Implications for Mindfulness-Based Interventions

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Date Received: Day Month Year Date Accepted: Day Month Year Date Published: Day Month Year Recommended citation:

Pizarro, J. P. (2023). The light explorer publishable journal format. St. Paul University Philippines.

EXPLORATION OF THE SELF-MANAGEMENT EXPERIENCE OF HYPERTENSION SUFFERERS REGARDING MINDFULNESS BASED STRESS REDUCTION

Amriati Mutmainna^[1], Erna Kadrianti^[2], Belinda C. Cabauatan^[3]

[1, 2] Nani Hasanuddin College of Health Sciences, Nursing Departement, Indonesia

[3] St. Paul University Philippines, EM Departement, Philippines

[1][email protected]

ABSTRACT

The blood pressure of someone suffering from hypertension needs to be controlled, one way to control it is to carry out self- management by reducing stress, which researchers are interested in reducing stress using mindfulness. This research methodology uses qualitative research with a phenomenological approach which aims to obtain in-depth information about the self-management experiences of hypertension sufferers in reducing stress by practicing mindfulness. The results of this research show that 5 findings were identified, namely: positive experiences in using mindfulness, challenges in practicing mindfulness, the impact of mindfulness on blood pressure and general well-being, factors supporting the success of mindfulness, and factors inhibiting the success of mindfulness. The conclusion of this research is that self-management of hypertension sufferers using mindfulness techniques can reduce stress, even though there are several challenges and inhibiting factors.

Keywords: Self-Management, Hypertension Sufferers, Mindfulness, Stress Reduction

INTRODUCTION

According to World Health Organization (WHO, 2023a) stated that an estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, most (two- thirds) living in low- and middle-income countries. An estimated 46% of adults with hypertension are unaware that they have the condition. Less than half of adults (42%) with hypertension are diagnosed and treated.

Approximately 1 in 5 adults (21%) with hypertension have it under control. Hypertension is a major cause of premature death worldwide. One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.

The prevalence of hypertension varies across regions and country income groups. The WHO African Region has the highest prevalence of hypertension (27%) while the WHO Region of the Americas has the lowest prevalence of hypertension (18%). The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, with the increase seen largely in low- and middle-income countries. This increase is due mainly to a rise in hypertension risk factors in those populations (WHO, 2023a).

According to WHO (2023b) stated Indonesia hypertension profile about total population in 2019 as much as 269.600.000 persons and total deaths in 2019 as much as 1.816.000 persons. Of the 51.3 million adults aged 30 – 79 years with hypertension diagnosed for male

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29% and female 41%, treated for male 15% and female 21%, controlled male 4% and female 5%.

Hypertension or high blood pressure is the number one cause of death in the world, with 90-95% of cases dominated by essential hypertension. In Indonesia, according to the 2023 Indonesian Health Survey or Survei Kesehatan Indonesia (SKI) and the 2011-2021 noncommunicable disease (NCD) cohort study, hypertension is the fourth highest risk factor for death with a percentage of 10.2% (Kemenkes, 2024). In order to achieve a 50%

control rate, 23.4 million more people with hypertension would need to be effectively treated (WHO, 2023b).

Based on the 2023 Indonesian Health Statistics profile, it is stated that levels of stress, anxiety and depression are increasing, requiring serious attention from the health sector and the government to provide adequate mental health services. In addition, the problem of noncommunicable diseases, such as diabetes, hypertension and obesity, remains a significant health challenge. In this case, one of them is hypertension, which is where I highlight hypertension in this research. Rapid urban lifestyles and changes in diet contribute to the increasing prevalence of these diseases. Therefore, preventative approaches and health education are crucial to reducing the burden of this chronic disease (Direktorat Statistik Kesejahteraan Rakyat, 2023).

Reducing hypertension prevents heart attack, stroke and kidney damage, as well as other health problems. One of the reduces the risks of hypertension by reducing and managing stress (WHO, 2023a).

Mindfulness-based interventions (MBIs) can be a potential novel and nondrug treatment for blood pressure control among patients with hypertension. It trains the participants' mindfulness ability, which is defined as the awareness that arises from paying attention on purpose, in the present moment nonjudgmentally in the service of self-understanding, wisdom, and compassion (Zinn, 2023). Based on research conducted by Lee et al (2020), the effect and acceptability of mindfulness-based stress reduction program on patients with elevated blood pressure or hypertension can reduce office blood pressure stress levels and mood symptoms.

Patients with hypertension should perform diverse self-care activities that incorporate medication

adherence and lifestyle modification, such as no smoking or alcohol, weight reduction, a low-salt diet, increased physical activity, increased self-monitoring, and stress reduction, for effective management at home (Konlan &

Shin, 2023).

Based on the background above, researchers are interested in researching self-management of hypertension sufferers regarding mindfulness-based stress reduction by exploring the experiences of hypertension sufferers.

Statement of the Problem

Based on the background above, the problem statement in this research is what kind of self-management is carried out by hypertension sufferers in reducing stress based on mindfulness.

METHODOLOGY

The methodology of research in this study used qualitative research approached phenomenological research. In this research deals with human subjects, so the researchers used informed consent. In this study used ethichal clearance for an Ethic Review Board in he Center for Research and Community Service or Pusat Penelitian dan Pengabdian kepada Masyarakat (P3M) STIKES Nani Hasanuddin with ethical code number 0397/STIKES- NH/KEPK/V/2024.

Research Design

The research method used in this research is qualitative research with a phenomenological research design approach. According to Ratyaningtyas et al (2023), qualitative research is research that is descriptive in nature and tends to use analysis. The theoretical basis is used as a guide so that the research focus is in accordance with the facts in the field. Qualitative methods place more emphasis on observing phenomena and research more into the substance of the meaning of these phenomena.

Phenomenological research is a research strategy in which researchers identify the nature of human experience about a particular phenomenon.

Participants of the Study

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Participants in this research were hypertension sufferers who expressed their willingness to be involved in this research and participants were able to talk fluently about their experiences while carrying out self- management using mindfulness-based stress reduction.

The number of participants in this research was 5 participants.

Instrumentation

The research instrument used in this research is an interview guide to conduct an in-dept review of participants. When researchers conduct in-depth interviews, researchers use a recording device to record conversations so that researchers obtain complete interview results.

Data Gathering Procedure

Researchers have determined the scope of the phenomenon to be studied, namely researching self- management of hypertension sufferers regarding mindfulness-based stress reduction by exploring the experiences of hypertension sufferers. Next, the researcher compiled a list of questions, then appointed informants who were relevant to this research problem.

Before researchers conduct research, researchers carry out ethical arrangements at the Center for Research and Community Service or Pusat Penelitian dan Pengabdian kepada Masyarakat (P3M) STIKES Nani Hasanuddin

with ethical code number

0397/STIKES-NH/KEPK/V/2024.

Moreover, this study used informed consent to ask for respondents' consent and interview sheets to conduct in-depth interviews with respondents. In addition, researchers collected research data by observing participants and intensely tracing participants.

Data Analysis

Data analysis in this research used three stages, namely the initial stage, the horizontalization stage, and the cluster of meaning stage. In the initial stage, the researcher provided a thorough description of the meaning and essence of the experience of hypertension sufferers in carrying out self-management towards mindfulness-based stress reduction. Furthermore, all

recordings of in-depth interviews with research subjects were transcribed into written language, from Indonesian language to English language. In the next stage, namely the horizontalization stage, where the transcript is produced, the researcher inventories important statements that are relevant to the self-management of hypertension sufferers in carrying out self-management towards mindfulness-based stress reduction. In addition, at the cluster of meaning stage, clarify the statements into themes of meaning, and eliminate overlapping or repetitive statements.

RESULTS AND DISCUSSION

There were five main themes found from research exploring the experiences of self-management of hypertension sufferers regarding mindfulness-based stress reduction; (1) Positive Experience in Using Mindfulness; (2) Challenges in Mindfulness Practice; (3) Impact of Mindfulness on Blood Pressure and General Well-Being; (4) Supporting Factors for the Success of Mindfulness; (5) Factors Inhibiting the Success of Mindfulness.

A. Theme 1: Positive Experiences in Using Mindfulness Hypertension treatment using Mindfulness techniques is a positive experience such as Stress Reduction, Self-Awareness, which can be seen in table 1.

Table 1. Theme analysis process: Stress reduction and self-awareness

Coding Category Theme

Feel calmer

Increased self-control

Stress Reduction

Positive Experiences in Using Mindfulness Increased awareness of

signs of stress

Early recognition of hypertension

Self- awareness

Through in-depth interviews, participants described their experiences in participating in Mindfulness. Research on stress reduction and self- awareness, after using the Mindfulness technique, participants said that the Mindfulness technique made them feel calm and increased alertness.

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From the results of the interviews, participants said they felt calmer and could control stress. Excerpt from the statement as follows:

Indonesian Language

“Saya merasa lebih tenang dan terkendali setelah rutin berlatih mindfulness, terutama dalam situasi yang biasanya membuat saya stress” (P1)

“Mindfulness membantu saya lebih sadar akan tanda-tanda awal stres, sehingga saya bisa mengambil tindakan pencegahan sebelum tekanan darah saya naik” (P2)

English Language

“I feel calmer and more in control after regularly practicing mindfulness, especially in situations that usually make me stressed” (P1)

“Mindfulness helps me be more aware of the early signs of stress, so I can take preventative action before my blood pressure rises” (P2) The same statement was also expressed by other participants who stated that after practicing mindfulness they were more focused and dealt with daily stress. Excerpt from the statement as follows:

“Dengan mindfulness, saya dapat lebih fokus pada saat ini dan tidak terlalu terbebani oleh kekhawatiran atau stres yang berlebihan” (P3)

“Praktik mindfulness membuat saya lebih peka terhadap perubahan dalam tubuh saya, membantu saya mengelola hipertensi dengan lebih baik” (P5)

English Language

“With mindfulness, I can focus more on the present moment and am less burdened by excessive worry or stress” (P3)

“Mindfulness practices make me more sensitive to changes in my body, helping me better manage hypertension” (P5)

The first theme in this research is about positive experiences in using mindfulness. This theme is an important experience in managing hypertension. This research is in line with research conducted by Chen et al (2024) providing evidence for the positive role of mindfulness-based interventions in hypertension management.

B. Theme 2: Challenges in Mindfulness Practice Hypertension treatment using Mindfulness techniques presents consistency difficulties and time constraints.

Table 2. Theme analysis process: consistency difficulties and barriers

Daily busyness

Feeling tired or lazy Consistency

Difficulty Challenges in

Mindfulness Practice Lack of free time

Other priorities are more pressing

Time Barriers

Through in-depth interviews, participants described their experiences in following Mindfulness, difficulties with consistency in following and time constraints due to work or obstacles that could cause them not to follow mindfulness.

From the results of interviews conducted, it was found that participants had difficulty consistently following mindfulness practices and had limited time due to work. Excerpt from the statement as follows:

“Sulit sekali untuk tetap konsisten dalam berlatih mindfulness, terutama karena jadwal sehari-hari saya yang sangat sibuk.” (P4)

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“Saya sering merasa terlalu lelah setelah seharian bekerja, sehingga sulit untuk menemukan energi dan waktu untuk melakukan latihan mindfulness” (P5)

English Language

“It is very difficult to stay consistent in practicing mindfulness, especially because of my very busy daily schedule.” (P4)

"I often feel too tired after a long day at work, so it is difficult to find the energy and time to do mindfulness exercises" (P5)

Another participant expressed the same statement who stated that it was very difficult to create a routine to follow mindfulness practices. Excerpt from the statement as follows:

“Meskipun saya tahu manfaatnya, saya sering kesulitan menciptakan rutinitas yang stabil untuk praktik mindfulness karena banyaknya gangguan.” (P2)

English Language

“Even though I know the benefits, I often have difficulty creating a stable routine for mindfulness practice because of the many distractions.” (P2)

The second theme in this research is about challenges in mindfulness practice. This theme is important to know because hypertension sufferers need to manage blood pressure with mindfulness exercises through existing challenges. This research is in line with research conducted by An et al (2021) which states that mindfulness has challenges in practicing it, namely that a multimodal mind-body program involving mindfulness training can improve blood pressure control in adults with hypertension.

C. Theme 3: The Impact of Mindfulness on Blood Pressure and General Well-Being

Hypertension treatment using Mindfulness techniques presents reduced blood pressure and increased welfare.

Table 3. Theme analysis process: reducing blood pressure and improving well-being

The frequency of blood pressure spikes is reduced The intensity of blood pressure spikes decreases

Reduced Blood Pressure

The Impact of

Mindfulness on Blood Pressure and General Well-Being Sleep quality improves

Emotional well-being improves

Increased Welfare

Through in-depth interviews, participants described their experiences in participating for mindfulness, reducing blood pressure and increasing well-being after participating in mindfulness.

From the results of the interviews conducted, participants stated that they experienced a decrease in blood pressure and blood pressure stability. Excerpt from the statement as follows:

“Setelah beberapa bulan rutin berlatih mindfulness, saya melihat penurunan yang signifikan dalam frekuensi lonjakan tekanan darah.” (P3)

English Language

“After several months of regular mindfulness practice, I noticed a significant reduction in the frequency of blood pressure spikes.” (P3) Another participant expressed the same statement who stated that it had a positive impact on both himself and his blood pressure. Excerpt from the statement as follows:

“Praktik mindfulness membantu saya merasa lebih tenang, yang berdampak positif pada stabilitas tekanan darah saya” (P1)

English Language

“Mindfulness practice helps me feel calmer, which has a positive impact on the stability of my blood pressure” (P1)

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The third theme in this research is about the impact of mindfulness on blood pressure and general well-being. This theme is important for hypertension sufferers because when the hypertension sufferers want to do their mindfulness, they need to know what is the impact of mindfulness on blood pressure and general well-being. This research is in line with research conducted by Babak et al (2022) which states that the mindfulness-based stress reduction program resulted impact in a significant reduction in the mean systolic and diastolic blood pressures and improvement in mental health and different aspects of quality of life.

D. Theme 4: social support and professional guidance Hypertension treatment using Mindfulness techniques is a technique for reducing blood pressure and improving well-being.

Table 4. Supporting Factors for the Success of Mindfulness

Support from family Support from a mindfulness community or group

Social

Support Supporting the Success of

Mindfulness Help from a doctor

Directions from a mindfulness therapist

Professional Guide

Through in-depth interviews, participants described their experiences in participating in Mindfulness, supported by the social environment and held by a professional team.

From the results of interviews conducted, participant statements were obtained that family support and support from the community or society were very important. Quotes from participant statements are:

“Dukungan dari keluarga saya sangat membantu, mereka bahkan sering ikut berlatih mindfulness bersama saya” (P2)

English Language

“Support from my family is very helpful, they often even practice mindfulness with me” (P2) Participants expressed the same statement regarding community support. Excerpt from the statement as follows:

“Kelompok dukungan di komunitas saya membuat saya merasa termotivasi untuk tetap konsisten dalam praktik mindfulness.” (P4) English Language

“The support group in my community keeps me feeling motivated to stay consistent in my mindfulness practice.” (P4)

The fourth theme in this research is about the supporting the success of mindfulness. This theme is important for hypertension sufferers because when the hypertension sufferers want to do their mindfulness, they need to know what is the impact of mindfulness on blood pressure and general well- being. This research is in line with research conducted by Babak et al (2022) which states that the mindfulness-based stress reduction program resulted impact in a significant reduction in the mean systolic and diastolic blood pressures and improvement in mental health and different aspects of quality of life.

E. Theme 5: Factors Inhibiting the Success of Mindfulness

Hypertension treatment using Mindfulness techniques has several obstacles in mindfulness, namely Social Stigma, Lack of Self-Confidence.

Table 5. Social stigma and lack of self-confidence

Lack of understanding

in the social

environment

Skeptical attitude from people around

Social

Stigma Factors Inhibiting the Success of

Mindfulness

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Doubts about the effectiveness of mindfulness Limited scientific evidence accessed by participants

Lack of Self- Confidence

Through in-depth interviews, participants described their experiences in participating in Mindfulness with obstacles, namely social stigma and lack of self-confidence.

From the results of interviews conducted, participants expressed a lack of understanding regarding mindfulness itself. his statement is quoted as follows:

“Kurangnya pemahaman dan dukungan dari lingkungan sekitar membuat saya merasa kesulitan untuk berkomitmen pada praktik mindfulness.” (P1)

English Language

“The lack of understanding and support from my surroundings made it difficult for me to commit to mindfulness practices.” (P1)

When you believe in the benefits you will feel.

The quoted statement is as follows:

“Keraguan akan efektivitas mindfulness muncul karena saya tidak merasakan perubahan instan, sehingga membuat saya sulit untuk tetap termotivasi.” (P1)

English Language

“Doubts about the effectiveness of mindfulness arose because I didn't feel any instant change, making it difficult for me to stay motivated.” (P1) The fifth theme in this research is about the factors inhibiting the success of mindfulness. This theme is important because there are some factors inhibiting self-management to make mindfulness success for blood pressure under control for hypertension sufferers. This research is in line with

research conducted by Apollo (2023) stated that researchers have identified that inner barriers include a lack of understanding of why we practice, the value of practice, and the ebb and flow of change over time.

External barriers include society that does not strengthen awareness and may actively distance us from our practice. In addition, stated from Oman (2023) that particularly relevant to public health today is that mindfulness-based programs have become a key reference point in efforts to integrate mindfulness into additional sectors that include stress reduction and wellness. However, it is conceivable that program features deemed important for some purposes such as appealing to corporate, professional or community stakeholder groups, may at least be tangential to producing other outcomes of interest, such as beneficiary outcomes. Trade-offs between these impacts, if any, may vary depending on the sociocultural context.

CONCLUSION

This research explores the experiences of hypertension sufferers in self-management through mindfulness-based stress reduction. Based on in-depth interviews with 5 participants, several main findings and conclusions can be drawn:

1. Positive Experiences in Using Mindfulness 2. Challenges in Mindfulness Practice

3. Impact of Mindfulness on Blood Pressure and General Well-Being

4. Supporting Factors for the Success of Mindfulness 5. Factors Inhibiting the Success of Mindfulness

RECOMMEDATION/S

Our recommendation to future researchers is to develop the concept of self-management using mindfulness techniques to reduce the stress experienced by hypertension sufferers. This is very beneficial for hypertension sufferers and families who have family members who suffer from hypertension.

Acknowledgments

First of all, we would like to thank the Nani Hasanuddin Makassar Education Foundation for supporting us financially in our research so that our

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research can be completed well. Second, we would also like to thank the Center for Research and Community Service or Pusat Penelitian dan Pengabdian kepada Masyarakat (P3M) STIKES Nani Hasanuddin who has supported and accommodated us while conducting this research. Third, we would also like to thank our colleagues who have made very helpful contributions to the completion of our research.

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