highest level of education was high school. Estimated forty-seven percent (N=15)
had attended high school, thirty-four percent (N=11) had attended grade school and
nineteen percent (N=6) had attended tertiary. The rest of the variables were also
illustrated on the table below.

42

Table 1 Demographic Profile of the Respondents

Characteristic
Gender

Age

Marital Status

Educational Attainment

Occupation

Spiritual beliefs

Total Sample
n=32

Percentage

Male

25

78.13

Female

21.88

30 to 35

15.63

36 to 40

21.88

41 to 45

25.00

46 to 50

12

37.50

Single

6.25

Married

22

68.75

Separated

15.63

Widow

9.38

None

0.00

Primary

11

34.38

Secondary

15

46.88

Tertiary

18.75

Employed

17

53.13

Unemployed

15

46.88

Catholic

16

50.00

Iglesia ni Kristo

18.75

Born Again

6.25

Others

25.00

A few questions asked about medications, home blood pressure monitoring,

transportation, living conditions, employment, and help at home. Eighty-four percent
(N=27) of the subjects took all medications as prescribed. Thirty-four percent (N=11) of
the subjects measured their blood pressures at home on a regular basis, while sixty

43
percent (N=19) had a blood pressure machine at home. Ninety-four percent (N=30) of
the subjects had transportation available for their primary care appointments. Seventyfive percent (N=24) had someone at home to help with health needs and twenty-five
percent (N=8) did not have help at home. Nevertheless, seventy-eight percent (N=25)
reported living alone and nineteen percent (N=6) did live with someone. Sixty-nine
percent (N=22) did not believe money was a barrier in controlling blood pressure

RQ2: What are the health promotion practices of the residents

of Brgy. 454 Lardizabal?

A summary of the HPLP II survey responses is located in Table 2. All fifty-two

questions from the HPLP II and all blood pressure measurements were examined using
Pearsons Correlation Coefficient. The following categories had significant results:
interpersonal relations, spiritual growth, health responsibility, and stress management.

Table 2 Summary of Health Promotion Practice

44

R3: What are the common barriers to health promoting lifestyle among the
respondents?

45

Interpersonal Relations was analyzed with the average blood pressure

measurements and yielded several moderately significant correlations. The results for
Interpersonal Relations are located in Table 3. First, an inverse correlation with
moderate significance was found (r= -0.398, p=0.024, p<0.05) between systolic blood
pressure measurements and praising other people easily for their achievements.
Secondly, a moderate correlation (r=-0.355, p=0.046, p<0.05) was found between
systolic blood pressure measurements and discussing my problems and concerns with
people close to me. Thirdly, a moderate correlation was discovered between systolic
blood pressure measurements and maintaining meaningful and fulfilling relationships
with others. Lastly, a moderate correlation (r=-0.374, p=0.035, p<0.05) was discovered
between systolic blood pressure measurements and touching and being touched by
people I care about.

46
Table 3.
Interpersonal
Relations
Question
Discuss my problems
and
concerns with people
close to me.
Praise other people
easily for their
achievements.
Maintain meaningful and
fulfilling relationships
with others.
Spend time with close
friends.
Find it easy to show
concern, love, and
warmth to others.
Touch and am touched
by people I care about.
Find ways to meet my
needs for intimacy.
Get support from a
network of caring
people.
Settle conflicts with
others through
discussion and
compromise.

Number of
Subjects

Systolic
Diastolic
r=Correlat r=Correlat
ion
ion
p=Signific p=Signific
ance
ance

N=32

r= - 0.355**
p= 0.046

r=- 0.269
p= 0.137

N=32

r= - 0.398**
p= 0.024

r= 0.008
p= 0.965

r= -0.428**
p= 0.015
r= -0.269
p= 0.136

r= 0.129
p= 0.481
r= 0.051
p= 0.783

N=32

r= - 0.130
p= 0.478
r= -0.374**
p= 0.035
r= -0.315
p= 0.079

r= -0.123
p= 0.502
r= 0.110
p= 0.551
r= 0.090
p= 0.626

N=32

r= -0.320
p= 0.074

N=32

N=32
N=32

N=32

r= 0.130
p= 0.477

\
]

r= -0.249
p= 0.169
r= -0.146
p= 0.426

Spiritual Growth was analyzed with the average systolic blood pressure
measurement. Three questions from the survey correlated significantly with the average
systolic blood pressure measurement. The questions were as follows: look forward to
the future (r=-0.363, p=0.041, p<0.05), work toward long-term goals in my life (r=-0.393,
p=0.026, p<0.05), and find each day interesting and challenging (r=-0.369, p=0.037,
p<0.05).
Health Responsibility had only one question that resulted in a moderately
significant correlation with systolic blood pressure. The significant correlation was noted

47
between discuss my health concerns with health professionals and the average systolic
blood pressure measurement(r=-0.412, p=0.019, p<0.05).

Stress Management had two moderately significant results. The average systolic
blood pressure and take some time for relaxation each day was correlated (r=-0.353,
p=0.048, p<0.05). The second correlation was between the question, balance time
between work and play, and systolic blood pressure (r=-0.353, p=0.048, p<0.05).
Among the different categories of the HPLP II, only one category provided a
correlation with elevated diastolic blood pressure. Under Stress Management, an inverse,
moderate correlation was discovered between subjects getting enough sleep and diastolic
blood pressure (r=-0.505, p= 0.003, p<0.05). In other words, subjects who claimed to get
enough sleep had lower diastolic blood pressures.

48

Chapter 5
SUMMARY AND CONCLUSIONS

This chapter summarizes the study on the research made in assessment to

health promotion lifestyle of the residents of Brgy. 454 with hypertension.

The

conclusions given were drawn from the outcomes of the research and observations on
the impact made. Recommendations were based from findings and conclusions of the
study.

Summary
This study would perform the concept of the Health Promotion Lifestyle Profile II
to assess residents health promotion practices and to discover common barriers to
health promoting lifestyle with hypertension.
Existing literature was reviewed to determine if any prior studies had been done
to assess health promotion practices in relation to hypertension that provides this
information. It was discovered that many studies had been done by health educators
and professionals on what they perceived to be important in developing healthy
promotion program that would greatly affect the lifestyles of the respondents in a
community. Knowing residents of Brgy. 454s perceptions based on their evaluation
could help health providers better understand the needs of their community and design
a specific program intended for the residents with hypertension.

49
The method of research to be used in this study is observational in nature which
utilizes a cross-sectional approach to determine the health promotion practices of ages
30-to-50-year-old respondents. Survey research was conducted in Brgy. 454 Sampaloc,
Manila with purposive sampling.
The HPLP II surveys data was coded and analyzed by the researchers. The
descriptive statistics were calculated using mean. The researcher examined the
demographic survey by evaluating percentage of subjects who responded to the
questions with a particular answer. Percentages also were used to evaluate the sample
characteristics.
The researchers used Pearsons r to statistically examine the HPLP II scores and
the average systolic and diastolic blood pressure measurements for correlations. The
researcher had hoped to discover significant correlations between the six dimensions of
the HPLP II survey and the average blood pressure measurements.

Conclusion
The following conclusions have been drawn based on the findings presented:

1. The demographic data provided great insight into the type of sample population
obtained for this study. The sample population mostly consisted of high school
educated, married, Caucasian males, who were between the ages of 66 to 75
years old. All 32 subjects were hypertensive and uncontrolled. The subjects
(N=32) had at least two blood pressure readings (consecutively) that were
greater than 140/90 mmHg.

50
2. Several categories of the HPLP II had moderately significant results that were
inversely correlated. The Interpersonal Relations category revealed that having a
relationship with others affects systolic hypertension. Interpersonal relations did
not affect diastolic blood pressures. A moderately strong correlation was
discovered between discussing my problems and concerns with others and
systolic blood pressure measurements, indicating that not discussing concerns or
problems with others increases systolic blood pressure. In addition, a stronger
correlation was found among systolic blood pressure and praising other people
easily for their achievements, indicating that not praising others increases
systolic blood pressure. Lastly, maintaining meaningful and fulfilling relationships
with others had the strongest correlation in the category. Maintaining meaningful
and fulfilling relationships decreases systolic blood pressures.
3. Spiritual Growth had a significant impact on systolic blood pressures, but not on
diastolic blood pressures. A correlation was found between looking forward to
the future and systolic blood pressure, signifying looking forward to the future
decreased systolic blood pressure. Another health behavior in this category,
working toward long-term goals and finding each day interesting/challenging,
was correlated with systolic blood pressures. Not having long-term goals or not
finding each day interesting increased the systolic pressure.
4. Health Responsibility and Stress Management had significant correlations with
systolic blood pressures. In Health Responsibility, the statement discuss my
health concerns with health professionals was moderately correlated to systolic
blood pressure. This result indicated that discussing problems with health
professionals, such as nurses or providers, decreased an elevated systolic
blood pressure. One statement from the Stress Management category, take

51
some time for relaxation each day was correlated to systolic blood pressures,
signifying that not taking some time for relaxation and not balancing time
between work and play may increase systolic blood pressures.
5. The other categories from the HPLP II, such as Nutrition and Physical Activity, did
not significantly correlate to systolic or diastolic blood pressures.
6. Hypertension has been deemed as the most notable disease among Filipinos.

In hopes to contribute for a better health program, the purpose of this study
was to discover the barriers to a health-promoting lifestyle among the
residents of Brgy. 454. The results significantly show that stress management,
interpersonal relationships, spiritual growth, and health responsibility effects
systolic blood pressure, either negatively or positively. The problems with
stress management, interpersonal relationships, spiritual growth, and health
responsibility can be considered barriers to controlled hypertension.

52

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Cosby, R., et al., Research Methods in Health Promotion. John Wiley and Sons, Inc.
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Cuevas et al.. Public Health Nursing in the Philippines. National League of Philippine
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Dayrit, M., National Policy on Health Promotion. Sta. Cruz, Manila 2001

Endelman, C. et al., Health Promotion Throughout the Life Span 6th Edition . Mosby,
Inc. 2006

53
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