Research Compiled As of January 26

St.
Paul University Philippines 1

Tuguegarao City, Cagayan 3500
HYPERTENSION RISK, KNOWLEDGE, ATTITUDE AND PRACTICES AMONG
EMPLOYEES OF ST. PAUL UNIVERSITY PHILIPPINES
A Thesis Study Presented to the Faculty of the School of
Nursing and Allied Health Sciences, St. Paul University
Philippines, Tuguegarao City, Cagayan Valley 3500
In Partial Fulfillment
Of the Requirements in the
Bachelor of Science in Nursing Program
Marlchiel Nathan S. Arreglado
Deborah T. Balogun
Kristine Marie S. Pablico
School of Nursing and Allied Health Sciences

St. Paul University Philippines 2
APPROVAL SHEET
In partial fulfillment of the requirements for the degree
BACHELOR OF SCIENCE IN NURSING, this thesis titled,
“HYPERTENSION RISK, KNOWLEDGE, ATTITUDE AND PRACTICES AMONG
EMPLOYEES OF ST. PAUL UNIVERSITY PHILIPPINES”, has been
prepared and submitted by Marlchiel Nathan Arreglado,
Deborah Balogun, Kristine Marie Pablico who is hereby
recommended for Oral Examination.
MRS. KATHERINE ARELLANO, MSN

Adviser
Approved by the Committee on Oral Examination with a

grade of PASSED as of January, 2020.
PANEL OF EXAMINERS
Dr. Emolyn Turingan

Chairperson
Mrs. Lilian P. Gonao, MSN Josephine D. Lorica, RN, DPA

Member Member
Accepted and approved in partial fulfillment of the

requirements for the degree BACHELOR OF SCIENCE IN NURSING.
DR. ANNUNCIATION TALOSIG, DNS

Dean, School of Nursing and Allied Health Sciences

ACKNOWLEDGEMENT

DEDICATION

TABLE OF CONTENTS
Title Page
Title Page ..................................... i
Approval Sheet ................................. ii
Acknowledgment ................................ iii
Dedication ..................................... iv
Table of Contents .............................. vi
List of Tables ................................. ix
List of Figures ................................ xi
Abstract ....................................... xii
Chapter 1. THE PROBLEM AND REVIEW OF RELATED LITERATURE
Introduction ........................... 1
Review of Related Literature and Studies 5
History of Information Communication
Technology (ICT) .................7
ICT Literacy ........................10

21st Century Skills..................13
Technology Integration.............. 15
Digital Technology..................47
Utilization of eBooks in
the Philippines............60
Synthesis of the Literature.........66
Theoretical Framework(optional)........ 70
Conceptual Framework................... 73
Paradigm of the Study.................. 74
Statement of the Problem .............. 75
Hypothesis/es .......................... 77
Significance of the Study ............. 77
Scope and Limitation .................. 79
Definition of Terms ................... 80
Chapter 2. METHODOLOGY
Research Design ....................... 83

Note: when including subtopics, indention is needed
EXAMPLE (IT Capstone)
System Architecture......................xx
System Development Life...................xx
Sources of Data/Participants of the Study/Subjects
of the Study ................................. 83
Instrumentation........................... 85
Data Gathering Procedures.............. 86
Data Analysis ........................ 87
Chapter 3. RESULTS AND DISCUSSIONS…………………………………..89
Chapter 4 SUMMARY OF FINDINGS, CONCLUSIONS AND
RECOMMENDATIONS
Summary of Findings ................... 129

Conclusions ............................ 136
Recommendations ....................... 138
REFERENCES ..................................... 140
APPENDICES
Appendix A. Questionnaire for Student-Participant.. 148
Appendix B. Questionnaire for Teacher-Participant.. 150
Appendix C. Questionnaire for Parent-Participant... 156
Appendix D. Letter to the Principal................ 160
CURRICULUM VITAE.................................. 161

LIST OF TABLES
Table
Page
1 Number of Student-Participants from
Grade 7 to Grade 10 .......................... 84
2 Scale of Interpretation ......................
87
LIST OF FIGURES
Figure
Page
A Conceptual Framework ........................ 74

ABSTRACT
Title : HYPERTENSION RISK, KNOWLEDGE, ATTITUDE AND

PRACTICES AMONG EMPLOYEES OF ST. PAUL UNIVERSITY
PHILIPPINES
Researcher :
Degree :
School : ST. PAUL UNIVERSITY PHILIPPINES
Year Completed :
Adviser :
Data Consultant:
Language Editor:

Chapter 1
THE PROBLEM AND REVIEW OF RELATED LITERATURE
Introduction
One of the most important risk factors for
cardiovascular disease, the leading cause of mortality, is
high blood pressure. Hypertension or normally known as high
blood pressure is a major risk component of chronic diseases,
and it often leads to undesirable outcome such as stroke and
heart attack when it is uncontrolled and not properly
managed.
Hypertension, according to World Health Organization
(WHO, 2015) is a condition in which the blood vessels have
persistently expanded in pressure, placing them under
increased stress. However, this may vary in severity,
symptoms and risk factors from person to person. Most people
with hypertension are asymptomatic, meaning it has no
symptoms at all, thus, this is why it is known as the “silent
killer” (WHO, 2013).
There have been guidelines provided in the diagnosis of
hypertension with the goal of early detection and prompt

treatment to prevent further complication. Prior to the 2017
Guidelines provided by the American College of Cardiology
(ACC), Hypertension was defined with a blood pressure reading
of 140/90 or higher. However, in 2017, diagnosis of
hypertension has been set on a blood pressure of 130/90 or
higher to initiate earlier lifestyle modification and
medication to prevent further complications. Whelton (2017).
According to Muntner (2017), these guidelines are necessary
to promote awareness on healthy lifestyle, treatment of
antihypertensive drugs, and possible risks for
cardiovascular diseases unless hypertension is controlled.
Study articles have shown that majority of people in
many developing countries does have blood pressure higher
than the adequate level that is regarded with a high
incidence of current hypertension (Global Burden of Disease,
2012). Persons with hypertension are strikingly increasing
in numbers overtime. Hypertension Deaths in the Philippines
exceeded 14,751 or 2.38 percent of total fatalities,
according to the latest World Health Organization information
released in 2017. The age-adjusted death rate in the globe

ranks Philippines #44 at 23.56 per 100,000 population (“Age
adjusted Death Rate Estimates: 2017”).
Despite the increased prevalence of hypertension, there
was only a moderate knowledge about hypertension and there
is lacking in comprehensive knowledge. Thus, it is important
to increase the public health knowledge and awareness in
preventing hypertension along with the distribution of
primary health care services with an emphasis on hypertension
and cardiovascular diseases (Kusuma, Gupta, and Pandav,
2009).
The findings of the study may help identify employees
of Saint Paul University Philippines with risk of having
hypertension, and provide information on their knowledge,
attitude and practices towards hypertension. Findings of the
study will guide in formulating health care plan specific
for hypertension among the employees. These can be utilized
by the university in ensuring that its workforce have lower
risk of acquiring the disease.

Review of Related Literature
The review of related literature focuses on the concepts
and theories of knowledge, attitude and practices (KAP) on
hypertension to which were taken from online database, online
journals, and resources found on the internet. These were
organized thematically to be able to understand and
strengthen the topic of the study.
Definition of Hypertension
Hypertension, according to World Health Organization
(WHO, 2015) is a condition in which the blood vessels have
persistently expanded in pressure, placing them under
increased stress. However, this may vary in severity,
symptoms and risk factors from person to person. Most
people with hypertension are asymptomatic, meaning it has
no symptoms at all, thus, this is why it is known as the
“silent killer” (WHO, 2013). Hypertension is a major risk
component of chronic diseases, and it often leads to

undesirable outcome such as stroke and heart attack when it
is uncontrolled and not properly managed.
According to the study of the American College of
Cardiology (ACC)(2017) and American Heart Association
(AHA)(2017), Hypertension has been categorized for years as
a 140/90 mm Hg or higher blood pressure (BP) reading, but
the revised guideline classifies hypertension as a 130/80 mm
Hg or lower BP reading. The new 2017 guidelines of
hypertension ought to be treated at 130/80 mmHg rather than
140/90 mmHg earlier with changes in lifestyle and in some
patients with medication (ACC, 2017). In regards with its
impact, it implies that the guideline has the potential to
raise awareness of hypertension, promote lifestyle
modification and focus on anti - hypertensive drug initiation
and monitor adults with cardiovascular disease risk factors
(Muntner, 2017). Since the first comprehensive guidelines in
2003, new guidelines in 2017 lowers the definition of high
blood pressure in order to take into account for
complications that may occur at decreased numbers and to
permit for earlier intervention. The lead author of the
guidelines emphasized that they wanted people to straightly

know if they are already having a doubling risk of developing
high blood pressure. Thus, this does not mean an instant need
for pharmacological treatment, instead it provides a yellow
light signal to the need to lower blood pressure (Whelton,
2017).
Categories of blood pressure in the new American College
of Cardiology (ACC) and American Heart Association (AHA) for
the detection, prevention, management and treatment of high
blood pressure guideline, 2017) are:
 Normal blood pressure is Less than 120/80 mm Hg;
 Elevated blood pressure’s systolic between 120-129
and diastolic lower than 80;
 Stage 1 high blood pressure’s systolic is between
130-139 or diastolic between 80-89;
 Stage 2 high blood pressure systolic is at least
140 or diastolic at least 90 mm Hg;
 Hypertensive crisis: Systolic over 180 and/or
diastolic over 120, with patients needing prompt
changes in medication if no other signs of problems
exist, or immediate hospitalization if signs of
organ damage exist.

One of the objectives of the study is to identify
employees who have been clinically diagnosed with
hypertension, and those who are currently taking anti-
hypertensive medication. Basing from the above literature,
the diagnosis of hypertension must be based from scientific
guidelines provided. And prescribed treatments must also be
based from the classification of hypertension to ensure
appropriate medication regimen and lifestyle modification.
Statistics of Hypertension
According to the (Department of Health, 2004),
Hypertensive vascular diseases is the second top leading
causes of mortality in the Region 2. Whereas, the top 4
leading causes of morbidity of the same year and 5 year-
average is still associated with hypertension. In the 5-year
average of the year 2008-2012 and 2013, heart disease and
diseases of the vascular system are the top two (2) leading
cause of death in the Philippines (Epidemiology Bureau,
Department of Health, 2013). Hypertension Deaths in the
Philippines exceeded 14,751 or 2.38 percent of total
fatalities, according to the latest World Health Organization

information released in 2017. The age-adjusted death rate in
the globe ranks Philippines #44 at 23.56 per 100,000
population (“Age adjusted Death Rate Estimates: 2017”).
Studies have reported that hypertension claims 1.5
million lives each year in South East Asia and approximately
one-third of the adult population in South East Asia has
hypertension and is one of the leading risk factor for death
(WHO,2013). Study articles have also shown that majority of
people in many developing countries does have blood pressure
higher than the adequate level that is regarded with a high
incidence of current hypertension (Global Burden of Disease,
2012). Persons with hypertension are strikingly increasing
in numbers overtime. It is estimated by the World Health
Organization (2015) that around 40 percent of people around
the world have increased blood pressure. It is not a surprise
that 55 % of the 17 million annual cardiovascular (CVD)
deaths are associated with complications caused by increased
blood pressure. Globally, in 2008, the general prevalence of
increased blood pressure in adults aged 25 years and older
was about 40 %, with that, the percentage of people with
uncontrolled hypertension rise from 600 million in 1980 to

roughly 1 billion in 2008 due to the rapid growth in
population and ageing (WHO, 2008).
Risk of Hypertension
-brief introduction 3 sentences
Differences in the Hypertension risk relative to
Age
Hypertension is a highly prevalent condition with
numerous health risks and their incidence is greatest among
older adults between age 65 and above (Buford T.W., 2016).
The prevalence of hypertension among adults of age 18 years
and older is substantial, in young adult hypertension have a
lower prevalence of hypertension diagnosed than in middle-
aged and older adults (Liu, 2017). Hypertension have focused
largely on risks for cardiovascular disease and associated
diseases, there are different effects including dementia,

physical disabilities, including inflammation, stress, and
endothelial dysfunction are common to aging and hypertension
development in the elders (Buford, T.W., 2016).
According to (Hajjar, Kotchen and kotchen, 2006) blood
pressure increments continuously increase with age in the two
sexes however men demonstrates an increase in BP with age
than in ladies before menopause. After menopause, ladies will
in general have a higher increase in blood pressure compared
to men.
Hypertension imposes numerous health risks especially
in older adults. In general, age and gender are underlying
risk factor for hypertension and cardiovascular diseases. It
has been an integral part of nearly all recent cardiovascular
disease risk algorithms. Researchers found in a study
published in that young adults with high or elevated blood
pressure before they turn 40 had a greater risk of subsequent
cardiovascular problems compared for those with normal blood
pressure before they turned 40 (Yano, Reis, and Colangelo,
2018).

Difference in the Hypertension risk relative to Gender
Men have higher blood pressure than women. According to
the National Health And Nutrition Examination Survey (Vargas,
Ingram, and Gillum, 2000) they reported overall mean arterial
pressure in hypertensive men compared to women, in all ethnic
group men have the highest systolic and diastolic pressure
than in women and also through middle age hypertension is
more prevalence in men (Everett and Zajacova, 2016).
The difference in hypertension that exist between men
and women are due to biological and behavioral factors
(Sandberg & Ji, 2012). The biological factors include; sex
hormones, chromosomal differences, these biological factors
become evident in the adolescences and persist through
adulthood until menopause in women. The behavioral risk
factors for hypertension include the body mass index (BMI),
smoking and less physical activity. BMI distribution varies
by gender and women have higher means to have obesity than
in men but at the same time, men have higher prevalence of
being overweight than women. Smoking is lower among women
than men and physical activity tends to be higher among men.
These behavioral factors such as obesity, physical activity

may close the gender gap in hypertension while other factors
like smoking may increase the disparity (Reckelholff, 2001).
Men are less aware and received less treatment for
hypertension compared to women. According to the National
Health And Nutrition Examination Survey, NHANES (2000), few
men had their blood pressure controlled, men have higher
death rate due to hypertension and men also have higher risk
for having stroke, heart failure, renal failure and coronary
heart disease (Phyllis, A.,1999).
In both men and women the mechanism of hypertension
remain unknown, hypertension is the determinants of CVD in
both sexes, despite this there are some causes of
hypertension that only occurs in women, these are eclampsia
in pregnancy and hypertension due to use of contraceptive,
these observation leads to the conclusion that before
menopause the female sex hormones offers risk protection
unavailable to men (Safar & Smulyan, 2004).

Difference in the Hypertension risk relative to Educational
Attainment
Socioeconomic factors such as education and income have
been shown to be associated with blood pressure, the
association of blood pressure and levels of education have
been studied among younger and middle-aged population but
not in older population because their education is relatively
stable (Kiely, Gross, Kim, and Lipsitz,2012).
The studies have shown that the lower socioeconomic
status as measured by education or occupation are more likely
to be hypertensive compare to an individual with higher
socioeconomic status (Vargas, Ingram and Gillum, 2000). Those
with the greatest education have the lowest prevalence of
hypertension and the lowest mortality rate from hypertension
disease.
Difference in the Hypertension risk relative to Physiological
Many studies have shown that work stress is related to
the incidence and prevalence of cardiovascular diseases, work
stress has been proving to be associated with high blood
pressure. Work stress is a set psychosocial factors

experienced by workers due to the condition of their work
generated as composite experience at different levels within
an organization (Clougherty, Elsen, Slade, Kawachi and
Collen,2008). Increased risk of hypertension and elevated
blood pressure have been observed with chronic job strain,
low job control and stressful work condition which includes
low promotion potential, low participation in decision
making, unsupportive co-workers and communication
difficulties.
Theories have predicted health risk in the exposed
population, this theoretical models are; (Babu, Mahapatra ,
and Detel , 2013) are demand control models; this model focus
on non-reciprocity of social exchange which contribute to
stress and psychosocial dimension at work which are the
effort, rewards and over-commitment, effort is part of the
work contract, rewards are in term of money, esteem and
career opportunity including job security. Over-commitment
acts as a risk factors and is a set of attitudes, behavior
and emotion that reflect the commitment and effort-reward
imbalance model, chronic job stress is caused by imbalance
between the effort spent and low rewards and over-commitment.

Job grade may capture difference in status and decision-
making authority, also chemical exposures, physical demands
and workplace. Poor health may lead to lower work status and
sick individual may be selected into lower status work or
unemployment (Gamage and Seneviratne , 2016).
Difference in the Hypertension risk relative to Behavioral
Behavioral activity such as alcohol consumption,
smoking is related to diagnosis of hypertension. People who
have daily alcohol consumption of more than 3 bottles a day
have an increased risk for hypertension. Meanwhile smokers
have higher ambulatory blood pressure compared to non-smoker
also those who are once a smoker have high prevalence of
hypertension. DASH(dietary approach to stop hypertension)
documented that fruits and vegetables consumption and low
fat dairy products have an effect on blood pressure by
controlling the rise in systolic and diastolic pressure in
regardless of age, gender, weight etc. other characteristic
of hypertension are stress and type of work is also
associated with risk for hypertension( Mundan, Muiva and
Kimani, 2013).

In addition to these risk factors, there are some
dietary practices that has correlation to the increase of
blood pressure. Based on results of clinical trials and
observational studies among population groups, Sodium
Chloride intake is related to the prevalence of hypertension
and the age-related increments of blood pressure. Having a
high potassium intake also has a relationship with blood
pressure, societies with higher potassium intake tend to have
a lower prevalence of hypertension compared to societies with
lower potassium. Alcohol intake also has an effect on the
prevalence of hypertension. The effect of alcohol intake of
two or more drinks per day to the prevalence of hypertension
has been estimated to be 5% to 7%. (Hajjar, Kotchen and
Kotchen, 2006)
Hypertension is characterized by age, gender,
physiological, behavioral, educational attainment and diet.
Blood pressure and prevalence of hypertension increased with
advance in age, diagnosis of hypertension is lower in people
with tertiary education compare to people with primary and
secondary education, this is attributed to health awareness
and practice among those with higher education, risk factors

are unknown to people with lower educational status. Higher
educational attainment has been associated with health care
seeking behavior and awareness that can alleviate the risk
factor associated with hypertension, educated people are more
knowledgeable, practice healthy behavior and have
nutritional education and stress coping mechanism which can
prevent chronic disease.
Additionally, having a family history of hypertension
is related with a steeper chance of prevalence and incidence
of hypertension.
Knowledge, Attitude and Practices (KAP) and Hypertension Risk
-brief intro
Knowledge on Hypertension
Reports have showed that knowledge on hypertension has
an association with the control of blood pressure. According
to Joint Nation Committee (The seventh report of the Joint
National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure: complete report, 2004)
patient knowledge on basic hypertension concepts is good.
However, about personal blood pressure control status,

knowledge is suboptimal. Having insufficient knowledge on
the appropriate systolic blood pressure was also uncovered
to be a risk factor for poor BP control (Knight, Bohn, Wang,
Glynn, Mogun and Avorn, 2001). According to (Kilic,
Uzunçakmak, and Ede, 2016) educational status and level of
knowledge on hypertension were shown to encourage positively
the control of high blood pressure but some patients in their
study has no knowledge that hypertension can be present
without any signs and symptoms. Due to the incorrect
perceptions, the patients think that their blood pressure is
under control in the absence of the signs and symptoms. The
knowledge on hypertension is very sensitive for patients to
evaluate themselves. In their study, it was found that the
level of knowledge about hypertension increased in proportion
with higher degree of educational states.
A study by (Tong, Tse, Jonathan and Khung 2017), found
that females has higher knowledge and attitude regarding
hypertension risk than males. However, lower score in
practices were shown as compared to males. One possible
explanation for higher scores of knowledge and attitude is
that women are more proactive in seeking information about

health. In addition, in comparison with men, women also
received more health-related information from family
members. It has been shown that this exposure to health
information leads to better knowledge.
In the study conducted by (Agyei-Baffour, Tetteh, and
Boateng, 2018) It was revealed that there is an associated
connection between the level of education and knowledge of
hypertension. The awareness on hypertension among the highly
educated was significantly higher than those compared with
low educational attainment. This is coherent with the
findings of previous studies conducted- all of which
documented a positive correlation between hypertension
education and knowledge level.
According to a study, in terms of Farquhar’s model of
behavioral change, their findings suggested that most
patients had enough knowledge regarding hypertension, but
only a few has showed real motivations to change. Most of
the patients had poor compliance of drugs in their study and
that the forgetfulness and interruptions of daily routine
were common reasons for nonadherence (Farquhar, et al, 1998).

Despite the increased prevalence of hypertension, there
was only a moderate knowledge about hypertension and there
is lacking in comprehensive knowledge. Thus, there is a need
to increase the distribution of primary health care and an
emphasis on cardiovascular diseases and hypertension along
with the increase of public health awareness and knowledge
on prevention of hypertension (Kusuma, Gupta, and Pandav,
2009).
Attitudes on Hypertension
It was stated by Aubert (Aubert, Bovet, Gervasoni,
Rwebogora, Waeber and Paccaud, 1998) that “In terms of
Bandura’s social learning theory, a situation where
environmental cues exist or good basic knowledge but fail
because of the low confidence that a behavior may actually
influence health. There are various explanations on why low
outcome expectation on chronic disease control and resistance
o actually adopting healthy lifestyles. First, is that lay
persons underestimate the serious consequences of having
hypertension because of the hidden evolution, chronic nature,
and the delayed impact on health outcomes. Second is that
lifestyle practices in a society are shaped by common

attitudes, beliefs, and behaviors that tends to be stable
over time. Third, is that the individual appeasement in
immediate “pleasurable” behaviors like eating fatty and salty
food, avoidance of physical exercise, and smoking is a
powerful restraint for adopting behaviors such as moderation
in salt, alcohol and caloric intake, regular physical
exercise, and cessation from smoking.”
While according to Meng (2012), link between risk for
hypertension and psychological factors is present. It was
stated that depression increased the risk of hypertension
incidence but in the study of (Nguyen, Bauman and Ding,
2018), having high risk of psychological distress has no
effect on the incidence of hypertension.
According to Peters & Templin (2010), behavioral changes
of patients who are at risk for hypertension will not occur
unless they value the goal underlying the behavioral changes.
Assessing the capacity of theory of planned behavior concepts
on predicting a medically recommended goal related to
combined, and multiple behaviors determines the attitude on
behavioral goal predicting accumulated self-care behaviors
needed for blood pressure control.

Practices on hypertension
Practice is important in order to apply preventive
measures that comes from knowledge.
Hypertension possesses a major public health challenges
in the world regarding its prevention and management. It is
a second leading major risk factor of morbidity and mortality
worldwide (Global Burden of Disease Study, 2015). Though it
is a preventable disease, numerous hypertensive people still
struggle to control their blood pressure due to their
lifestyle choices.
Practice according to Cambridge’s dictionary is defined
as, an action that is regularly done; it is usually to do a
habit, tradition or custom. These are connected area of
activities done by the participants that are in low, moderate
and high-risk in relation to hypertension (HTN). Adhering
to self-care practices to prevent hypertension can decrease
the risk of heart attack, stroke, and other life-threatening
illnesses.
There are significant number of modifiable risk factors
have been identified that can lead to hypertension, including

excess body weight; too much intake of dietary sodium; lack
or less physical activity; insufficient consumption of
fruits, and vegetables; and excessive alcohol intake are a
common characteristic of a person high-risk or diagnosed with
hypertension. Unhealthy lifestyle choices tend to play a
major concern in the increase of blood pressure. Eating
unbalanced diet is known to be linked with half of
hypertension cases. At about 30 % of people with hypertension
is linked with excess consumption of salt while; 20% of cases
had low dietary intake of potassium that can be an effect of
inadequate intake of fruits and vegetables (Institute of
Medicine of the National Academies, 2010)
Many people who are hypertensive are unaware of their
conditions because of its asymptomatic effect. Headache,
dizziness, nape pain, and blurry vision are the only known
known symptoms yet it is non-specific and might be due to
other causes. It is encouraged to practice monitoring blood
pressure more often to find out if the person is at-risk
(Castillo, 2018).

Discovering the knowledge, attitude, and practices
level of at-risk hypertensive clients gives a great
importance in developing the appropriate educational and
self-management programs. Planning a proper managing
intervention that leads to adequate control of blood pressure
will result in the prevention of most complications and
comorbidities in line with hypertension. The most significant
area in management of hypertension depends on lifestyle
modification which includes diet, exercise, and social
attitudes. In addition, it is advised to the public the
importance of monitoring blood pressure on a regular basis
knowing that hypertension affects three of every 10 filipino
adult population and also continuously monitoring among
younger age bracket and even of adolescent age (Department
of Health, 2018). Preferably measure the blood pressure few
times a week and seek professional health care providers for
any significant changes. (American Heart Association, 2018)
These studies support the assertion that hypertension
is one of the most prevalent disorders of the cardiovascular
system that can lead to more severe complications if prompt
treatment is not initiated. While there are non-modifiable

risk factors such as age and gender that an individual cannot
control, most of the risk factors are associated to lifestyle
such as diet, smoking and alcoholism. Therefore, adequate
knowledge on prevention, diagnostic and treatment of
Hypertension is essential to promote positive attitude and
health practices.
Given that work environment and stress are contributory
factors to hypertension, it is important that employees or
workers in various disciplines must be provided with health
programs to improve their health care practices. This is the
purpose of this study, to gather data on the knowledge,
attitude and practices towards hypertension among employees
as basis in developing health care programs.
Conceptual Framework
Hypertension or elevated blood pressure is a serious
medical condition leading to various complications affecting
the heart, brain and kidneys. It is more prevalent in low
and middle income countries. This is attributed to inadequate
health services and poor socioeconomic status.

In terms of gender, men have higher risk of having the
disease than women which can be associated to their lifestyle
or behaviors toward health. Alcoholism and smoking which
poses great risk for hypertension are more common in male
than in females. Though family history and age which are non-
modifiable risk factors for hypertension, modifiable factors
which include unhealthy diets, physical inactivity,
consumption of alcohol and tobacco, and being obese pose
greater risk.
Hypertension is called “silent killer” because there
are no warning signs and symptoms, and most often, it is only
diagnosed when complications arise and when it became worst.
For this reason, early diagnosis is encouraged for prompt
treatment and prevention of complications. In order to
promote awareness and compliance to healthy practices among
the people, it is necessary to provide knowledge on the risk
factors, mechanism, signs and symptoms, complications,
diagnostics and treatment of hypertension. An adequate
knowledge could lead to positive attitude towards the
prevention and compliance to treatment regimen and ultimately
will promote health care practices

-discuss the knowledge, attitude and practices connection to
the hypertension risk…
Research Paradigm
Input Process Output

Participant’s Assessment of Level of
profile: profile, Hypertension
 Age knowledge, risk in 4
 Gender attitude, and years, 2
practices as years, and 1
 Educational
well as level year
attainment
of
 Type of Work Very
hypertension
 Socioeconomic risk of the knowledgeable,
Status participants knowledgeable,
 Usual blood by using a Limited
Pressure reading Framingham knowledge,
 Body Mass Index non- poor knowledge
(BMI) laboratory- on
based Hypertension
Level of hypertension Very
Hypertension Risk risk favorable,
assessment favorable,
Level of knowledge tool and a moderately
relative to questionnaire favorable,
hypertension tool. unfavorable,
Attitudes of or very
participants unfavorable
relative to attitude
hypertension towards
hypertension
Practices of
participant’s Frequency of
relative to practices on
hypertension Hypertension
FEEDBACK
Figure 1: Conceptual paradigm of the study.
Figure 1 describes the paradigm of the study where in the
input consists of the participant’s demographic profile in
terms of Age, Gender, Educational attainment, Type of Work,
Socioeconomic Status, the participant’s health related
profile: Usual blood Pressure reading and Body Mass Index
(BMI) as well as their Level of Hypertension Risk, Level of
Knowledge, Attitude and Practices relative to Hypertension.
Process is the assessment of profile, knowledge, attitude,
and practices as well as level of hypertension risk of the
participants by using a Framingham non-laboratory-based
hypertension risk assessment tool and a questionnaire tool
while the output is the proposed program, Hypertension
prevention care plan for St. Paul University Philippines
employees.

Statement of the Problem
Generally, this study aims to determine the knowledge,
attitude, practices and level risks on hypertension among
employees of St. Paul University Philippines – Tuguegarao.
Specifically, the study sought to answer the following:
1. What is the profile of the employees in terms of:
1.1 Personal Profile
1.1.1 Age
1.1.2 Gender
1.1.3 Highest Educational Attainment
1.1.4 Type of Work
1.1.5 Monthly Income
1.2 Health Related Profile
1.2.1 Blood pressure reading

1.2.1.1 Systolic
1.2.1.2 Diastolic
1.2.2 Body Mass Index (BMI)
1.2.3 History of Parental Hypertension
1.2.4 Diagnosis of hypertension
1.2.5 Drug maintenance for hypertension if any
1.2.6 Previous episodes of elevated blood pressure
2. What is the level of hypertension risk among the SPUP
employees as revealed by the Framingham test?
3. What is the level of knowledge of the participants on
hypertension?
4. What is the attitude on hypertension of the participants
on hypertension?
5. What are the practices on hypertension of the
participants?
6. Is there a significant difference in the level of
hypertension risks of the participants when grouped
according to their profile variables?
7. Is there significant difference in the level knowledge
of the employees on hypertension when grouped according
to their profile variables?

8. Is there significant difference between the attitudes
and practices of the employees when grouped according
to their profile variables?
9. Is there a significant association between the knowledge
of the respondents and their attitude?
of the respondents and their attitude?
of the respondents and their practices?
12. Is there significant association between the
participant’s risk score to their knowledge, attitude
and practices?
Hypothesis
The following hypotheses are tested by following 0.05
level of significance.
1. There is no significant difference in the level of
hypertension risks of the participants when grouped
according to their profile variables.
2. There is no significant difference between the knowledge
of the employees when grouped according to their profile
variables.

3. There is no significant difference between the attitudes
and practices of the employees when grouped according
to their profile variables.
4. There is no significant association between the
knowledge of the employees and their attitude and
practices towards hypertension.
5. There is no significant relationship between the
participant’s risk score to their knowledge, attitude
and practices?
Significance of the Study
The information obtained from this study aims to benefit
the following:
Employees of Saint Paul University Philippines. This
study aims to improve the health and awareness of the
employees for a more effective lifestyle to prevent the
occurrence of hypertension.
St. Paul University Clinic. This study aims to provide
an input for the proposed care plan and school’s health data
base to the clinic

Saint Paul University Philippines Institution. This
study aims to provide information on the knowledge, attitude
and practices of employees on the prevention of hypertension
which could assist them on implementation of programs that
would benefit its employees.
Human Resource. This study aims to intervene programs
for welfare of employees and improve their well-being.
Researchers. This study aims to encourage further
research for the improvement of knowledge, attitude, and
practices of prehypertensive employees of SPUP.
Future researchers. The study benefits and helps the
future researchers as their reference or guide in creating
future research program or topics in relation to the current
study.
Scope and Limitation
The study included the knowledge, attitude, and
practices including the significant differences regarding
the knowledge, attitude, and practices among employees of
SPUP – Tuguegarao and their level of hypertension risk.
Answers acquired through questionnaire done by the research

team. Answers that were collected regarding practices were
not be validated through direct observance of actual
activities.
The study was limited to participants who are full time
employees of SPUP regardless of the type of work and
excluding part time employees of Saint Paul University
Tuguegarao
Definition of Terms
For the reader’s knowledge throughout the research
study, the following terms are operationally defined:
Attitude. It is measured by the participants’ perception
and response towards hypertension, its prevention and
management.-operational
Body Mass Index (BMI)- It is one way of measuring
whether a person’s weight is ideal for their height. It
indicates if the person has significant increase to
Diagnosis of Hypertension
Drug Maintenance

Episodes of Elevated Blood Pressure
Health Related Profile
History of Parental Hypertension
Hypertension. It is defined as to a systolic blood
pressure greater than or equal to 140mmHg and/or diastolic
blood pressure greater than or equal to 90mmHg.-cite source
Hypertension Risk. It is defined as the participants
demographic and health profile variables that may precipitate
or predispose the participant to hypertension by using a
Framingham non laboratory-based tool.
Knowledge. The participants’ level of awareness and
familiarity to the prevention, risk factors, manifestations
and complications, and management of hypertension.-
operational
Practices. It is defined as the activities of
participants pertaining to hypertension prevention-
operational
Prevention. It defined as the act or practice of stopping
something bad from happening

Risk factors. It is defined as any element that increases
the likelihood of developing a disease.
Type of work. It is defined as to the kind of work that
the employee does. (Admins, Faculty, Security, staff and
maintenance).
Chapter 2
METHODOLOGY
This chapter presents the research design methods,
procedures, participants of the study, data gathering tools,
and data gathering procedures that will be used in this
study.

Research Design
This is a quantitative research study that utilized
descriptive-comparative design to describe the level of
knowledge attitude and practices, and hypertension risk among
the employees based on data gathered through a questionnaire.
A test of difference was used to analyze differences in the
response of the participants based on their profile variables
and a test of correlation was used to identify significant
relationships among study variables.
Participants of the Study
Stratified random sampling was used to identify the
participants of the study using an alpha value of .05. Among
the 446 registered employees of SPUP for SY 2019-2020, a
total of 211 was taken participants based on slovin’s
formula. The following are the number of participants in each
stratum:
Table 1. Distribution of Participants
Work Category Total Population Sample Percentage

Administrative 40 19 9.01%
Faculty 250 118 55.92%
Staff 73 34 16.11%
Security 12 6 2.84%
Maintenance 71 34 16.11%
Total 446 211 100%
Instrumentation
A self-made questionnaire was the primary gathering tool
used in the study. It has 3 parts; the first part was used
to gather information on the demographic profile and health
status of the participants which was inputted to the
Framingham Hypertension Risk Calculator to measure the
hypertension risk of the participants; the second part
measured the knowledge of the participants on the risk
factors, manifestations, complications and preventive and
management of hypertension; the third part assessed the
attitude of the participants towards hypertension by means
of a 5-point Likert scale; and the fourth part evaluated the

practices of the participants towards hypertension
prevention using a 5-point likert scale.
Questions regarding knowledge, attitude and practices
were taken from:
1. Yaseen, R., et al., 2018 on their study, “Knowledge,
Attitude and Practice of Iranian Hypertensive Patients
regarding Hypertension,”
2. Rahman, N. on his study, “Knowledge, Attitude and
Practice about Hypertension among Adult People of
Selected Areas of Bangladesh.”
Framingham Hypertension risk prediction excel
spreadsheet was utilized for calculating the hypertension
risk of the participants. The weight and height were taken
from the participants to compute for their BMI as well as
their age which are necessary in the computation.
Data Gathering Procedure
The study commenced with the submission of the study
procedure to the SPUP Ethics Review Committee. Likewise, the

researchers also asked the permission of the administration
of the St. Paul University Philippines for floating the
questionnaires to the participants. Before administering the
questionnaires, the researchers provided an informed consent
and explained to the participants the research they are
conducting and how the questionnaire is filled up. The
questionnaires was handed to the participants during their
lunch break or free time, which can be answered at their own
choice and was collected the next day. The participants were
informed that their voluntary participation will provide
information in regard to their level of knowledge, attitude
and practices on hypertension including the level of risk
for hypertension. The participants were also informed that
they are free to ask questions or inquiries while answering
the questionnaires. In addition, it was informed to the
participants that the information they provided will be kept
confidential and that they may refuse or withdraw from the
study. After that, the data was collated and processed for
analysis.
Data Analysis

Statistical analysis were used to draw conclusion from
the data gathered. The following statistics were used:
1. Frequency count and percentage distribution were used
to statistically describe the profile and health
status variables of the participants.
2. The score of the participants in the assessment of
their knowledge were statistically analyzed and
presented using a frequency count and percentage
distribution based on the following description of
their scores:
Table 2. Level of Knowledge on Hypertension
Score Description
10-12 Very knowledgeable
7-9 Knowledgeable
4-6 Limited Knowledge
1-3 Poor knowledge
3. Weighted mean was used to statistically describe

the attitude and practices of the participants based on
the 5-point Likert scale with the following description:
Table

4. Analysis of Variance (ANOVA) was used to test the
difference in the level of knowledge, practices and
attitude, and their Framingham test scores of the
participants based on their profile variables
5. Chi-square was used to test the significant
difference between the level knowledge of the employees
on hypertension when grouped according to their profile
variables
6. Pearson R Correlation was used to test significant
association between the Framingham test score of the
participants to their level of knowledge, attitude and
practices and test of relationship between the knowledge
of the participants and their attitude and practices.

Chapter 3
RESULTS AND DISCUSSION
This chapter presents the results of the study about

the demographic profile of the participants and the analysis
and interpretation of data. Statistical analyses which answer
the research questions and test hypothesis are likewise
included in this part of research.
I. Demographic Profile of the Participants
Table 1. Frequency Count and Percentage Distribution of the

Personal Profile Variables of the Participants According to
Their Age
Age Frequency Percentage
21-30 years old 84 39.81
31-40 60 28.44
41-50 50 23.70
51-60 17 8.06
Total 211 100%
The table shows that most of the participants are age

21-30 years old (39.8%), followed by 31-40 years old (28.4%),
and 41-50 years old (23.7%). Participants aged 51-60 years
old (8.1%) accounts for the least number of participants.
This implies that most of the workforce of SPUP are young
adults and middle-aged adults based on the age categories of
age by the WHO (2013).


Their Gender
Gender Frequency Percentage
Female 124 58.77

Male 87 41.23
Total 211 100%
The above table presents that majority of the

participants are female (58.3%) compared to males (41.7%).
This implies that majority of the workforce of SPUP are
female employees.

Personal Profile Variables Participants According to Their
Highest Educational Attainment
Educational Frequency Percentage
Attainment
Elementary level 0 0
Elementary 2 0.95
graduate
High School level 9 4.27
High School 9 4.27

Graduate
College level 3 1.42
College graduate 91 43.13
TESDA 16 7.58

Table 3. (continued)
Graduate school 2 0.94
Masters 63 29.86
Doctorate 16 7.58
Total 211 100%
The table demonstrates that most of the

participants have highest educational attainment of College
Graduate (43.1%), followed by those with masters degree
(29.9%); with Doctorate (7.6%) and TESDA graduates (7.6%).

their Type of Work
Type of Work Frequency Percentage
Faculty 118 55.92
Staff 34 16.11
Security 6 2.84
Maintenance 34 16.11
Administrative 19 9.00
Total 211 100%
The table shows the distribution of the participants in

terms of their type of work in SPUP, wherein, most are faculty
members (55.9%); followed by staff (16.1%) and Maintenance
(16.1%); the administration (9.0%) and security personnel
(2.8%).


their Monthly Income
Monthly Income Frequency Percentage
<10,000 12 5.69
10,000-15000 46 21.80
15 001-20,000 70 33.18
20,001- 25,000 55 26.07
>25,000 28 13.27
Total 211 100%
It can viewed on the table the socio-economic status of

the participants in terms of their monthly net income. Most
of the participants earns Php 15,001 to 20,000 (33,2%);
followed by 10,001 to 15,000 (21.8%); Php 20,001 to Php
25,000 (26.1%); more than Php 25,000 (13.3%) and less than
Php 10,000 (5.7%). The result suggests that most of the
participants belong to low middle income earners base on the
Philippine Statistics Authority classification of
socioeconomic status (2015).
II. Health-Related Profile of the Participants

Health Related Profile Variables of the Participants
According to their Usual Systolic Blood Pressure Reading
Systolic Blood Frequency Percentage
Pressure

<120 mmHg 81 38.39
120-129 mmHg 94 44.55
130-139 mmHg 34 16.11
140 mmHg and above 2 0.95
Total 211 100%
It is evident on the table that most participants have

systolic blood pressure reading of 120-129 mmHg (44.5%) which
is classified under “Elevated Blood Pressure” by the American
Heart Association (AHA, 2017). There are 38.4% participants
who gave systolic BP of less than 120 mmHg which under the
same classification is considered “Normal”, while there are
16.1% of the participants with systolic BP of 130-139 mmHg
which can be classified as Stage 1 hypertension. There are 2
participants (0.9%) who have systolic BP of 140mmHg and above
which is considered Stage 2 hypertension by the AHA. This
implies that the participants with elevated systolic blood
pressure have higher risk of hypertension later in life and
is a strong predictor of early, intermediate and late
cardiovascular problems along with smoking, and cholesterol
levels. (Engeseth, Prestgaard, Grundvold, et al, 2018)

According to their Usual Diastolic Blood Pressure Reading
Diastolic Blood Frequency Percentage
Pressure

<80 mmhg 73 34.60
80-89 110 52.13
90 and above 28 13.27
Total 211 100%
The table indicates the diastolic blood pressure

of the participants. Most have diastolic Blood pressure of
80-89mmHg (52.1%) which can be classified under “stage 1”
Hypertension. It is followed by participants with less than
80 mmHg (34.6%) which is classified under “Normal”. The least
percentage of the participants (13.3%) have diastolic
pressure of 90 mmHg and above which suggests for a possible
stage 2 hypertension. This implies that the participants
having higher than normal diastolic blood pressure increases
the risk for having hypertension in later life (AHA, 2017).
According to Bishop (2010), elevated diastolic blood pressure
increases the risk of having elevated systolic blood pressure
thus resulting to the increase in risk for hypertension.

Health-Related Profile Variables of the Participants
According to their Body Mass Index
Body Mass Index Frequency Percentage

Underweight
(<18.4) 10 4.74
Normal (18.5-24.9) 153 72.51

Overweight (25-
29.9) 45 21.3
Obese (30-34.9) 2 0.9
severely obese
(35-39.9) 0 0
morbidly obese 1 0.5
(>40)
Total 211 100%
Most of the participants has normal BMI (72.5%);

followed by overweight (21.3%) and Underweight (4.7%). There
are two (2) obese participants (0.9%) noted and 1 mildly
obese (0.5%). BMI reflects the nutritional status of an
individual which is considered one of the precipitating
factors to Hypertension. It is implied that most have normal
BMI which reflects their nutritional status and suggests that
their diet and physical activities is at a balance which
contributes to the commensuration of their body with with
their height thus lowering the risk for having hypertension
on the other hand, the participants with BMI greater than
normal will have higher risk of hypertension later in life.
(Shibab, Meoni, Chu, et al, 2012)


According to Their Parental Hypertension History
Parental Frequency Percentage
Hypertension
History
None 99 46.92
Maternal 53 25.12
Paternal 29 13.74
Both 30 14.22
Total 211 100%
It is seen on the table that most of the participants

have no parental history of hypertension (46.9%) compared to
those with maternal history (25.1%), both maternal and
paternal (14.2%) and Paternal history (13.7%). According to
Ranasinghe, Cooray, Jayawardena, and Katulanda (2015)
Participants with positive parental hypertension history
have displayed a higher mean BMI, waist and hip
circumference and diastolic blood pressure those with
negative parental hypertension history which implies that
have higher risk of hypertension.

Table 10. Frequency Count and Percentage Distribution of

the Health Related Profile Variables of the Participants
According to their Diagnosis of Hypertension
Diagnosis of Frequency Percentage
Hypertension
No 180 85.3
Yes 31 14.7
Total 211 100%
The table reveals that most of the participants are not

clinically diagnosed with hypertension (85.3%) as compared
to those who have been clinically diagnosed (14.7%). This
further implies that 14.7% of the participants have
experienced the manifestations of the disease and have sought
consultation wherein they have been clinically diagnosed.

the Health Related Profile Variables of the Participants
According to their Episodes of Elevated BP
Episodes of Frequency Percentage
Elevated BP
None 147 69.67
Yes 64 30.33
Total 211 100%
The table shows that there are more participants who do

not have episodes of elevated BP (70.1%) compared to those
who have experiences BP elevation (39.9%). It is implied that

there most participants are not aware that their blood

pressure is already elevated referring to table table 6 and
7, 44.55% and 52.13 of the population has elevated blood
pressure which is self stated.

the Health-Related Profile Variables of the Participants
According to their Frequency of BP elevation
Frequency of BP Frequency Percentage
elevation
None 147 69.67

Always 27 12.80
Often 23 10.90
Seldom 14 6.64
Total 211 100%
It is gleaned on the table that most of the participants

have not experienced BP elevation (69.2%). However, 12.8%
reported that they always experience BP elevation, and 10.9%
has often experience increase in BP, and 6.6% seldom. This
further implies that there are more participants not
experiencing BP elevation compared to those who have.

Table 13. Level of Hypertension Risk Percentage in One

Year, Two Years, and 4 Years among the SPUP Employees as
Revealed by the Framingham Test
Risk Level Frequency Percentage
Low (<5%)
Medium (5% - 10%)
High (>10%)
Risk in 1 year
Low 176 97.78
Medium 4 2.22
High 0 0
TOTAL 180 100%
Risk in 2 years
Low 153 85.00
Medium 23 12.78
High 4 2.22
TOTAL 180 100%
Risk in 4 years
Low 99 55.00
Medium 58 32.22
High 23 12.78
TOTAL 180 100%
It is revealed by the table that most of the

participants have low risk of having hypertension in one
year, two years, and four years (97.78%, 85%, and 55%
respectively). It is further evident that compared to the

participants’ hypertension risk in one year, two years and

four years, their risk for hypertension have increased.
The risk for hypertension among the participants in four
years have further increased compared to their risk in one
year and two years as evident by the lesser number of
participants with low risk of hypertension (55%), and the
highest hypertensive risk have further increased to 12.78%
as compared to the risk in one year and two years.
This further implies that as the participants age, they
are exposed to multiple risk factors which may increase their
susceptibility to hypertension. Moreover, their present
health condition which include their BMI and history or
smoking can contribute to this risk in years.
III. Level of Knowledge

the Participants According to their Level of Knowledge on
Hypertension
Knowledge on Frequency Percentage
Hypertension
Very knowledgeable
(10-12) 94 44.55
Knowledgeable (7-
9) 87 41.23
Limited knowledge
(4-6) 30 14.22
Poor knowledge (1-
3) 0 0
Total 211 100%

The table displays the distribution of the participants

in terms of their level of knowledge to hypertension. Most
of the participants are “Very Knowledgeable” (44.5%) while
others are “Knowledgeable” (41.2%) and has “Limited
Knowledge” (14.2%). This classification is based on the
correct answers that they have in the questionnaire in terms
of the risk factors, manifestations, prevention and treatment
of hypertension.
The result is favorable based on the assertion of
Knight, et al., (2001) that insufficient knowledge on the
appropriate blood pressure can be a risk factor for poor BP
control. Furthermore, knowledge on hypertension can be
motivation for proper control of blood pressure. (Kilic,
Uzunçakmak, & Ede, 2016).

the Participants According to their Knowledge on
Hypertension Questions
Items Frequ Percen Level of

ency tage Knowledge
1. Normal blood pressure 204 96.68 Very

reading is 120/80. Knowledge
able
2. Hypertension usually have 123 58.29 Knowldgea

no signs and symptoms. ble
3. Stress is a risk factor for 198 93.83 Very

hypertension. Knowledge
able

4. Obesity is a risk factor 206 97.63 Very

for hypertension. Knowledge
able
5. Toxins(Alcohol, Cocaine, 180 85.31 Very

Nicotine, etc.) is a risk Knowledge
factor for hypertension. able
6. Aging is a risk factor for 117 55.45 Knowledge

obesity. able
7. Age group older than 40 is 165 78.20 Very

more susceptible for high Knowledge
blood pressure. able
8. If hypertension is not 192 91.00 Very

controlled, it can lead to Knowledge
many cardiovascular and able
kidney complications.
9. The prevalence of 98 46.45 Low

hypertension in subjects <30 Knowledge
years is low.
10. There are no 133 63.03 Moderate

identifiable cues of high knowledge
blood pressure.
11. Analgesic drugs are 96 45.50 Low

one of the risk factors for Knowledge
high blood pressure.
12. Hypertension is a 173 82.00 Very

hereditary disease. Knowledge
able
The table summarizes the level of knowledge of the

participants in every statements related to hypertension. It
is evident that the statement wherein most of the
participants are very knowledgeable on risk factors of

hypertension such as stress, obesity, toxins, age, and

genetics, however, the participants have low knowledge
regarding the risk of having high blood pressure due to
intake of analgesic drugs. The participants are also very
knowledgeable and aware of the normal blood pressure reading.
These shows that the participants are aware that obesity
could lead to hypertension but were only knowledgable (55%)
on aging as a risk factor for obesity. The participants are
also knowledgeable (58.3%) on question number 2 (Hypertension
usually have no signs and symptoms and have low knowledge
on the prevalence of hypertension
Table 18. Attitude of the Participants on Hypertension

Statements Weighted Description
Mean
Diet is important in the 3.91 Favorable

prevention of hypertension
Exercise is important in the 3.79 Favorable

prevention of hypertension
Continuous regulation of salt and 3.73 Favorable

fat intake is important in
preventing hypertension
Lifestyle and daily activities 3.77 Favorable

have effect in blood pressure
Hypertension has great effect to 3.94 Favorable

health and wellbeing
Taking medicines is important to 3.73 Favorable

keeping blood pressure control

Being overweight is a risk of 3.66 Favorable

having hypertension
Hypertension is a serious 3.94 Favorable

condition
Categorical weighted mean 3.81 Favorable
The table explicate the attitude of the participants

towards hypertension. A Categorical Weighted Mean of 3.81
described as “Favorable” suggests that the participants have
positive attitude in terms on the prevention of hypertension,
however, it is also apparent that they have not “Strongly
Agreed” on all the statements, this connotes that they may
have hesitancies towards the statements. Peters and Templin,
(2010) claim that attitude is influenced by culture,
traditions and customs, and habits which may have positive
or negative impact. It is important to maintain a positive
attitude as it encourages behavioral modification in
lifestyle and health care.
The statements with the highest mean are “Hypertension
has great effect to health and wellbeing” and “Hypertension
is a serious condition” (3.94). This suggests that the
participants acknowledge the health impact of hypertension
and its complications.

Table 19. Prevention Practices of the Participants towards

Hypertension
Statements Weighted Description
Mean
I monitor my blood pressure 3.31 Sometimes

regularly
I have moderate intake of salty 3.40 Often

food
I avoid eating fatty and oily food 3.36 Sometimes
I avoid drinking alcohol 4.09 Often
I maintain my physical activities 3.48 Often

and exercise regularly
I monitor my weight regularly 3.32 Sometimes
I avoid smoking 4.06 Often
I take my hypertensive medicines 4.06 Often

on time ( Only if you have
maintenance)
I have regular consultation with 3.18 Sometimes

health professionals
I increase my vegetable intake to 3.65 Often

prevent hypertension
I have moderate intake of 3.33 Sometimes

caffeinated drinks/coffee
I get enough sleep 3.52 Often

Categorical Weighted Mean 3.34 Sometimes
It is revealed on the table that the participants

sometimes practice preventive and management practices
towards hypertension (CWM=3.34). It implies that they do not

regularly practice the mentioned practices as evident by

their impartial response to the statements.
The statement with the highest mean is “I avoid
drinking alcohol” (4.09) which have a positive connotation
considering the risk of alcohol consumption to hypertension.
The effect of alcohol intake of two or more drinks per day
to the prevalence of hypertension has been estimated to be
5% to 7%. (Hajjar, I., et al, 2006).
It is also shown that in terms of health monitoring
specifically on blood pressure (3.31) and weight (3.32) the
participants sometimes practice these. Castillo (2018)
emphasized the need for blood pressure monitoring specially
among middle age adults and those with high risk of having
hypertension to have prompt management and avoid further
complications.
In terms of dietary practices, the participants
responded to statement “I have moderate intake of salty food”
(WM=3.40)that they often practice this preventive measure
but sometimes on “I avoid eating fatty and oily food” (3.36)
and “I have moderate intake of caffeinated drinks/coffee”
(3.33). Which suggests that while the participants agree on
moderate intake salty food, they are uncertain of avoiding
fatty and oily food and in moderate drinking of caffeinated
drinks. Eating habits is highly attributed to culture and
tradition. Northern Luzon, where Tuguegarao City the local
of the study is located is known for its delicacies which
are salty and fatty which may have led to these responses by

the participants. However, dietary modification must be

emphasized.
Table 20. Analysis of Variance in the different Level of

Hypertension Risk of the Participants when Grouped
according to Age
Hypertension Age Mean F-Ratio p- Decision at
risk value 0.05 level
21-30 3.20
Hypertension 31-40 5.30
risk in 4 4.717 .003 Significant
years 41-50 4.16
51-60 8.29
21-30 1.39
risk in 2 4.694 .003 Significant
years 41-50 2.00
51-60 3.88
21-30 .58
risk in 1 5.497 .001
years 41-50 .90 Significant
51-60 1.82
The table above reveals that there is a significant

difference between the level of hypertension risk in 1,2,4
years when grouped according to age, with the p-value of
.003, .003, and .001 respectively. Thus, the null hypothesis
is rejected. This means that age does affect the level of
hypertension risk of the participants. The highest mean is

the age group 51-60 which implies that participants in this

group age have higher risk in having hypertension compared
to those who are in a younger agre group.
Researchers found in a study published in that young

adults with high or elevated blood pressure before they turn
40 had a greater risk of subsequent cardiovascular problems
compared for those with normal blood pressure before they
turned 40 (Yano, Reis, Colangelo, et al, 2018).
According to (Hajjar, I., et al, 2006) blood pressure

increments continuously increase with age in the two sexes
however men demonstrates an increase in BP with age than in
ladies before menopause.

according to Gender
Hypertension Gender Mean F-Ratio p- Decision at
risk value 0.05 level
Female 4.20 Not
Significant
Hypertension Male .516 .473
risk in 4 4.77
years
Female 1.93 Not
.475 .491 Significant
Hypertension Male
risk in 2 2.20
years
Female .90 .144 .704

Hypertension Male Not

risk in 1 .97 Significant
years
The table above reveals that there is a no significant

difference between the level of hypertension risk in 1,2,4
years when grouped according to gender, with the p-value of
.473, .491, and .704 respectively which are higher than the
alpha value of .05, hence, the null hypothesis is accepted.
This implies that the gender of the participants don’t have
an effect on their hypertension risk.
This finding does not support the prior findings that
men have higher blood pressure than women. (Vargas, C.M., et
al, 2000) and in all ethnic group men have the highest
systolic and diastolic pressure than in women and also
through middle age hypertension is more prevalence in men
(Everett, B., Zaracova, A.,2016).

according to Highest Educational Attainment
Hypertensio Highest Mean F- p- Decision
n risk Educationa Ratio valu at 0.05
l e level
Attainment
Elementary 13.5
graduate 0
Hypertensio 2.54 SIGNIFICAN
n risk in 4 High .012
0 T
years school 9.11
level

High
school 4.44
graduate
College
8.67
Level
College
4.40
graduate
TESDA 4.50
Graduate
School 2.50
level
Masters 4.25
Doctorate 1.00
Elementary
6.50
graduate
Hypertensio
n risk in 2 High
years school 4.33
level
High
school 2.00
graduate
2.40
.017 SIGNIFICAN
College 5
4.33 T
Level
College
1.98
graduate
TESDA 2.00
Graduate
School 1.00
level
Masters 1.97

Doctorate .56
Elementary
3.00
graduate
Hypertensio
n risk in 1 High
years school 2.00
level
High
school 1.11
graduate
College
2.00 2.31 SIGNIFICAN
Level .021
8 T
College
.89
graduate
TESDA .81
Graduate
School .50
level
Masters .89
Doctorate .25
The table shows that there is a significant difference

in the hypertension risk of the aprtcipants in 1, 2 and 4
years when they are grouped according to their highest
educational attainment. The p-values of less than .05 set as
alpha value means that thenull hypothesis is rejected. This
further shows that the risk of hypertension changes according
to the educational attainment of an individual. The
educational attainment with the highest mean is the
elementary graduate, in the hypertension risk in one year,

two years, and four years and implies that participants with
lower educational attainment have higher risk of having
hypertension later in life. According to Wang, Y., Wang, K
and Edwards, C. (2006), a higher educational attainment is
associated with a greater awareness of the mechanisms of
wellness, good health, blood pressure and cardiovascular
maintenance. In addition, the inverse relationship between
educational attainment and blood pressure in urban
populations may reflect the exposure to increased
environmental risk factors including behavior and lifestyle.

according to Type of Work
Hypertension Type of Mean F- p- Decision at
risk work Ratio value 0.05 level
Faculty 3.47
Hypertension Staff 5.32

risk in 4
Security 9.17 2.945 .021 Significant
years
Maintenance 6.09
Admin 4.37
Faculty 1.60
2.405 .017 Significant
Staff 2.41

Hypertension Security 4.33

risk in 2
Maintenance 2.82
years
Admin 2.00
Faculty .70
Hypertension Staff 1.15

risk in 1
years
Maintenance 1.30
Admin .90
It is gleaned on the table that the hypertension risk

of the partcipants differ in terms of the type of work.
Hypertension risk for 1, 2 and 4 years have p-vales f grater
than the alpha value of .05 which means that the hypothesis
is rejected. This implies that the type of work of an
individual contributes to its risk of acquiring hypertension.
The table above shows that the security has the greatest
mean and implies that this type of work has higher risk of
having hypertension which could be a result of their nature
of work. According to Zimmerman (2012), security work is a
high-stress work. Although, stress does not cause
hypertension directly, the repeated exposure to stress could
cause repeated increase in blood pressure which can
eventually lead to hypertension.

Many studies have shown that work stress is related to

the incidence and prevalence of cardiovascular diseases, work
stress has been proving to be associated with high blood
pressure. Work stress is a set psychosocial factors
experienced by workers due to the condition of their work
generated as composite experience at different levels within
an organization (Jane,E.C, Ellen, A.E, et.al,2008).
Increased risk of hypertension and elevated blood pressure
have been observed with chronic job strain, low job control
and stressful work condition which includes low promotion
potential, low participation in decision making,
unsupportive co-workers and communication difficulties.

according to Monthly Income
Hypertension Monthly Mean F- p- Decision at
risk Income Ratio value 0.05 level
<10,000 7.33
Hypertension 10,000-
4.87
risk in 4 15000
years
15,001- Not
4.53 1.227 .301
20,000 Significant
20,001-
3.62
25,000
>25,000 3.86
<10,000 3.33
Not
10,000- .995 .411
2.20 Significant
15000

2.10
risk in 2 20,000
years
20,001-
1.67
25,000
>25,000 1.79
<10,000 1.50
1.07
risk in 1 15000
years
15,001- Not
.87 .892 .470
20,000 Significant
20,001-
.82
25,000
>25,000 .79
The table reveals that there is no significant diffence

in the hypertension risk of the partcipants when grouped
accoding to their monthly income as evident by the p-vaues
of greater than the alpha value of .05 which means that the
null hypothesis is accepted.
This finding is contrary to the findings of Clemecia et
al (2000) that individuals with lower socioeconomic status
are more likely to be hypertensive compare to individuals
with higher socioeconomic status.

according to Usual Systolic Blood Pressure

Hypertension Usual Mean F- p- Decision at

risk systolic Ratio value 0.05 level
BP
<120
2.25
mmHg
Hypertension
risk in 4 120-
6.11
years 129mmHg
130-
5.30
139mmHg
140 and
.00
above
<120
.93
mmHg
Hypertension
risk in 2 120-
2.81
years 129mmHg
130-
2.56
139mmHg
140 and
.00
above
<120
.37
mmHg
Hypertension
risk in 1 120-
1.31
years 129mmHg
130-
1.24
139mmHg
140 and
.00
above
It is evident on the table that there is a significant

difference in the hypertension risk for 1,2 and 4 years of
the partcipants when grouped according to their systolic

blood pressure. The p-values of greater than the lapha value

of .05 means that the null hypotheis is rejected.
The blood pressure reading 120-129mmHg has the greatest
mean (6.11) which implies having elevated blood pressure have
higher risk of hypertension later in life because
participants are not aware that this is an elevated blood
pressure reading and ignore practices on lowering their blood
pressure thus increasing their risk for hypertension.
According to the American Heart Association, the
diagnosis and classification of hypertension is based on the
systolic and diastolic pressure of a person, hence an
increase on the systolic pressure may result into an increase
risk of hypertension.

according to Usual Diastolic Blood Pressure
Hypertension Usual Mean F-Ratio p- Decision at
risk diastolic value 0.05 level
BP
<80 mmHg 2.04
Hypertension 80-89mmHg 5.62
risk in 4
years 90 and
6.04
above
<80 mmHg .86

risk in 2
years 90 and
2.93
above

<80 mmHg .38

risk in
1years 90 and
1.36
above
It is evident on the table that there is a significant

difference in the hypertension risk for 1,2 and 4 years of
the partcipants when grouped according to their diastolic
blood pressure. The p-values of greater than the alpha value
of .05 means that the null hypotheis is rejected.
This implies that the risk for hypertension when the
diastolic blood pressure is 90 and above is higher compared
to the lower diastolic blood pressure reading because higher
diastolic blood pressure results to an increase in systolic
blood pressure thus increasing risk for hypertension.
According to Bishop (2010) elevated diastolic blood pressure
increases the risk of having elevated systolic blood pressure
thus resulting to the increase in risk for hypertension.
Table 27 Analysis of Variance in the different Level of

according to Body Mass Index (BMI)
Hypertension BMI Mean F- p- Decision at
risk Ratio value 0.05 level
Underweight
4.20
(<18.4) Not
Hypertension 1.569 .184
risk in 4 Normal Significant
3.10
years (18.5-24.9)

Overweight
5.96
(25-29.9)
Obese (30-
9.00
34.9)
severely
obese (35- .00
39.9)
morbidly
.00
obese (>40)
Underweight
1.80
(<18.4)
Hypertension
risk in 2 Normal
1.80
years (18.5-24.9)
Overweight
2.82
(25-29.9)
Not
Obese (30- 1.741 .142
4.50 Significant
34.9)
severely
obese (35- .00
39.9)
morbidly
.00
obese (>40)
Underweight
.80
(<18.4)
Hypertension
risk in 1 Normal
.80
years (18.5-24.9) Not
1.903 .111
Overweight Significant
1.33
(25-29.9)
Obese (30-
2.00
34.9)

severely
obese (35- .0
39.9)
morbidly
.00
obese (>40)
It is shown in the able that the hypertension risk of

an individual has no significant difference when they are
grouped according to their Basal Mass index. This is evident
by the p-values of greater than .05 which means that the null
hypothesis is accepted.
This finding is contrary to the previous findings that
obesity is one of the major risk factors of hypertension.
BMI which reflects the nutritional status of a person
suggests that individuals with higher than 25 BMI are
considered obese, hence are not considered normal.

according to Family history of Parental Hypertension
Hypertensio History of Mean F- p- Decision
n risk parental Ratio valu at 0.05
hypertensio e level
n
none 5.6
4
Hypertensio
n risk in 4 Maternal 4.2 4.03 Significan
.008
years 8 5 t
Paternal 3.1
4

Both 2.0
0
none 2.5
7
Hypertensio
n risk in 2 Maternal 2.0
years 0 3.37 Significan
.019
5 t
Paternal 1.4
8
Both .90
none 1.1
6
Hypertensio
n risk in 1 Maternal .91 2.92 Significan
.035
years 7 t
Paternal .66
Both .43
The tabe shows that there is a significant difference

in the hypertension risk for 1, 2 and 4 years of the
partcipants when they are grouped according to their history
of parental hypertension. This implies that parental history
affect the risk of the partcipants in having hypertension.
Such finding affirms the study of Hajjar et al,
(2006) who revealed that having a family ancestry of
hypertension is related with a steeper chance of prevalence
and incidence of hypertension.

according to Episodes of Elevated Blood Pressure

Hypertensio Episodes of Mean F- p- Decision

n risk Hypertensio Ratio value at 0.05
n level
None 4.8
7 Not
Hypertensio 2.97 .086 Significan
n risk in 4 Yes 3.1 t
years 4
None 2.2
4 Not
n risk in 2 Yes 1.5 t
years 6
None 1.0
2 Not
n risk in 1 Yes t
.70
years
The table shows that there is no significant difference

in the hypertension risk of the individuals in 1, 2 and 4
years when grouped according to their frequency of elevated
BP as evident by p-vaues of greater than .05. This means that
the reported frequency of BP elevation among the partcipants
does not affect their risk of having hypertension.
VII.
Table 31. Chi-Square Test in the Significant Difference of

the Participants’ Level of Knowledge When Grouped According
to Profile Variables
Profile X2 – Value Probability Decision at
Variable Value 0.05 level

Age 5.336 0.502 Not

Significant
Gender 1.346 0.510 Not
Significant
Educational 29.527 0.021 Significant
Attainment
Type of Work 15.282 0.054 Not

Significant
Status 11.271 0.187 Not
Significant
Systolic 9.105 0.168 Not
Significant
Diastolic 5.976 0.201 Not
Significant
Body Mass 5.235 0.732 Not
Index Significant
Family 6.762 0.343 Not
History of Significant
Parental
Hypertension
Diagnosis of .990 0.610 Not

Hypertension Significant
Episodes of 3.279 0.194 Not
Elevated Significant
Blood
Pressure
Frequency of 7.188 0.304 Not

Elevated Significant
Blood
Pressure
Smoker 2.909 .573 Not

Significant

Crosstab education Tot

on al
knowledg 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.
e * 0 0 0 0 0 0 0 0 00
educatio
n

1.
2 1 3 3 43 4 1 30 7 94
00
know
2.
ledg 0 6 2 0 33 7 1 29 9 87
00
e
3.
0 2 4 0 15 5 0 4 0 30
00
Total 2 9 9 3 91 16 2 63 16 211
The table demonstrates that there is a significant
difference in the level of knowledge of the participants when
they are grouped according to their highest educational
attainment (sig 2 tailed-.021) which is lower than the alpha
value set at .05. There are no significant differences in
the level of knowledge in all other profile variables.
The difference in the level of knowledge as to their
highest educational attainment coincide with the assertion
of Agyei-Baffour et al., (2018), that there is an association
between the level of education and knowledge of hypertension.
The awareness on hypertension among the highly educated was
significantly higher than those compared with low educational
attainment. This is coherent with the findings of previous
studies conducted in which all documented a positive
correlation between hypertension education and knowledge
level.
Table 32. Analysis of Variance in the Significant

Difference of the Participants’ Attitude and Practices when
Grouped According to Age
Variable Age Mean F-Ratio P- Decision at

value 0.05 level

Attitude 21-30 3.73

31-40 3.64 Not
1.709 .166
41-50 4.15 significant
51-60 3.75
Practices 21-30 3.20

31-40 3.12 2.394 Not
.069
41-50 3.51 significant
51-60 3.42
It is shown in the table that there is no significant

diference in the attitude (p value- .166) and Practices (p-
value= .069) of the partcipants hen they are grouped
according to their age. This implies that their attitudes
and practices on hypertension do not vary with their age.
Table 8. Analysis of Variance in the Significant Difference

of the Participants’ Attitude and Practices when Grouped
According to Gender
Variable Gender Mean F-Ratio P-

value
Attitude Female 3.87 .672 .413 Not

Male 3.72 significant
Practices Female 3.33 Not

1.426 .234
Male 3.19 significant

The table reveals that there is no significant

difference in the attitude (p value-.14) and pactices (
.234) of the partciants when they are grouped according to
their Gender. This suggests that gender does not affect
their attitude and practices towards hypertension.
The findings is in contrast with the assertion of

Sandberg & Ji, (2012) that the risk of hypertension among
men and women is not only atributed to physiological but also
behavioral. The behavioral risk factors for hypertension
include the body mass index (BMI), smoking and less physical
activity. Smoking is lower among women than men and physical
activity tends to be higher among men. These behavioral
factors such as obesity, physical activity may close the
gender gap in hypertension while other factors like smoking
may increase the disparity (Reckelholff, 2001).

Grouped According to Highest Educational Attainment
Variable Highest Mean F-Ratio P- Decision at

Educational value 0.05 level
Attainment
Attitude Elementary
3.25
graduate
High school
3.63 6.187 .000 Significant
level
High school
3.58
graduate

College
2.96
Level
College
3.31
graduate
TESDA 3.61
Graduate
School 5.00
level
Masters 4.42
Doctorate 4.76
Practices Elementary
3.75
graduate
High school
3.01
level
High school
2.10
graduate
College
2.33
Level
College
3.01
graduate
TESDA 3.16
Graduate
School 4.42
level
Masters 3.62
Doctorate 3.82

It is gleaned on the table that there is a significant

difference in the attitude and practices of the partcipants
when they are grouped according to their highest
educational attainment. A p-value of .00 for both attitude
and practices signify rejection of the null hypotheis. This
further means that the educational attainment of an
individual affects his or her attitude and practices toward
hypertension. The highest educational attainment with the
highest mean is the graduate school (5.0 and 4.42
respectively). This implies that these participants have a
more positive attitude towards hypertension and greater
practice of the mechanisms of wellness and good health.
This finding contradicts the finding of Aubert, et al.,

(1998) asserting that despite having greater knowledge on
hypertension, compliance to healthy lifestyle is poor, hence,
high educational attainment is not a guarantee for positive
attitude.
This is also substantial with the Farquhar’s model of
behavioral change in which their findings suggested that most
patients had enough knowledge regarding hypertension, but
only a few has showed real motivations to change. Most of
the patients had poor compliance of drugs in their study and
that the forgetfulness and interruptions of daily routine
were common reasons for nonadherence.

Grouped According to Type of Work

Variable Type of Mean F-Ratio P- Decision at

work value 0.05 level
Attitude Faculty 4.47

Staff 1.40
Maintenance 3.78
Admin 4.74
Practices Faculty 3.67

Staff 1.96
Maintenance 3.18
Admin 3.72
The table shows that there is a significant difference

in the attitude (.00) and Pactices (.00) of the participants
towards hypertension when they are grouped according to their
type of work.
Theories have predicted health risk in the exposed

population, this theoretical models are; (Giridhara ,R.B.,
et.al, 2013) are demand control models; this model focus on
non-reciprocity of social exchange which contribute to stress
and psychosocial dimension at work which are the effort,
rewards and over-commitment, effort is part of the work
contract, rewards are in term of money, esteem and career
opportunity including job security. Over-commitment acts as
a risk factors and is a set of attitudes, behavior and emotion
that reflect the commitment and effort-reward imbalance

model, chronic job stress is caused by imbalance between the

effort spent and low rewards and over-commitment.

Grouped According to Monthly Income
Variable Monthly Mean F-Ratio P- Decision at

Income value 0.05 level
Attitude <10,000 3.70

10,000-
3.13
15000
15 001-
3.56 10.041 .000 Significant
20,000
20,001-
4.38
25,000
>25,000 4.47
Practices <10,000 3.10

10,000-
2.83
15000
15 001-
3.18 8.108 .000 Significant
20,000
20,001-
3.62
25,000
>25,000 3.63
The table expliciate that there is a significant

difference in the attitude (.00) and practices (.00) or the
participnats when they are grouped according to their socio-
economic status.

The result is accord with the prior findings wherein,

socioeconomic factors such as education and income have been
shown to be associated with blood pressure. (Dan, K.K., Alden
, L.G., et al,,2012).
Other studies have shown that the lower socioeconomic
status as measured by education or occupation are more likely
to be hypertensive compare to an individual with higher
socioeconomic status (Clemencia, Deborah & Richard, 2000).
Those with the greatest education have the lowest prevalence
of hypertension and the lowest mortality rate from
hypertension disease. The table above shows that the higher
monthly income displays a more positive attitude towards
hypertension and the more they strive towards having a good
health and wellness.

Grouped According to Usual Systolic BP
Variable Usual Mean F-Ratio P- Decision at

systolic value 0.05 level
BP
Attitude <120
3.79
mmHg
120-
3.78
129mmHg Not
.148 .931
130- Significant
3.91
139mmHg
140 and
4.19
above

Practices <120
3.18
mmHg
120-
3.25
129mmHg Not
1.731 .162
130- Significant
3.50
139mmHg
140 and
4.00
above

in the attitude (.931) and practices (.162) of the
participants whe they are grouped according to their systolic
Blood pressure. This suggests that the attitude and practices
of the partcipants do not vary when they are grouped in terms
of their systolic pressure.

Grouped According to Usual Diastolic BP
Variable Usual Mean F-Ratio P- Decision at

diastolic value 0.05 level
BP
Attitude <80 mmHg 3.80

80-89mmHg 3.83 Not
.054 .947
Significant
90 and
3.75
above
Practices <80 mmHg 3.25 Not

.048 .953 Significant
80-89mmHg 3.29

90 and
3.25
above

in the attitude (.947) and practices (.953) of the
participants whe they are grouped according to their systolic
Blood pressure. This suggests that the attitude and practices
of the partcipants do not vary in terms of their systolic
pressure.

Grouped According to BMI
Variable BMI Mean F- P- Decision at

Ratio value 0.05 level
Attitude Underweight
3.71
(<18.4)
Normal
3.83
(18.5-24.9)
Overweight
3.78
(25-29.9)
Not
Obese (30- .507 .731
2.75 Significant
34.9)
severely
obese (35-
39.9)
morbidly
4.75
obese (>40)

Practices Underweight
3.01
(<18.4)
Normal
3.28
(18.5-24.9)
Overweight
3.29
(25-29.9)
Obese (30- .456 .768

3.13 Not
34.9) Significant
severely
obese (35-
39.9)
morbidly 4.00
obese (>40)

in the attitude (.731) and practices (.768) of the partcipans
when they are grouped according to their BMI. This implies
that regardless of their BMI their attitude and pratices do
not vary.

Grouped According to History of Parental Hypertension
Variable History of Mean F- P- Decision at

parental Ratio value 0.05 level
hypertension
Attitude None 3.69 Not

2.599 .053
Maternal 4.21 Significant

Paternal 3.78
Both 3.52
Practices None 3.20

Maternal 3.49 Not
Paternal 3.17
Both 3.24

in the attitude of the particpants (.053) when grouped
according to their parental history of hypertension.

Grouped According to Diagnosis of Hypertension
Variable Diagnosis of Mean F- p- Decision at
Hypertension Ratio value 0.05 level
Attitude No 3.76
Not
2.127 .146
Yes Significant
4.12
Practices No 3.20
Yes 3.71
The table reveals a significant difference in the

practices of the particpants when grouped according to their
diagnosis. This suggests that participants who have been
diagnosed with hypertension may have more favorable practices

as compared to those who have not been diagnosed. According

to Peters & Templin, (2010), behavioral changes of patients
who are at risk for hypertension will not occur unless they
value the goal underlying the behavioral changes. In relation
to the finding of the study, thse who have been diagnosed of
hypertension may have already experienced its signs and
syptoms and have been made aware of its complications, hence,
this motivates them to have lifestyle modification and change
their practices to prevent these complications.
On the other hand, it is shown on the table that there
is no significant difference in the attitude of the
partcipants when grouped according to their diagnosis.
Table 41. Analysis of Variance in the Significant Difference

of the Participants’ Attitude and Practices when Grouped
According to Episodes of Elevated Blood Pressure
Variable Episodes Mean F- p- Decision at
of Ratio value 0.05 level
Elevated
Blood
Pressure
Attitude No 3.93
Yes 3.52
Practices No 3.29
Not
.232 .631
Yes Significant
3.23
The table shows that there is a significant diference

in the attude (.033) of the participants when grouped

according to their episodes of elevated blood pressure. This

implies that those who have not experienced BP elevation
may have different attitude on hypertension compared to those
who have had episodes of hypertension.
On the other hand, there is no significant difference
in the pratices of the partcipants when grouped according to
their episode of hypertension.
Table 42. Significant Association Between Participants’

Knowledge and the Participants’ Attitude and Practices on
Hypertension
Variables Pearson-R Probability Decision at

Value 0.05 level
Attitude 0.663 0.03 Significant
Practice 0.005 0.943 Not

Significant
It is shown on the table that knowledge of the

study participants have significant association with their
attitude (sig. 2 tailed- .03). Moreover, a positive
correlation is found in the positive pearson value (0.663).
This suggests that the higher the knowledge of the
participant the more favorable is their attitude. Thus, there
is a direct or positive relationship between the knowledge
and attitude of the participants to hypertension
This is supported by the assertion of Shen Tong et al.,
(2017)that higher educational attainment has been associated
with health care seeking behavior and awareness that can

alleviate the risk factor associated with hypertension,

educated people are more knowledgeable, practice healthy
behavior and have nutritional education and stress coping
mechanism which can prevent chronic disease.
Table 43. Test of Association Between the Participants’

Risk Score to their Knowledge, Attitude and Practices
Knowledge Attitude Practices
Pearson
.031 -.139* -.179**
Correlation
Risk 4
Sig (2-
.657 .043 .009
tailed)
Risk 2 Pearson
.037 -.126 -.174*
Correlation
Sig (2-
.592 .069 .011
tailed)
Risk 1 Pearson
.026 -.145* -.188**
Correlation

Sig (2-
tailed) .710 .035 .006
The table shows that there is a significant association

between the participants’ Hypertensive risk in four years
and their attitude (Sig. 2 tailed- .043) and their Practices
(.009): moreover, a significant relationship was also noted
between the participants’ hypertension risk for 2 years and
their practices (.011); Hypertension risk for 1 year and
their attitude (.035) and practices (.006).
All of which are negative correlations as evident by
the negative pearson correlation values. This suggests that
the higher the risk of the participants to hypertension, the
more negative their attitude and practices are. Those with
higher risk of hypertension in one year, 2 years and four
years may have more negative attitude towards the preventive
and management practices of hypertension compared to those
with lower risk.

Chapter 4
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATION
This chapter summarizes the findings and presents the
conclusions and recommendations drawn from the study.
Summary of Findings
The following is a summary of the results of the study
which was presented in detail in the previous chapter:
1. Demographic Profile of the St. Paul University Employees

Majority of the participants are age 21-30 years old
(39.8%); female (58.3%); with highest educational attainment
of College Graduate (43.1%); working as faculty members
(55.9%); with socio-economic status measure in terms of
monthly income of Php 15,001 to 20,000 (33,2%).
2. Profile of the St. Paul University Employees

Most participants have systolic blood pressure reading
of 120-129 mmHg (44.5%) which is classified under “Elevated
Blood Pressure” by the American Heart Association (AHA); and
diastolic Blood pressure of 80-89mmHg (52.1%) which can be
classified under “stage 1” Hypertension. Majority has normal
BMI (72.5%).
Most of the participants have no parental history of
hypertension (46.9%) compared to those with maternal history

(25.1%), both maternal and paternal (14.2%) and Paternal

history (13.7%).
Most are not clinically diagnosed with hypertension
(85.3%) as compared to those who have been clinically
diagnosed (14.7%).There are more participants who don’t have
episodes of elevated BP (70.1%) compared to those who have
experiences BP elevation (39.9%).
Most of the participants have not experiences BP
elevation (69.2%). However, 12.8% reported that they always
experience BP elevation, and 10.9% has often experience
increase in BP, and 6.6% seldom.
Most of the participants have no risk or has 0% risk
of having hypertension for one year (43.3%), while there
are 47 (26.1%) who have 1% Risk of acquiring the disease,
and 20.6% have 2% risk. The highest identified risk for one
year among the participants is 9% (0.5%).
There are 53 (29.4%) who were identified with 0% risk
of hypertension, while 39 or 21.7% of them have 1% risk; 16
or 8.9% have 2% Risk and 25 or 13.9% have 3% risk. It is
further evident that compared to the participants’
hypertension risk in one year as seen in the previous table,
their risk for hypertension in two years have increased.
The risk for hypertension among the participants in four
years have further increased compared to their risk in one
year and two years as evident by the lesser number of
participants with 0% risk of hypertension (19.4%), and the
highest hypertensive risk have further increased to 38% as
compared to the previous.

As to the level of knowledge of the particpants, most

of them are “Very Knowledgeable” (44.5%) while others are
“Knowledgeable” (41.2%) and has “Limited Knowledge” (14.2%).
A Categorical Weighted Mean of 3.81 described as “Agree”
suggests that the participants have positive attitude in
terms on the prevention of hypertension, however, it is also
apparent that they have not “Strongly Agreed” on all the
statements, this connotes that they may have hesitancies
towards the statements.
The participants are “Neutral” in term of the preventive
and management practices towards hypertension (CWM=3.34). It
implies that they do not regularly practice the mentioned
practices as evident by their impartial response to the
statements.
Risk of hypertension for one year, two years and four
years have significant difference when grouped in age,
highest educational attainment, type of work, systolic,
diastolic, parental history and diagnosis of hypertension
with p-vaue of less than .05 which is the set alpha value.
There is a significant difference in the level of
knowledge of the participants when they are grouped according
to their highest educational attainment (sig 2 taile-.021)
There is a significant difference in the attitude of
the participants towards hypertension when they are grouped
according to their Highest educational attainment, type of
work, socio-economic status and episodes of elevated BP.
A significant difference in the practices of the
participants when grouped according to their Highest

Educational Attainment, Type of Work, Socio-economic status

and Diagnosis
A significant association between the participants’
Hypertensive risk in four years and their attitude (Sig. 2
tailed- .043) and their Practices (.009): moreover, a
significant difference was also noted between the
participants’ hypertension risk for 2 years and their
practices (.011); Hypertension risk for 1 year and their
attitude (.035) and practices (.006).
Conclusion
The researchers conclude that there is an increasing
risk to hypertension in one year, two years and four years
analysis on the Framingham among the employees of SPUP.
Furthermore, most of them are knowledgeable on the risk
factors, manifestation and management of hypertension.
However, their attitude and practices towards hypertension
can still be improved.
The participants with elevated systolic blood pressure

have higher risk of hypertension later in life and is a
strong predictor of early, intermediate and late
cardiovascular problems along with smoking, and cholesterol
levels (Engeseth, Prestgaard, Grundvold, et al, 2018).
Furthermore, the participants having higher than normal
diastolic blood pressure increases the risk for having
hypertension in later life (AHA, 2017). According to Bishop,

(2010) elevated diastolic blood pressure increases the risk

of having elevated systolic blood pressure thus resulting to
the increase in risk for hypertension.
Most participants have normal BMI which reflects their

nutritional status and suggests that their diet and physical
activities is at a balance which contributes to the
commensuration of their body with their height thus lowering
the risk for having hypertension on the other hand, the
participants with BMI greater than normal will have higher
risk of hypertension later in life (Shibab, Meoni, Chu, et
al, 2012). However, family history is also one of the factors
affecting BMI and risk for hypertension. According to
Ranasinghe, Cooray, Jayawardena, and Katulanda (2015)
participants with positive parental hypertension history
have displayed a higher mean BMI, waist and hip
circumference and diastolic blood pressure those with
negative parental hypertension history which implies that
have higher risk of hypertension.
When it comes to the participants awareness on their

episodes of elevated blood pressure, most participants are
not aware that their blood pressure is already elevated
referring to table table 6 and 7, 44.55% and 52.13 of the
population has elevated blood pressure which is self-stated.

The participant’s educational attainment is also a

factor affecting hypertension risk, participants with lower
educational attainment have higher risk of having
hypertension later in life. According to Wang, Y., Wang, K
and Edwards, C. (2006), a higher educational attainment is
associated with a greater awareness of the mechanisms of
wellness, good health, blood pressure and cardiovascular
maintenance. In addition, the inverse relationship between
educational attainment and blood pressure in urban
populations may reflect the exposure to increased
environmental risk factors including behavior and lifestyle.
It was found that type of work also contributes to the risk
of having hypertension. Work stress is proven to be connected
to hypertension although it does not cause hypertension
directly, the repeated exposure to stress could cause
repeated increase in blood pressure which can eventually lead
to hypertension (Zimmerman, 2012).
Recommendations
Given the results of the study, the researchers would
like to recommend the following:
1. For the Saint Paul University Clinic and School of
Nursing and Allied Health Sciences department of SPUP
to provide a specific care plan on managing hypertension
for those who are clinically diagnosed employees and a
prevention program for those who are at risk.
2. For the health department of SPUP to conduct lifestyle
programs to improve the attitude and health care

practices of the participants specifically on diet,

sleep and exercise.
3. For the school clinic to encourage employees to have
regular check of their BP and weight monitoring
4. For the administration to provide medical diagnosis on
hypertension among the employees to facilitate early
diagnosis and offer prompt treatment.
5. For the employees to practice healthy lifestyle and
consult medical checkup regularly.
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Appendix A

LETTER TO HUMAN RESOURCE MANAGEMENT
September 11, 2019
Juana C. Rivera, PhD

Director, Human Resource Management
St. Paul University Philippines
Dear Dr. Rivera:
We are 4th year Bachelor of Science in Nursing students of St. Paul University Philippines
embarking on a thesis with the title “Hypertension Risk, Knowledge, Attitude, and Practices
(KAP) of St. Paul University Philippines Employees; An Input for Hypertension Nursing Care
Plan.
In connection to this, we would like to ask permission to gather information regarding the
hypertension risk, knowledge, attitude and practices among employees of St. Paul University
Philippines, Tuguegarao City. This information would be relevant and helpful in our study. Rest
assured that any information that will be given to us will only be used for our study.
Your consideration will be deeply appreciated by our group.
Thank you very much!
Respectfully yours,
Arreglado, Marlchiel Nathan Pablico, Kristine Marie

Researcher Researcher
Balogun, Deborah
Researcher
Noted by:
Katherine Arellano, MAN Ma. Elizabeth Baua, DNS

Research Adviser Program Coordinator, Nursing
Appendix

LETTER TO PARTICIPANTS
September 27,2019
Dear Sir/Ma’am:
The undersigned are conducting a research titled

“Hypertension risk, knowledge, attitude and practices among
employees of St. Paul university Philippines”.
We wish to ask your help by taking time to answer the

questionnaire. Your response will be of great help in the
completion of our research work. Your answers will be kept
confidential and will be used only as an important data for
the study. Your participation is voluntary, therefore any
concerns with regards to the filling of the questionnaire
can be directed to the researchers. If there are any
questions with regards to the study, the researchers will
gladly answer your queries.
Thank you very much.
The researchers,
Marlchiel Nathan Arreglado
Kristine Pablico
Deborah Balogun

Appendix
INFORMED CONSENT
Title of Research Project: Hypertension Risk, Knowledge,

Attitude, and Practices of St. Paul University Philippines
Employees
Name of Investigators: Kristine Marie Pablico, Marchiel Nathan

Arreglado, Deborah Balogun
Contact email: jaypablico@gmail.com, narreglado15@gmail.com,
A. PURPOSE AND BACKGROUND
Kristine Marie Pablico, Marchiel Nathan Arreglado, and Deborah

Balogun of BSN-4 of St. Paul University Philippines are
conducting research on the Hypertension Risk, Knowledge,
Attitude, Practices and of St. Paul University Philippines
Employees. The purpose of your participation in this research
is to help the researchers assess what the participants already
know, how they feel, and what they do in regards to
hypertension. You were selected as a possible participant in
this study because you met the needed qualifications that we
require in order to gather data that is both accurate and
representable as a full-time employee of St. Paul University
Philippines.
B. PROCEDURES
If you agree to participate in this research study, the

following will occur:
1. You will be given a questionnaire of 3 parts. The first part

will require some of your profile variables; the second part
will elicit information regarding your health status; and the
third part is a Likert type tool that will assess your
knowledge, attitude and practices towards hypertension.

2. The questionnaire will be distributed within the duration of

your free time, and it will be collected the following day.
3. The researchers will use your profile variables such as age,

height, weight and BMI to assess your hypertension risk using
the Framingham method.
4. The results of the tests will be sent to the participants

through the use of emails or text messages. The study will be
presented in front of panelists of St. Paul University
Philippines.
C. RISKS
The participant will be exposed to no risks during the

conduction of the study, but inconveniences such as
embarrassment, or the time that it takes to complete the
questionnaire
D. CONFIDENTIALITY
The records from this study will be kept as confidential as

possible. No individual identities will be used in any reports
or publications resulting from the study. All answered
questionnaires will be given codes and stored separately from
any names or other direct identification of participants.
Research information will be kept in locked files at all times.
Only research personnel will have access to the files and
questionnaires and only those with an essential need to see
names or other identifying information will have access to that
particular file. After the study is completed in a span of 10
months the data gathered will be kept in safe storage. In case
of future use, the participant will be informed and asked for
consent in usage of the file and data.
E. BENEFITS OF PARTICIPATION
The benefit that you will receive is the knowledge regarding

your Framingham non-laboratory hypertension risk score.

F. VOLUNTARY PARTICIPATION
Your decision whether to participate in this study is voluntary

and will not affect your relationship with the St Paul
University. If you choose to participate in this study, you can
withdraw your consent and discontinue participation at any time
without prejudice.
G. QUESTIONS
If you have any questions about the study, please contact

Marchiel Nathan Arreglado by calling +639175176411. You can
also contact Kristine Pablico by calling +639776868804 with any
questions about the rights of research participants or research
related concerns.
CONSENT
YOU ARE MAKING A DECISION WHETHER OR NOT TO PARTICIPATE IN A

RESEARCH STUDY. YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE
DECIDED TO PARTICIPATE IN THE STUDY AFTER READING ALL OF THE
INFORMATION ABOVE AND YOU UNDERSTAND THE INFORMATION IN THIS
FORM, HAVE HAD ANY QUESTIONS ANSWERED AND HAVE RECEIVED A COPY
OF THIS FORM FOR YOU TO KEEP.
Signature ________________________________ Date

________________
Research Participant
Signature ________________________________ Date

________________
Interviewer

Appendix
SPUP Employees' Knowledge, Attitude, and Practices on

Hypertension Questionnaire
Name: (Optional)_________________________________
Below are series of personal questions regarding demographic
data. All answers will be treated with strict
confidentiality.
Part I: Personal Information
Please indicate your response by putting a check mark ().

A. Personal Profile
1) Age: _____
2) Gender
( ) Female ( ) Male
3) Highest Educational Attainment
( ) Elementary level
( ) Elementary graduate
( ) High school/secondary level
( ) High school/ secondary graduate
( ) College level
( ) College graduate
( ) Vocational/TESDA
( ) Graduate School
( ) Masters Degree
specify ___________________________
( ) Doctoral Degree

specify ___________________________
4) Type of Work
( ) Faculty/Teacher
( ) Staff
( ) Security
( ) Maintenance
( ) Administrative
5) Socio-economic status (Based on gross monthly income)
( )less than Php 10,000

( ) Php 10,000-15,0000
( ) Php 15,001- 20,000
( ) Php 20,001-25,000
( ) More than Php 25,000
B. Health Profile
6) Usual Systolic BP:_____mmHg Example: 120  Systolic BP
80  Diastolic BP
7) Usual Diastolic BP:_____mmHg
8) Height:_____Ft. Example: 5’4” (5 feet, 4 inches)
9) Weight:_____Kg.
10) BMI:_____
11) Parental hypertension
( )None ( )Mother ( )Father ( )Both
12) Are you diagnosed with hypertension?
( ) Yes ( )No

13) If Yes, what prescribed drug are you taking for

maintenance?
_____________________________________________
14) Have you ever experienced episodes of elevated blood
pressure? If Yes, how often?
( ) Yes ( )No
( ) Always ( )Often ( )Seldom
15) Current Smoker?
( ) Yes ( )No
Below are series of question to assess the level of your

knowledge, attitude, and practices on hypertension. All
answers will be treated with strict confidentiality.
Part II: Knowledge towards Hypertension
Please put a check mark () in the appropriate box based on

your assessment of your own knowledge regarding the
statement.

Items True False
1. Normal blood pressure reading is 120/80.
2. Hypertension usually have no signs and

symptoms.
3. Stress is a risk factor for hypertension.
4. Obesity is a risk factor for hypertension.
5. Toxins (Alcohol, Cocaine, Nicotine, etc.)

is a risk factor for hypertension.
6. Aging is a risk factor for obesity.
7. Age group older than 40 is more susceptible

for high blood pressure.
8. If hypertension is not controlled, it can

lead to many cardiovascular and kidney
complications.
9. The prevalence of hypertension in subjects

<30 years is low.
10. There are no identifiable cues of high

blood pressure.
11. Analgesic drugs are one of the risk factors

for high blood pressure.
12. Hypertension is a hereditary disease.

Part III: Attitude towards Hypertension

Please put a check mark () in the appropriate box on how

you rate the following statement in terms of your
agreement:
1 = Strongly Disagree 4 = Agree
2 = Disagree 5 = Strongly Agree
3 = Neutral
Statements 1 2 3 4 5
1. Diet is important in the prevention of

hypertension.
2. Exercise is important in prevention of

hypertension.
3. Continuous regulation of salt and fat

intake is important in preventing
hypertension.
4. Lifestyle and daily activities have effect

in blood pressure
5. Hypertension has great effect to health

and wellbeing
6. Taking medicine is important to keeping

blood pressure control.
7. Being overweight is a risk of having

hypertension.
8. Hypertension is a serious condition.

Part IV: Practices towards Hypertension
Please put a check mark () in the appropriate box on how

you rate the following activities in terms of how often do
you do the practices.
1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Often, 5 = Always

Statements 1 2 3 4 5
1. I monitor my blood pressure regularly
2. I have moderate intake of salty food
3. I avoid eating fatty and oily food
4. I avoid drinking alcohol
5. I maintain my physical activities and

exercise regularly
6. I monitor my weight regularly
7. I avoid smoking
8. I take my hypertensive medicines on time.

(Only if you have maintenance)
9. I have regular consultation with health

professionals
10. I increase my vegetable intake to prevent

hypertension.
11. I have moderate intake of drink

caffeinated drinks/coffee.
12. I get enough sleep.
THANK YOU VERY MUCH FOR YOUR TIME!
GOD BLESS 😊

Appendix B
CURRICULUM VITAE
NAME: Kristine Marie S. Pablico

BIRTH DATE: December 24, 1998
AGE: 21
ADDRESS: 2 Avocado St. Airport Village, Pengue Ruyu,
Tuguegarao City, Cagayan Valley 3500
EMAIL ADDRESS: jaypablico@gmail.com
CIVIL STATUS: Single
RELIGION: Roman Catholic
Educational Attainment:
Elementary:
High School
College

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St.

Paul University Philippines 1

HYPERTENSION RISK, KNOWLEDGE, ATTITUDE AND PRACTICES AMONG

EMPLOYEES OF ST. PAUL UNIVERSITY PHILIPPINES

A Thesis Study Presented to the Faculty of the School of

Nursing and Allied Health Sciences, St. Paul University

Philippines, Tuguegarao City, Cagayan Valley 3500

Of the Requirements in the

Bachelor of Science in Nursing Program

Marlchiel Nathan S. Arreglado

Kristine Marie S. Pablico

School of Nursing and Allied Health Sciences

In partial fulfillment of the requirements for the degree

BACHELOR OF SCIENCE IN NURSING, this thesis titled,

“HYPERTENSION RISK, KNOWLEDGE, ATTITUDE AND PRACTICES AMONG

EMPLOYEES OF ST. PAUL UNIVERSITY PHILIPPINES”, has been

prepared and submitted by Marlchiel Nathan Arreglado,

Deborah Balogun, Kristine Marie Pablico who is hereby

recommended for Oral Examination.

MRS. KATHERINE ARELLANO, MSN

Approved by the Committee on Oral Examination with a

Dr. Emolyn Turingan

Mrs. Lilian P. Gonao, MSN Josephine D. Lorica, RN, DPA

Accepted and approved in partial fulfillment of the

DR. ANNUNCIATION TALOSIG, DNS

School of Nursing and Allied Health Sciences

School of Nursing and Allied Health Sciences

School of Nursing and Allied Health Sciences

Title Page ..................................... i

Approval Sheet ................................. ii

Acknowledgment ................................ iii

Table of Contents .............................. vi

List of Tables ................................. ix

List of Figures ................................ xi

Abstract ....................................... xii

Chapter 1. THE PROBLEM AND REVIEW OF RELATED LITERATURE

Review of Related Literature and Studies 5

History of Information Communication

Technology (ICT) .................7

ICT Literacy ........................10

School of Nursing and Allied Health Sciences

21st Century Skills..................13

Synthesis of the Literature.........66

Paradigm of the Study.................. 74

Statement of the Problem .............. 75

Significance of the Study ............. 77

Scope and Limitation .................. 79

Definition of Terms ................... 80

Research Design ....................... 83

School of Nursing and Allied Health Sciences

Note: when including subtopics, indention is needed

EXAMPLE (IT Capstone)

System Development Life...................xx

Sources of Data/Participants of the Study/Subjects

of the Study ................................. 83

Note: when including subtopics, indention is needed

Data Gathering Procedures.............. 86

Note: when including subtopics, indention is needed

Data Analysis ........................ 87

Note: when including subtopics, indention is needed

Chapter 3. RESULTS AND DISCUSSIONS…………………………………..89

Chapter 4 SUMMARY OF FINDINGS, CONCLUSIONS AND

Summary of Findings ................... 129