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Pensar Enfermagem / v.27 n.01 / july 2023
DOI: 10.56732/pensarenf.v27i1.258
Quantitative Original Article
How to cite this article: Figueiredo S, Brites M, Sousa J. Empowerment of hypertensive individuals and
families in disease management: a community nursing intervention. Pensar Enf [Internet]. 2023 Jul; 27(1):61-
72. Available from: https://doi.org/10.56732/pensarenf.v27i1.258
Empowerment of hypertensive individuals and
families in disease management: a community
nursing intervention
Hypertension is a chronic disease with high national prevalence, being the main risk factor
for cardiovascular brain disease. Thus, training for disease management is essential for
disease control and eviction of complications. By determining the level of knowledge of
the person and family about hypertension, it was possible to structure the intervention
aimed at promoting autonomy for conscious decision-making, adopting healthy lifestyles
and active participation in their health project.
Empower hypertensive people aged 45-65 years and family, enrolled in a Family Healthcare
Unit in the intervention area of the Health Centre’s Cluster Almada/Seixal.
The analytical cross-sectional observational study was based on the methodology of Health
Planning, underpinned by the theoretical framework of Dorothea Orem's Nursing Self-
Care Model. A questionnaire was designed and applied to conduct the Situation Diagnosis
for the sociodemographic characterization of the sample and to identify the behaviors for
disease management. The sample was composed using the purposive sampling technique.
A favorable opinion was previously obtained from the Ethics Committee for Health of the
Regional Health Administration of Lisbon and Tejo Valley (ARSLVT) under reference -
The situation diagnosis revealed a deficit of knowledge about the disease and its
management, as well as a deficit of self-care, which compromises the quality of life of the
participants. With the prioritization of the problems, health education was selected as a
strategy. After the community intervention, 70% of the participants assess and record daily
BP values; 100% of them correctly identify risk behaviors for worsening hypertension; 63%
of the participants practice regular physical activity; 87% of the participants report having
reduced the daily intake of salt; and, 100% of family members identified two areas in which
their family member needs more support, being the most frequent, encouragement for
physical activity and restriction/substitution of salt in food.
This project was an important contribution to the empowerment of the hypertensive
person and family to manage the disease, since after its completion there was an increase
in knowledge of the participants, as well as behavioral changes associated with healthy
Empowerment; Health management; Treatment Adherence and Compliance;
Hypertension; Nurse.
Soraia Nobre Figueiredo1
Maria Jorge Brites2
José Edmundo Sousa3
1 Master. Hemato-oncology Service, Centro Hospitalar
e Universitário de Lisboa Central, Lisbon, Portugal.
2 Master. Family Healthcare Unit Ponte, ACeS Almada-
Seixal, Almada, Portugal.
3 PhD. PhD Professor of the Lisbon School of
Nursing, Adjunct Professor, Department of
Community Health, Lisbon, Portugal.
Corresponding author
Soraia Nobre Figueiredo
E-mail: soraia.nobre87@gmail.com
Received: 07.02.2023
Accepted: 19.05.2023
62 | Figueiredo, S.
Quantitative Original Article
Arterial Hypertension (HT) affects one billion people
worldwide, accounting for 7.6 million premature deaths
worldwide. It is the most prevalent risk factor for
cardiovascular disease (CVD), causing approximately 14%
of all deaths worldwide, and 143 million disability-
associated life years [Disability Adjusted Life Years
(DALYs)].1,2 In Portugal, according to data from the
Instituto Nacional de Saúde Doutor Ricardo Jorge
(INSA)3, resulting from the National Survey with Physical
Examination (INSEF)3, the national prevalence of
hypertension is 36%. It constitutes a public health problem,
given its high prevalence in the adult population, low levels
of therapeutic adherence and often late diagnosis4. It is a
chronic non-transmissible disease, which consists of the
sustained elevation of systolic blood pressure values equal
to or greater than 140mmhg and diastolic pressure values
equal to or greater than 90mmhg.5,6 Its installation is
progressive, which is why, initially, its signs and symptoms
are not perceptible, however its continuous increase over
time generates lesions in the vessels, weakening them,
which may later give rise to aneurysms, cerebrovascular
accident (CVA), heart failure (HF), acute myocardial
infarction (AMI), renal failure, among others1. Its
symptoms are nonspecific and easily associated with other
causes, leading to late diagnosis4. It is classified into three
levels of severity: (1) Grade 1 - mild arterial hypertension
(140-159/ 90-99 mmHg); (2) Grade 2 - moderate arterial
hypertension (160-179/100-119 mmHg); and (3) Grade 3 -
severe arterial hypertension (180/110 mmHg), according to
the etiology it is classified as: essential, primary or idiopathic
hypertension, the most frequent (unknown cause); and
secondary hypertension, less frequent, derives from an
associated pathology (potentially treatable or not), such as,
for example, kidney disease, obstructive sleep apnea
syndrome; obesity; among others4,5,6. Hypertension is a
multifactorial condition, according to the Portuguese
Society of Hypertension (SPH)7 the risk factors for its
development are, essentially, uncontrollable genetic factors,
related to ethnicity, age, history familiar; behavioural
factors, linked to unhealthy lifestyles, subject to
modification; and socioeconomic factors such as education
level, low family income and poor housing conditions. As
for potentially modifiable risk factors, the World Health
Organization (WHO)1 identified overweight and/or
obesity, smoking, sedentary lifestyle, excessive
consumption of alcoholic beverages, excessive intake of
foods high in fat and salt. In Portugal, about two thirds of
hypertensive people do not know that they are, and of
those who are diagnosed, only 11% have their hypertension
Amorim et al.8 suggest that the management of
hypertension should mostly be the responsibility of primary
health care, thus in this sense, urging the need to identify
effective strategies for managing the disease, preventing
situations of disability, and reducing the quality of care. life,
which lead to a high expression in the consumption of
health services, medications, and hospitalization episodes1.
The current rules of the Directorate-General for Health
(DGH)9 dictate that “the person with HT must have the
opportunity to make informed decisions about their
treatment”(p.14) and that for this the treatment should “be
culturally appropriate and accessible”9(p.4), as well as
allowing “family members to be involved in decisions
about patient care and indicated treatment”.9(p.5) Since it is
fundamental to involve the person and family in the
therapeutic process, we are guided by the assumption that
the better informed they are about the disease, therapy, and
healthy lifestyles, the greater the autonomy in managing the
disease, achieving better results of health4. Aligning the
aforementioned assumptions with the National Health Plan
(NHP) 2021-2030 “the complexity of health problems and
their determinants, and their dynamics of interpenetration
and dependence require us to move (...) to
multidimensional approaches”,10(p.36) they choose
“Education for (Self)Management of chronic illness” as
one of the intervention strategies aimed at health
In the field of chronic disease (CD) management, the
differentiated intervention of the Specialist Nurse in
Community Nursing (SNCN) aims at the systematic and
cohesive training of the person and family for the
management of chronic disease.11 In order to promote a
practice based on the most current scientific evidence, as
Ferreira et al. 12 points out, it is essential to promote
adherence to the therapeutic regimen, especially with
regard to physical activity and dietary care, and the CEE
must act on these determinants to increase the effectiveness
of HT disease management. Thus, and according to the
studies consulted, regarding the most effective nursing
interventions for training hypertensive patients and their
families, the potential of Health Education (HE) in groups
or individually stands out, with a focus on changing
behaviours in everyday life, monitoring, promoting health
literacy, person-centred care, and family involvement.
Train hypertensive people between the ages of 45 and 65
and their families to manage the disease, enrolled in a
Family Health Unit (FHU) in the intervention area of the
Grouping of Health Centres (ACeS) Almada/Seixal.
An analytical cross-sectional observational study was
carried out,13 developed according to the Health Planning
methodology (Tavares, 1990)14, based on Orem's Self-Care
Model (2001)15, aiming at predetermining a set of actions
to achieve the expected results.16,17 Planning, in health, “is
a continuous process of forecasting resources and
necessary services, to achieve certain objectives according
to the established order of priorities, allowing to choose the
optimal solution(s) in several alternatives; these choices
take into account current or foreseeable future
constraints”.14(p.29) It consists, then, of a continuous
dynamic process, with several stages that provide for
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DOI: 10.56732/pensarenf.v27i1.258
Quantitative Original Article
methodological rigor. The community intervention was
developed in the area of influence of ACeS A-S. The
population of this geographical area has great cultural
diversity, low level of education and the highest
unemployment and morbidity rate in ACeS A-S. 17 With an
illiteracy rate of 5.21%, it is the highest in the country. It
has an unemployment rate of 19%. 17(p.13) According to PLS
A-S17 regarding the priority population groups, “(...) the
analysis of the health status of the population showed the
high risk of premature death of the population residing in
the municipality of Almada, namely associated with
ischemic heart disease(...)”.17(p.13) As diseases of the
circulatory system are the most frequent cause of
proportional morbidity and mortality in all ages and
genders within the area of influence of ACeS. The project
population is all individuals enrolled in the FHU, the target
population being defined as users enrolled in the USF with
a diagnosis of uncomplicated hypertension in the age group
between 45 and 65 years old, enrolled in the FHU, which
translates into in a total of 113 people. The following
inclusion criteria were defined: population diagnosed with
uncomplicated hypertension (coded with the ICPC-2 code
K86 in the MedicineOne computer system); in the
aforementioned age group; and, who voluntarily agreed to
participate in the study. The sample was constituted using
the technique of convenience or intentional sampling,
composed of people with the aforementioned diagnosis
and age group, who had a surveillance consultation with the
family doctor and/or nursing consultation in the period
between June 8th and 30th. 2022, and of these, those who
made themselves available and gave their informed consent
to participate in the collection of information. Integrated
by thirty participants. A questionnaire was constructed and
applied, which is structured in three parts: 1st part -
sociodemographic characterization; 2nd part - clinical
situation and lifestyle and 3rd part - The Medication
Adherence Reasons Scale (MARS)18. The scale consists of
seven questions structured in order to be able to synthesize
the habits and beliefs of adherence to treatment medicinal
product, was created by Morisky, Green and Levine (1986)
translated, adapted and validated for the Portuguese
population and culture, by Delgado and Lima18, who were
requested and obtained authorization for its application. To
ensure an ethically sound intervention, authorization was
requested to carry out the project from the USF
Coordinator and Mr. Director of ACeS Almada/Seixal,
having been granted. Obtained a favourable opinion
(5043/CES/2022) from the Health Ethics Committee
(HEC) of the Regional Health Administration of Lisbon
and Tagus Valley (ARSLVT). After the favourable opinion
of HEC ARSLVT, the participants were informed about
the methodology, purpose and objectives of the project,
and the questionnaires were applied to all participants in the
sample, ensuring that they completed and signed the
informed consent. Ensuring that they understand the risks
and benefits of their participation, their rights, including the
right not to participate or to withdraw from participation at
any time without prejudice. A duplicate informed consent
form was given to each participant. The questionnaires
were self-completed, with the exception of situations in
which the participants needed help to complete them, due
to illiteracy and/or vision changes, being replaced in this
task by one of the project's researchers. However, aiming
to minimize data bias, the questionnaires were completed
at the beginning of the nursing consultation, and those that
were completed with assistance, the questions were read as
written in the questionnaire. The collected data was coded,
ensuring anonymity and confidentiality.
The empirical material, resulting from the application of
the data collection instrument, was treated using
descriptive statistics analysis, through the SPSS software
Statistical Package for the Social Sciences (
Participants have a mean age of 56.27 (SD=6.38) years,
47% of participants are male. With regard to the
constitution of the household in the sample, 34% of
respondents live in a nuclear dyad type family after the
children leave, 23% in a nuclear family with spouse and
children, 13% are single parents and 30% refer to living
alone, the reason being most frequently, the death of a
spouse. It was asked if there is any other element in the
household with HT, 47% answered yes, referring to being
the spouse, 60% of the participants are professionally
active, in different professional areas. Regarding the
monitoring of Arterial Pressure (AP) values, 66% of the
respondents only evaluated it in a biannual consultation at
the FHU. Regarding the practice of physical exercise, 87%
of the participants reveal high levels of physical inactivity
and sedentary lifestyle. They were asked if they had changed
their lifestyle habits after the diagnosis of HT, 73%
reported not having changed, and the 27% who answered
affirmatively, were asked which habits had changed, and
these responded to the reduction of salt in their diet, not
specifying what is the amount of salt ingested previously,
nor the current reduction, the questionnaire does not allow
us to quantify the number of grams ingested per day.
Regarding the control measures they use in their daily lives,
80% of the participants mention only complying with the
prescribed medication without associating with other
control measures. As for salt restriction in their daily diet,
53% reported not restricting it. Regarding family support
for the implementation of measures to control their HT,
70% reported not having support from their household.
Most participants do not consider changing lifestyle habits
as a benefit in controlling hypertension. The MAT18 scale
was also applied to identify medication adherence
behaviour, since 80% reported only complying with the
medication as a measure of hypertension management.
Based on the authors' recommendation, 39% of the
participants do not meet all the criteria for adherence to
treatment. The answers to the questions that make up the
scale were analysed separately, and the weaknesses in the
adherence criteria were listed, namely: forgetting to take,
delay in taking the time, treatment abandonment due to
improvements and abandonment due to the end of the
64 | Figueiredo, S.
Quantitative Original Article
medication. On average, study participants were
overweight, with an average weight of 75.46 kg, in relation
to personal history, 60.0% of non-insulin dependent
Diabetes Mellitus and 80% of participants suffer from
After surveying the problems and consequent needs,
nursing diagnoses were prepared according to the
International Classification for Nursing Practice (ICNP)19:
(1) health surveillance [on HT] compromised; (2)
knowledge about compromised physical exercise regime;
(3) knowledge about the committed dietary regimen; (4)
knowledge about the process of changing committed
behaviours; (5) knowledge [about HT] compromised; (6)
compromised family knowledge about the disease; (7)
compromised adherence to the therapeutic regimen; (8)
compromised self-care; (9) compromised family capacity to
manage the regime; (10) risk of impaired cardiovascular
function. Thus, defining the starting point from which the
benefit of the intervention will be evaluated14. The
prioritization of real health needs was carried out with the
support of experts, according to the Hanlon Method. The
method was applied in an adapted way to the sample,
considering the criteria set out by Tavares14: (1)
Amplitude/Magnitude of the Problem; (2) Gravity; (3)
Effectiveness of the Solution and (4) Feasibility of the
Project classified with the acronym PEARL (P- Relevance,
Economic Feasibility, Community Acceptance, Resources
and Legality). According to the results obtained, the
objective and the time limit of the project, we intervened in
the problems that obtained the highest score, namely,
compromised health surveillance; family knowledge about
the compromised disease; compromised self-care;
knowledge [about HT] compromised; knowledge about the
process of changing committed behaviours; knowledge
about committed exercise regime; and knowledge about the
committed dietary regimen. We continued with the setting
of objectives, formulating the general objective - To train
hypertensive people and their families enrolled in the FHU
to manage the disease, from October 2022 to January 2023
and the specific objectives for the target population in the
same time period: (1) train hypertensive people and their
families on the importance of health surveillance; (2) train
the hypertensive person and family to manage the exercise
regimen; (3) train the hypertensive person and family to
manage the dietary regimen; (4) enable the hypertensive
person and family to identify risk factors; (5) train the
person and family on the health gains of changing
behaviours in the control of hypertension; and, (6) involve
the family in the process of managing the illness of the
hypertensive family member. With regard to the selection
of strategies, it was essential to rethink the CD management
concept. According to WHO20, the costs attributable to CD
for health systems worldwide are equivalent to 60%-80%
of total expenses, revealing the burden and problems of
financial sustainability for health systems. In Portugal,
according to INSA3 data, around 43.9% of the Portuguese
population suffers from CD. Facts that highlight the
importance of implementing strategies that promote CD
management, as a guarantee of clear gains in health with
positive repercussions in terms of health costs and quality
of life20. By definition, the concept of CD management
consists of a system coordinated interventions aimed at the
individual, group or population, through the
implementation of strategies and/or creation of programs
that integrate the most recent norms and guidelines, for the
promotion of autonomy for the self-care of the person with
Considering that the community intervention developed
corresponds to the level of secondary prevention, aiming
to empower the person and family to make autonomous
decisions, increasing their motivation to change
behaviours and promote the ability to manage the disease,
we combine a set of strategies health promotion, such as
health education, involvement of the person and family
and follow-up. In this process, possible barriers to existing
learning were taken care of and thus implemented
strategies to facilitate learning and to motivate and
encourage the participation of individuals and families.
The activities carried out allowed the achievement of the
defined objectives, and aimed to provide adequate follow-
up to the participants, creating an environment that
promotes the acceptance of CD, motivating them to
acquire knowledge, change behaviours and manage the
disease. As methods we used group discussion, analogies,
lecture, demonstration and practice, questions, and
The group sessions were an opportunity to encourage
participants to identify strategies, share experiences and
We also individually monitored the person and family in
the context of nursing consultations and home visits of
participants who revealed some degree of dependence
according to the Barthel scale assessed in Sclinic®, using
Figueiredo's family assessment model22, more specifically
in the functional domain (caregiver role). The activities
included a walk, ludic-pedagogical games, video exhibition,
AP self-assessment training, and the transmitted
information was compiled and distributed in the form of
informative leaflets.
In order to evaluate the objectives, activities and indicators
of the community intervention, the knowledge obtained by
the participants regarding the addressed themes was
considered, in line with the defined objectives and result
indicators. By weighting: the responses of the participants
after the end of the individual educational process in an HT
nursing consultation; answers to the questionnaires applied
after the end of the HE sessions; and finally, after the end
of all activities, a final questionnaire was applied consisting
of some questions extracted from the data collection
instrument and questions that intend to measure the
acquisition of knowledge and the possible change of
behaviours for the management of the disease. Its analysis
and comparison with values obtained in the DS phase
allows inferring that all objectives were achieved as shown
in Table 1. As for the changes obtained with the
intervention, we analysed using descriptive statistics, the
data obtained with the final questionnaire, which was
presented in tables 2, 3, 4, 5 and 6.
Quantitative Original Article
Chart 1 Evaluation of the result indicator, referring to the defined operational objectives
Data referring to changes in behaviour were also
analysed, which we present in a table, contrasting
the initial data and those obtained with the
Chart 2 Comparison of the variable frequency of assessment and recording of AP in the 1st and 2nd moments
How often do you measure
and record your Arterial Blood
1st Moment (July 2022)
Diagnosis of situation
2nd Moment (January 2023)
Final evaluation
f= 30
Chart 3 Comparison of the variable HT control measures in the 1st and 2nd moment.
What kind of measures are
taken to control HT
1st Moment (July 2022)
Diagnosis of situation
2nd Moment (January 2023)
Final evaluation
f= 30
Just medication
Decreased fat intake
Medication and reducing salt
Objective: 30% of participants evaluate and record their blood pressure values
Result Indicator
Value obtained
% of participants who regularly assess and record blood pressure values
Objective: 70% of participants and their families who were present at the activities identified risk behaviours
Result Indicator
Value obtained
% of participants who identified risk behaviours after EC.
Objective: 50% of the participants who were present at the activities identified the importance of practicing 30
minutes of physical activity in a row, daily or at least three days a week
Result Indicator
Value obtained
% of participants who consider it important to perform regular physical activity
Objective: 50% of the participants who attended the activities would restrict salt intake in their daily diet
Result Indicator
Value obtained
% of participants restricting salt intake
Objective: 70% of the participants who attended the activities could identify options for replacing salt in their
daily diet.
Result Indicator
Value obtained
% of participants who correctly identify options for replacing salt in their diet, through
the 2nd HE assessment questionnaire “control your heart, reduce salt in your diet”
66 | Figueiredo, S.
Quantitative Original Article
Chart 4 Comparison of the physical activity practice variable in the 1st and 2nd moments
Chart 5 Comparison of the dietary salt restriction variable in the 1st and 2nd moments
Salt restriction in food
1st Moment (July 2022)
Diagnosis of situation
2nd Moment (January 2023)
Final evaluation
f= 30
Chart 6 Comparison of the family support variable in the 1st and 2nd moments
Family support to follow HT
control recommendations
1st Moment (July2022)
Diagnosis of situation
2nd Moment (Janeiro 2023)
Final evaluation
f= 30
After analysis and evaluation, all the objectives were
reached, as well as the pre-established values, regarding
the process and activity indicators. The results reflect the
acquisition of knowledge by the participants, as well as the
acquisition of skills that promote behaviour change,
adopting healthier lifestyles.
The increase in CD worldwide is a multifactorial
phenomenon, however it is essentially related to the
lifestyles and consumption patterns of today's society.
Approximately half of people with CD develop
comorbidities associated with the difficulty in managing
the disease1,23. This fact points to the importance of
adopting health promotion strategies in an approach that
promotes disease management.
Hypertension is a CD with a high national prevalence3,25,
associated with non-adherence to the therapeutic
regimen.1,25,26 Inappropriate behaviours and lifestyles are
generators of comorbidities that lead to loss of quality of
life and high economic impact, social and family life, as
well as the increase in premature deaths27,28,30. Thus, the
central importance of the SNCN in the process of
empowering the person and family to develop skills that
facilitate decision-making and the implementation of self-
care behaviours emerges, as stated by Silva et al.29.
In the community intervention developed, the main
needs identified in the SD stage corroborate what has
been verified in other studies developed in
Portugal30,31,32,33, where the need to promote nursing
interventions for guidance, knowledge acquisition, skills
development, and instrumentation in self-care. Thus,
according to the defined objectives, HE was used as a
strategy, aiming at training for the management of the
disease of the hypertensive person and family. As
mentioned by Oliveira et al.,35 in their study, HE as a
strategy to promote adherence to healthy lifestyles for the
control and management of hypertension is the most
effective strategy with regard to changes in lifestyles,
having found a significant change regarding salt intake,
physical activity, and blood pressure control. The same is
reaffirmed by Gama et al.36 in the bibliographic review,
where HE is highlighted as the most effective
intervention for increasing levels of knowledge,
adherence to recommendations and healthy lifestyles of
hypertensive people.
Practice physical activity
1st Moment (July 2022)
Diagnosis of situation
2nd Moment (January 2023)
Final evaluation
f= 30
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DOI: 10.56732/pensarenf.v27i1.258
Quantitative Original Article
Thus, in relation to the sample, the gender variable
deserves special attention, because although there are no
significant differences in prevalence between genders
within the sample, there are different self-care behaviours,
with female participants being more participatory in the
activities carried out, a fact that we relate to the different
perception of their health condition, greater demand for
health services, as well as greater compliance with the
recommendations of health professionals, as verified in
the study developed by Motter et al.37
As for the level of education, most of the participants
have low levels of education, as in the study by Ribeiro32,
corroborating the data expressed in the INSEF3, where a
higher prevalence of hypertension is verified in
individuals with a lower level of education. Regarding the
SD phase, poor monitoring of Arterial Pressure (AP)
values was verified, most participants only evaluated the
tension in the context of a consultation at the FHU or
occasionally at the pharmacy when associated
symptomatology (dizziness, headache, or tinnitus),
revealing little knowledge about the disease, as well as
skills for monitoring and evaluating AP at home. Recent
studies highlight the importance of monitoring AP in
disease management.27,30,36 A high rate of sedentary
lifestyle and physical inactivity, with 87% of participants
not practicing regular physical activity, a value higher than
the values described in the Report on the point of the
global situation of physical activity33, 27.5% of adults do
not comply with the levels of physical activity
recommended by the WHO34. With regard to salt
restriction in their daily diet, 53% refer not to restrict it, a
value that coincides with national studies, as in the priority
program for healthy eating.39,41,25
With regard to changing lifestyle habits after the diagnosis
of hypertension, most participants did not make any
changes, a fact similar to the results of recent studies,
where participants prior to the intervention had not
autonomously, following the diagnosis, changed lifestyle
habits35 ,40, which we relate to the lack of knowledge about
the disease, its course and management. With regard to
the control measures they use in their daily lives to
manage high blood pressure, at the time of the SD, most
participants were only complying with the medication
prescribed by the doctor, not adhering to the non-
pharmacological measures for controlling high blood
pressure25, data that coincide with the study by Ferreira et
al.13; Pereira38; Dantas et al.44, where the rate of adherence
to control measures varies between 16.9% and 49.8%.
Regarding family support for the implementation of
measures to control their hypertension, 70% of
participants deny having family support for controlling
hypertension, revealing the family's non-involvement in
the disease management process. Thus, once again
highlighting the need to promote adherence to the
therapeutic regimen, increasing the quality of care
provided to the person and the family, and thus,
consequently, health gains32,44,46,46.
The results obtained after the intervention reveal the
success in achieving the defined objectives, corroborating
the scientific evidence consulted, which highlights the HE
as a fundamental resource in the therapeutic intervention
of nurses, to increase knowledge and change
The implementation of the educational process, in the
context of a nursing consultation, HE group sessions and
home visits revealed a high potential in the acquisition of
knowledge and consequent motivation for changing
behaviors30. It was possible to promote the strengthening
of the bond between the professional of health, the
person, and the family, encouraging the development of
educational processes aimed at the person and the
specificities of each family, which, as a social support for
the hypertensive person, are crucial for the
implementation and maintenance of healthy
In the FHU where the community intervention took
place, an HT nursing consultation (CEHTA) has not been
implemented, so a guide to good practices for the
CEHTA was developed and applied in a nursing
consultation, which includes the most recent protocols
and guidelines for management. HT, which made it
possible to guide the intervention in a way adapted to the
person and family, guiding the educational process in each
consultation to the needs felt, avoiding redundant
teaching,29,35,43 stimulating adherence to the
recommendations for the management of HT, through
the counselling and monitoring.22,30,42
Therefore, we believe that the activities carried out, the
distribution of informative material, the on-site training
of AP self-assessment, the supply of instruments (label
decoder) that facilitate the interpretation of the amount
of salt in each food at the time of its purchase and the
ludic games, allowed establishing a positive correlation
between the educational process developed, adherence to
recommendations regarding lifestyle and the reduction of
risk factors related to the disease, as an example of this we
have the increase of participants who evaluate and record
blood pressure values frequently, who decreased daily salt
intake and increased regular physical activity.
In short, the SNCN, through specific skills48, promotes
the process of empowering the person and family to
manage the disease, increasing their involvement in the
health project, fostering an attitude that promotes
autonomy for informed decision-making. The HE
strategy contributed to improving the health conditions
of the group, increasing health literacy, involvement and
identification, strengthening the therapeutic relationship,
improving the quality of care.36,45,49
The results obtained allow us to state that the planning of
the appropriate intervention for the population, the HT
nursing consultation, home counselling and partnerships
that reinforced the transmission of information about the
dietary regimen, physical activity, health surveillance, self-
care and family involvement, promoted greater adherence
to the therapeutic regimen, as well as increased the change
in the behavioural pattern.
During the course of the community intervention, some
limitations were identified, delaying its initiation and
68 | Figueiredo, S.
Quantitative Original Article
development, given the delay in responding to the various
requests necessary to ensure ethical procedures. In an
initial phase, there were several requests for
authorizations and opinions that could not be requested
simultaneously, the request for an opinion was first
submitted to the TIN of ACES A-S and only after the
response with a positive opinion, was it possible to submit
it to the CES of ARSLVT), the which conditioned the
beginning of the application of the data collection
instrument. After the opinions, participants were called
who, given their age group, are professionally active,
which made it difficult for them to be available to attend
the FHU, leading to a sample of thirty participants in a
universe of one hundred and thirteen. However, it was
possible and extremely important to survey the real needs
of the population, as well as its contribution to the proper
development of community intervention.
The increase in life expectancy, combined with changes in
the lifestyles of the population, generates an increase in
CD.39 The high prevalence of hypertension at national
level leads to high costs, at economic, social, and
individual levels40, which makes it urgent to intervene.
Hypertension must be approached considering the most
effective nursing interventions, through evidence-based
practice, considering the evolutionary course of the
disease, in order to obtain health gains. For this reason,
the intervention of the SNCN48 is fundamental, which in
its daily practice resorts to partnerships with other
professionals, as well as with the person and family,
promoting their active participation in the whole process.
The person with CD and their family need systematic
monitoring given the specificity of their needs29,42,45,46
through an integrated approach, considering the changes
they manage to make, the necessary adaptations, internal
resources, support networks and life situation.
The community intervention developed, supported by the
Health Planning methodology and the theoretical
framework of Orem15, contributed to the training of
hypertensive people and their families to manage the
disease in a FHU of ACeS A-S, constituting a
contribution to practice by highlighting the benefit of the
SNCN intervention in the process of training
hypertensive people to manage CD, leading to an
approach centred on the person and family with a focus
on avoiding complications, maintaining quality of life and
involving the family. It highlights the contribution of the
SNCN's intervention in improving the population's
health through interventions based on Health Promotion
and Education. It reveals that HE strategies within the
scope of CD management mobilized by nurses enhance
autonomous and informed decision-making by
hypertensive people in their daily lives with adequate
family support. It also consists of a contribution to
training in the sense that it encourages the development
of educational competence integrated into the curricula of
the nursing course, with the mobilization of individual
resources in clinical practice. Considering that, for this
purpose, training should begin in the degree course,
deepening in specialization courses, with the transmission
of theoretical assumptions and research results, which
allow the development of specific skills in interpersonal
relationships and knowledge, guiding conduct, and
dissemination of relevant information to the
target audience.
Finally, it constitutes the same as a contribution to
research, as scientific evidence, on the benefit of
interventions in the context of nursing consultation, HE
sessions and home visits, in the process of training the
person and family for the management of CD.
With the end of the community nursing intervention,
most of the project participants increased their knowledge
regarding the course of the disease, measures to control
and monitor HT and a healthy lifestyle adapted to their
condition, revealing behavioural changes in their daily
Regarding the theoretical framework, it was decided to
use the support-education system, recommended in
Orem's Self-Care Deficit Theory1, which proved to be
adequate and essential for the acquisition of knowledge
and training of the person and family for conscious and
informed decision-making the management of the
disease. This system presupposes the association of
effective help techniques with support, provision,
guidance, and teaching, where the person's requirements
are related to decision-making, behaviour control,
acquisition of knowledge and strategies, through learning
behaviours, becoming a self-care agent. As for the
person's and family's help needs, they were related to
decision-making, behaviour control and the acquisition of
knowledge and development of competences, where
training for the management of the disease of the
intervenients was stimulated. Since, Orem15 sees self-care
as a skill that can be trained and thus improve the health
status of the person, group, or community.
With the implementation of the community
intervention, it was possible to promote the training of
the participants, the HE sessions were a fundamental
strategy to promote the self-care of the person and
family, favouring the identification of peers, sharing of
knowledge, experiences, and the acquisition of
knowledge. The evaluation, as a stage of the
methodology, indicated the success of the intervention
through process, activity, and result indicators, allowing
the identification of effective health gains. There was an
increase in knowledge and changes in self-care
behaviours, however, there is a discrepancy between
knowledge and its consistent operationalization in
everyday life, which we intend to reduce with the
implementation of the HT nursing consultation,
promoting the effectiveness of teaching moments,
commitment to the process of change, ability to self-
care and health literacy. Such as, home visitation, which,
as we have seen, was a very successful strategy, as an
assistance tool, based on the care plan for training
related to disease management, enabling the
Pensar Enfermagem / v.27 n.01 / july 2023 | 69
DOI: 10.56732/pensarenf.v27i1.258
Quantitative Original Article
educational process, on-site training and family
interaction, the family is the first social unit where the
individual is inserted and has a key role in maintaining
and encouraging the management of chronic illness.
The promotion of healthy behaviours and lifestyles
cannot be decontextualized from the socioeconomic
and political environment where the person and family
are inserted, thus highlighting the importance of the
intervention of the SNCN47, given the proximity to the
community, it identifies health problems, having a role
primordial in the support and monitoring of the
community, through its specific interventions that lead
to the improvement of the provision of care, with the
implementation of projects that respond to the
identified needs.
Thus, ensuring the continuity of this project, the results
obtained were presented to the FHU multidisciplinary
team, the pedagogical material developed was given to the
nursing team, enabling the continuity of its application.
During the project, the nursing consultation, based on the
best practices guide that compiles all the national norms
and policies regarding the management of the disease and
the training processes at home, revealed an added value
for the results obtained, all the material that allows
implementation and operationalization, allowing, in
addition to continuity, improvement with the
introduction of new strategies and interventions, which
allow monitoring, counselling, and teaching. And as for
the home visit, the in loco training of the hypertensive
person and family, focusing attention on family
Despite the evidence that proves the management of
hypertension through effective non-pharmacological
and/or pharmacological measures, the control rates of
this disease remain low41, constituting one of the greatest
global challenges, highlighting the relevance of the study
developed, since, the health education process, the
established partnerships and the involvement of the
multidisciplinary team made it possible to increase the
knowledge of both the professionals where it was possible
to validate the relevance of the implemented strategies
and activities, and the participants in terms of health
literacy and skills development for disease management.
That said, we reinforce the need to continue research in
this area, with the implementation of intervention
projects in the community, promoting the training of the
person and family for the management of chronic illness,
identifying the strategies that promote training for the
management of chronic illness and of measures capable
of increasing it by reducing the costs for the person,
family, and society. In future studies, we deem it pertinent
to reach more participants, especially those less
frequenting health services.
Authors’ contributions
SF: Study conception and design; Data collection; Data
analysis and interpretation; Statistical analysis; Manuscript
MB: Data analysis and interpretation; Critical revision of
the manuscript.
ES: Conception and design of the study; Data analysis and
interpretation; Statistical analysis; Critical revision of the
Conflicts of interests
No conflict of interest declared by the authors.
1. World Health Organization. A Global Brief on
Hypertension: sillent killer a global public health
crisis. Geneva: WHO; 2013. 39 p.
2. Forouzanfar MH, Liu P, Roth GA, et al. Global
Burden of Hypertension and Systolic Blood
Pressure of at Least 110 to 115 mm Hg, 1990-
2015. JAMA. 2017; 317(2):165-182. Avaliable
rticle/2596292 .
3. Instituto Nacional de Sade dr. Ricardo Jorge.
Inquérito Nacional de Sade com Exame
Fsico. Lisboa; INSA; 2015. 50 p.
4. Sociedade Portuguesa de Hipertenso.
Tradução Portuguesa das Guidelines de 2018
das ESH / ESC para o Tratamento da
Hipertenso Arterial. Lisboa: SPH; 2020. 76. 10-
12. 111p.
5. World Health Organization. International
Classification of Diseases 11th Revision (CID-
11) [Internet]. Geneva: WHO; 2022 [cited 2022
apr 23]. Avaliable from:
/classification-of-diseases .
6. Direção-Geral da Saúde. Norma n.º 020/2011.
Hipertensão arterial: definição e classificação
[Internet]. Lisboa: DGS; 2011 [cited 2022 mar
03]. Avaliable from: https://normas.dgs.min-
7. Sociedade Portuguesa de Hipertensão. Conheça
melhor a hipertensão arterial. [Internet]. Lisboa:
SPH; 2022 [cited 2022 mar 2]. Avaliable from:
8. Amorim L, Caldas P, & Roca S. Perfil dos
valores de tensão arterial em indivíduos
submetidos a mapa em cuidados de saúde
primários. Revista Portuguesa de Hipertensão e
Risco Cardiovascular. 2019; (72), 11-16.
9. Direção-Geral de Saúde. Norma 020/2011:
Hipertensão Arterial: definição e classificação
[Internet]. Lisboa: DGS; 2013 [cited 2023 jan
23]. Avaliable from: https://normas.dgs.min-
70 | Figueiredo, S.
Quantitative Original Article
10. Direco-Geral da Saúde Plano Nacional de
Saúde 2021-2030. Lisboa: DGS; 2019 [cited
2022 jun 04]. Avaliable from:
11. Disease management association of America
[Internet].c2004 [cited 2022 may 20]. Avaliable
12. Ferreira, RSS; Graça, LCC & Calvinho, MSE.
Adesão ao regime terapêutico de pessoas com
hipertensão arterial em cuidados de saúde
primários. Revista de Enfermagem Referência.
2016; 4(8): 7-15.
13. Fortin, MF. Fundamentos e etapas do processo de
investigaco. Loures: Lusociencia. 2009. 595 p.
14. Tavares A. Métodos e Técnicas de Planeamento
em Saúde. Lisboa: Ministério da Saúde; 1990.
223 p.
15. Orem D. Nursing: concepts of practice 6th ed.
St. Louis: Mosby; 2001. 542 p.
16. Imperatori, E, Giraldes M. Metodologia do
Planeamento da saúde. Manual para uso em
serviços centrais, regionais e locais. 3ed.Lisboa:
Escola Nacional de Saúde Pública; 1993. 200 p.
17. Serviço Nacional de Saúde. Bilhete de
identidade dos cuidados de saúde Primários,
regulamento interno [Internet]. Lisboa: SNS;
2022 [cited 2022 apr 05]. Avaliable from:
18. Delgado AD & Lima ML. Contributo para a
validação concorrente de uma medida de adesão
aos tratamentos. Psicologia, Saúde & Doenças;
2001; 2 (2), 81-100.
19. International Council of Nurses. CIPE® verso
2015 - classificaco internacional para a prtica
de enfermagem. Loures: Lusodidacta; 2015. 278
20. World Health Organization. The World Health
Statistic Monitoring health for SDGs
[Internet]. Geneva: WHO; 2022 [cited 2022 mar
10]. Avaliable from:
21. Ordem dos Enfermeiros. Servir a comunidade e
garantir qualidade: os enfermeiros na vanguarda
dos cuidados na doença crónica: «Delivering
quality, serving communities: nurses leading
chronic care» [Internet]. Lisboa: OE; 2010 [cited
2023 nov 03]. Avaliable from:
22. Figueiredo MH. Modelo dinâmico de avaliação
e intervenção familiar. Loures: Lusociência;
2012. 205 p.
23. Pan American Health Organization. Improving
Chronic Illness Care (ICIC) [Internet]. Regional
Office of the World Health Organization;
c2012. [cited 2022 Mar 2]. Avaliable from:
24. Tan CS, Hassali MA, Neoh CF, & Saleem F. A
qualitative exploration of hypertensive patients’
perception towards quality use of medication
and hypertension management at the
community level. Pharmacy Pratice
[Internet].2017; 15(4), 1-12. Avaliable from:
25. Polonia J, Martins L, Pinto F, Nazaré J.
Prevalência, sensibilização, tratamento e
controlo da hipertensão e consumo de sal em
Portugal: mudanças ao longo de uma década. O
estudo PHYSA. Journal of Hypertension. 2014;
32(6): 1211-1221.
26. Barreto M da S, Reiners AAO, Marcon SS.
Conhecimento sobre hipertensão e fatores
associados à não adesão ao tratamento
medicamentoso. Rev Latino-Am Enfermagem
[Internet]. 2014 [cited 2022 mar 5]; 22 (3): 484-
90. Avaliable from:
http://doi.org/10.1590/0104-1169.3447.2442 .
27. Fu SN, Dao MC, Wong CKH, & Cheung, BMY.
The Association of Health Literacy with High-
Quality Home Blood Pressure Monitoring for
Hypertensive Patients in Outpatient Settings.
International Journal of Hypertension
[Internet]. 2020 [cited 2022 mar 2]; (1): 1-15.
Avaliable from:
28. World Health Organization. Noncommunicable
diseases country profiles 2018 [Internet]. WHO,
2018 [cited 2022 apr 27] 224 p. Avaliable from:
29. Silva SSBE da, Oliveira S de F da SB de; Pierin
AMG. The control of hypertension in men and
women: a comparative analysis. Rev Esc
Enferm USP [Internet]. 2016 [cited 2022 nov 6];
50(1): 50-58. Available from:
30. Santiago M, Carvalho R, Pereira C, Magalhães A,
Penetra J, Baptista A, Campos A, et al. Arterial
hypertension: its knowledge, compliance and
quality of life impact in hypertensive patients.
Rev Port Hiper e Risco Cardiovascular
[Internet]. 2016 [cited 2022 mar 2]; (56): 3-38.
Avaliable from:
31. Macedo ME, Lima MJ, Silva AO, Alcantara P,
Ramalhinho V, Carmona J. Prevalence,
Pensar Enfermagem / v.27 n.01 / july 2023 | 71
DOI: 10.56732/pensarenf.v27i1.258
Quantitative Original Article
awareness, treatment and control of
hypertension in Portugal: the PAP study. J
Hypertens. 2005; 23(9): 16616.
32. Ribeiro, DC. Adesão terapêutica e qualidade de
vida em adultos e adultos idosos com
hipertensão: fatores motivacionais [dissertation
on the internet]. Lisboa (Portugal): Universidade
do Porto; 2013 [cited 2022 mar 30] Avaliable
from: https://repositorio-
33. Direção-Geral da Saúde. Relatório sobre o
ponto de situação global da atividade física 2022:
sumário executivo [Internet]. Lisboa: DGS;
2022 [cited 2023 jan 04]. Avaliable from:
34. World Health Organization. Guidelines on
physical activity and sedentary behaviour: at a
glance [Internet]. Geneva: WHO; 2020 [cited
2023 jan 04]. Avaliable from:
35. Oliveira T, Miranda L, Fernandes P & Caldeira
P. Eficácia da educação em saúde no tratamento
não medicamentoso da hipertensão arterial.
Acta Paulista de Enfermagem. 2013; 26 (2) 179-
36. Gama EJS, Queiroz JWG de, Rodrigues AKBF.
Intervenções educativas no contexto da
hipertensão arterial sistêmica: uma revisão
sistetica. Temas em Educ. e Saúde [Internet].
2021 [cited 2022 jun 06]; 7(00) e021010.
Avaliable from:
37. Motter F, Olinto M. & Paniz V. Avaliação do
conhecimento sobre níveis tensionais e
cronicidade da hipertensão: estudo com
usuários de uma farmácia básica no sul do Brasil.
Cadernos de Saúde blica. 2015; 31 (2), 395-
38. Pereira, AM. Adesão ao tratamento: estudo com
usuários hipertensos em uma unidade básica de
saúde no município de São José de Ribamar.
[master’s thesis] Coimbra: Instituto Politécnico;
2018. 50 p.
39. Ribeiro, DC. Adesão terapêutica e qualidade de
vida em adultos e adultos idosos com
hipertensão: fatores motivacionais [dissertation
on the internet]. Lisboa (Portugal): Universidade
do Porto; 2013 [cited 2022 mar 30] Avaliable
from: https://repositorio-
40. Godinho F, Andrade C e Silva C.
Acompanhamento dos doentes hipertensos nos
cuidados de saúde primários - a nossa prática.
Revista Portuguesa de Hipertensão e Risco
Cardiovascular. 2017; (60): 16-17.
41. Direco-Geral da Saúde. Programa nacional
para a promoção da alimentação saudável
[Internet]. Lisboa: DGS; 2020 [cited 2022 jun
11]. Avaliable from:
42. Sousa P, Pereira G. Intervenção na hipertensão
arterial em doentes em cuidados de saúde
primários. Psicologia, Saúde & Doenças
[Internet]. 2014 [cited 2022 dec 19]; 15 (1) 245-
261. Available from:
43. Barbosa ME, Bertelli EV, Aggio CM, Scolari
GAS, Marcon SS, & Carreira L. Fatores
associados à adesão de adultos/idosos ao
tratamento da hipertensão arterial na atenção
básica. Revista Enfermagem UERJ [Internet].
2019 [cited 2022 dec 11]; (27): 1-8. Available
from: https://www.e-
44. Dantas RCO & Roncalli AG. Protocolo para
hipertensos assistidos na atenção básica em
saúde. Cncia & Saúde Coletiva [Internet]. 2019
[cited 2023 jan 03]; 24 (1): 13 p. Available from:
45. Costa Y, Araújo C, Almeida LB, & Viegas S M.
O papel educativo do enfermeiro na adesão ao
tratamento da hipertensão arterial sistêmica:
revisão integrativa da literatura. O Mundo da
Saúde [Internet]. 2014 [cited 2022 jun 30]; 38(4):
473-481. Available from:
46. Barreto SM, Marcon SS. Participação familiar no
tratamento da hipertensão arterial na
perspectiva do doente. Texto Contexto Enferm
[Internet]. 2014 [cited 2022 jun 30]; 23(1): 38-46
Available from:
47. https://pdfs.semanticscholar.org/97d9/f36925
48. Direco-Geral da Saúde. Programa nacional
para as doencas cérebro cardiovasculares:
Lisboa. DGS; 2017 [cited 2022 apr 09].
Available from: https://www.dgs.pt/pns-e-
49. Regulamento n.º 428/2018. Regulamento de
competências específicas do enfermeiro
especialista em enfermagem comunitária na área
de enfermagem de saúde comunitria e de sade
pblica e na área de enfermagem de saúde
familiar. Dirio da Repblica, II Série (nº 135 de
16-07-2018), 19354-19359.