International Journal of Public Health Science (IJPHS)

Vol. 13, No. 1, March 2024, pp. 276~281

ISSN: 2252-8806, DOI: 10.11591/ijphs.v13i1.23179  276

Knowledge, eating patterns, and hypertension among elderly in

the coastal areas of Bangkalan, Indonesia

Pipit Festi Wiliyanarti1, Fitri Wulandari1, Eni Sumarliyah1,2

1
Department of Community Nursing, Faculty of Health Science Universitas Muhammadiyah of Surabaya, Surabaya, Indonesia
2
Department of Adult Nursing, Faculty of Health Science, Universitas Muhammadiyah of Surabaya, Surabaya, Indonesia

Article Info ABSTRACT

Article history: Hypertension is a non-communicable disease which frequently occurs in the
elderly. This study aimed to assess hypertension and knowledge as well as
Received Mar 20, 2023 hypertension and eating patterns among elderly in the coastal areas. The
Revised Aug 3, 2023 design of this study is cross-sectional study. The population in this study were
Accepted Aug 15, 2023 elderly with hypertension who lived in the Sukolilo Health Center area in
Bangkalan. The sample was selected using simple random sampling of 110
elderlies. The inclusion criteria were elderly who were aged ≥60 years old
Keywords: with systolic blood pressure (SBP) of >140 mmHg and diastolic blood
pressure (DBP) of >90 mmHg. The instrument was food frequency
Blood pressure questionnaire (FFQ). The blood pressure was measured by using standard
Eating pattern operating procedures. The data were analyzed by the Spearman’s rank test.
Elderly The results indicated that most of the respondents were lack of knowledge of
Hypertension 66 people (29.1%) and had a poor eating pattern of 78 people (70.9%). Most
Knowledge of the respondents were in the moderate hypertension of 52 people (47.3%).
The statistical analysis indicated a relationship between knowledge and the
incidence of hypertension of p=0.004 (p<0.05; r=0.974). In conclusion,
understanding about blood pressure control is required to prevent
hypertension.
This is an open access article under the CC BY-SA license.

Corresponding Author:
Pipit Festi Wiliyanarti
Department of Community Nursing, Faculty of Health Science, Universitas Muhammadiyah of Surabaya
Surabaya, East Java 60113, Indonesia
Email: [email protected]

1. INTRODUCTION
Hypertension is a non-communicable disease that frequently occurs in the elderly [1]. Hypertension
can cause morbidity, falls, or fractures among the elderly [2]. The high prevalence of hypertension among the
elderly in coastal areas becomes a public health issue. Hypertension among the elderly can be caused by various
factors including poor eating patterns and consuming too much salt, especially for the elderly who live in the
coastal areas [3], [4]. Poor eating patterns are affected by the knowledge about diet intake which causes
hypertension [1], [5], [6]. A healthy eating pattern among hypertension patients is reflected in the selection of
food [7].
The results of the Indonesian Basic Health Research showed that the prevalence of hypertension in
the elderly was higher in men, approximately 50.5% [8]. East Java Province has a hypertension rate exceeding
the national rate of 22.71% [9]. Furthermore, in one of the cities in East Java, Bangkalan, it was found that
there were 1,518 hypertension cases, and this increased to 7,034 sufferers in 2018. The preliminary data
obtained from the Sukolilo Health Center in 2019 for three months revealed 695 people (25%) who experienced
hypertension. In other words, the number of hypertension cases in Bangkalan is still high. Furthermore, the
preliminary study also indicated that 66.7% of elderly with hypertension in coastal areas consumed excessive

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Int J Public Health Sci ISSN: 2252-8806  277

salt intake, fatty foods with high cholesterol, and also sugar. The results of the food frequency questionnaire
(FFQ) screening questionnaire found that 60% of the elderly with poor eating patterns also experienced
moderate and severe hypertension.
The elderly living in the coastal areas consume salty foods, and it can trigger high blood pressure [3].
Also, they consume food without sufficient potassium and fiber. This condition can cause an imbalance in
nutritional status [10] and risk factors for hypertension, coronary heart disease, and diabetes mellitus [11]. The
preliminary data also indicated that the community in Sukolilo Health Center often consumes junk food, salty
food, high calorie and sugar, low fiber, fatty food, and coffee. They also had short sleep duration. The
previously-mentioned conditions can trigger hypertension [11]–[13].
Eating pattern has an important role in the process of monitoring, maintaining, and preventing
complications of hypertension [14], [15]. A good eating pattern is also the key to preventing hypertension [15]–
[18]. To our best knowledge, references related to eating patterns and the incidence of hypertension in the
coastal areas are still rare. Knowledge of food management and food selection is also related to the occurrence
of hypertension. Preventing and controlling blood pressure by reducing stress, consuming healthy foods
including fruits, fresh vegetables, fiber, and potassium, limiting salt intake and high sugar, and reducing
alcoholic beverages and coffee [19]. This study highlighted eating patterns and knowledge in food management
among the elderly in the coastal areas. In light of this background, this study aimed to assess hypertension and
knowledge as well as hypertension and eating patterns among the elderly in the coastal areas. By understanding
these factors, hypertension among the elderly can be prevented and controlled.

2. METHOD
This study was granted by ethical clearance number 072/1508/433/2021 from Nursing School,
Universitas Muhammadiyah Surabaya, Indonesia. The population in this study were elderly with hypertension
who lived in the Sukolilo Health Center area, Bangkalan. The data were obtained through three months of
documentation. This study applied observational analytic correlation with a cross-sectional design. Total
population in this study was 152. We used Slovin Formula to calculate the sample size. The final sample was
110 elderlies selected by simple random sampling. The inclusion criteria were elderly aged ≥60 years old with
a systolic blood pressure of >140 mmHg and diastolic blood pressure of >90 mmHg [19]. The exclusion criteria
were the elderly with serious hearing loss, aggressive physical behavior, and not having other disease
complications. The researchers obtained informed consent from respondents before collecting the data.
The data were collected by using a self-report questionnaire. We already tested content validity and
reliability using internal concistency. The content validity for each questionnaire was measured using
correlation between each item and total score. The result showed significant (p-value <0.05) and r>0.2. The
Cronbach alpa of each questionnaire showed >0.6, it was acceptable. The instrument used to assess eating
patterns was FFQ. The questionnaires measured the type, frequency, and amount of food consumed in a certain
period. It used an ordinal scale with a score of 0 (not consumed), 1 (rarely consume), 10 (once to twice a week),
15 (3-6 times a week), 25 (once a day), and 50 (every day) [20]. The total score was interpreted as good,
moderate, and fair. The researchers used six questions to assess knowledge of hypertension among elderly with
two options to answer, yes (1) and no (0). The questionnaire consisted of a definition of hypertension, the
causes of hypertension, foods that should and should not be consumed, and prevention of hypertension through
dietary adjustments. A total score of ≤2 was considered to have poor knowledge, a score of >2-4 was considered
to have sufficient knowledge, and a score of >4 considered to have good knowledge. Blood pressure was
measured by using standard operating procedures from JNC 8 (2014) and Potter & Perry [21], [22] . Then, the
data were analyzed by the Spearman’s rank test with a statistical p-value<0.05. In addition, a correlation of
more than 0.2 was satisfaction [23].

3. RESULTS AND DISCUSSION

3.1. The characteristic of respondents
Data in Table 1 show the characteristic of respondents. A total of 80 respondents (72.72%) are female,
44 respondents (40%) are 66-70 years old, and 49 respondents (44.54%) are widows. A total of 58 respondents
(52.7%) are elementary school graduates, 72 respondents (65.4%) have income less than IDR 1,000,000, and
11 respondents (10%) earn more than IDR 3,000,000. Most of the respondents were elderly with no education
degree and their income was less than IDR 1,000,000 (<66 USD). Previous study mentioned that elderly had
risk of cognitive impairement [24]. Furthermore, less income also related with unhealthy eating [25]. It
contributed to lack of knowledge and eating pattern among the elderly.

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3.2. Knowledge, eating patterns, and hypertension among elderly with hypertension
Data in Table 2 show the distribution of knowledge, eating patterns, and hypertension among the
elderly. A total of 66 respondents (60%) are lack of knowledge, 78 respondents (70.9%) have a poor eating
pattern, and 52 respondents (47.3%) are in the moderate hypertension category.

Table 1. The characteristics of respondents

Characteristics Frequency Percentage (%)
Gender
Male 30 27.27
Female 80 72.72
Total 110 100.0
Age
60-65 years old 26 23.63
66-70 years old 44 40
71-75 years old 25 22.7
76- 80 years old 15 13.63
Total 110 100.0
Marital status
Marriage 40 36.36
Widower 21 19.09
Widow 49 44.54
Total 110 100.0
Educational background
Not finished school 31 28.2
Elementary school 58 52.7
Junior high school 15 13.6
Senior high school 6 5.5
Total 110 100.0
Income
<IDR. 1,000,000 72 65.4
IDR 1,000,000 - 3,000,000 27 24.54
>IDR 3,000,000 11 10
Total 110 100.0

Table 2. Distribution of knowledge, eating pattern, and hypertension among elderly

Variable Frequency Percentage (%)
Knowledge
Good 2 1.81
Sufficient 42 38.18
Poor 66 60
Eating pattern
Good 0 0
Moderate 32 29.1
Poor 78 70.9
Hypertension
Mild >140/90 mmHg 44 40
Moderate >160/100 mmHg 52 47.3
High >180/110 mmHg 14 12.7

In terms of knowledge, 29.1% of the elderly had inadequate or less knowledge about foods prone to
hypertension. The 50% of the elderly reported that hypertension was a common disease at their age. Knowledge
is needed to prevent hypertension, especially to control hypertension. A previous study mentioned that good
knowledge could control high blood pressure [6]. Healthcare providers must pay attention to health education
promotion among the elderly and families of elderly with hypertension to increase their knowledge [26], [27].
This study also found respondents in the less knowledge category had a history of low education. It is assumed
that the elderly is hard to receive information related to good food consumption to prevent hypertension from
healthcare providers, family, or friends.
The majority of the elderly living in the Sukolilo Health Center area had poor eating patterns. Eating
patterns are a way or behavior of a person in choosing food to be consumed every day, which includes the type
of food, the amount of food, and the frequency of food to maintain health, and it is related to diet quality [28].
The elderly must pay attention to nutritional intake to prevent some diastases [29]. This essential nutritional
need for maintaining their immune system [30]. This study found that respondents often consume foods
containing high sodium and fatty foods. Nutrition is also needed for the elderly to reduce degenerative diseases

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Int J Public Health Sci ISSN: 2252-8806  279

and the possibility of malnutrition [31], [32]. Controlling the elderly’s eating patterns includes the amount of
food, meal schedule, and type of food according to the needs of the elderly. It also requires attention from the
elderly’s families in providing good food for the elderly. Moreover, initially, healthcare providers must provide
health education to them [33].
Regarding hypertension, the majority of respondents were in the category of moderate hypertension based
on WHO guidelines [19], in which their systolic blood pressure was above 140 mmHg and their diastolic blood
pressure was above 90 mmHg. Hypertension is a condition in which a person experiences an increase in blood
pressure which can result in morbidity and mortality [19]. In addition, hypertension occurred when blood pressure
is too high. High blood pressure is related to cardiovascular disease, renal failure, and cerebral stroke [34].
Factors affecting hypertension in the elderly include uncontrolled risk factors (major) such as age,
sex, heredity, and race, while controlled risk factors include changes in lifestyle, poor diet, excessive alcohol
consumption, smoking habits, obesity, lack of exercise, and excessive sodium consumption. Consuming salty
foods leads to hypertension, volume expansion, a disorder in sodium balance, and renin-angiotensin,
aldosterone system [35]. Therefore, it is required to control salt intake among the elderly.

3.3. The relationship between knowledge, eating pattern, and hypertension in the elderly
Data in Table 3 showed the correlation between knowledge, eating pattern, and hypertension. It shows
that most of the elderly with severe hypertension category have poor eating patterns as many as
14 people (12.7%). The statistical test results show that there is a relationship between diet and the incidence
of hypertension p=0.004 (p<0.05; r=0.974). In addition, 32 elderly people with moderate hypertension have
less knowledge (29.1%). Furthermore, there is a relationship between knowledge and the incidence of
hypertension p=0.004 (p<0.05; r=0.974).

Table 3. The Relationship between Knowledge, Eating Pattern, and Hypertension

Hypertension
Mild Moderate High
n % n % n %
Knowledge
Good 2 1.8 16 14.5 26 23.6 p-value<0.05
Sufficient 0 0 20 18.2 32 29.1 r=+0.974
Poor 0 0 6 5.4 8 7.3
Eating pattern
Good 0 0 18 16.4 26 23.6 p-value<0.05
Moderate 0 0 11 10 41 37.3 r=+0.974
Poor 0 0 3 2.7 11 10

The results showed that the elderly with moderate hypertension had poor eating patterns. In this study,
the respondents were reported to consume salty food and coconut milk. These foods are associated with high
blood pressure [35], [36]. In addition, the lack of consuming food containing potassium and fiber will cause
the amount of sodium to accumulate [37], [38].
The elderly consumed foods containing high sodium, such as salt, salted fish, salted eggs, and boiled
fish because their sense of taste was decreasing. Furthermore, the respondents did not know about foods and
eating patterns which could trigger hypertension [39]. The results of the interviews showed that 8 respondents
with severe hypertension often consumed salty food and fatty foods. Cholesterol from fatty food can trigger
hypertension among the elderly. High cholesterol can increase the risk of atherosclerosis as well as blood
pressure [40]. Cholesterol levels can form a plaque which causes blood flow to slow down, forcing the heart
to pump blood harder, and leading to hypertension [41]. On the other hand, fresh vegetables and fruit contain
lots of vitamins, minerals, and potassium which can help lower blood pressure [41].
Based on the results of the study, it was found that there was a relationship between knowledge, eating
patterns, and hypertension among the elderly. Controlling blood pressure is required to prevent hypertension
and can be conducted by having good eating patterns. In addition, health education related to hypertension
must be provided by nurses or healthcare providers in the primary health care.

4. CONCLUSION
In conclusion, the elderly living in the coastal areas is lack of knowledge about hypertension. Also, most
of the elderly had poor eating patterns. The incidence of hypertension in the elderly is predominantly with
moderate hypertension. Furthermore, there is a relationship between knowledge, eating patterns, and the incidence
of hypertension in the elderly living coastal areas. The elderly must pay attention to their eating patterns and at
the same time, healthcare services must provide health education to the elderly and their families, especially those
Knowledge, eating patterns, and hypertension among elderly … (Pipit Festi Wiliyanarti)
280  ISSN: 2252-8806

living in the coastal areas. This study is limited in terms of location, in the coastal areas, so it cannot be generalized.
Further study is needed to assess high blood pressure among the elderly in other areas.

ACKNOWLEDGEMENTS
We would like to thank all the respondents, especially for the elderly in Bangkalan. We obtained grant
from Universitas Muhammadiyah Surabaya number 123.1/II.3.AU/LPPM/F/2022

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BIOGRAPHIES OF AUTHORS

Pipit Festi Wiliyanarti is Lecturer at Faculty of Health Science, Universitas

Muhammadiyah of Surabaya. The area of expertise includes community and family health
nursing. She was graduated from doctoral degree, Public Health Faculty, Universitas
Airalngga. She can be contacted at email: [email protected].

Fitri Wulandari was graduated from school of nursing, Faculty of Health

Science, Universitas Muhammadiyah of Surabaya. Currently she is working as a nurse. She
can be contacted at email: [email protected].

Eni Sumarliyah is a lecturer at School of Nursing, Faculty of Health Science,

Universitas Muahammadiyah of Surabaya. She had background as a nurse and she was
graduated from bachelor of nursing, Universitas Airlangga. She can be contacted at
[email protected].

Knowledge, eating patterns, and hypertension among elderly … (Pipit Festi Wiliyanarti)