Adherence to Self-management of Hypertention and Associated factors among

Adult Hypertensive patients attending at chronic follow up Clinic of Jimma

Medical Center, Southwest Ethiopia.

By:

Wosen Darge (BSc)

Research Proposal to Be Submitted to Jimma University, Institute of Health,

Faculty of Public Health, Department of Epidemiology; In Partial Fulfillment for
The Requirements for Master’s of Public Health in Epidemiology.

May, 2020

Jimma, Ethiopia

i
Adherence to self-management of Hypertention and Associated factors among
Adult Hypertensive patients attending at Chronic follow up units of Jimma
University Medical Center, Southwestern Ethiopia.

By:

Wosen Darge(BSc)

Advisors:

[Link]. Hailu Merga (MPHE, Assistant professor)

[Link]. Assefa Legesse (MSc, in Bio-statics)

May, 2020

ii
Proposal Summary
Background - Hypertension is the most significant risk factor for cardiovascular disease and its
prevalence is still increasing in developed and developing countries. Chronic-disease self-
management was important to minimize the impact of chronic diseases on physical health status
and functioning, allowing individuals to cope with the effects of disease allows patients to tackle
the progress of the disease before the emergence of severe complications and has been proven to
be cost-effective, but influencing factors and pathways remain complex and unclear.

Objectives: This study will try to assess adherence to self-management of Hypertantion and
associated factors among Adult Hypertensive patients on Chronic follow up Clinic at Jimma
Medical Center, Southwest Ethiopia, from June 20 to July 20, 2020.

Method: A cross-sectional study design will be conducted and Systematic random sampling
technique will be employed to select a sample of 400 Hypertensive Adults at Jimma medical
center. A validated and pretested questionnaire will be used for data collection after informed
consent will be obtained from participants. Data will be entered into Epi Data Version 3.1, and
imported into SPSS version 23 for analysis. and Results will be presented using tables and
figures. Binary Bivariate analysis logistic models will be used to test associations between every
independent risk factors of adherence to Hypertensive Self - management with the current
adherence status. Variables that demonstrate significance association at p-value 0.25 will be set
a candidate for multivariate logistic regression model to control effect confounding by
backward stepwise technique. Finally, the Variables which have statistically significant (a p-
value of < 0.05) associations with the outcome variable will be expressed as potential
determinants of adherence to hypertensive self -management by AOR and 95% C.I.
Work plan and budget: Over all duration of this reasech will be from March to October, 2020
and a total of 20,838 (Twenty thousand Eight hundred and thirty-eight) Birr will be required for
this research.

Keywords: Self- management, adherence, ; hypertension, ; lifestyle modifications, Anti-

hypertensive medications.

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Table of contents

Table of Contents
Proposal Summary....................................................................................................................................iii
Table of contents.......................................................................................................................................iv
List of abbreviations and acronyms...........................................................................................................vi
Acknowledgement...................................................................................................................................viii
1.1. Background...............................................................................................................................1
1.2 Statement of the problem...........................................................................................................3
1.3 Significance of the study.........................................................................................................5
2. Literature review................................................................................................................................5
2.1. Reviews related to adherence....................................................................................................5
2.1.1. Adherence to Anti-hypertensive medication.......................................................................5
2.1.2. Adherence to Life style modification..................................................................................5
[Link]. Adherence to DASH.......................................................................................................6
[Link]. Adherence to Exercise....................................................................................................6
[Link]. Moderation of Alcohol intake.........................................................................................6
[Link]. Smoking cessation..........................................................................................................6
2.2. Reviews Related to Factores of Adherences to Hypertensive self- management.......................6
2.2.1 Socio-demography.....................................................................................................................6
2.2.3 Social support............................................................................................................................8
2.2.4 Self-efficacy..............................................................................................................................8
2.3. Conceptualframework.....................................................................................................................9
3. Objectives.............................................................................................................................................10
3.1 General Objective...........................................................................................................................10
3.2 Specific objectives..........................................................................................................................10
4. Methods...............................................................................................................................................11
4.1 Study Area and Period....................................................................................................................11
4.2 Study Design..................................................................................................................................11
4.3. Population.....................................................................................................................................11
4.3.1. Source population...................................................................................................................11
All Adult Hypertensive patients on follow-up clinic at JMC............................................................11
4.3.2. Study population.....................................................................................................................11

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 4.4. Inclusion and exclusion criteria.....................................................................................................11
4.4.1 Inclusion criteria......................................................................................................................11
4.4.2. Exclusion criteria....................................................................................................................11
4.5. Sample size and sampling procedure.............................................................................................12
4.5.1. Sample size determination......................................................................................................12
4.5.2. Sampling technique................................................................................................................13
4.6. Variables.......................................................................................................................................14
4.6.1 Dependent Variable.................................................................................................................14
4.6.2 Independent Variables...........................................................................................................14
4.7 Operational Definitions................................................................................................................14
4.8 Data Collection Instruments...........................................................................................................15
4.9. Data collection methods................................................................................................................16
4.10 Data quality Assurance...............................................................................................................16
4.11 Data processing and analysis........................................................................................................16
4.12. Ethical consideration.................................................................................................................17
4.13. Dissemination plan......................................................................................................................17
4.14. Limitation of the study................................................................................................................17
References...............................................................................................................................................21

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List of abbreviations and acronyms
AHT- Antihypertensive Treatment

AOR-Adjusted odds ratio

BP – Blood Pressure

CAD- coronary artery disease

CI- Confidence Interval

CVD – Cardiovascular Diseases

CKD – Chronic Kidney Disease

DASH – Dietary Approaches to Stop Hypertension

DM- Diabetes mellitus

ECG – Electro cardiograph

HELM- hypertension evaluation of lifestyle and management

HTN – Hypertension

JNC- Joint National Committee

LV- left ventricular

MA – Medication Adherence

MAP- Mean arterial pressure

MMAS – Morisky‟s Medication Adherence Scale

MNA- Medication Non Adherence

PI- Principal Investigator

RCT- Randomized controlled trials

TOD- Target organ damage

SCT – Social Cognitive Theory

vi
USA- United State of America

WHO – World Health Organization

vii
Acknowledgement
First and for most I would like to acknowledge Jimma University Faculty of Public Health
Department of Epidemiology for Selecting me this interesting research topic and
I would like to express my sincere thanks to both of my Advisors Mr Hailu Merga and Assefa
Legesse for their never ending support in the process of my Proposal writing and always being
available for me to clear my queries and their expertise of innumerable help.

viii
 1. Introduction

1.1. Background
Hypertension, the most common cardiovascular disorder affecting approximately one billion
people globally, remains the leading single contributor to global burden of disease and mortality
accounting for approximately 9.4 million deaths annually(1–3). WHO defines hypertension as
“a persistent raised systolic or diastolic blood pressure equal to or more than 140/90 mmHg in
adults aged 18 years and over(4). HTN is often called the “silent killer” because it often has no
warning signs or symptoms, and many people do not realize they have it (5). Hypertension is
one of a major risk factor and precursor for myocardial infarction, chronic kidney disease, heart
failure and premature death and these vascular events increased costs of hypertension
management (6). High blood pressure is a global public health problem that affects more than a
quarter of the global adult population, Globally the prevalence of high blood pressure (BP) in
adults aged 18 years and older is 31.1%(7) and its prevalence is projected to be 1.56 billion by
2025(8,9). The magnitude and prevalence of HTN has shifted from developed countries to
developing countries since the past four decades (10)(5). In developing Countries , almost
three-fourths of people were living with HTN (11). In Africa region the prevalence of HTN is
estimated to be 46%(12). According to the study conducted in four Africa countries, the
prevalence of hypertension and pre-hypertension are high and it differs by population group
defined by occupation and degree of urbanization and half of them are aware of their
hypertension which indicates high burden of un diagnosed(13). Likewise, the magnitude of
HTN has been increasing in Ethiopia, it has a widely varied rate ranging from 0.8% to
31.5%(14). The rate was 28.3% and 25.1% for Gondar town (5) and Bahir Dar (11)
respectively. Hypertension (HTN) is a modifiable cardiovascular risk factor for which
medications effective to regulate the raised blood pressure as well as to hamper the
complications are available. But, the maximal beneficial effect of an appropriate treatment plan
can be achieved only if patients strictly adhere to the recommendations(15).This increasing
prevalence of hypertension is attributed to population growth, ageing and behavioral risk
factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight
and exposure to persistent stress(16). The adverse health consequences of hypertension are
compounded because many people affected also have other health risk factors that increase the

1
odds of heart attack, stroke and kidney failure. These risk factors include tobacco use, obesity,
high cholesterol and diabetes mellitus(4).

Adherence is defined as patient’s behavior corresponds with health care provider’s

recommendation like taking medication, following a diet, executing lifestyle changes and
follows medical advice (17).A review from the 2095 articles identified that therapeutic non-
adherence occurs when an individual’s health-seeking behavior lacks similarity with the
recommendations as prescribed(18). Non adherence to treatment medication and lifestyle
modification is a complicated issue affecting patients’ health, health expenditure, and resources’
utilization while adherence to Antihypertensive Treatment (AHT) has been associated with
improved blood pressure (BP), decreased hospitalizations rates, and lower medical care costs
(19–21).

Hypertension self-management is more than simple adherence to provider recommendations it

also incorporates the psychological and social management of living with it and engaging in
activities that promote physical and psychological health(22).

The major aim of chronic self-management was to minimize the impact of chronic diseases on
physical health status and functioning, allowing individuals to cope with the effects of disease.
In addition, it allows patients to tackle the progress of the disease before the emergence of
severe complications (23).
Chronic Disease Self-management program is designed to reduce the impact of CVD might
include components to address each problem by promoting patient centered care and improving
physician-patient communication, increasing patients’ adherence to recommended medications
and self-care regimens and increase focus on self-monitoring like weight and blood
pressure(24,25).

Life style modification and antihypertensive medication are the two main components of
hypertention self management are essential for prevention of high blood pressure(26).

Life style modification is one of the most important factors in effective management of
hypertension. It includes patient’s ability to adopt the Dietary Approaches to Stop Hypertension
(DASH), adopt a low sodium diet, engage in physical activity, moderate alcohol consumption

2
and cease smoking so patients are expected to adhere to these activities in order to alleviate the
burden imposed by their disease (27).

1.2 Statement of the problem

Hypertension is one of the most significant risk factor for cardiovascular disease and its
prevalence is still increasing globally, But, awareness about treatment and control of
hypertension is extremely low among developing nations(28). HTN is a modifiable
cardiovascular risk factor, in which early detection, proper management and control of BP can
avoid long-term complications by using appropriate treatment plan(29). Hypertension is
preventable, with a 10 mmHg reduction in systolic blood pressure (BP) resulting in a 32%
reduction in stroke risk and 14% relative reduction in ischemic heart-disease risk(30). For better
control of hypertension and prevent CVD, experts have implemented a number of measures,
among which chronic-disease self-management is considered cost-effective (31).
According to the Eighth Joint National Committee for the Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (JNC-8), Engagement in self-management behavior is
indispensable for the management of HTN(28).
Even if the risk factors, prevention, and controlling mechanisms of hypertention are well
familiar, the negative outcomes resulting from the disease will possibly continue for many
years,And this makes the disease the biggest and most terrible social and health related
challenges (32).
Medication Adherence, self-blood pressure monitoring and life style modification which is
hypertension self-management components are recommended and have been shown to result in
a significant reduction in blood pressure(33)
Even though there are medications that are used to treat hypertension, because of large
proportion of patients not taking these medicines as prescribed the benefits of these drugs are
not being realized and this indirectly raises the issue of therapeutic adherence among
hypertensive persons (34). Effective antihypertensive treatment should be maintained
indefinitely to reduce the relative risk of stroke and other cardiovascular disease events (35).
Hypertension medication adherence is still significant challenge around the world due to the
asymptomatic nature of the disease and indefinite treatment duration(36). The World Health
Organization (WHO) identifies poor adherence as the most significant cause of uncontrolled BP
and estimates that 50–70% of people do not take their antihypertensive medication as prescribed

3
(37). In Ethiopia, studies done in Hawasa and North west Ethiopia showed that the level of
adherence to antihypertensive treatment was 67% and 67.2% respectively which is low (38,39).
Some Studies conducted in Ethiopia shows, daily alcohol intake, number of antihypertensive
medications, availability of medications without fee, age, residence, presence of co-morbidities,
knowledge towards HTN and its treatment, are the factors affecting anti-hypertensive adherence
(40)(38). Despite the availability and improvement in diagnostic options and therapeutic
interventions of hypertension with proven benefits in reducing cardiovascular morbidity and
mortality; BP control rates are grossly inadequate (< 30% controlled to < 140/90 mmHg) even
among those diagnosed as hypertensive and taking anti-hypertension treatment (41). The
effective lifestyle modification can lower the BP as much as the single antihypertensive drug
(42). It includes patient’s ability to adopt dietary approaches to stop HTN (DASH), adopt a low
sodium diet, engage in physical activity, moderate alcohol consumption, and cease smoking
(32). The studies also show that diets high in fruits, vegetables and low-fat dairy products can
prevent the development of the HTN and can also lower the elevated BP(43). There are only
few studies that specifically address the issue of adherence with recommendations for healthy
lifestyle and these limited number of studies conducted show lower adherence towards lifestyle
modifications; with adherence to regular physical exercise being the least (44). According to the
study conducted in Addis Ababa the overall adherence (including diet, exercise, smoking
cessation and moderation of alcohol consumption) is 23%. Diet related adherence is 69.1%,
exercise related adherence 31.4% shows most hypertensive client in the follow up is poor
adherent (45). There is increase in the number of older people who cannot care for themselves
and have to stay in nursing homes and in older people the prevalence of hypertension is high,
but disease awareness and self- management are found to be low(46,47).
Social support has the potential to influence self-management behavior significantly, either
directly or indirectly, through self-efficacy(48). However, inappropriate and well-intentioned
advice from friends and family members may have unintentional negative influences on self-
management behavior(49). Demographic and disease characteristics also have an influence on
Hypertensive self-management, patients with higher education, higher personal income, medical
insurance, and longer disease course have have
better self -management practice(50). However,
hypertension stage, age, sex, race/ethnicity, marital status and employment relationships with
self -management remain heterogeneous(51).Though the issue of self-management and its

4
adherence requires strong devotion and considerable attention, there is few local study that
assesses both adherence to lifestyle modifications and anti – hypertensive medications in
Ethiopia. This study therefore will try to assess adherence to self-management and its associated
factors among adult hypertensive patients in Jimma Medical Center.
1.3 Significance of the study
This study result would worth to detect the gaps in the area of adherence to self-management
among hypertensive patients in the study setup which would have further guide concerned body
to give emphasis towards this emerging issue and development of programs that play a key role
in controlling complications that are due to hypertension.
This study is an important piece of work that could serve as an important source of information
to design prevention strategies or to conduct further Investigations.

2. Literature review
2.1. Reviews related to adherence
2.1.1. Adherence to Anti-hypertensive medication
The World Health Organization (WHO) identifies poor adherence as the most significant cause
of uncontrolled BP and estimates that 50–70% of people do not take their antihypertensive
medication as prescribed(33). In United States, half of the 3.2 billion annual prescriptions
dispensed medications were not taken as prescribed, to be an enormous burden to the world’s
health care system(52). Non adherence to Hypertention medication will be the source of
psychological and medical complications and has an impact on patients’ quality of life, wasting
health care resources and reducing individuals believe towards the health care system (53).
In,Brazil 52.9%, 77%, Nigeria 44.7% ,(at Nedjo) in Ethiopia Hypertensive adults were reported
to be adherent to their medication(54–56). Particularly in Ethiopia at the site of the current study
area, Jimma medical center, 61.8% of adults were reported to be adherent to antihypertensive
management (57).

2.1.2. Adherence to Life style modification.

One of the most important factors in effective management of HTN is lifestyle modification
either as an initial treatment or an adjunct to medications. Since patient’s ability to adopt dietary
approaches to stop HTN (DASH), adopt a low sodium diet, engage in physical activity,

5
moderate alcohol consumption, and cease smoking were considered under this sub heading (58).
The studies conducted in Jordan in 2016 shows that 23% of the patients were fully compliant
with healthy lifestyle behaviors(59). Similarly, the study conducted in Addis Ababa found that
23% of the respondents were adhered to all studied lifestyle recommendations(60).
[Link]. Adherence to DASH
The Dietary Approaches to Stop Hypertension (DASH) diet substantially reduces blood pressure
and is recommended for preventing cardiovascular disease(61). The DASH diet emphasizes
intake of fruits, vegetables, low fat dairy foods, and reduced saturated and total [Link],
a recent ancillary analysis of an original DASH randomized trial found that the DASH diet
lowers serum uric acid levels substantially among people with hyperuricemia compared with a
typical American diet(62). According to study conducted in Saud Arabia 2015, Only 17(11.8%)
patients admitted full adherence to a healthy hypertensive diet(63). The Study in Addis Ababa
shows 60% of hypertensive patients rarely or never consumed spicy food since diagnosis and
12.4 % of respondents were never or rarely used salt in their food (60).

[Link]. Adherence to Exercise

Having Exercise, changes the cardiovascular level, including increased systolic blood pressure,
diastolic blood pressure, and mean arterial pressure (MAP)(64). According to the study
conducted in Saudi Arabia , adherence to exercise is 20.1% and in Ethiopia Mekele Hospital
49.4 % which low (63).

[Link]. Moderation of Alcohol intake

Excessive alcohol consumption exerts the risk of hypertension due to its damaging effects to the
heart (64). The Study conducted in Nigeria shows among 322 adult hypertensive participants,
87.6% of them met requirements for alcohol intake(65),where as in Hara (Ethiopia), 95.8% were
adherent to the alcohol(66).
[Link]. Smoking cessation
Cigarette smoking is very prone to damage the wall of arteries, which may lead to the
pathologic changes in the arterial walls like atherosclerosis and cause the narrowing of the
lumen of the arteries this narrowing leads to hypertension(67). The Study conducted in Ukraine
shows that among 925 daily smokers, 183 (19.8%) respondents were suffering from
hypertension(15).

6
 2.2. Reviews Related to Factores of Adherences to Hypertensive self- management
2.2.1. Socio-demography
The risk of being hypertensive increases with an advancement of age with significant risk
differences among in males and females(64). According to the Malaysian National Health and
Morbidity Survey 2015, the prevalence of hypertension among adults aged 18 years and above
was 30.3% and the prevalence increases with age(68).The risk of being hypertensive is greater
among the males starting from the early middle age whereas in the females, they are at risk after
the attainment of menopause. Most studies conducted regarding adherence to lifestyle
modifications and anti-hypertensive medications asserted that females were found to be better
than men. A study conducted in China shows that males had lower self-care behaviors than
female(69).According to the study conducted in turkey presence of three or more types of
adherence to self-management was related to income level (29). Another study conducted at
Black lion hospital, Addis Ababa showed, respondents who had private business were 72% less
likely to adhere to medication management compared to governmental employed(69).
A study conducted in the US revealed that being separated with spouses was found to be
associated with having a higher DASH score. Another study from Nigeria partially contradicts
this study in that respondents who were married at the time of data collection were more likely
to practice salt restriction (69).
Health and Health related factores.
Time of hypertension diagnosis has effect on self –management. According to the study
conducted in Bangladesh depicted that study subjects who had longer times since diagnosis (>6
years) were found more likely to be adherent to lifestyle modifications and anti-hypertensive
medications(70). Study Conducted in Ayder Comprehensive Specialized Hospital, Tigray,
Ethiopia shows Controlled BP was found 2.7 times more associated to good self-care practice
than uncontrolled BP (AOR = 2.728, 95% CI 1.256–5.926, p = 0.011) disease duration (AOR =
3.124, 95% CI 1.204–8.105) BP status (AOR = 2.728, 95% CI 1.256–5.926), showed significant
statistical association with self-care practice(71).
In developed countries, more than 50% of older adults have three or more chronic conditions
and more than 20% of all patients were multi morbid (72). A local study conducted at Harar,
showed 47.9 % respondents were co-morbid (73). There are several factors which affects
Hypertension prevention, diagnosis, treatment and control from this important barrier to
diagnosis is lack of knowledge and awareness on hypertension and its complications(74).
The study conducted in Jamaica Suggested that approximately 5 percentages of the variance in
self- care management practices can be accounted for by knowledge on hypertension, this shows
the presence of relation between knowledge on hypertension and self-care management
practices(75). A study conducted in northwest Ethiopia shows that about two-third of the
respondents, 258 (63.1%), were knowledgeable and 287 (70.2%) had favorable attitude towards
hypertension (HTN) and its treatment(39).

7
 2.3. Social support
Social support is considered a complex and dynamic process that involves individuals and their
social networks, working to satisfy their needs, provide and complement the resources they have
and, thus, cope with new situations (76).Study conducted in Nigeria shows having a family
member with hypertension was significantly associated with compliance to self-management
behaviors(77). A result that is similar with the above findings is seen in a study done on self-
management of chronic diseases at three public health hospitals in Addis Ababa(78).
2.4. Self-efficacy
One of a major contributor for successful lifestyle change, close treatment adherence, and
positive health outcomes among chronically-ill patients is Self-efficacy (79). A study done in
Nigeria showed those respondents with high self-efficacy (88/262, 33.6%) had significantly
higher adherence to medications than those with moderate and low self-efficacy(80). A local
study conducted in three selected public hospitals of Addis Ababa found that self-efficacy
significantly predicted self-management(78).

8
 2.5. C
Behavioral factors o
Self efficacy n
c
e
pt
u
al
Socio-demographic factors fr
Age a
Gender m
Income e
Work status Adherence to Hypertensive Self-management Health and Health related factores w
Educational status Co-morbidity factors or
Place of resident BMI
k
Marital status Family histry of HTN
Time of diagnosis
Knowledge

Social support factors

Histroy of social support

Figure 1 conceptual frame work for determinants of Adherence

9 to Hypertensive management in Jimma , 2020
(Adapted from risk factors of HPN care )
3. Objectives
3.1. General Objective
 To assess adherence to Self-management of Hypertention and associated factors among
Adult Hypertensive patients attending at Chronic follow up Clinic at Jimma Medical
center, Southwest Ethiopia, 2020.
3.2. Specific objectives
1. To assess adherence to recommended lifestyle modifications among hypertensive
adult patients
2. To identify adherence to prescribed medications among hypertensive adult’s patients
3. To identify related risk factors of Adherence to Hypertensive Self-Management
among Adult Hypertensive patients on chronic follow up clinic at Jimma Medical
Cente.

10
 4. Methods
4.1. Study Area and Period
The study will be conducted in Jimma Medical Center which is located in Jimma town, Oromia
regional state, South West Ethiopia from June 20 to July 20, 2020. Jimma town is located 354
km far from Addis Ababa and has 205,384 total populations. Administratively the town is
divided into 11 Kebeles with different level health institutions currently delivering different
health care services. The institution named Jimma Medical center governed by Jimma
University, and provide different health care services for greater than 20,000 admission and
140,000 outpatient visitors. Chronic disease follows under which hypertension enclosed is one
of the services that the center delivers every week to population expected to visit the center
monthly. Based on our current observation to the center, there are on average 500 adult’s
visitors with hypertensive case crowding the center on weekly bases.
4.2 . Study Design
Hospital -based cross sectional study will be deployed.
4.3 . Population
4.3.1. Source population
All Adult Hypertensive patients on follow-up clinic at JMC.
4.3.2. Study population
All Selected Adult Hypertensive patients on follow up who fulfil inclusion criteria and available
during study period.
4.4. Inclusion and exclusion criteria
4.4.1. Inclusion criteria
Hypertensive adults who resided in the area and followed the center for six consecutive months.
4.4.2. Exclusion criteria
Patients who will critically ill, pregenat women’s, psychotic and/or unable to communicate with
data collector due to other underlying medical disorder and not available during study period
will be excluded.

11
 4.5. Sample size and sampling procedure
4.5.1. Sample size determination
For Objective 1
The sample size of the study group recruited for the research will be calculated using the
single population proportion formula for specific objective 1 and 2 by considering level of
confidence of 95% and margin of error 5%.

P (1−P)
Sample ¿ n ¿=(Z α )2
2 d2

Where p - Proportion of patients who adhere to self-management practices

q- Proportion of patients who don’t adhere to self-management
d- Margin of error
n- sample size

Study Conducted in Addis Ababa shows Adherence to recommended lifestyle modifications is

23%(60)

P- of 0.23%

0.23(1−0.23)
Sample ¿ n ¿=(1.96)2 2
0.05

= 272

For Objective 2
Adherence to prescribed anti – hypertensive medications in study area prevalence of
61.8%(81) .

0.618(1−0.618)
Sample ¿ n ¿=(1.96)2 2 = 363
0.05

= 363

By adding 10 % contingencey the final sample size for this objective is 400.

12
 Objective 3

The sample Size of study participant for associated risk factors for Adherence to Hypertensive
Self-Management(60)(71) is calculated using Stat Calc of Epi info software by considering a
power of 80% and margin of error 5%.,P-value of 0.05 and 95% CI.

Variable % outcome % outcome AOR Sample size Final sample size

among un among by adding non
exposed exposed response rate 10%
Sex 14.7 27.9 2.254 200 220

Knowledge 95.2 99.6 13.26 310 341

Self-efficacy 88.2 75.2 0.407 190 209

By compairing all calculated sample size for all specicic objectives the largest number is 400.

So the final sample size for this study will be 400

4.5.2. Sampling technique

Systematic random sampling technique will be employed to select study participants. The
Hypertensive clinic runs daily and there were about 2050 Hypertensive patients on follow up
taken from Hypertensive outpatient unit coordinatores. These patients will be our sampling
frame and the patients included in the sample will be selected every 5 intervals. We will get the
interval by dividing source population 2050 to final sample size 400. The first patient will be
selected randomly from patient’s registration by listing their ID number and select by a lottery
method, and the next patient will be interviewed and examined every five intervals until
required sample will be attained.

13
 4.6. Variables
4.6.1 Dependent Variable
Adherence to Hypertensive Self-management.

4.6.2 Independent Variables

Socio-demographic factors
This variable includes Age, Gender, Income, Work status, Educational status, Place of resident
and Maritalmarital status of a participants.

Health and Health related factores

Co-morbidity, BMI, Type of medication, Time since Diagnosed, Family histry of HTN and
Knowledge.

Behavioral factors
Self-efficacy and Social Support

4.7. Operational Definitions

Adherence to self-management of hypertention: adherence to all the components of the
Hypertention Self-Management of H-SCALE.

Non Adherence to self-management of hypertention: non-adherence to at least one component

of Hypertention self management of H-SCALE.

Adherence to anti-hypertensive medications: respondents with a score of 0 on the Morisky 4

item self-reported Medication Adherence scale will be taken as adherent to prescribed anti –
hypertensive medications.

Adherence to lifestyle modifications: respondents who adhere to diet, exercise, smoking and
alcohol consumption related recommendations.

Diet-related adherence: In this study, those respondents who reported, they usually or always
consumed a diet rich in vegetables, grains and fruits; rarely or never consumed salt; rarely or
never consumed foods rich in spices and saturated fat were considered to be adherent.

Exercise-related adherence: respondents who reported, they exercise for >30 minutes per day;
at least three times per week.

14
Smoking-related adherence: respondents who reported, they either never smoked or stopped
smoking.

Alcohol consumption related adherence: respondents who reported, they either never consumed
alcohol or whose overall score on FAST < 3 will be taken as adherent to moderation of alcohol
consumption.

Co-morbidities: respondents with one or more medical conditions in addition to HTN.

Knowledge about hypertension: respondents with scores above the mean value on hypertension
evaluation of lifestyle and management (HELM) scale will be taken as having good knowledge
about hypertension.

Social support: is the support gained from family and non-family members. In this study,
respondents whose score will above the mean value on the Duke Social Support and Stress scale
will be taken as having social support.

4.8. Data Collection Instruments

Structured interviewer administered questionnaire will be used to collect data. All the questions
will be prepared in English and will translated to local language of Afaan Oromo and Amharic
by experts who are fluent in both language and back translated to English to see its consistency.

Adherence to life style modification is in terms of four components including the DASH,
regular exercise, minimizing alcohol consumption and cessation of smoking

Since there were no available standard questionnaires to assess adherence to lifestyle

modifications, questioners will prepared by the reviewing of pertinent literatures(82–84).
The hypertension evaluation of lifestyle and management (HELM) scale which has 14 items
will be used as a tool to assess respondents‟ knowledge (85).
The Duke Social Support and Stress Scale which contains 12 items will be used to assess
support gained from family, friends or significant others(86).
The six items Chronic Disease Self-Efficacy Scale will be used to measure self-efficacy(87)
Medication adherence: Adherence status will be assessed using the Morisky medication

15
adherence scale −4 which is Self- reporting Medication-taking Scale (88).
4.9. Data collection methods
Face to face interview method will be used for data collection using a structured questionnaire.
The questionnaire will include questions that is used to assess all information related to
variables of the study and characteristics of study participants. Data collectors and supervisors
will be assigned to chronic clinic follow-up unit for four consecutive weeks to reach all
attendants of the service at the study area. In data collection 4 diploma nurses and two
supervisors who will be selected from the study institution and given a two days’ data collection
and related training will participate.
4.10. Data quality Assurance
The questionnaire will initially be prepared in English, translated to local language Afan Oromo
and Amharic, and retranslated to English by another person, who is blind to the original
questionnaire for consistency check. Pre-test of the questionnaire will be conducted on 5% of
cases at Shanana Gibe Hospital (which is out of the study facilities, but share similar socio-
demographic characteristics with the study area). After the quality of questionnaire will be
confirmed, a two days training will be given to Four data collectors and two supervisors by
Principal Investigator (PI). Completeness, accuracy, clarity and consistency of every filled
questionnaire will be checked by the supervisors on daily basis. Checking for completeness and
consistency of variables during data entry and analysis will be continued before data analysis
using frequency distributions & cross tabulations.
4.11. Data processing and analysis
Data will be manually checked for completeness & consistence, coded & entered into EpiData
entry version 3.1 and then will be exported in to SPSS version 23 for analysis. During the
process of management, frequencies & percentages will be calculated to describe the data by
tables or figures. Bivarate analysis will be used to test associations between every independent
risk factors of adherence to hypertensive management with the current adherence status.
Variables that demonstrates significance association at p-value 0.25 will be set a candidate for
multivariate logistic model to control effect confounding by backward stepwise technique.
Finally, the Variables which have statistically significant (a p-value of < 0.05) associations with
the outcome variable will be expressed as potential determinants of adherence to hypertensive
self- management by AOR and 95% C.I. Variables which will not be statistically significant in
the bivariate analysis will be excluded from the multiple logistic regression models since they
have small measure of effect (Odds ratio) and assumed such variables might not be important
confounders.
4.12. Ethical consideration
Ethical clearance will be obtained from the Ethical Review Committee of Institute of Health,
Jimma University and official letter will be sent to the Jimma medical center directorate. The
directorate then will write an official permission letter to Chronic Disease Follow up clinic of
the center. After getting permission from the chronic follow up center, a verbal and written
consent will be obtained from study participants. The informed consent will be taken from the

16
respondents by data collector after explaining the objectives and purpose of the study based on
an information sheet prepared and printed out by PI. Illiterate respondents additionally will have
the full information sheet read to them where literate subjects will be given time to read the
information sheet that will be translated to local language, in their own time. The participants
will be assured that they have full right to participate or withdraw from the study at any time.
Any questions that arise from participants will be then answered by the data collector and the PI
could further be consulted if necessary. After the participants will agree to participate, written
consent will be obtained, through either a signature or thumb print and data will be collected and
kept confidential.
4.13. Dissemination plan
The findings of the study will be submitted to Jimma university department of Epidemiology for
evaluation of student’s academic exercise. After approval will be obtained from JU, further
dissemination will be processed to Jimma medical center and other concerned organization
through electronic copy and to community through local Radio for developing evidence-based
practice.
4.14. Limitation of the study
The rates of adherence to all study domains will be obtained through self-report method, which
is easy and cheap, however it is less reliable, especially among those patients who deny poor
adherence and also this self-reported measures depends largely on individuals‟ memory, and
recall bias may be exist.

17
 5. WORK PLAN

From March- October , 2020 Responsible

S.
List of Activities

September,202

October,2020
August,2020
No
March,2020

April,2020

May,2020

June,2020

Jul-20

0
First draft Proposal
PI and
1 Development and
Advisors
Submission
Second draft
PI and
2 Proposal
Advisors
Submission
Proposal
Submission for PI and
3
Approval to advisor Advisors
for defense.
Wosen
4 Proposal defense.
Darge
Final proposal
submission in
cooperating PI and
5
comments and Advisors
approval of advisor
after defense.
6 Submission to Ethical
ethical clearance Clearance
for approval of the Committee

18
 protocol and
obtaining ethical and PI
clearance.
PI and
Data
7 Data Collection
Collectors
Supervisors
Data cleaning,
8 PI
coding, analysis
Submitting first
PI and
9 draft report to
Advisors
Advisory
Submitting second
PI and
10 draft report to
Advisors
Advisory
Thesis submission
for mock defense
11 PI
after approval by
advisory
12 Mock defense PI
Final thesis
13 submission for PI
defense

14 Defense PI

6. BUDGET BREAKDOWN

19
 [Link] Item Unit No. Cost Total Remark
Required per cost in
item Birr
in
Birr
I Stationary materials / For Report writing and Data collection.

1 Lexi Pen Pcs 14 6 84

2 Pencil Pcs 7 2 14

3 Paper for report writing Pack 2 120 240

4 Questionnaire Printing and pages 5400 1 5400

duplication
5 Printing & binding Number 350 2 700
6 Binder Number 5 40 200
II Training
For Data Collector and 6 100 600
Supervisor Training
Meeting Hall 0 0 0
III For others
1 Transportation cost Trip/Taxi 1 400 400
or Bajaj

2 Per diem for Data Collectors 20 Birr/1 400 8000

Qes
Per diem for Supervisors 100 22 2200
Sub total 17838
Contingency 3000
Grand total 20838

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Annex I
Information sheet

28
Hello. My name is ________________and I am here on behalf of Wosen Darge, a post graduate
student from Jimma University, Institute of Health, Faculty of Public Health, Department of
Epidemiology. I am conducting a study on adherence to self-management of Hypertention and
associated factors among Adult Hypertensive patients following up at this hospital. The result
that will come out of this study will be used by the hospital to base their rational decision to
develop appropriate strategies to combat this problem. The research is intended to benefit the
community including the people that will be participating in this research and will introduce no
risk to the participant. The questionnaire requires maximum of 30 minutes to complete. Your
participation is entirely voluntarily, and you can quit from the study any time you want. You
will have no penalty if you fail to show desire to participate. I, however, do hope that you will
participate in the study since the data that will come from you will be important for us. Your
name and other personal identity will not be used, and hence the information we will collect
from you will completely be kept confidential and will not be disclosed to any third person other
than the people participating in this study.

29
Consent form

I have well understood the condition stated above. I understand that there is no risk on
participating and no incentives are given upon my participation in the study. Therefore, I am
willing to participate in the study.

Signature ____________

Date: ------------------

30
Annex II
1. Questionnaire (English version)
Questionnaire identification number _____________
PART 1 – Socio-demography
This section is about sociodemographic characteristics of the respondent. circle on the responses
from the given alternatives

# Questions Categories
001 Sex of the respondent 1= Male
2 = Female
002 Age of the respondent -----------------------

003 Religion 1 = Orthodox 2 = Islam 3 = Protestant

4 = Catholic 9 = Other (Specify) __________

004 Marital status 1 = Single 2 = Married 3 = Divorced 4 = Widowed

005 Ethnicity 1= Oromo 2 = Amhara 3 = Tigre

4 = Gurage 9 = Other… (Specify) __________
006 Level of education 1 = Illiterate 2 = Read and write 3 = Primary
4 = Secondary 5 = College/University
99 = Other (Specify) __________
007 Work status 1 = Governmental employee 2 = Private employee
3 = Private business 4 = Non-employed
5 = Retired 99 = Other
(Specify) __________
008 Monthly income 1= No regular income 2 = <999 ETB
3 = 1000-1999ETB 4 = 2000-2999ETB
5 = > 3000 ETB

PART II – Health related assessment

31
 This section is about the general health condition of the respondent. Pose the questions to the
respondent and fill the given answer on the space provided.

# Questions Categories
101 What was the respondent’s blood _______________ mmHg
pressure measurement today?
102 What is the respondent’s BMI? Weight_________ Height__________
BMI_______________
103 How long has it been since you were
diagnosed with hypertension?

104 How long have you been taking anti-

hypertensive medications?

105 How many types of anti-hypertensive

medications do you take?

106 Do you have any of these comorbidities? 1= No comorbidities 2= Diabetes mellitus

3 = CKD 4 = Stroke 5 = Coronary artery disease
99 = Others… (Specify) __________

PART III– Knowledge about hypertension

This section is about knowledge regarding hypertension, measurement of BP and its management.
circle on answer (Only one answer should be prompted)

# Questions Categories
201 A person is considered to have hypertension if either their 1=True 0=False
systolic blood pressure is 140 or their diastolic is 90 or
higher on two separate
202 Uncontrolled hypertension can lead to which of the 0=Lung cancer 1 = Kidney failure
following: 0 = High cholesterol 0 = Diabetes
203 Most people can tell when their blood pressure is high 0 = True 1 = False
because they feel bad.
204 Which of the following increases your risk of having 0 = Weight lifting

32
 hypertension? 0 = Drinking >2 cups of coffee a day
0 = Smoking a pack of cigarettes
1 = Gaining 6 kg on your weight
205 People with hypertension do not need to take medicine if 0 = True
they exercise regularly 1 = False
206 Which of the following statements about taking blood 0 = Blood pressure medicine should always
pressure medicine is TRUE? be taken with food
1 = More than one type of blood pressure
medicine can be taken at the same time
0 = Blood pressure medicine works best if it
is taken at bedtime
1 = Blood pressure medicine should not be
taken if a person drank alcohol that day
207 An overweight 60-year-old man has hypertension. He 1 = Lose 4 kg
drinks one bottle of beer and 4 cups of regular coffee a 0 = Stop drinking alcohol
day. He adds regular table salt to his food at most meals. 0 = Switch to decaffeinated coffee
Which one of the following changes is the most likely to 0 = Stop consuming salt
lower his blood pressure?
208 Which one of the following changes to your diet is most 1 = Eat more fruits, vegetables, whole
likely to lower blood pressure? grains, and low-fat dairy products
0 = Eliminate spicy foods
0 = Drink one glass of red wine daily
0 = Drink herbal tea instead of coffee
209 Which one of the following statements about exercise and 0 = People who are on their feet most of the
blood pressure is TRUE? day will not benefit from exercise
1 = Exercising for 30 minutes every day
lowers blood pressure more than exercising
for 30 minutes, 3 days a week
0 = Weight lifting should be avoided by
people with high blood pressure
0 = When exercising, you must raise your
heart rate to at least 100 beats a minute to
improve blood pressure
210 Blood pressure is measured with two numbers, an upper 1 = When the upper is below 120 and the

33
 number and a lower number. It is usually written as lower is below 80
upper ⁄ lower. If someone is told that their goal blood 0 = When the upper is below 120, even if
pressure is 120 ⁄ 80, when have they reached that goal? the lower is over 80
0 = When the lower is below 80 even if the
upper is over 120
0 = When the average of the upper and the
lower is <100

PART IV – Self efficacy

This section is concerned with respondent’s self-efficacy to deal with hypertension. Tick (√) on the
alternatives. Please elaborate the following possible answers for the respondent.
 Totally unconfident – if the respondent is not self-assured at all to cope up with the disease
process

 Unconfident – if the respondent have no self-assurance

 Not sure – if the respondent is not sure about the answer to the question

 Confident – if the respondent is self-assured to cope up with disease process

 Totally confident – if the respondent highly self-assured about coping with disease process

No Questions Totally Unconfident Not Confident Totally
unconfident sure Confident
301 How confident are you that you can keep
the fatigue caused by your disease from
interfering with the things you want to
do?
302 How confident are you that you can keep the
physical discomfort or pain of your disease from
interfering with the things you want to do?
303 How confident are you that you can keep the
emotional distress caused by your disease from
interfering with the things you want to do?

304 How confident are you that you can keep any other
symptoms or health problems you have from

34
 interfering with the things you want to do?

305 How confident are you that you can do the different
tasks and activities needed to manage your health
condition so as to reduce you need to see a doctor?

306 How confident are you that you can do things other
than just taking medication to reduce how much you
illness affects your everyday life?

PART V – Social support

This section is about support gained from family and non-family members. After stating the family
or non-family member, tick on :-
 None - if there is no support at all from the stated individual

 Some – if there is minimal support from the stated individual

 A lot – if the individual stated is very supportive.

 NA – if there is no such family or non-family member

No Questions
Do you get support from these family members? None (0) Some A lot (2) NA (0)
(1)
401 Your wife, husband, or significant other person
402 Your children or grandchildren

403 Your parents or grandparents

404 Your brothers or sisters

405 Your other blood relatives

35
406 Your relatives by marriage (for example: in-laws, ex-
wife, ex-husband)
Do you get support from these non-family members?

407 Your neighbors

408 Your co-workers

409 Your religious peers

410 Your other friends

411 Do you have one particular person whom you trust

and to whom you can go with personal difficulties?

412 Which of the above types of person is he or she? Family

member
Non family
member

PART VI – Adherence to dietary modifications

This section is about adherence to dietary modifications. Tick on the response given by the
respondent as an answer. The question on salt consumption is categorized into four alternatives:
 Never – if the respondent entirely avoids the behavior

 Rarely - if the behavior is performed sometimes performs

 Usually - if the behavior is performed most of the time

 Always - if the behavior is performed all the time

No Questions Never Rarely Usually Always

50 Do you include fruits, vegetable, grains, and beans in your diet

1 after your diagnosis with hypertension?

36
50 How often do you consume foods that contain high saturated fat
2 (e.g., cheese, coconut oil, cottonseed oil, mutton fat etc.) since
being diagnosed?

50 Do you consume spicy foods since being diagnosed?

3
50 Do you consume salt in your food?
4
50 Do you read nutritional Facts on food labels to compare the
5 amount of sodium in products?

Part VII – Respondent’s adherence to exercise

No Questions Category Coding Skip

601 Do you perform physical Yes 1 If No skip to …. Q 701

exercise at all? No 0

602 How often do you exercise? <Three times per 0

week 1
Three times per 1
week
> Three times per
week
603 What type of exercise do you 1 Walking
perform? 2 Jogging
3 Cycling
9 Others…
(Specify)
__________
604 For how long do you exercise <30 min 0
per session? >30min 0

37
 Part VIII – Adherence to cessation of smoking

This section is about adherence to cessation of smoking. Tick (√) on the responses

No Questions Categories Coding

701 Have you ever used tobacco? Yes
No
702 Do you still smoke cigarettes? Yes
No
703 Have you tried to quit smoking? Yes
No
Part IX – Adherence to moderation of alcohol consumption

This section is about adherence to moderation of alcohol consumption. Tick (√) on the responses
given by the respondent.
Before starting this part, ask what kind of alcohol drink is mostly preferred by the respondent. If
never drank or stopped drinking alcohol, pass to Part X.
 1 drink = 1/2 pint (1 bottle) of beer or 1 glass of wine, „Tela‟, „Tej‟ or 1 single spirits

No Question Never Less Monthly Weekly Daily Skip to

s than or
Mont almost
hly daily
801 How often do you have 8 drinks (men) If never skip
/ 6 drinks (women) or more on one to 901

occasion??
802 How often in the last year have you
not been able to remember what
happened when drinking the night
before?

803 How often in the last year have you

failed to do

38
 what was expected of you because of
drinking?
804 Has a relative / friend / doctor / health No
worker been concerned about your Yes, on one
drinking or advised you to cut down occasion
on your drinking? Yes, on more
than one
occasion
PART X – Adherence to medications

This section is concerned with the respondent’s adherence to prescribed anti – hypertensive
medications. Tick on the responses given by the respondent.

No Questions Category Coding

901 Do you ever forget to take your medicine? Yes

No
902 Are you careless at times about taking your Yes
medicine? No

903 Sometimes if you feel worse when you take the Yes
medicine, do you stop taking it?

904 When you feel better do you sometimes stop No

taking your medicine?

2. Questioner (Afaan Oromo version)

Gaaffilee qorannoo
Kutaa1: Odeeffannoo haala jireenya hirmaattotaa
Lakk ID _____________________

39
# Gaafi Deebii
001 Saala hirmaataa 1= hiira
2 = halaa
002 Umuriin kee waggaadhan ----------------------
meeqa(hirmaata)?
003 Amantaan kee maali? 1 = Ortodoksii 2 = Islaaama 3 = Proteestaantii
4 = Kaatolikii 9 = kan biroo (Ibsii) __________

004 Haalli Gaa’ila kee maali? 1 = Kan hin heerumne/ hin fuune 2 = Kan heerumte /fuudhe 3 = Kan
hiikee/ttee 4 = Kan haati mana ykn abbaan manaa jalaa du‟e
005 Sabinni kee 1= Oromoo 2 = Amhaara 3 = Tigree
maali? 4 = Guraagee 5 = kaffaa… 9 kan biroo (ibsii) __________
006 Sadarkaa barnootaa 1 = Kan hin baranee 2 = Dubisuuf bareesuu kan danda’uu 3 =
Sadarkaa 1ffaa kan baratee/ttee
4 = Sadarkaa 2ffaa kan baratee/ttee 5 = College/University
99 = kan biroo
(Ibsii) __________
007 Haala Hojii 1 = Hojjetta/ttu Motummaa 2 = Kaan dhunfaa qaxaramanii
3 = Hojii Dhunfaa 4 = Hojjii kan hin qabnee
5 = Hojii kan addaan kuttee/tte 99 = kan biraa
(Ibsii) __________
008 Galiii Ji’aa 1= Galii dhaabtaa kan hin qabnee 2 = <999 ETB
3 = 1000-1999ETB 4 = 2000-2999ETB
5 = > 3000 ETB

Kutaa 2 – Halaa Fayyaa waligalaa

Kutaan kun haalaa waaligalaa fayyaa irrattii kan xiyyefatuu dha. Gaffii 101 irraa jiruu oggessaa
fayyaan kan safaramee safariin sirrii kan gutamuu yoo ta’uu gaafiin hafee garuu gafataama
gafachuun kan gutamuu dha.

40
# Gaafii Deebi
101 Haara dhibaan dhigaa safaramee meqaa? _______________ mmHg
102 BMI Isaani Meeqa? Ulfatinaa_________ Dheerinaa
BMI________________
103 Ergaa Hypertenshinii/Dhibaa Dhigaa qabahuun
keessaan ergaa dhageesaan haamamii?

104 Qorichaa ergaa jalqabdaan hangaa taheraa?

105 Qorichaa goosaa meeqaa fudhatuu?

106 Dhibee walqabataa kan biro qabduu? 1= Hin qabuu 2= Dhibee sukaaraa/Diabetes
mellitus/
3 = Dhibee kale /CKD/ 4 = Stroke
5 = Dhukubaa onnee/Coronary artery disease/
99 = kan biroo…
(Ibsii) __________

Kutaa 3– Beekumsaa dhibaa dhigaa waliin kan walqabatuu

Kutaan kun gafanowaan beekumsaa haalaajirenyaa fi akaataa fuudhanaa qorichaa dhibaa dhigaa
waaliin kan walqabatuu qabaa deebisaa sanduqaa jiruuratii mallattoo (√) ka’aa. Deebii
tokkoo qofaa lachuu akkaa danda’aan ittii himuun jalqabaa.

41
# Gaafii Deebii
201 Namnii tokkoo dhibee dhigaa qabaa kanjenuu yoo 1=Dhugaa
dhibaan dhigaa isaa yeroo adda addaa safaramee 0=Soba
>=140/90 yoo tahee dha
202 Dhibaa Dhigaa sirrittii hordafuu dhabuun dhibee waal 0= Kaansarii Sombaaf
qabataa kaamiif namaa saxilaa? 1 = Dhibee kaaleef
0 = Dabaluu koolestrooliif
0 = Dhibee Sukaaraaf
203 Dhukubsatoonii dhibaa dhigaa dabaluu dhibaa 0 = Dhugaa
dhigaa isaanii kan baraan yoo waan gaariin itti hin 1 = Soba
dhagahamnee dha.
204 Kan armaan gadii keessaa dhibee dhibaa dhigaaf kan 0 = Ulfaatinaa kaasuu
si saxiluu isaa kami? 0 = Guyyatii bunaa shinii 2 ol dhuguu
0 = Sigaraa paketii tokkoo xuxxuu
1 = Ulfatiina kg 6 tahuu dabaluu.
205 Namonii dhibaa dhigaa qabaan dhaabidhaan isportii 0 = Dhugaa
kan hojataan yoo tahee qorichaa dhibaa dhigaa 1 = Sobaa
fudhachuu hin qaban.
206 Kan Tarefamaan kessaa qorichaa dhibaa dhigaaf 0 = Yeroo hundumaa qorichaa nyaata
fudhatamuuf sirrii kan tahee kami? waliin fudhachuu qabuu.
1 = Al tokkotii qorichaa tokkoo ol
fudhachuu barbachisuu ni dandahaa
0 = Fayyidaan qorichaa hiribaa duraa
fudhachuun ni dabalaa
1 = Guyya san keessatii yoo dhugatii
alkoolii dhugee qoorichaa fudhachuu hin
qabuu

42
207 Namnii Dhukubsataa dhibaa dhiigaa,ummurii waggaa 1 = Ulfatinaa 4 kg hirisuu
60 fi ulfaatiini isaa kan dabalee nyaata nyaatuu 0 = Alkoolii dhuguu dhisuu
keessaati ashaboo ni fayadamaa, Guyyaattii Birraa 1, 0 = Buna dhuguu dhisuu
bunaa shiinii 4 ni dhugaa. Goochaa armaan gadii 0 = Ashaboo fayadamuu dhaabuu
keessaa kamtuu irraa caalaa dhibaa dhigaa isaa
hirisaafii?
208 Gosaa nyaata armaan gadii kessaa kamtuu dhibaa 1 = Kuduraa fi fuduraa adda addaa, nyataa
dhigaa irraa gudessaa hirisuuf fayadaa? baala magarisaa
0 = Nyaata cooma qabuu nyachuu dhisuu
0 = Waayinii birciqoo 1 guyyattii dhuguu
0 = Bunarraa shaayii dhuguu
209 Waa’ee sosoochii qaamaa fi Dhibaa dhigaa siriidha? 0 = Namotnii yeroo baayyee hojii hojataan
sosochiin qaamaa hin barbachisuuni
1 = Sosochiin qamaa guyyaatii daqiqaa 30f
godhamuu torbeetii daqiqaa 30f guyyaa
sadiif godhamuu caalaa dhibaa dhigaa nii
hirisaa
0 = Namotaa dhibaa dhigaa qabaniif
ulfaatinaa kaasuun dhorkaa dha.
0 = Yeroo sossochii qamaa/Isportii
hojataan dhibaa dhigaa hirisuuf dhahaanaan
oonnee 100 fi isaa ol tahuu qabaa
210 Dhibaan dhigaa namaa tokkoo 120/80 darbuu hin 1 = Yoo kan irraa 120 gadii fi kan jalaa 80
qabuu gaaf jenuu maal jechuu kenyaa? gaadi tahee
0 = yoo kan irraa 120 gaadii fi kan jalaa 80
ol tahuus
0 = Yoo kan kan jaala 80 gadii tahee fi kan
irraa garuu 120 ol tahuus
0 = Giduugalesaan kan irraa fi jallaa 100
gad tahee

43
 Kutaa 4 – Ofitii amantaa qabachuu hirmataa
Kutaan kun ofitii amantaa qabachuu dhukubsataa dhibaa dhigaa qabuu waliin kan waal qabatuuf
kan armaan gadii ergaa ibsiteefi bodaa debisaa irraa (√) godhii.

No Gaafii Gonkumaa hin Hin Amantaa Nan Gutumaati naan

amanuu Aamanuu guutu amanaa amaana
hin
qabuu
301 Dadhabinii dhibeen
keessaan fiduu waan
gochuu barbadaan irraa
akkaa isiin hin dhorkinee
hamaam ofitii amantuu.
302 Dhukubii qaamaas tahee
kanbiroo dhibeen kessaan
waan gochuu barbadaan
akkaa isiniin hin goonee
hamaam ofitii ammantuu?
303 Sababa dhukubaatiin
jeqamuun miraa waan
barbadaan akkaa gochuu
dndesaan akaa isiin hin
dhorkinee ammaam ofitii
amantuu?

304 Rakkon fayyaa kan biro ykn

mallatoon fayyaa kaa biro
waan gochuu barbadaan
irraa akkaa isiin hin
dhorkinee hamaam ofiit

44
 amantuu?

305 Sochii fi gochawwaa adda

addaa rawachuun fayyaa ofii
eguun tajajilaa yalii isinnif
latamuu hirisuu akka
dandesaan hamaam ofittii
amantuu fi hojii?

306 Qorichaa fayadamtaan alaa

dhukubnii keessaan jirenyaa
guyyaa guyyaa kessaan iratii
dhibaa fiduu hirisuuf
hamaam amantaa qabduu?

Kutaa 5 – Degarsaa hawasaan kan waal qabatuu.

No Questions
Maatiwaan armaan gadii keessaa Naa hin Xiqqoo Sirrittii Gaafichii
gargarsaa kan argatuu? gargaaranii(0)
nagargaaruu nagargaaruu naanilalatuu
(1) (2) (0)

401 Abbaa Manaa kee,Hadhaa manaa

kee ykn Jaalalee keessaan.

45
402 Ijoollee kee ykn Muccaa ijollee
kee.

403 Hadhaa /Abbaa/akaakayuu kee

404 Obbolessaa/obbolettiikee

405 Firaakee

406 Gaaheelaan kan firomtaan /Abbaa

ykn Hadhaa Abbaa manaa/Hadha
manaa kee ykn kan biroo
Maattii kerraan alaa namootaa
kaan irraagargarsaa hagamii
argataa?

407 Olaa keeraa?

408 Hiriyyaa Hojjii keerraa

409 Hiriyyaa Amantaa kerraa

410 Hirriyaa kee

411 Yeroo rakkon siimudatuu namnii Eyyee

rakkoo kee ittii himtuufi biraa Lakkii
demtuu qabdaa?

412 Guubattii Kan Caqasamaan Maattii kee 2

keessaa kamtuu? dha 2
Maattii

46
 Mittii

Kutaa 6 – Dhibee dhibaa dhigaa waliin Jijiraa sirnaa nyaataa waliin kan waalqabatuu

Lakk Gaafii Goonkumaa Darbedarbe Irraa Yeroo

e caalaa Hundaa
naan
rawadha

501 Erga Dhiibaa dhigaa qabaachuu keessaan

bartaan nyaata kan akkaa kuduraa fi
muduraa akasumaas nyaata gosaa baala
magarisaa qabaan nyaachaa jirtuu?

502 Nyaata coomaa qabuu, ayiibii fi kkf?

503 Nyaata qimamaa qimaamii ittii baayatee

ni nyaataa?

504 Nyaata nyaatan keessaatii Ashaboo ni

fayadamtuu?

505 Gosaa nyaataa adda addaa gaafa bitaan

hangaa ashaaboo irraattii barahee jiruu ni
dubistuu?

Kutaa 7 – Gaafanoo Sossochii qaamaan kaan waalqabatuu

No Gaafi Deebii Coding Gara gaafi____ ti
darbii

47
601 Isportii sosochii qamaa ni Eeyyee  1
gotuu? Laki  0 Lakki yoo ta’ee garaa
701 darbii
602 Yeroo haamaamif isportii Torbettii yeroo 3 Gadii 0
hojrtuu? Torbettii yeroo 3 1
Torbettii yeroo sadii ol. 1
603 Sosochii qamaa gosaa kaam 1 Tarkaanfii
tasiftaa? 2 Susuukuu
3 Saaykilii oofuu
9 Kan biroo…
(Ibsii) __________
604 Al takkaattii daqiqaa <30 daqiqaa 0
haamamiff sosochii qamaa >30 daqiqaa 0
gootaa?

Kutaa 8 – Tanboo Xuuxu

Gaafi Deebii Coding Gara lakkofsaaa---Darbii

Lakk
701 Sigaaraa xuxaanii Eeyyee Lakkii yoo ta’ee garaa 801
beektuu? Lakki darbii
702 Amayuu Xuxxaa jirtaa? Eeyyee Lakkii yoo ta’ee gara 801 ti
Lakkii darbii
703 Sigaaraa xuxxuu dhisuuf Eeyyee
yaaltee beektaa? Lakkii

Kutaa 9 – Gaafanoo dhugaatii Alkooliin kan waal qabatuu.

48
 Hiramataan yoo dhugatii alkoolii dhugaani hin bekaan tahee garaa kutaa 10ttii darbii
Ossoo gafanoo hin jalqabiin duraa gosaa dhugattii dhugaan gaafadhuu.
Biraa berchiko 1= birciqoo 1/2 (1 xarmuzii) ykn wine birciqoo 1, „Farsoo‟, „Daadhii‟
No Gaafi Gonkumaa Ji’a Ji’attii Torbettii Guyya Darbii
(0) yero yeroo 1 yeroo 1 a
o1 (2) (3) guyaan
gadi (4)
i(1)
801 Carraan dhiraaf 8 fi isaa
ol/dubarraaf 6 fi isaa ol
takkaattii dhugdaan
hangaamii?
802 Waggaa darbee keessattii
dhugatii dhugdanii isaa
duraa kan turee kan
iranfataan ni jiraa ture?

803 Waggaa darbee keessaa

sababaa dhugaattii
dhugudhaan hojiraa kan kan
oltaan hangaam ta’aa?
804 Waggaa darbee kessaa, Lakko
hiriyyaa,olaa, mattiii, Eeyyee, yeroo
oogeessii fayyaa keessan tokko qofaa
wa’een dhugatii alkolii Eeyyee, yeroo
keessaan yadoo ittii tahee bayyee
kan isiin gorse hangaa
turee?

Kutaa 10 – Gaafanoo qorichaa dhibee Dhibaa dhigaaf latamuu ittii fufinsaan ossoo
addaan hin kutiin fudhachuu kaan ilalatuu.

49
 Deebisaa saanduqaa armaan gaadii keessattii mallattoo (√) godhii.

No Gaafi Deebii Coding

901 Qorichaa dhibaa dhigaa keessaan fudhachuu iranfatanii Eeyyee 1

bektuu? Lakkii 0

902 Qorichaa Dhibee dhibaa dhigaa keessaanif xiyyefanoo ni Eeyyee 1

laatuu? Lakkii 0

903 Yeroo tokko tokkoo qorichaa keessaan fudhatanii yoo Eeyyee 1

dhukubiin isinittii dhagahamee qorichaa fudhachuu ni Lakkii 0
dhabduu?

904 Dhibaa dhigaa keessaan waaliin kan walqabatuu dhukubnii yoo Eeyyee 1
hin jiranee qorichaa keessaan fudhachuu ni dhabduu ? Lakkii 0

3. Questionnaire (Amharic version)

የመጠይቅ መለያ ቁጥር _____________
ክፍል 1 - የተጠያቂ ማህበራዊ መረጃ
የሚከተሉትን ጥያቄዎች በመጠየቅ አማራጭ መልሶችን ፉት ለፊት ባለዉ ሳጥን ላይ ምልክት ያድርጉ፡፡ አማራጭ
መልስ ለሌላቸው ጥያቄዎች የተሰጠው ክፍት ቦታ ላይ የተጠያቂውን መልስ ያስቀምጡ፡፡

ቁጥር ጥያቄዎች አማራጭ መልስ

001 የተሳታፉው ፆታ 1 =ወንድ

2 =ሴት
002 ዕድሜ

003 ኃይማኖት 1 = ኦርቶዶክስ 2 = ሙስሊም

3 = ኘሮቴስታንት 4 = ካቶሉክ

9 = ሌላ --------------------

004 የትዳር ሁኔታ 1 = ያላገባ 2 = ያገባ

3 = የፈታ 4 = በሞት የተለየ
005 ብሔር 1 = ኦሮሞ 2 = አማራ 

50
 3 = ትግሬ 4 = ጉራጌ 
9 = ሌላ --------------------
006 ወርሃዊ ገቢ 1 = ምንም ገቢ
2 = < 999 ብር
3 = 1000-1999 ብር
4 = 2000-2999 ብር
5 = >3000 ብር
007 የትምህርት ደረጃ 1 = ያልተማረ
2 = ማንበብና መፃፍ 
3 = የመጀመሪያ ደረጃ 
4 = የሁለተኛ ደረጃ 
5 = ኮሌጅ/ዩኒቨርስቲ 
9 = ሌላ
008 የስራ ዓይነት 1 = የመንግስት ተቀጣሪ 
2 = የግል ተቀጣሪ 
3 = የግል ሥራ
4 = ስራ የሌላው /ላት/
5 = ጡረተኛ

ክፍል 2 - አጠቃላይ የጤና ሁኔታ

ይህ ክፍል የተጠያቂው አጠቃላይ ሁኔታ ላይ ያተኩራል፡፡ ለጥያቄ ቁጥር 101 አስፈላጊዉን ልኬት በማረግ በእርሶ
በጠያቂው የሚሞላ ሲሆን ቀሪዎቹን ጥያቄዎች ተጠያቂው የሚመልሳቸው ይሆናለ፡፡

ቁጥር ጥያቄዎች መልስ

101 በእለቱ የተለካው የግፉት መጠን

102 ደም ግፉት እንዳለቦት ካወቁ ምን ያህል ጊዜ ሆኖታል?

103 ለደም ግፉት የሚሰጠው መድሀኒቶችን ለምን ያህል ጊዜ
ወሰዱ?
104 ስንት አይነት የደም ግፌት መድሀኒቶችን ይወስዳሉ?

105 ሌላ የታወቀ ተያያዥ በሽታ አለቦት? 1 = ምንም የለም

2 = ስኳር
3 = የኩላሊት ስራ ማቆም

4 = የአእምሮ 

51
 5 = የልብ ደም ቧንቧ መጥበብ 
99 = ላሊ ካሇ ይጠቀስ
--------------------

ክፍል - 3 ስለ ደም ግፉት በታ ያለ ግንዛቤ

ይህ የመጠየቅ ክፍል ተሳታፉው ስለ ግፉት መድሃኒቶች አወሳሰድ ፣ ሰለ ኑሮ ዘይቤ ለውጦች እንዱሁም ስለ የደም
ግፉት በሽታ ያለውን አጠቃላይ ግንዛቤ ይፈትሻለ፡፡ ከተሰጡት አማራጮች ውስጥ አንደ ብቻ መልስ ሊሆን
እንደሚችል ካስረዱ ቦኣላ ጥያቄውን ይጀምሩ እንዱሁም በተሳታፉው መልሶች ጎን ባለው ሳጥን ውስጥ ምልክት
(√) ያድርጉ፡፡

# ጥያቄዎ አማራጭ መልስ

ች
201 አንድ ሰው የደም ግፉት አለዉ የሚባለው በሁለት 1= እውነት
የተለያዩ ጊዚያት ያለው የደም ግፉት ልኬት መጠን 0= ሐሰት
ከ 140/90 በላይ ሲሆን ነው

202 የደም ግፉትን በአግባቡ አለመቆጣጠር ለየትኛው 0=የሳንባ ካንሰር

ተያያዥ በሽታ ያጋልታል? 1 =የኩላሊት መድከም
0 =የኮልስትሮሌ መጨመር
0 = የስኳር በሽታ
203 የደም ግፊት ህመምተኞች የግፊት መጠናቸው 0 = እውነት
መጨመሩ በሚሰማቸው መጥፎ ስሜት ማወቅ 1 = ሐሰት
ይችላሉ፡፡
204 ከሚከተሉት ውስጥ ለደም ግፊት በሽታ የበለጠ አጋላጭ 0 = ክብደት ማንሳት 
የሆነው የትኛው ነው? 0 =በቀን ከሁለት ሲኒ ቡና በላይ መጠጣት
0 = 1 ፖኮ ሲጋራ ማጨስ
1 = 6 ኪ.ግ ያህል ክብደት መጨመር 
205 የደም ግፊት ያለባቸው ሰዎች በቋሚነት የአካል ብቃት 0 = እውነት
የሚሰሩ ከሆነ መድሀኒት መውሰድ አይጠበቅባቸውም፡፡ 1 = ሐሰት

206 ከሚከተሉት ውስጥ ለደም ግፊት ሰለሚወሰዱ 0 = መድሀኒቶች ምን ጊዜም ከምግብ ጋር መውሰድ አልባቸው
መድሀኒቶች ትክክል የሆነው የትኛው ነው? 1 = በአንድ ጊዜ ከአንድ በላይ መድሀኒቶችን መውሰድ ሊያስፈልግ
ይችላል 
0 = መድሀኒቶች ከእንቅልፍ በፊት መውሰድ ያላቸው ጥቅም
ይጨምራል
1 =በሽተኛው በቀን ውጥ መጠጥ ከወሰደ መድሃኒቱን መውሰድ
የለበትም 
207 አንድ ክብደቱ የጨመረ የ 60 ዓመት የደም ግፊት በሽተኛ 1 = 4 ኪ.ግ ክብደት መቀነስ
ብዙ ጊዜ በምግቡ ውስጥ ጨው ይጠቀማል ፣ በቀን 1 0 = መጠጥ ማቆም
ጠርሙስ ቢራ እንዲሁም 4 ስኒ ቡና ይጠጣል፡፡ 0 = ቡና አለመጠጣት
ከሚከተሉት የትኛው ተግባር በበለጠ ግፊቱን ለመቀነስ 0 = ጨው አለመጠቀም 

52
 ይረዳዋል?

208 የትኛው የአመጋገብ ለውጥ ግፊትን ለመቀነስ በተሻለ 1 = ቅጠላ ቅጠል ፣ፍራፍሬ፣ እና ጥራጥሬን አብዝቶ መመገብ 
ይረዳል? 0 = ቅባት ያላቸውን ምግቦች ፈፅሞ ማስወገድ
0 = በቀን አንድ ብርጭቆ የወይን ጠጅ መጠጣት 
0 = ከቡና ይልቅ ሻይ መጠጣት
209 ከሚከተሉት ውስጥ ስለ አካላዊ እንቅስቃሴ እና ግፊት 0 = ብዙ ጊዜ ሰራቸውን ቆመው የሚያከናውኑ ሰዎች የአካል ብቃት
ትክክል የሆነው የቱ ነው? እንቅስቃሴ አያስፈልጋቸውም 
1 = በሳምንት 3 ቀን ለ 30 ደቂቃ የሚደረግ እንቅስቃሴ የተሻለ ግፊትን
ለመቀነስ ይረዳል፡፡
0 = ክብደት ማንሳት /ብረት መግፋት/ ለደም ግፊት በሽተኞች ፈፅሞ
የተከለከለነው 
0 = በእንቅስቃሴ ጊዜ ግፊትን በተሻለ ለመቀነስ የልብ ምት መቶ እና
ከዛ በላይ መሆን አለበት፡፡ 
210 የአንድ ግለሰብ የደም ግፊት ልኬት መጠን የላይኛው 1 = የላይኛው ከ 120 በታች የታችኛው ከ 80 በታች መሆን አለበት
ከ 120/80 ማለፍ የለበትም ሲባል ምን ማለት ነው፡፡ 0 = የላይኛው ከ 126 በላይ የታችኛው ከ 80 በታች መሆን አለበት
0=የላይኛው ከ 126 በታች የታቺኛው ከ 80 በላይ መሆን አለበት
0 = የሁለቱ አማካይ ከ 100 ማነስ አለበት

ክፍል - 4 - የተጠያቂው በራስ የመተማመን ሁኔታ

ቀጥሎ የቀረቡት ጥያቄዎች ከደም ግፊት በሽታ ጋር በተያያዘ የተሳታፊውን በራስ መተማመን ሁኔታ የሚዳስሱ
ናቸው፡፡ የሚከተሉትን አማራጭ መልሶች ለተሳታፊው ካብራሩለት በኋላ ወደ ጥያቄዎቹ ይለፉ፡፡ በተሳታፊው
መልሶች ስር ምልክት (√) ያድርጉ፡፡
 ፈፅሞ አልተማመንም ማለት የተገለፀውን ተግባር ለማከናወን ምንም ዓይነት በራስ መተማመን የለቸውም
 አልተማመንም ማለት የተገለፀውን ተግባር ለማከናወን የተወሰነ በራስ መተማመን የላቸውም
 እርግጠኛ አይደለሁም ማለት የተገለፀውን ተግባር ለማከናወን በራስ መተማመን የላቸውም
 እተማመናለሁ ማለት የተገለፀውን ተግባር ለማከናወን በራሳቸው ይተማመናሉ
 በጣም እተማመናለሁ የተገለፀውን ተግባር ለማከናወን በከፍተኛ ደረጃ በራሳቸው ይተማመናሉ
ቁጥር ጥያቄዎች ፈፅሞ አልተማመንም እርግጠኛ እተማመናለሁ በጣም
አልተማመንም አይደለሁም እተማመናለሁ
301 ህመም የሚያስከትልቦት
ድካም ማድረግ
የሚፈልጉትን ነገር
ከማድረግ እንዲያግዶት
ምን ያህል በራሶ
ይተማመናለ?
302 አካሎ ላይ ምቾት የማያሰጦ
ወይም ህመም የሚፈልጉትን

53
 ነገር ከማድረግ እንዲያግዶ
ለመቋቋም ምን ያህል በራሶ
ይተማመናሉ?

303 በህመሞ ምክንያት

የሚያጋጥሞ የስሜት
መረበሽ የሚፈልጉትን ነገር
ከማድረግ እንዳያግዶ
ለመቋቋም ምን ያህል በራሶ
ይተማመናሉ?

304 ሌሎች የጤና ችግሮች

ወይም የህመም ምልክቶች
የሚያደርጉትን ነገር
ከማድረግ እንዳያግዶ
ለመቋቋም ምን ያህል በራሶ
ይተማመናሉ?

305 የተለያዩ ተግባራትንና

እንቅስቃሴዎችን በማከናወን
ጤናዎን በመጠበቅ የህክምና
እርዳታ ፍላጎቶን ለመቀነስ
ምን ያህል በራሶ
ይተማመናሉ?

306 መድሃኒት ከመጠቀም ዉጪ

ህመሞ የቀን ከቀን ህይወቶ
ላይ የሚያመጣዉን ተጽእኖ
ለመቀነስ ምን ያህል በራሶ
ይተማመናሉ?

ክፍል 5 – ከማህበረሰብ ስለሚገኝ ድጋፍ

ይህ የመጠይቅ ክፍል ተሳታፉው ከቤተሰብ እና ከቤተሰብ ውጪ ካለ አካላት ምን ያህል ድጋፍ ያገኛለ የሚለውን
ይዳስሳል ወደ መጠይቁ ከማለፍት በፊት በአማራጭ መልሶች ላይ የሚከተለውን ማብራሪያ ይስጡ፡፡ በተሳታፉው
መልሶች ስር ምልክት (√) ያድርጉ፡፡
 ምንም አይደግፈኝም - የምጠቅስላዎ አካል ፈፅሞ ድጋፍ የማይሰጦ ከሆነ

 ትንሽ ይደግፈኛለ - የምጠቅስልዎ አካል አልፎ አልፎ (የተወሰነ) ድጋፍ የሚሰጥዎ ከሆነ

 ሁሌም ከጏኔ ናቸው - የምጠቅስሎዎ አካል ሁሌጊዜ (ብዙ ጊዜ) ድጋፍ የሚሰጥዎ ከሆነ

 ጥያቄው አይመለከተኝም - የምጠቅስሎዎ አካል በህይወትዎ ውስጥ ከሌለ

54
 ቁጥር ጥያቄዎች

ከነዚህ የቤተሰብ አባላት ምን ያህል ድጋፍ ምንም ትንሽ ሁሌም ጥያቄው

ያገኛል? አይደግፈኝም ይደግፈኛል ከጏኔ አይመለከተኝም
(0) (1) ናቸው (0)
(2)

401 ባለቤትዎ/ፍቅረኛዎ

402 ልጆችዎ /የልጅ ልጆችዎ

403 እናትዎ/አባትዎ/አያቶችዎ

404 ወንድምዎ/ እህትዎ

405 ላላ የስጋ ዘመድዎ

406 በጋብቻ የተዛመደዎት /የሚስት እናት/አባት
ወዘተ…../
ከእነዚህ ከቤተሰብ ውጪ ካለ አካላት ምን ያህል
ድጋፍ ያገኛሉ
407 ጎረቤቶችዎ
408 አብርዎት የሚሰሩ
409 የሀይማኖት አቻዎችዎ(ጓደኞችዎ)
410 ጓደኛዎ
411 ችግር በሚያጋጥምዎት ጊዜ ሊረዲዎት የሚችል አዎ የለም ከሆነ ወደ
ወይም የሚተማመኑበት ሰው አለ? የለም 501 አለፍ
412 ከላይ ከተጠቀሱት ውስጥ የቱ ነው? የቤተሰብ አባል
ከቤተሰብ ውጪ
ክፍል 6 ከደም ግፊት በሽታ ጋር በተያያዘ ስለሚደረግ ቋሚ የአመጋገብ ለውጥ

የሚከተሉት ጥያቄዎች ከደም ግፉት ጋር በተያያዘ የሚደረጉ የአመጋገብ ዘይቤ ለውጦች ላይ ያተኩራል፡፡ ለተሳታፊው
በአማራጮቹ ላይ ማብራሪያ ከሰጡ በኋላ ወደ ጥያቄዎቹ ይለፉ፡፡ በተሳታፉው መልሶች ስር ምልክት (√) ያድርጉ፡፡

ምንም አላደርግም - የተጠቀሰውን የአመጋገብ ዘይቤ ፅሞ የማይተገብሩት ከሆነ

አልፎ አልፎ አደርገዋለሁ - የተጠቀሰውን የአመጋገብ ዘይቤ የተወሰነ የሚተገብሩት ከሆነ

አብዛኛውን ጊዜ አደርገዋለሁ - የተጠቀሰውን የአመጋገብ ዘይቤ ብዙ ጊዜ የሚተገብሩት ከሆነ

ሁሌም አደርገዋለሁ - የተጠቀሰውን የአመጋገብ ዘይቤ ሁሌም የሚተገብሩት ከሆነ

ቁጥር ጥያቄዎች ምንም አልፎ አልፎ አብዛኛውን ሁሌም

አላደርግም አደርገዋለሁ ጊዜ አደርገዋለሁ
አደርገዋለሁ

55
 501 የደም ግፊት እንዳለብዎት ካወቀ በኃላ ፊራፊሬ፣
ጥራጥሬ እና ቅጠላ ቅጠላ ምን ያህልይጠቀማለ?
502 ስብነት ያላቸው ምግቦች (እንደ ጮማ፣አይብ፣
….የመሳሰሉትን) ምን ያህል ይጠቀማሉ
503 ቅመማ ቅመም የበዛባቸው ምግቦች ይመገባሉ
504 በምግብዎ ውስጥ ጨው ይጠቀማሉ
505 በተለያዩ የምግብ ሸቀጦች ላይ ሊፃፍ የሚችለውን
የጨው መጠን ያነባሉ?

ክፍል 7- በቋሚነት የሚደረግ የአካል ብቃት እንቅስቃሴ

የሚከተሉትን ጥያቄዎች ከቀረቡት አማራጮች ጋር ለተሳታፉዎች ያቅርቡላቸው፡፡ በመልሶች ጎን በሚገኙት ሳጥኖች

ወስጥ ምልክት (√) ያድርጉ፡፡

ቁጥር ጥያቄዎች አማራጭ መልስ ወደ ጥያቄ…. እለፍ

601 የአካል ብቃት አንቅስቃሴ ያደርጋሉ 1 = አደርጋለሁ 701
0 = አላደርግም
602 በየስንት ጊዜው እንቅስቃሴ ያደርጋሉ 0 = በሳምንት ከ 3 ቀን በታች
1 = በሳምንት 3 ቀን
1 = በሳምንት ከ 3 ቀን በሊይ
603 ምን አይነት እንቅስቃሴ ያደርጋሉ እርምጃ
ሶምሶማ
ብስክሌት መንዲት
ላሊ
(ግለጽ) __________
604 በቀን ለምን ያህል ጊዜ ይንቀሳቀሳለ 0 = ‹ 30 ደቂቃ
1 = ›30 ደቂቃ

ክፍል 8 በቋሚነት ሲጋራን ስለማቆም

የሚከተሉት ጥያቄዎች በቋሚነት ሲጋራን ስሇማቆም ሊይ ያተኩራለ፡፡ እያንዲንደ ጥያቄ ሁሇት አማራጭ መሌሶች
አለት፡፡ በተሳታፉው የተሰጠው መሌስ ሊይ ምሌክት (√) ያድርጉ፡፡

No ጥያቄዎች አማራጭ መሌስ ወደ ጥያቄ…. እለፍ

56
 70 ሲጋራ አጭሰው 1=አዉቀዋለዉ አዉቀዋለዉ ከ ሆነ ወድ 801
1 ያውቃለ 0 = አላውቅም ኢለፍ
70 አሁንም ሲጋራ ያጨሳሉ 1 = አጨሳለሁ አላጨስም ከ ሆነ ወድ 801
2 0 = አላጨስም ኢለፍ
70 ሲጋራ ማጨስ ለማቆም ሞክረው 1 = አላውቅም
3 ያውቃሉ 0 = አውቃለሁ
ክፍል 9 በቋሚነት የአልኮል መጠጥ አወሳሰድን ስለመመጠን

የሚከተሉት ጥያቄዎች የአሌኮል መጠጥ አወሳሰድ ላይ ያተኩራል፡፡ ተሳታፉው መጠጥ ጠጥተው የማያውቁ ከሆነ
ወይም ካቆሙ ወደ ክፍል 10 ይለፉ፡፡ ጥያቄዎችን ከመጀመርዎ በፉት ተሳታፉው የሚያዘወትሩትን መጠጥ ይጠይቁ፡፡

1 መጠጥ - 1 ጠርሙስ ቢራ ወይም 1 ብርጭቆ ወይን/ጠላ/ጠጅ ወይም 1 መለኪያ አረቄ/ጅን/ቮድካ/ውስኪ

ቁጥ ጥያቄዎች ምንም በወር በ ወር ከ 1 በየሳምን በሳምንት ከ 2 ወደ

ር የሇም (0) ከ 1 ጊዜ ግዜ በላዬ ቱ በላይ አለፍ
በታች
(1)
801 በአንድ ጊዜ 8 እና ከዛ በላይ
(ለወንዶች)፤ 6 እና ከዛ በላይ
(ለሴቶች) የሚጠጡበት
አጋጣሚ ምን ያህል ነው
802 ባለፈው ዓመት ውስጥ መጠጥ
ጠጥተው ከዛ ቀን በፊት
ያደረጉትን ነገር የረሱበት
አጋጣሚ ምን ያህል ነው
803 ባለፈው ዓመት ውስጥ በመጠጥ
ምክንያት ከስራ የተስተጓጎለበት
አጋጣሚ ምን ያህል ነው
804 ባለፈው ዓመት ውስጥ 0= ምንም
ዘመዶችዎ/ ጓደኛዎ / ሀኪምዎ የለም
ወይም ሌላ የጤና ባለሙያ 1 = አንድ
የመጠጥ አጠቃቀምዎ አጋጣሚ
አሳስቡዋቹው ያውቃሌ ወይም አለ
የመከርዎት አጋጣሚ አለ 2 = ከአንድ
በላይ
አጋጣሚ
አለ

57
ክፍል 10 ለደም ግፊት የሚሰጡ መድሀኒቶችን በአግባቡ በቋሚነት ሳያቋርጡ ስለመውሰድ

የሚከተሉት ጥያቄዎች ለደም ግፊት የሚሰጡ መድሀኒቶችን በአግባቡ በቋሚነት ሳያቋርጡ ስለመውሰድ ላይ
ያተኩራለ፡፡ እያንዳንዱ ጥያቄ ሁለት አማራጮች አሉት፡፡ በተሳታፊው የተሰጠው መልስ ላይ ምልክት (√) ያድርጉ፡፡

ቁጥር ጥያቄዎች አማራጭ መሌስ

901 የግፊት መድሃኒቶች መውሰድ ረስተው ያውቃለ? 1 = አውቃለሁ

0 = አላውቅም
902 ስለ ግፉት መድሃኒት አወሳሰድዎ የሚገባውን ትኩረት 0 = እሰጣለሁ
ይሰጣሉ? 1 = አልሰጥም

903 የግፉት መድሀኒት ወስደው ምቾት ካልተሰማዎት 1 = አቆማለሁ

መድሃኒቱን ያቆሙታል? 0 = አልቆምም
904 ከግፊት ጋር በተያያዘ የሚሰማዎት ህመም በማይኖርበት 1 = አቆማለሁ
ጊዜ መድሃኒቶችን መውሰድ ያቆማሉ? 0 = አልቆምም

58