Caregiver-Delivered Foot Massage and Structured Family Education in Uncontrolled Essential Hypertension: An Observational Analytic Case Study of Blood-Pressure and Knowledge Outcomes

Abstract

Background: Caregiver-delivered foot massage and structured education are used as non-pharmacological nursing interventions for hypertension in Indonesian community practice. Evidence from complete family nursing records remains limited. Objective: To document one family nursing record for uncontrolled essential hypertension and quantify blood-pressure and family-knowledge outcomes using exact methods and pre-stated criteria. Methods: An observational analytic case study followed one rural South Kalimantan household during four ADPIE contacts in April 2024. The index patient was a 46-year-old woman with uncontrolled essential hypertension; her husband was the caregiver. Three daily 30-minute bilateral foot-massage sessions were delivered as a supervised handover with leaflet-supported education. Blood pressure was measured before and after each session, and family knowledge with a 10-item interview at each visit. Exact non-parametric tests evaluated changes. Results: Baseline blood pressure was 160/95 mmHg. Systolic pressure fell at every session by a mean 7.0 mmHg (SD 3.0; Hedges gz = -1.33), and diastolic pressure by 3.0 mmHg; exact tests returned the smallest two-sided values the design permits (0.25 systolic; 0.50 diastolic). Of the -20 mmHg net systolic change, -21 mmHg occurred within sessions. Knowledge increased from 2/10 to 10/10 (Cochran Q = 13.000; exact permutation p = 0.0009), four of five goals were attained, and no adverse event occurred. Conclusion: The intervention was feasible, acceptable and safe, and accompanied by consistent within-session blood-pressure reductions and a large family-knowledge gain. Adequately powered multiple-baseline designs with a washout interval are needed to test persistence.