INTRODUCTION:

Noncommunicable Diseases (NCDs) have emerged as a great contributor to the global burden of disease, holding theresponsibility of 71% of all deaths globally¹. High morbidity and prevalent diseases such as hypertension, diabetes, obesity, and smoking are risk factors of the incurable Chronic Kidney Disease (CKD), thus promoting it into an international concern throughout the recent decades.

The prevalence of CKD has reached 700 million worldwide, exceeding the number of individuals with other chronic diseases as diabetes, chronic obstructive pulmonary diseases or depression in the recent years². High occurrence rates of the disease is expected in the Middle East Region though the limited literature^2,3, which emerge the burden of the End-Stage Renal Failure (ESRF) that has an annual growth of 8%⁴ and a mortality rate higher by 17 times morethan healthy people with related age and gender³. Moreover, in the absence of governmental services, the costs of dialysis or transplantation are still unaffordable to many. While CKD can be detected using simple and readily available tests, diagnosis is still more frequent at the progressive stages given the non-specific nature of the disease⁵. The risk of theassociation of ESRF with hypertension or diabetes is high, owing to a complicated cause-outcome relationship^6,7. Difficulties arise to control blood pressure once CKD is developed, particularly in the later stages (4-5) CKD⁸. Therefore, the treatment and control ofhypertension are crucial to prevent kidney diseases. The prevalence of hypertension in the Gulf Cooperation Council (GCC) varied between 6.6% - 33.6%⁹. However, the percentage of undiagnosed and undertreated hypertensive patients is higherindeveloping than in developed countries¹⁰. Preventing the progression of CKD requires efforts to manage risk factors among the at-risk populations, alongside with longer-term lifestyle enhancements¹¹. A. El-Nahas and Bello(2005) reported that a significant difference in reducing the incidence of CKD and the consequent ESRF could be made through structured and well-resourced primary prevention programs¹². These programs must be implemented as a customized approach to different characteristics of the high-risk populations in different regions. The lack of knowledge of preventive benefits or the magnitude of the problem could be an obstacle to make a change¹³. To better improve the prevention efforts, the identification of specific clinical and sociodemographic features is required¹⁴.

Studies from different countries outlined a critical level of knowledge, various attitudes, and practices regarding prevention and early diagnosis of CKD at the community level and the patients-level^15–20. However, a few investigated these aspects in terms of high-risk patients before developing the disease. Up to the best of our knowledge, this is the first study to assess the hypertensive patients’ knowledge, attitudes and practices (KAP) regardingthe CKD in the United Arab Emirates (UAE).This study is directed toassess the KAP scores towards early identification and prevention ofCKD among hypertensive patients attending cardiology and primary care clinics in the Emirates of Ajman and Sharjah in the UAE, and to identify the socio-demographics and clinical factors related tothe KAP levels of hypertensive patients.

METHODS:

Study design:

A validatedand reliable instrument called “CKD screening index”^15,21 was conducted face-to-face following a cross-sectional design to assess of the knowledge, attitudes and practices of the hypertensive patients regarding early detection and preventionof the CKD.

Settings and population:

The study took place in two private outpatientclinics in the Emirates of Ajman and Sharjah from December 2019 until February 2020. The study included registered hypertensive attendeesat a cardiology clinic in Thumbay University hospital located in Ajman, and at a general practitioner clinic at Al Bustan primary health care centre at the Sharjah’s central region.

Sampling method and Data collection:

Non-probability convenience sampling method was determined to recruit patients. The study population involved consenting adults of 18 years or older, able to read or understand Arabic or English, had beendiagnosed with hypertension for at least 6 months and still receiving antihypertensive medical treatment. Previously diagnosedpatients with CKD were excluded from the study.

Study instrument(s):

The conducted questionnaire involved close-ended questions in three parts:

1 The sociodemographic section,which consisted of questions about age, gender, residency type, marital status, level of education, employment and monthly income. The age was collected as continuous data and then transformed into two categories: “18-64 years old” and “65 years old and above”¹⁶.

2 The clinical characteristics section. This part involved questions about the duration of hypertension, number of antihypertension medications taken, other chronic conditions except for hypertension if any, number of total daily medications taken, weight and height to calculate the Body Mass Index (BMI) following Quetelet's equation (weight (kg)/[height (m)]2)²². The BMI results were categorized into four categories (underweight, normal, overweight and obese)²³.

3 Avalidated instrument developed by Khalil et al., (2013)called the “CKD screening index”^15,21. It consisted of KAP questionnaire about prevention and early detection of CKD.In this study, the internal consistencyfor the knowledge, attitudes andpractices scales were 0.884, 0.746 and 0.775 respectively, using Cronbach’s alpha coefficient. The questionnaire and scoring system for each scale was provided by the developer in both Arabic and English languages. The knowledge scale had 24 items enfolding questions about CKD definition, risk factors, signs and symptoms, and complications. It was measured as a dichotomous scale, where “Yes” was represented by (1) and “No” or “Unsure” were represented by (0). The score was the total sum of the answers¹⁵, thus the range of possible scores were (0 to 24). The attitudes scale had 18 items questioning patients’ perspectives about preventing CKD and requesting medical help if needed. It consists of a 5-point Likert-type scale from “Strongly disagree” as (1) to “Strongly agree” as (5), the range of possible scores were (18 to 90). The practices scale had 12 items listing healthy habits to maintain one’s health and recording them in a 4-Likert-type scale, recording “Never” as (1), and “always” as (4), thus ranging from (12 to 48).

Data analysis:

The data analysis was done using the IBM-SPSS version 25. The correlation between KAP subscales was assessed by Spearman’s coefficient test. Mann-Whitney U and Kruskal-Wallis tests were used to assess differences between medians for binominal and multinomialvariables, respectively. The level of significance was set at p ≤ 0.05. Using dummy coding of 0 and 1, multiple linear regression was carried out tofurther estimate the relation of the KAP scores to the variables of significantdifferencesin the univariate analysis. Independence of residuals was assessed by Durbin-Watson statistic, and multicollinearity was assessed by the variance inflation factor (VIF).

Ethical considerations:

This study obtained the ethical approval from the Research Ethics Committee at Ajman University(Reference number: P-F-H-19-04-17)and from the Institutional Review Board in the Gulf Medical University (Reference number: EXT/COP/PG/08-2019). Before conducting the survey, verbal authorizations from the head of cardiology and primary clinics were acquired.Each participant filled an informed consent form before taking part in the study

RESULTS:

Socio-demographic characteristics of participant:

A total of200 patients with hypertension consented to participate.The mean (±SD) of age was 49.97 (9.67) years (range 23–80 years).Majority were males (81%), living in urbanresidency (86%), employed (83.5%) and married (96.5%). Nearly half of the participants completed university education (54%) and52.5% were of low monthly income. A quarter of patients had beendiagnosed with hypertension for less than one year (25%) and 36% (n=71) had been diagnosed for more than 5 years. 61% of the patients were taking only one anti-hypertension medication. Besides hypertension, no other chronic diseases have been reported by 38% (n=76). Only 5 patients (2.50%) had 4 or more other chronic diseases. Three quarters (75.0%) had total daily medication of less than 4.

CKD screening index: The KAP questionnaire:

Spearman’s test of correlation indicated a weak positive significant correlation between the knowledge and attitudes(0.294, p <0.001), and with practices scores (0.392, p < 0.001). The correlation between attitudes and practices was (0.325, p < 0.001).

Characteristics of patients related to the knowledge score:

Themean (±SD) of the knowledge’squestionnaire was 12.2 (6.09). Bivariate analysis revealed a significantly higher knowledge among females (p<0.001), urban residents (p˂0.001), university graduates compared to lower degrees (p˂0.001), andcardiology clinic setting (p=0.002). The knowledge score was significantly lower in patients earning less than 6,000 AED as monthly income than higher incomegroups (p=0.010) (Table 1).Based onlinear regression results,being female (p=0.001), living in urban residencies (p=0.015) and university level education (p=0.006) were related toa significantly higher knowledge score (Table 2).There was independence of residuals, as assessed by a Durbin-Watson statistic of 2.099. No evidence of multicollinearity was observed (VIF ranged from 1.022-1.744).

Table 1. Bivariate analysis of differences in the knowledge scores between the characteristics of 200 hypertensive participants

Variables		Median	IQR	Mean rank	p-value
Age (years)	18- 64	11.0	8.0	89.2	0.444^a
Age (years)	≥ 65	13.0	12.5	100.6	0.444^a
Gender	Male	10.0	7.3	93.5	˂ .001^a
Gender	Female	15.0	9.0	130.4	˂ .001^a
Residency	Urban	12.0	8.0	107.9	˂ .001^a
Residency	Rural	6.00	6.0	54.8	˂ .001^a
Employment	Employed	11.0	8.0	98.6	0.443^a
Employment	Unemployed	13.0	9.5	107.1	0.443^a
Marital status	Married	11.0	8.0	100.0	0.989^a
Marital status	Unmarried	13.0	12.0	99.7	0.989^a
Monthly income (AED^c)	Low (Less than 6,000)	10.0	5.5	82.4	˂ .001^b
	Middle (between 11,000 – 6,000)	13.0	9.8	118.9
	High (more than 11,000)	14.5	10.0	116.9
Educational level	Did not attend school	7.00	4.5	37.3	˂ .001^b
	Primary school	9.00	5.0	68.5
	High school	10.0	5.0	87.0
	University	14.0	9.0	121.2
Hospital settings	Primary clients	10.0	6.0	88.7	0.002^a
Hospital settings	Cardiology clients	13.0	8.5	113.9	0.002^a
Body Mass Index (BMI)	Normal	12.0	8.0	98.2	0.060^b
	Overweight	10.0	5.0	86.5
	Obese	13.0	10.0	107.3
Hypertension duration	Less than 1 year	11.5	12.8	106.4	0.548^b
	1-3 years	11.0	6.0	95.4
	4-5 years	10.0	7.3	88.6
	More than 5 years	12.0	9.0	101.8
Therapy type	One anti-HTN drug	12.0	9.0	184.8	0.066^a
Therapy type	More than one anti-HTN drug	10.0	8.0	89.5	0.066^a
Number of chronic diseases excluding HTN	0	12.0	9.8	111.5	0.237^b
	1	10.0	7.0	89.9
	2	12.0	9.0	98.6
	3	11.5	14.8	99.3
	4 or more	12.0	14.5	95.8
Number of total daily medications	Less than 4	11.0	9.0	98.7	0.572^a
Number of total daily medications	4 or more	12.0	7.5	104.0	0.572^a

^aStatistical significance of differences using Mann-Whitney U test

^bStatistical significance of differences using Kruskal-Wallis test

Values less than the significance threshold of 0.05 are bolded

Table 2. The association of the knowledge scores of hypertensive patients with their characteristics in multiple linear regression

Variables		B	β	SE B	95% CI		p-value
Variables		B	β	SE B	LL	UL	p-value
Gender^a	Female	Ref.					0.001
Gender^a	Male	-3.33	-0.21	1.03	-5.36	-1.29	0.001
Residency^a	Rural	Ref.					0.018
Residency^a	Urban	2.89	0.17	1.21	0.51	5.27	0.018
Monthly income (AED)^a	Middle or high	Ref.					0.104
Monthly income (AED)^a	Low	-1.64	-0.13	1.00	-3.62	0.34	0.104
Educational level^a	Under university degree	Ref.					0.006
Educational level^a	University degree	2.85	0.23	1.03	0.81	4.89	0.006
Hospital settings^a	Tertiary	Ref.					0.642
Hospital settings^a	Primary	0.44	0.04	0.94	-1.41	2.28	0.642

B Unstandardized coefficients;βStandardized coefficient; SE B standard error of the coefficient; Ref. Reference category; CI Confidence interval; LL lower limit; UL upper limit.

^aSignificant value from the univariate analysis were entered into the multiple regression analysis using dummy coding

Values less than the significance threshold of 0.05 are bolded

Table 3.Bivariate analysis of differences in the attitudes scores between the characteristics of 200 hypertensive participants

Variables		Median	IQR	Mean rank	p-value
Age (years)	18- 64	61.0	10.0	86.7	0.009^a
Age (years)	≥ 65	66.0	6.5	125.5	0.009^a
Gender	Male	61.0	10.5	95.1	0.013^a
Gender	Female	63.0	6.3	120.9	0.013^a
Residency	Urban	62.0	9.0	103.1	0.064^a
Residency	Rural	59.0	9.8	81.3	0.064^a
Employment	Employed	61.0	9.0	90.0	0.168^a
Employment	Unemployed	63.0	6.8	112.3	0.168^a
Marital status	Married	62.0	9.0	100.2	0.362^a
Marital status	Unmarried	60.0	10.0	80.1	0.362^a
Monthly income (AED^c)	Low (Less than 6,000)	60.0	13.0	92.1	0.219^b
	Middle (between 11,000 – 6,000)	63.0	8.0	108.1
	High (more than 11,000)	62.0	4.0	103.5
Educational level	Did not attend school	56.0	21.3	61.8	0.003^b
	Primary school	59.0	13.0	86.4
	High school	60.0	15.0	88.1
	University	63.0	7.0	113.1
Hospital settings	Primary clients	60.0	11.3	83.7	˂ .001^a
Hospital settings	Cardiology clients	63.0	7.5	118.6	˂ .001^a
Body Mass Index (BMI)	Normal	61.0	8.0	100.1	0.027^b
	Overweight	60.0	11.3	84.4
	Obese	63.0	9.0	107.6
Hypertension duration	Less than 1 year	59.0	11.3	84.9	0.027^b
	1-3 years	61.0	11.5	52.3
	4-5 years	61.5	7.0	96.5
	More than 5 years	63.0	7.5	114.8
Therapy type	One anti-HTN drug	62.0	9.3	101.1	0.408^a
Therapy type	More than one anti-HTN drug	61.0	9.3	94.2	0.408^a
Number of chronic diseases excluding HTN	0	62.0	8.0	101.9	0.538^b
	1	61.0	10.5	91.7
	2	63.0	10.0	109.2
	3	63.0	6.5	115.7
	4 or more	62.0	8.0	98.8
Number of total daily medications	Less than 4	61.0	10.0	94.4	0.027^a
Number of total daily medications	4 or more	63.0	9.0	115.2	0.027^a

^aStatistical significance of differences using Mann-Whitney U test

^bStatistical significance of differences using Kruskal-Wallis test

Values less than the significance threshold of 0.05 are bolded

Table 4. The association of the attitudes scores of hypertensive patients with their characteristics in multiple linear regression

Variables		B	β	SE B	95% CI		p-value
Variables		B	β	SE B	LL	UL	p-value
Knowledge score^b		0.16	0.10	0.31	-0.10	0.42	0.231
Age^a	18- 64	Ref.
Age^a	≥ 65	-4.14	-0.11	2.94	-9.94	1.66	0.160
Gender^a	Female	Ref.					0.195
Gender^a	Male	-2.75	0.10	2.11	-6.92	1.42	0.195
Educational level^a	Under university degree	Ref.					0.319
Educational level^a	University degree	1.91	0.10	1.91	-1.87	5.69	0.319
Hospital settings^a	Tertiary	Ref.					0.007
Hospital settings^a	Primary	-5.15	-0.27	1.88	-8.87	-1.44	0.007
Body mass index (BMI)^a	Normal or overweight	Ref.					0.299
Body mass index (BMI)^a	Obese	-1.78	-0.09	1.71	-5.15	1.59	0.299
Hypertension duration^a	Less than 5 years	Ref.					0.372
Hypertension duration^a	More than 5 years	1.44	0.07	1.61	-1.73	4.61	0.372
Number of total daily medications^a	Less than 4	Ref.					0.837
Number of total daily medications^a	4 or more	-0.39	-0.02	1.89	-4.11	3.34	0.837

B Unstandardized coefficients;βStandardized coefficient; SE B standard error of the coefficient; Ref. Reference category; CI Confidence interval; LL lower limit; UL upper limit.

^aSignificant value from the univariate analysis were entered into the multiple regression analysis using dummy coding

^b The knowledge score is a continuous variable ranging from 0 to 24

Values less than the significance threshold of 0.05 are bolded

Table 5. Bivariate analysis of differences in the practices scores between the characteristics of 200 hypertensive participants

Variables		Median	IQR	Mean rank	p-value
Age (years)	18- 64	34.0	9.0	84.8	0.011^a
Age (years)	≥ 65	38.0	6.0	121.5	0.011^a
Gender	Male	34.0	9.0	92.1	0.020^a
Gender	Female	38.0	8.5	124.3	0.020^a
Residency	Urban	35.0	8.0	105.4	˂ .001^a
Residency	Rural	29.0	7.8	53.8	˂ .001^a
Employment	Employed	35.0	8.8	98.3	0.661^a
Employment	Unemployed	34.0	12.0	93.4	0.661^a
Marital status	Married	35.0	9.0	98.4	0.260^a
Marital status	Unmarried	33.0	9.0	74.1	0.260^a
Monthly income (AED^c)	Low (Less than 6,000)	33.0	9.3	84.4	0.001^b
	Middle (between 11,000 – 6,000)	38.0	8.0	119.9
	High (more than 11,000)	34.0	6.0	99.6
Educational level	Did not attend school	28.0	9.3	47.5	˂ .001^b
	Primary school	32.0	7.0	72.8
	High school	33.0	8.8	91.4
	University	36.0	8.0	112.5
Hospital settings	Primary clients	33.0	9.0	86.1	0.002^a
Hospital settings	Cardiology clients	36.0	8.0	111.0	0.002^a
Body Mass Index (BMI)	Normal	35.0	9.0	102.5	0.055^b
	Overweight	33.0	9.0	83.3
	Obese	35.5	9.0	102.7
Hypertension duration	Less than 1 year	33.0	9.0	89.2	0.738^b
	1-3 years	34.0	10.0	99.1
	4-5 years	35.0	6.0	99.8
	More than 5 years	35.0	8.3	99.8
Therapy type	One anti-HTN drug	34.0	11.0	99.2	0.476^a
Therapy type	More than one anti-HTN drug	35.0	6.0	93.3	0.476^a
Number of chronic diseases excluding HTN	0	34.0	8.0	97.5	0.240^b
	1	33.0	9.0	89.3
	2	35.0	8.3	109.2
	3	37.0	5.0	126.9
	4 or more	37.0	5.5	116.6
Number of total daily medications	Less than 4	34.0	8.5	94.5	0.200^a
Number of total daily medications	4 or more	36.0	7.5	106.5	0.200^a

^aStatistical significance of differences using Mann-Whitney U test

^bStatistical significance of differences using Kruskal-Wallis test

Values less than the significance threshold of 0.05 are bolded

Table 6. The association of the practices scores of hypertensive patients with their characteristics in multiple linear regression

Variables		B	β	SE B	95% CI		p-value
Variables		B	β	SE B	LL	UL	p-value
Knowledge score^b		0.19	0.18	0.08	0.03	0.34	0.018
Attitude score^c		0.17	0.26	0.05	0.08	0.27	˂ .001
Age^a	18- 64	Ref.
Age^a	≥ 65	-2.64	-0.11	1.62	-5.84	0.56	0.105
Gender^a	Female	Ref.					0.114
Gender^a	Male	-1.96	-0.11	1.23	-4.40	0.48	0.114
Residency^a	Rural	Ref.					0.002
Residency^a	Urban	3.93	0.23	1.27	1.42	6.44	0.002
Monthly income (AED)^a	Middle or high	Ref.					0.951
Monthly income (AED)^a	Low	-0.07	-0.01	1.05	-2.14	2.01	0.951
Educational level^a	Under university degree	Ref.					0.669
Educational level^a	University degree	4.84	0.04	1.13	-1.75	2.72	0.669
Hospital settings^a	Tertiary	Ref.					0.921
Hospital settings^a	Primary	-0.11	-0.01	1.08	-2.23	2.02	0.921

B Unstandardized coefficients;βStandardized coefficient; SE B standard error of the coefficient; Ref. Reference category; CI Confidence interval; LL lower limit; UL upper limit.

^aSignificant value from the univariate analysis were entered into the multiple regression analysis using dummy coding

^b The knowledge score is a continuous variable ranging from 0 to 24

^cThe attitude score is a continuous variable ranging from 18 to 90

Values less than the significance threshold of 0.05 are bolded

Characteristics of patients related to the attitudes score:

The mean (±SD) of the attitudes’ questionnaire was 59.9 (9.33). Bivariate analysis revealed a significantly higher attitudes score in patients ≥65 years old (p=0.009), females (p=0.013), university graduates compared to patients who didn’t attend school (p=0.042), cardiology clinic setting (p<0.001), obese compared to overweight patients (p=0.027), patients with 5 or more years of hypertension than recently diagnosed (less than one year) (p=0.027) and patients taking 4 or more daily medications (p=0.027) (Table 3).Based on linear regression results,only cardiology clinic setting was related to significantly higher attitudes score (p=0.007) (Table 4).There was independence of residuals, as assessed by a Durbin-Watson statistic of 2.128. No evidence of multicollinearity was observed (VIF ranged from 1.143-1.988).

Characteristics of patients related to the practices score:

The mean (±SD) of the practices’ questionnairewas 34.4 (6.18). Bivariate analysis revealed a significantly higher practices score among patients ≥65 years old (p=0.011), females (p = 0.020), urban residents (p < 0.001), middle- compared to low-monthly income (p=0.001), cardiology clinic setting (p=0.002), and university graduates compared to patients who did not attend school (p=0.003) and primary school graduates (p=0.007)(Table 5).Based on linear regression results,higher practices scoreswere related with higher knowledge scores (p=0.018),higher attitudes scores (p< 0.001) andurban residents (p=0.002) (Table 6).There was independence of residuals, as assessed by a Durbin-Watson statistic of 1.898. No evidence of multicollinearity was observed (VIF ranged from 1.064-1.968).

DISCUSSION:

We found that the percentagesof hypertensive participants’ knowledge,attitudes and practices about prevention and detection of CKDwere50.8%, 66.6% and 71.7% respectively.In linear regression, asignificantlyhigher knowledge score was related tofemale patients, urban residents, and university graduates.Patients in cardiology clinics had significantly more positive attitudes. Higher practices scores weresignificantly related tohigherknowledge score, higher attitudesscore and urban residency.

The mean percentage of knowledge scores in this study wascomparable to results of an Ethiopian study atpublic hospitals of 47.9%²⁰,but more than the findings of a Malaysian study at tertiary hospitals where only 30.1% had good knowledge about CKD¹⁷.On the contrary, studies from Jordan and Palestine showed higher knowledge scores of80.3% and 61.8% respectively^15,16. Despite using the same questionnaire, the disparity in the mentionedstudiescould be explained by different health literacy in diverse cultural backgrounds, considering that the study population from Jordan included all high-risk populations such as diabetic patients and those with a family history of CKD. One unanticipated finding was that females hadsignificantly betterknowledgeregarding CKD unlike the earlier studies where gender was not related to knowledge scores^15,16,18. Moreover, the opposite was found in the study from Malaysia where males had better knowledge than females¹⁷.The finding of this study may partly be explained by the predominance of women in tertiary and university educational institutes in the United Arab Emirates²⁴. These results reflect those of Chylinska et al., (2017) who also found that women had more knowledge and desire to preserve healthy status and corporate in their treatment process²⁵.Lower knowledge scores were found to be significantly related to rural residents, in accord to findings from Gondor in Ethiopia¹⁸. Comparable evidence from the literature supported these findings,as rural settings in the Tanzanian community had a strong impact on their knowledge level regarding CKD¹⁹. In general, rural areas are challenged with a shortage of health care facilities, including the UAE despite the ongoing development²⁶. These populations are at more threat of late detection of early symptoms or biomarkers of evidence (e.g., albuminuria)²⁷.In accordance with the present results, previous studies from Palestine, Jordan, Tanzania, Ethiopia and Australia had demonstrated that university graduates were significantly related to better knowledge than lower degrees^{15,16,18,19,28}. A possible reason could be that higher educationencourages patients toseek adequate knowledge on health from trustworthy sources. This is supported by Chow et al., (2012), whose assessment of knowledge about CKD in primary care patients revealed that primary level of education was associated with lower knowledge scores²⁹.Pursuing less educated patients in rural communities may yield more efficient outcomes of the health awareness plans in the emirates of Ajman and Sharjah.

The percentage ofattitudes scoreswas 66.6%, which waslower compared tothe study from Jordan (78.7%) and Malaysia, where 68.9% hadgood attitudes scores^15,17. It seems possible that these results were due to smaller sampler size and the involvement of primary settings in the current study. We found that primary care settingwas significantly related to lower attitudes score. It is a widely held view that priorities in primary care settings are dependent on the providers’ judgment in a tight time for each appointment where patients are flooded with many chronic diseases²⁹. Considering the silent symptoms of CKD, it is less likely for a general practitioner to be concerned about screening or educating patients about the disease²⁹. Having positive attitudes implies stronger desires to change and adopt healthy behaviours, which needs support driven by knowledge. A critical situation of positive attitudes without underlying knowledge and preferred practicesrequires encouragement and advice from health care providers to establish their decision-making choices and enrich adequate information³⁰.Moreover, awareness among providers should account for tertiary hospital settings as revealed by Al Shamsi et al., (2016).A large ratio of patients who had the potential to develop CKD were not screened by a large percentage of specialists in a tertiary hospital in Al Ain in the UAE³¹.

The practices score of 71.7%was relatively higher than the Jordanian study(64.6%)¹⁵. This study indicated that higher knowledge and attitudes were related to more preventive practices to prevent and early detect CKD.These findings further support the idea of the relation between knowledge and attitudes to the practices that was found in earlier studies from Palestineand Jordan^15,16. Another relation tobetter practices scores was the urban residency which were in line with an earlier study fromEthiopia¹⁸.Contrary to expectations, this study did not find a significant relation between monthly income or educational level with the practices scoresunlike previous studies from Jordan and Ethiopia^15,18. However, with a small sample size, the findings might not reflect a generalizable view of hypertensive population in the UAE.

These findings may help in understandingthe variety of characteristics of hypertensive patients, and aid to implement comprehensive dimensions of preventive programs or self-management support groups that should be applied to correct the lack of knowledge among patients, manage various attitudes towards CKD, thus enhancingthe early detection and preventive practices. Screening for CKD among the high-risk population who had characteristics of low health literacy and unhealthy practices was found to be economically feasible and more effective in managing their current chronic conditions^32,33. Nevertheless, population-based screening was cost-effective when accounting for the burden of expensive management of End-Stage Renal Failure³⁴.

CONCLUSIONS:

The findings showed that lower preventive practices scores regarding CKD among hypertensive patients were related to lower total knowledge,lower totalattitudes and rural residency. This study revealed the importance the knowledge, attitudes and residency area on the desired preventive practices of CKD among hypertensive patients. Which could imply targeted campaigns in rural areas to enhance the levels of knowledge about CKD.

CONFLICT OF INTEREST:

The authors declare that they have no conflict of interests.

ACKNOWLEDGEMENTS:

The authors would like to thank Ajman University, Gulf Medical University, nurses at the cardiology clinic inThumbay hospital, and nurses at Al Bustan primary health care centre for their corporation in conducting the survey.

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Received on 04.11.2021 Modified on 09.03.2022

Research J. Pharm. and Tech 2023; 16(1):221-228.

DOI: 10.52711/0974-360X.2023.00041