A causal model of lifestyle modification behaviors in Thai adults with hypertension

Patcharawadee Tongnuang, Piyanuch Jittanoon, Umaporn Boonyasopun, Karnsunaphat Balthip, Diane Ruth Lauver


Lifestyle modification behaviors are a key strategy for controlling hypertension. Understanding the causal model of lifestyle modification behaviors would shape the behaviors which are necessary for controlling blood pressure levels among Thai adults with hypertension. The purpose of this study was to examine the proposed relationships between psychosocial variables, such as desire, attitude, perceived behavioral control (PBC), intention, trying, social support, illness identity, self-efficacy, and lifestyle modification behaviors (LMB). This study was a descriptive cross-sectional study using a self-administered questionnaire which was responded to by 240 selected Thai adults with hypertension at the out-patient clinic in five hospitals throughout Thailand. A set of questionnaires were used for collecting data and the internal consistency was between .75 – .95. Data were analyzed by path analysis. The results found that PBC and social support had a positive and direct influences on LMB (β = .31, p < .001; β = .36, p < .001, respectively). Desire and PBC had a positive and direct influence on intention (β = .55, p < .001; β = .19, p < .01, respectively). Self-efficacy, intention, and PBC had a positive and direct influence on trying (β = .46, p < .001; β = .19, p < .01; β = .15, p < .05, respectively). The revised model accounted for 47%, 30%, and 39% of the variance in intention, trying, and lifestyle modification behaviors, respectively. Knowledge about the factors influencing lifestyle modification behaviors in Thai adults with HTN will assist a nurse in developing interventions/ programs to promote lifestyle modification behaviors in this population.


Hypertension, lifestyle modification behaviors, Thailand, causal model


World Health Organization, (2015). Available at: http://apps.who.int/iris/bitstream/10665/170250/1/ 9789240 694439 _eng.pdf, accessed December 2016.

Thai Ministry of Public Health, Available at: https://hdcservice.moph.go.th/hdc/reports/ report.php? source=formated/format_1.php&cat_id=6a1fdf282fd28180eed7d1cfe0155e11&id=29eec762c9591d1f8092da14c7462361, accessed May 2017.

T Pangjunant, and N Panthuvaj, Available at: http://www.thaincd.com/news/hot-news-view.php?id=9129, accessed August 2015.

Bureau of Non-Communicable Disease Thailand. The Annual Report 2015. The War Veterans Organization of Thailand under Royal Patronage of His Majesty the King press, Bangkok, 2016.

A Pakdeepinit, S Kaewklin, and S Khongchin, Available at: http://www.thaincd.com/document/file/ info/non-communicable-disease2559.pdf, accessed December 2016.

AV Chobanian, GL Bakris, HR Black, WC Cushman, LA Green, JL Izzo, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003; 42, 1206-1252.

BD Rigsby. Hypertension improvement through healthy lifestyle modifications. ABNF J. 2011; 22(2), 41-43.

M Rocha-Goldberg, L Corsino, B Batch, CI Voils, CT Thorpe, HB Bosworth, and LP Svetkey. Hypertension improvement project (HIP) Latino: Results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults. Ethnicity & Health. 2010, DOI:10.1080/13557851003674997.

Y Ruixing, L Hui, W Jinzhen, L Weixiong, Y Dezhai, P Shangling, and L Xiuyan. Association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations. Public Health Nutr. 2009, DOI:10.1017/S1368980008002437.

PA James, S Oparil, BL Carter, WC Cushman, C Dennison-Himmelfarbet, J Handler, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA. 2014, 311(5), 507-520.

Thai Hypertension Society. Thai guidelines on the treatment of hypertension updates 2012. Huanam printing, Bangkok, 2012.

CD Ford, MJ Kim, and BL Dancy. Perceptions of hypertension and contributing personal and environmental factors among rural Southern African American women. PMC. 2010, 19(4), 407-413.

LL Lee, MC Watson, CA Mulvaney, CC Tsai, and SF Lo. The effect of walking intervention on blood pressure control: A systematic review. Int J Nurs Stud. 2010, DOI:10.1016/ j.ijnurstu.2010.08.008.

JL Middleton. A proposed new model of hypertensive treatment behavior in African Americans. J Natl Med Assoc. 2009, 101(1), 12-17.

A Nangyaem. 2007, Determinants of eating behavior of hypertensive patients, Master’s thesis, Burapha University, Chonburi, Thailand.

VA Brown, K Bartholomew, and AD Naik. Management of chronic hypertension in older men: An exploration of patient goal-setting. Patient Educ Couns. 2007, 69, 93-99.

S Chen, J Tsai, and K Chou. Illness representations and adherence to therapeutic regimens among patients with hypertension: A structural modeling approach. Int J Nurs Stud. 2011, 48, 235-245.

M Scisney-Matlock, HB Bosworth, JN Giger, OL Strickland, RV Harrison, D Coverson, et al. Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans. Postgrad Med J. 2009, 121(3), 147-159.

SJ Yang, D Jung, and AE Choi. Prediction model of blood pressure control in community-dwelling hypertensive adults in Korea. Nurs Health Sci. 2010, DOI:10.1111/j.1442-2018.2009. 00501.x.

M Baghianimoghadam, S Aivazi, SS Mzloomy, and B Baghianimoghadam. Factors in relation with self-regulation of hypertension based on the Model of Goal Directed behavior in Yazd city. J Med Life. 2011, 4(1), 30-35.

SD Taylor, RP Bagozzi, and CA Gaither. Decision making and effort in the self-regulation of hypertension: Testing two competing theories. Br J Health Psychol. 2005, 10, 5050-530.

E Pinprapapan, S Panuthai, T Vannarit, and W Srisuphan. Causal model of adherence to therapeutic regimens among Thais with hypertension. Pac Rim Int J Nurs Res Thail. 2013, 17(3), 268-281.

HB Bosworth, and EZ Oddone. A model of psychosocial and cultural antecedents of blood pressure control. J. Natl. Med. Assoc. 2002, 94(4), 236-248.

M Perugini, and RP Bagozzi. The role of desires and anticipated emotions in goal-directed behaviors: Broadening and deepening the theory of planned behavior. Br J Soc Psychol. 2001, 40, 79-98.

I Ajzen. The theory of planned behavior. Organ Behav Hum Decis Process. 1991, 50, 179-211.

RP Bagozzi, UM Dholakia, and S Basuroy. How effortful decisions get enacted: The motivating role of decision processes, desires, and anticipated emotions. J Behav Decis Mak. 2003, 16, 273-295.

AD Heymann, R Gross, H Tabenkin, B Porter, and A Porath. Factors associated with hypertensive patients’ compliance with recommended lifestyle behaviors. Isr Med Assoc J. 2011, 13, 553-557.

T Kebwai. 2006, Selected factors related to health promoting behaviors in bodyweight control of overweight patient with hypertension, Master’s thesis, Chulalongkorn University, Bangkok, Thailand.

P Purateeranrath. Health beliefs and social support with self-care of essential hypertension patients at Surin hospital, Surin Province. Medical journal of Srisaket Surin Buriram hospitals. 2011, 26(3), 449-462.

S Sukprungprom. 2008, Factors related to health promoting behavior of hypertension patients in Amphawa District, Samut Songkhram Province, Master’s thesis, Mahidol University, Bangkok, Thailand.

SD Taylor, RP Bagozzi, and CA Gaither. Gender differences in the self-regulation of hypertension. J Behav Med. 2001, 24(5), 469-487.

A Bandura. In: E Pinprapapan, S Panuthai, T Vannarit, and W Srisuphan. Causal model of adherence to therapeutic regimens among Thais with hypertension. Pac Rim Int J Nurs Res Thail. 2013, 17(3), 268-281.

S Tantayothin. 2004, Factor influencing nutritional and exercise behaviors of hypertensive patients in Sainoi District, Nonthaburi Province, Master’s thesis, Mahidol University, Bangkok, Thailand.

BC Wingo, RA Desmond, P Brantley, L Appel, L Svetkey, VJ Stevens and JD Ard. Self-efficacy as a predictor of weight change and behavior change in the premier trial. J Nutr Educ Behav. In press.

H Leventhal, I Brissette, and EA Leventhal. The common-sense model of self-regulation of health and illness. In: Cameron L and Leventhal H (Eds.). The self-regulation of health and illness behavior, Routledge, New York, 2003, p.42-65.

BH Munro. Statistical methods for health care research, 4th ed. Lippincott, Philadelphia, 2001.

MA Willgerodt, M Kataoka-Yahiro, E Kim and C Ceria. Issues of instrument translation in research on Asian immigrant populations. J Prof Nurs. 2005, 21(4), 231-239.

Self-efficacy for managing chronic disease 6-item scale, Available at: http://patienteducation. stanford.edu/research/secd6.html, accessed July 2013.

S Leelacharas. 2005, Illness representations in Thai women diagnosed with hypertension and relationships to medication-taking behavior, Ph. D. Dissertation. University of Michigan, USA.

S Limcharoen. 2006, Factor related to adherence to treatment among essential hypertensive patients, Master’s thesis, Burapha University, Chonburi, Thailand.

GM Maruyama. Basic structural equation modeling. Sage, Thousand Oaks, California, 1998.

JB Schreiber, A Nora, FK Stage, EA Barlow and J King. Reporting structural equation modeling and confirmatory factor analysis results: A review. J Educ Res. 2006, 99(6), 323-338.

BG Tabachnick and LS Fidell. Using multivariate statistics, Volume 2 (5th ed.). Pearson Education, Boston, Miami, 2007.

LT Hu and PM Bentler. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999, 6(1), 1-55.

K Schermelleh-Eagle and H Moosbrugger. Evaluating the fit of structural equation models: Test of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online. 2003, 8(2), 23-74.

I Ajzen. Perceived behavioral control, self-efficacy, locus of control, and the Theory of Planned Behavior. ‎J Appl Soc Psychol. 2002, 32(4), 665-683.

RM Peters and TN Templin. Theory of Planned Behavior, self-care motivation, and blood pressure self-care. Res Theory Nurs Pract. 2010, 24(3), 172-186.

JS House, KR Landis and D Umberson. Social relationships and health. Science. 1988, 241(4865, July), 540-545.

K Glanz, BK Rimer and K Viswanath. Health behavior: Theory, research, and practice, 5th ed. A Wiley Brand, Jossey-Bass, California, 2015.

American Heart Association. Available at: http://www.heart.org/HEARTORG/Conditions/ HighBlood Pressure/SymptomsDiagnosisMonitoringofHighBloodPressure/What-are-the-Symptoms-of-High-Blood Pressure_UCM_301871_Article.jsp#.WBonAMk-u99, accessed December 2016.

S Leelacharas and D Rujiwatthanakorn. Thai women’s perceptions of the causes of hypertension based on age and educational level. Pac Rim Int J Nurs Res Thail. 2012, 16(1), 3-12.


  • There are currently no refbacks.


Online ISSN: 2228-835X


Last updated: 29 December 2018