Contextual Effect of the Integrated Health Post (Posbindu) and Biopsychosocial Determinants of Tertiary Preventive Behavior in Patients with Hypertension

Very Retnowati, Pawito Pawito, Bhisma Murti


Background: Tertiary prevention of hyper­ten­sion is a preventive effort to make patients with hypertension do not have disabilities and further complications. It also improves the quality of life and makes life longer. The bio­psy­chosocial aspect affects individuals in lear­n­ing, doing, and maintaining certain beha­viors based on social cognitive theory. This stu­dy aimed to analyze the biopsychosocial deter­mi­nants of tertiary preventive behavior among patients with hypertension.

Subjects and Method: This study was an analytical observational study with a cross-sectional design. The study was conducted at 25 Integrated Health Posts (Pos­bin­du) in Sragen, Central Java. A sample of 200 hypertensive patients was selected by stratified random sam­pling. The dependent variable was the ter­tiary preventive behavior of hypertension. The in­­de­pendent variables were observational lear­ning, role model, imitation, vicarious learning, rein­forcement, self-efficacy, self-regulation, out­­­­­come expectation, and attitude. The data were collected by ques­tion­naire and analyzed by a multilevel multiple logis­tic regression.

Results: Hypertension preventive behavior in­crea­sed with observational learning (b= 2.85; 95% CI= 0.17 to 5.53; p= 0.037), role model (b= 2.73; 95% CI =0.73 to 4.73; p=0.007), imi­tation (b= 3.46 ; 95% CI= 0.73 to 6.19; p= 0.013), vica­­rious learning (b= 2.54; 95% CI =0.16 to 4.93; p= 0.036), reinforcement (b= 3.89; 95% CI= 0.96 to 6.82; p= 0.009), self-efficacy (b= 3.04; 95% CI= 0.41 to 5.67; p= 0.024), self-re­gu­­­­lation (b= 2.28; 95% CI= 0.02 to 4.54; p= 0.048), outcome expectation (b= 3.56; 95% CI= 0.75 to 6.38; p= 0.013), and a positive attitude (b= 2.86; 95% CI= 0.26 to 5.47; p= 0.031). Posbindu had a contextual effect on ter­tiary preventive behavior of hypertension with an Intra Class Correlation (ICC) value of 63.05%.

Conclusion: Tertiary preventive behavior of hypertension increases with high observational learning, strong role model, strong imitation, high vicarious learning, strong reinforcement, high self-eff­icacy, high self-regulation, positive outcome expec­­­­tation, and positive attitude. Posbindu has a contextual effect on tertiary preventive behavior of hyper­ten­sion.

Keywords: tertiary prevention, hypertension, social cognitive theory, multilevel analysis

Correspondence: Very Retnowati. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Suta­mi 36A, Surakarta 57126, Central Java. Email: Mobile: +628154­8­5­92491.

Journal of Health Promotion and Behavior (2020), 05(03): 174-186


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