In total, 3450 of the sampled 3,854 participants agreed to participate and were included in the analyses (89.5%), with one participant sampled from each household.
Almost 60% of participants were women, and half were from each rural and urban areas (Table
Descriptive information on sample population, disaggregated by age, sex, urbanicity, educational level and employment status
The median age of participants was 33 years. Rural and urban median age was not significantly different (32 and 34 years, p = 0.08), while females, overall, were older than their male counterparts by three years (p <0.05).
The majority of participants were educated to a secondary school level with 33% having attended university, while 6.4% had received education to the level of primary or less. Students made up one-fifth of participants, of which half were women. More than 43% of participants reported to be employed and 14.7% currently unemployed. Retirees or home-makers accounted for 20% of the sample, of which 75% were women.
Comparing rural versus urban populations, no significant differences were found in terms of median age, gender distribution or employment status. Although, significantly more urban participants had received secondary or tertiary education than their rural counterparts (p <0.05).
General Health Knowledge Regarding Blood Pressure
With respect to blood pressure, 17.4% (95%CI: 16.2% to 18.7%) of participants rated their knowledge as ‘never heard the term before’ – indicating no health knowledge with regards to blood pressure (Table
). This basic health knowledge was significantly lower among younger populations, observed through both univariate and multivariate analyses; and male populations. These associations held after controlling for urbanicity, educational level and employment status. No significant difference in awareness was found between urban and rural populations, though there was a significant relationship between a lack of basic knowledge and lower levels of formal education. In addition, retirees and home-makers were the best informed with regards to blood pressure while the unemployed and students were significantly more likely to lack basic knowledge.
Knowledge and attitudes toward blood pressure
Two-fifths (40%, 38.3-41.5) of participants rated their knowledge as high and felt they were ‘very familiar’ with the concept of blood pressure. Women were more likely to rate their knowledge as high (42% versus 36%), as were tertiary graduated participants (46%, 42.9-48.7) and those currently employed (18.4% versus 11.0% in unemployed). All these differences were statistically significant. No significant differences were found between rural and urban groups.
Following this question, a brief explanation of ‘blood pressure’ was provided to all participants.
Risk perceptions regarding high blood pressure and related disease
The majority of participants recognised high blood pressure to be a threat to health (Table
). Females were significantly more likely to hold this view, 81.3% (95%CI: 79.6 to 83.0) versus 74.2 (95%CI: 71.9 to 76.5) in men. This was also significant when all other variables were controlled. Urban as well as older populations held higher risk perceptions (p <0.05). Education level was again linked to a heightened knowledge and risk perception (p <0.05).
Participants were then questioned on their awareness regarding the risk posed to specific body organs from high blood pressure, as another measure of risk perception and knowledge. This time, 54.2% were aware of the risks of blood pressure to the heart, kidneys and brain. Women were significantly more likely to be aware of the risks than men (MOR 1.4), and urban populations were again better informed than their rural counterparts (MOR 1.2). Tertiary educated, and oldest populations, were again most informed (p <0.05).
Knowledge, attitudes and practices regarding blood pressure screening
Attitudes towards blood pressure screening were similar across all groups, once the concept of blood pressure was explained, with more than 95% (95%CI: 95.8% to 97.0%) of respondents perceiving screening programs to be valuable (Table
). Small but significant differences were observed between men and women, 94.5% (95%CI: 93.3% to 95.7%) and 97.8% (95%CI: 97.2% to 98.4%). The oldest age group, aged 55 – 64 years, perceived the risk to be higher than younger age groups (p <0.05).
Exploring barriers to blood pressure screening, participants rated a ‘lack of self-perceived importance’ as the main deterring factor for screening amongst fellow Mongolians (47.8%, 46.1-49.5) (Figure
Perceived barriers to public blood pressure screening, total population.
A ‘lack of awareness of the need’ to be screened was reported by almost three in ten responses (95%CI: 27.9-30.9). Time constraints, or ‘a lack of time’ was cited by 17.3% of Mongolians (95%CI: 15.4-19.2), while few (5.4%, 4.3-6.5) blamed a lack of awareness of screening services and access. No statistically significant differences were found between groups disaggregated by gender, urbanicity, educational experience or employment status.
Groups with less education tended to cite time constraints and a lack of awareness of the services, than more educated groups, though these trends were not statistically significant.
Prevention of high blood pressure
Field surveyors then read participants a list of four commonly used prevention methods for high blood pressure and asked to weight their perceived effectiveness on a 3-point Likert scale from not effective to highly effective. Results between one and two represent low or no perceived-effectiveness, while results between two and three represent increasing perceived-effectiveness (Table
Perceived effectiveness of common prevention methods for high blood pressure, as measured by mean and associated 95% confidence-interval* from a three-point Likert Scale
Overall, participants perceived medication and exercise as the only interventions moderately effective at preventing high blood pressure. Medication was perceived to be significantly more effective than weight loss, dietary changes or exercise, with a mean of 2.16 (95%CI: 2.14-2.18). Exercise was perceived to be borderline effective with a mean score of 2.04 (95%CI: 2.02-2.06). Weight loss was perceived to be least effective of the four and on the whole, not effective with a score of 1.85. Dietary changes were also not perceived as effective in preventing high blood pressure and its complications.
Disaggregated analysis showed on average, women found all interventions to be more effective compared to men, as did urban populations compared to rural. These findings were all statistically significant (Table
). The youngest populations perceived all prevention methods to be significantly less effective than older counterparts, with an increasing age-related gradient noted across all four prevention methods (all p <0.05). Across educational backgrounds, higher education was associated with a higher perceived effectiveness across all interventions with lower educated groups only reporting medications to be effective. Significant differences were also evident between employed and unemployed groups, with higher perceived prevention effectiveness among the employed, for three out of four methods.
Knowledge, attitudes and practices regarding blood pressure risk factors
Turning to knowledge with regards to risk factors and focusing on dietary salt intake (Table
), roughly seven in every ten participants were aware of the relationship between salt and blood pressure, both that intake affected blood pressure and that increased salt consumption could lead to a rise in blood pressure. Women were significantly more aware, with 77.6% of women recognising the link. Again, urban populations and older populations were significantly more informed with regards to this risk factor, independent of other factors. While students were comparatively less aware, only small differences were found between employed and unemployed groups. This level of awareness was not affected by educational background.
Questions were then posed exploring attitudes and knowledge around dietary salt and sources of dietary salt (Table
). Participants were asked whether they were conscious of their salt consumption in their daily lives, to which two-thirds answered that they were (95%CI: 64.6%-67.8%). Females significantly more likely to be conscious of dietary salt intake and this difference was heightened by multivariate analysis. Advancing age (both univariate and multivariate models), employment and higher education were significantly associated with consciousness (p <0.05). No significant differences were found between urban and rural or educational groups.
Perceptions and attitudes towards dietary salt and sources of dietary salt
Participants were then asked to choose the main perceived source of dietary salt, from either raw foods; added salt during cooking and eating; or salt consumed from processed meats, breads and biscuits. Nine in every ten participants (91.8%, 90.9-92.7) believed that the main source of dietary salt was that which they added to their meals during cooking or eating. Similar numbers of participants reported ‘raw foods such as milk, meat and vegetables’ and ‘processed foods such as bread, sausages and biscuits’ as their main sources, with four (3.7%, 3.1-4.3) and five percent (4.5%, 3.8-5.2) respectively. Disaggregated data showed no differences between sexes, age, educational or employment groups. While rural dwellers were statistically more likely to recognise the high dietary-salt contributions of processed foods to Mongolian diets, the two percent difference is unlikely to confer any meaningful population-level benefits.