Intervention program to improve health promoting behaviors of patients with hypertension in light of Logotherap

Kazuko Kikuchi How should hypertensive patients live a daily life? The author and joint researchers developed and implemented an intervention program to improve health promoting behaviors of patients with hypertension. This paper deals with the results of the program in light of Logotherapy.

Focusing on hypertension as a common health issue, the author et al. and the faculty of School of Nursing, The University of North Carolina at Wilmington, USA researched how health promoting behaviors of hypertensive patients are related to "knowledge on hypertension," "spirituality" and others. The findings about Japanese patients suggested the necessity of guidances to patients about effects of body weight and exercises on hypertension. In a study on diabetes, another chronic aliment, when being asked what they can do for better glycemic control, diabetic patients answered "to do more exercises," "to live a happy and meaningful daily life," or "to take actions to relieve stress." But also heard were they have no time or no will to do so.

Based on such findings, the author et al. designed a program to encourage patients with hypertension, a chronic aliment, to do exercises, to control stress, and to enhance spirituality. Enhanced spirituality is considered to bolster purpose in life and human dignity, and important also for making good habits for healthy life.

This program was implemented for six months, during which participants attended a session once a month. In the first session, participants received a pedometer and a blood pressure with recording function for lending. Participants walked with the pedometer all the day and measured their blood pressure every morning and evening. In the next session, they connected the devices to a computer to plot monthly data on a chart. Using the chart, each participant did interview with a researcher. The researcher was requested to listen to the participant with respect and sympathy, and make some proposals to the participants instead of offering a solution.Participants in the program were local residents who had participated in a class on blood pressure and agreed to be surveyed. Participated were 13 residents in the first survey and 30 in the second. When compared with the data in the first month, the average blood pressure of the highest and the lowest in the last month decreased and the average number of steps (body active mass) increased with statistical significance (1% in significance level). Participants gave comments such as "When I made walking a daily habit, I could relieve my stress. Such a good habit is encouraging and satisfying me in my daily life."

From the perspective of Frankl’s tri-dimensional ontology, exercises in this program is considered as approach to the physical dimension, stress control as that to the psychological dimension and spirituality as that to the noetic dimension.

One of participants, Japanese pickles lover, gave up eating pickles for meal by figuring that she would not be able to take care of her son with disability if she becomes sick due to high blood pressure. She continued giving up the small thing, which originated from will to meaning and led to realization of a big meaning; she became having nearly normal blood pressure. Humans have freedom to say No in the noetic dimension to their instinct in the psycho-physical dimension even when they are acting by instinct. Frankl named human spiritual ability to transcend oneself "the defiant power of the human spirit." Making it a habit to give up small things resulted in strengthening the defiant power of the human spirit, which encouraged her to continue health improving behaviors.

Approach to participants in their spirituality during interviews with thoroughgoing listening, sympathy, and respect is considered to enhance abilities in the noetic dimension, which alleviated problems in feeling in the psychological dimension, and fostered executive ability to improve health in the physical dimension. As a result the participants gained self confidence, which helped the participants to develop habits to i mprove health.