Self-care intervention combined three different theories to increase self-care and self-efficacy of elderly patients with hypertension or prehypertension, namely Dorothea Orem’s 1993 self-care deficit theory (Taylor and Renpenning, 2011; Fawcett, 1995), Albert Bandura’s 1970s self-efficacy theory (Bandura, 1994), and Martha Tyler John’s 1988 geragogy theory (Glendenning, 2000; Thomas, 2007). The conceptual framework of the intervention is shown in Figure 1.
Salt Reduction Training (SRT)
To improve participants’ knowledge, attitudes, and low-salt intake while maintaining high self-efficacy, a two-day educational training, Salt Reduction Training (SRT),was conducted weekly. Each 90-minute session with 8–10 participants was followed by a 15 minute break. This training applied learning methods derived from geragogy and self-efficacy concepts. Geragogy is defined as a process involved in stimulating and helping the elderly to study (John,1988).
In SRT, the geragogy concept is used with frequent repetition and evaluation of key points in hypertension self-care, including demonstrating how to measure daily salt intake and prioritizing important skills. Self-efficacy concepts were utilized by stressing that maintaining a low-salt diet is easy, changing negative thoughts about salt and hypertension, and reinforcing positive attitudes during discussion. In addition, to motivate participants, trained elderly role models who had implemented low-salt diets shared their experiences about the benefits and ease of implementing a low-salt diet. Participants were given time to ask questions. To master the concepts of a low-salt diet, participants and researchers cooked a low-salt menu together during the second day of training. The majority of training information and leaflets were in pictures, including the leaflets “You Can Deal with High Blood Pressure by Reducing Salt Intake.”
Salt Reduction and Efficacy Maintenance (SREM) program
One month after training, participants in the SREM group attended a 90-minutefollow-up meeting, called a maintenance meeting, designed to help them overcome difficulties and challenges they faced in applying a low-salt diet. Members in the SRT group received only the initial two-day training. Table 1 gives an overview of the intervention given to the SRT and SREM groups. During the maintenance meeting, participants shared their progress, benefits, and challenges of following a low-salt diet. Role models were invited again for interactive discussions with participants. As opposed to the mainly one-way communication by role models during the SRT, in the maintenance meeting, both role models and participants had a lively discussion because they had implemented a low-salt diet together. Any solutions and progress reported in this meeting were reinforced. Participants were given a chance to adjust their low-salt diet targets based on difficulties and solutions offered by other participants.