Logotherapy Increase Self-efficacy and Improve Blood Pressure’s
Regulation in Patients with Hypertension
Eka Mishbahatul Marah Has, Nita Tri Septiana and Herdina Mariyanti
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
Keywords: Logotherapy, Self-efficacy, Blood Pressure Regulation, Hypertension
Abstract: Strong self-efficacy is needed to ensure patients with hypertension follow their long-term treatment and
regulate their blood pressure. Logotherapy is one type of psychotherapy that can heal through discovering the
meaning of life. This study was aimed to analyze the influence of logotherapy towards self-efficacy and blood
pressure regulation in patients with hypertension. A quasi-experimental research method was used. The
selected sample were 30 patients with hypertension, selected through purposive sampling, and divided into
treatment and control group. The data were collected through a self-efficacy questionnaire and blood pressure
measurement. Data were analyzed using the Wilcoxon Signed Ranks Test and Mann Whitney Test with α =
0.05. The result showed differences in self-efficacy between pre- and post-test results in the treatment
group (p = 0.001), but there were no differences in the control group. There were differences in systolic and
diastolic blood pressure in the treatment group (p = 0.001; p = 0.001), but there were no differences in the
control group. There were significant differences between treatment and control groups in self-efficacy (p =
0.038) and the regulation of systolic and diastolic blood pressure (p = 0.006; p = 0.032). Logotherapy can
increase self-efficacy and improve blood pressure regulation in patients with hypertension. Nurses can use
logotherapy as an alternative nursing intervention, both in clinical and community practice.
1 BACKGROUND
Hypertension is a chronic disease that cannot be
cured, but can be controlled through long-term
treatment, both through pharmacological and
nonpharmacological treatments (Soenarta et al.,
2015). Treatment compliance with low hypertensive
control, results in high rates of morbidity and
mortality in hypertensive patients (World Health
Organization, 2013). A survey on hypertensive
treatment compliance in China indicated that out of
232 hypertensive patients there was low adherence
(26.3%), moderate adherence (22.0%) and high
adherence (51.7%) to treatment (Yue, Bin, Weilin, &
Aifang, 2015). WHO (2013) estimates that
uncontrolled blood pressure in hypertensive patients
results from a 50%–70% non-compliance rate.
Self-efficacy is defined as optimistic self-belief in
competence or chances of successfully
accomplishing a task and producing a favorable
outcome (Bandura, 1994). Self-efficacy plays an
important factor in improving long-term treatment
adherence to chronic disease (Warren-Findlow &
Huber, 2013). Strong self-efficacy is significantly
associated with the prevalence of medication
adherence (Bash, 2015). Huber & Warren Findlow
(2011) also explain that management of chronic
diseases, such as hypertension, require patients to
have the confidence to care for themselves. Self-
efficacy is a dominant factor affecting self-care
management so action is recommended, improving
self-efficacy aims to produce good self-care
management (Prasetya, Handayani, & Purbandari,
2013).
Self-efficacy improvement can be achieved
through psychological approaches using
psychotherapy, such as logotherapy. Logotherapy has
been used as a therapeutic intervention for individuals
who struggle with long-term treatment disease, such
as cardiac illness (Marshall, 2012). Logotherapy is
defined as therapy that seeks to heal through
accessing the meaning and purpose of life (Viktor E
Frankl, 1966). By discovering the meaning of life,
one can increase their confidence and view each
moment as a positive experience (Engel & Yusuf,
2013). Bastaman (2007) explains that logotherapy
can be done over four session: 1) identify the
problems and changes; 2) express an individual's life
206
Has, E., Septiana, N. and Mariyanti, H.
Logotherapy Increase Self-efficacy and Improve Blood Pressure’s Regulation in Patients with Hypertension.
DOI: 10.5220/0008322802060214
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 206-214
ISBN: 978-989-758-336-0
Copyright
c
 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

expectations and the reasons; 3) determine the most
important meaning of life; and 4) evaluate the
implementation of logotherapy.
The results of research conducted by Agustini
(2016) explains that someone who finds the meaning
of life in accepting their disease will have stronger
self-efficacy when undergoing treatment. DeWitz
(2004) also mentioned that discovering the purpose of
life affects individual's self-efficacy. Self-efficacy
will drive motivation, cognitive ability, and action to
achieve a desired goal (Bandura, 1994). Research
conducted by Julom and de Guzmán (2013) shows the
effectiveness of logotherapy on the meaning of life.
The use of logotherapy in finding the purpose of life
can be done in hypertensive patients to increase self-
confidence and achieve treatment success. The
success of treatment in hypertensive patients is that
blood pressure regulation can be controlled normally.
Fatimah (2009) mentions that logotherapy
influences decreasing the level of blood pressure in
elderly patients with hypertension. Previous research
also determines that the improvement of self-efficacy
significantly decreases systolic and diastolic blood
pressure (Yu, Song, & Lee, 2001).
The effect of logotherapy on self-efficacy and
blood pressure regulation in hypertensive patients
needs to be analyzed. The results of this study are
expected to provide new knowledge for hypertensive
patients and nurses as an alternative in the
management of hypertension, through discovering
the meaning of life to increase self-efficacy in
continuing long-term treatment and maintaining
stability in blood pressure. The aim of this research is
to analyze the influence of logotherapy towards self-
efficacy and blood pressure regulation in patients
with hypertension.
2 METHODS
This research used a quasi-experimental research
method with a pre- and post-test control group design.
The total population were 108 patients with
hypertension. The sample of 30 respondents was
selected by using a purposive sampling technique,
divided into treatment and control groups (15
respondents in each).
Each respondent in the treatment group received
four meetings for individual logotherapy during the
afternoon, over two weeks. Each meeting took 45
minutes to complete. At the end of each meeting,
respondents fill out the logotherapy workbook, and
the researcher evaluates their achievement, against
the criteria listed in the standard operational
procedures. If the respondent meets the outcome
indicators for the session, the respondent can proceed
to the next session. If the respondent is not able to
meet the outcome indicators of the session, the
respondent remains at the same session at the next
meeting.
Data were collected by using a hypertension
management self-efficacy scale and blood pressure
measurement. Patients’ blood pressure was measured
using a sphygmomanometer and stethoscope. The
level of self-efficacy and blood pressure of the
treatment group were measured before treatment
(pre-test) and after the four meetings (post-test). The
control group was measured twice: firstly, a pre-test
measurement, then after two weeks for post-test. Data
were then analyzed using Wilcoxon Signed Ranks
Test and Mann Whitney Test with a level of
significance α = 0,05.
This research protocol was ethically accepted by
the Ethical Committee of Health Research at the
Faculty of Nursing, Universitas Airlangga, Indonesia.
Ethic approval certificate number 321–KEPK at
January 24, 2017.
3 RESULTS
Table 1 shows the distribution of respondents’
characteristics in the control and treatment groups.
The number of respondents altogether in both groups
was 30. The characteristics of respondents in the
control group were as follows: twelve (most)
respondents (80%) were 55–64 years old, six (46.7%)
were retired, nine (60%) were elementary school
graduates, and five (46.7%) respondents had suffered
from hypertension for five years. The characteristics
of respondents in the treatment group were as
follows: eight respondents (53.3%), were 55–64 years
old, eight (53.3%) were housewives, eight (53.3%)
were elementary school graduates, and seven (46.7%)
had suffered from hypertension for seven years.
Table 1: The characteristics of respondents.
Characteristic
Control groups
Treatment
g
rou
p
s
n % n %
Age
45
–
54 3 20 7 46.7
55–64 12 80 8 53.3
Total 15 100 15 100
Jobs
Housewife 2 13.3 8 53.3
Entrepreneu
r
5 33.3 3 20
Private employee 2 13.3 2 13.3
Logotherapy Increase Self-efficacy and Improve Blood Pressure’s Regulation in Patients with Hypertension
207

Retired 6 40 2 13.3
Total 15 100 15 100
Level of education
Elementar
y
school 9 60 8 53.3
Junior high school 2 13.3 1 6.7
Senior high school 4 26.7 6 40
Total 15 100 15 100
How long experiencing hypertension
5
y
ears 5 33.3 3 20
6 years 4 26.7 4 26.7
7 years 2 13.3 7 46.7
8 years 2 13.3 0 0
10 years 2 13.3 0 0
13 years 0 0 1 6.6
Total 15 100 15 100
Table 2 explains the distribution of respondents’
self-efficacy in both the treatment and control groups.
The level of respondents’ self-efficacy in both groups
at pre-test were mostly at a moderate level (11
respondents on control group and 12 respondents in
the treatment group). Post-test, the level of
respondents’ self-efficacy was also on a moderate
level (10 respondents in each of the control and
treatment groups).
Table 2: The level of self-efficacy.
Category
Control group Treatment group
Pre Post Pre Post
n % n % n % n %
Strong 2 13.3 1 6.6 - - 5 33.3
Moderate 11 73.4 10 66.7 12 80 10 66.7
Weak 2 13.3 4 26.7 3 20 - -
Total 15 100 15 100 15 100 15 100
Mean 66.67 65.80 57.00 72.27
Wilcoxon si
g
ned Rank test
p
= 0.507
p
= 0.001
Mann Whitney Test
p
= 0.038
Table 3: The regulation of blood pressures.
Control Group Treatment Group
Systolic Diastolic Systolic Diastolic
Pre Post ∆ Pre Post ∆ Pre Post ∆ Pre Post ∆
R1 140 140 0 100 80 -20 150 130 -20 100 90 -10
R2 160 150 -10 80 100 [phone] 100 -10
R3 150 160 [phone] 90 90 0
R4 170 160 -10 110 100 -10 160 150 -10 100 80 -20
R5 150 150 0 100 90 -10 160 140 -20 100 90 -10
R6 150 150 0 90 90 0 170 140 -30 100 100 0
R7 170 170 0 110 100 -10 140 140 0 90 80 -10
R8 140 150 [phone] -30 100 90 -10
R9 140 150 +10 80 100 [phone] -10
R10 140 150 [phone] 90 80 -10
R11 170 170 0 100 110 [phone] -10
R12 140 150 [phone] 100 90 -10
R13 130 150 [phone] 90 80 -10
R14 140 150 +10 90 100 [phone] -10
R15 150 140 -10 90 90 0 160 140 -20 100 80 -20
Mean 150 152 94 94 157 141 98 88
SD 12.53 8.61 9.1 7.36 9.612 9.904 5.606 6.76
Wilcoxon
p
= 0.366
p
= 0.951
p
= 0.001
p
= 0.001
Mann
Whitney
Test
Pre-test
Systolic
p
= 0.080
Diastolic
p
= 0.131
Post-test
Systolic
p
= 0.006
Diastolic
p
= 0.032
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
208

The distribution of self-efficacy in the control
group showed that there were only two respondents
who had strong self-efficacy in the pre-test and this
decreased to one respondent in the post-test. The
number of respondents with a moderate level of self-
efficacy decreased from 11 in the pre-test to 10
respondents in the post-test. In the opposite group, the
number of respondents with a weak level of self-
efficacy increased from two respondents in the pre-
test to four respondents in the post-test.
The distribution of self-efficacy in the treatment
group showed a significant increase. The number of
respondents with a strong level of self-efficacy scored
zero in the pre-test, then increased to five respondents
in the post-test. However, the number of respondents
with a weak level of self-efficacy decreased from
three respondents in the pre-test to zero in the post-
test.
Statistical analysis was conducted using the
Wilcoxon Signed Rank Test, which compares
respondents’ level of self-efficacy between the pre-
and post-tests in each group. The results showed that
there were significant differences in the treatment
group (p = 0.001), but no significant differences in the
control group (p = 0.507).
The Mann Whitney Test was used to compare the
level of self-efficacy in the post-test between the
control and treatment group. The result had shown p
= 0.038 (p<0.05), which means there was a
significant difference in the level of self-efficacy
between the control and treatment group after
logotherapy.
Table 3 shows the average systolic and diastolic
blood pressure pre- and post-test in both groups. The
mean of systolic blood pressure in the control group
pre-test was 150mmHg and post-test it was
152mmHg. The highest difference between pre-and
post-test was +20mmHg and the lowest was -10
mmHg. The mean of diastolic blood pressure in the
pre-test was 94mmHg, and this was the same in the
post-test. The biggest difference between pre- and
post-test was +20mmHg and the smallest was -20
mmHg. On the other hand, the mean of systolic blood
pressure in the treatment group pre-test was 157.33
mmHg and post-test it was 141.33mmHg. The
greatest difference between pre- and post-test was
0mmHg and the smallest was -30mmHg. The mean
of diastolic blood pressure pre-test was 98mmHg and
post-test it was 88mmHg. The greatest difference
between pre- and post-test was 0mmHg and the
smallest difference was -20mmHg.
The results of the Wilcoxon Signed Rank Test
show that there were no significant differences in
respondents’ systolic and diastolic blood pressure
between pre- and post-tests in the control group (p =
0.366 for systolic blood pressure; p = 0.951 for
diastolic blood pressure). In the opposite group,
results show a significant difference in respondents’
systolic and diastolic blood pressure between the pre-
and post-tests (p = 0.001 for both systolic and
diastolic blood pressure).
The Mann Whitney Test compared the systolic
and diastolic blood pressure of respondents in both
groups pre- and post-test. The result of the pre-test on
systolic blood pressure comparison showed p = 0.131
and diastolic blood pressure showed p = 0.080,
indicating that there was no significant difference
between the two groups in the pre-test. However, in
comparison, the results of the post-test on systolic
blood pressures showed p = 0.032 (p<0.005) and
diastolic blood pressures showed p = 0.006
(p<0.005), meaning there were significant differences
between the control and treatment groups regarding
to systolic and diastolic blood pressure after
logotherapy.
4 DISCUSSION
Most respondents within the control group had a
moderate level of self-efficacy in the pre-test. Only
two respondents who had a high level of self-efficacy,
as well as weak level of self-efficacy. However, in the
post-test, respondents mostly demonstrated a
moderate level of self-efficacy, but, the number of
respondents with strong level of self-efficacy were
decreased by one respondent only. In the opposite
group, the number of respondents with a weak level
of self-efficacy increase to four respondents. It can be
concluded that the level of self-efficacy in control
group decreased.
Bandura (1986) cited in Quigley (2005), stated
that self-efficacy has three dimensions: magnitude,
strength, and generality. Magnitude refers to the level
of difficulty a person believes he or she is capable of
performing. Strength refers to the level of conviction
a person has to perform a task or behavior. Generality
refers to the extent to which a person’s success or
failure in a task or behavior will influence the
person’s self-efficacy in other tasks or behaviors.
Most respondents in the control group were
primary education graduates. Low levels of education
lead to low knowledge, skills, and self-ability. It will
also decrease respondents’ strength of self-efficacy.
Coincidentally, six respondents had a higher post-
test score than pre-test. The highest increase in the
respondents scores, whose post-test results were
Logotherapy Increase Self-efficacy and Improve Blood Pressure’s Regulation in Patients with Hypertension
209

higher than the pre-test was +4, and the lowest was
+1.
According to Bandura (1986) individuals acquire
information about their personal self-efficacy from
six primary sources: 1) actual experience; 2) vicarious
experience; 3) verbal persuasion; 4) physiological
states; 5) imaginal experience; and 6) distal and
proximal sources.
Respondents in the control group who
experienced an increase in self-efficacy had mostly
suffered from hypertension for more than five years.
Actual experience is a source for self-efficacy belief.
When dealing with hypertension and its treatment,
one will have more experience and learn lessons from
their past experiences. They will build better self-
efficacy to face their health condition. Bandura
(2004) states that if individuals experience a
condition of pain, higher self-efficacy would be
owned.
Before the logotherapy was administered, most
respondents in the treatment group had moderate
levels of self-efficacy. Pre-test results determined that
respondents with a moderate level of self-efficacy
were aged 55–64 and had already suffered from
hypertension for almost seven years. There were three
respondents who had shown a weak level of self-
efficacy in the pre-test score. All of them had only
completed elementary schooling. There were no
respondents with a strong level of self-efficacy. This
is reflected by Bandura (2004), who states that that
there are several factors that affect self-efficacy, such
as: (1) age; (2) level of education; and (3) how long a
problem has been experienced. It can be concluded
that the level of self-efficacy in the treatment group
before logotherapy may differ because they have a
different age range, level of education, and a longer
period in dealing with hypertension.
After the logotherapy, it is evident by seeing
respondents score in post-test that most of the
respondents had a moderate level of self-efficacy,
five respondents had a strong level, and none
demonstrated a low level. The data also indicated that
the mean of the post-test score was higher than the
pre-test. This demonstrates that logotherapy
increased the level of self-efficacy in the treatment
group.
Bandura (2004) believes that self-efficacy can be
established through four processes: cognitive,
motivational, affective, and selection. The process of
establishing self-efficacy begins with a cognitive
process whereby one will predict the outcome of an
action as a control in their life. The second is a
motivational process whereby a person who has
purpose based on cognitive activity will motivate
themselves to perform actions to achieve their goals.
The affective and selection process refer to a person’s
generation of an emotional reaction to their ability to
act and make a choice regarding the action they can
carry out. The statement shows that cognition and
motivation play an important role in the formation of
life goals. When cognitive and motivational processes
are achieved, the affective and selection processes
continue as the next stage of self-efficacy for
controlling the condition that it faces. Researchers
argue that a person who is able to discover the
meaning of life through the cognitive process will
tend to motivate themselves to take action to achieve
their purpose in life, thereby fostering self-efficacy to
achieve their goals. The existence of the meaning of
life or the achievement of the purpose of life will
improve self-efficacy and the ability to achieve it.
Logotherapy was an intervention which used
psychotherapy techniques to heal and reduce or
alleviate a disease through discovering the meaning
of life (Frankl, 1966). Logotherapy in this research
was conducted over four sessions. The first session
identified changes and problems that had been
experienced. The second session expressed
individuals’ life expectations and the reasons for their
choices. The third session determined the most
important meaning of life, and the fourth session
evaluated the implementation of logotherapy
(Bastaman, 2007).
This study shows that most of the respondents
were able to follow logotherapy. Logotherapy can
increase one’s self-efficacy through verbal
persuasion. The logo therapist mobilizes innate
human qualities during therapy (Frankl, 2006). As
many as 11 respondents were able to achieve the goal
of each session during one meeting only. During the
third session, respondents generated their new
purpose and meaning in life. Respondents’ meaning
of life was typically that they want to have more time
to care for their children and grandchildren.
Respondents who were able to determine the meaning
of life experienced a significant change in their level
of self-efficacy. This can be observed in the
differences between pre- and post-test scores,
although the category remained.
According to Frankl (2006), the core of
logotherapy saw optimism as a source of strength and
embedded a positive approach to life. Logotherapy
presupposes that human capacity is creative and can
turn life’s negative aspects into something positive
and constructive, and the insight gained through
reflection should be applied in the daily tasks of life
(Graber, 2004). Respondents who were not able to
determine the meaning of life also experienced a
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210

change in their self-efficacy score but it was not
significant to change their category. This can be seen
regarding Respondents 4, 8, 11, and 13. The
differences in self-efficacy scores between pre- and
post-test can happen because each respondent has
unique and creative learning behavior and their own
method of finding the meaning of their lives if they
follow a logotherapy session.
Respondents who were able to discover the
meaning of their life have a goal to live their life by
and accept the disease. This is reflected in the opinion
of Bastaman (2007), who states that one of the
characteristics of the meaning of life is to provide
guidance and direction towards the actions taken, so
they will be more motivated to implement and
achieve their goals. Motivation arising from
discovering the meaning of life will affect self-
efficacy and people can act in order to achieve their
purpose in life. Bandura's (1994) theory suggests that
the perceived power of self-efficacy is not necessarily
directly related to behavioral choices, but to the self-
efficacy of stronger individuals, greater persistence,
and the chance to achieve what they pursue.
Results indicate that there were significant
differences between the control and treatment groups
regarding the level of self-efficacy following
logotherapy. Respondents in the treatment group
mostly demonstrated an increase in the self-efficacy
score, while respondents in the control group
demonstrated the opposite. From the data analysis, it
can be determined that after two weeks of
logotherapy, respondents in the treatment group had
a higher mean of self-efficacy score than the control
group.
The differences in post-test results in both groups
may occur depending on how long they have suffered
from hypertension and the implementation of
logotherapy. Data regarding respondents’
characteristics across the two groups showed a
difference in the length of time suffering from
hypertension; the control group mainly had
hypertension for five years, while the treatment group
mainly had hypertension for seven years. These data
indicate that the treatment group had suffered for
longer from hypertension. So, the level of self-
efficacy in the treatment group was better than the
control group. These results reflect with Bandura
(2004), who states that the longer an individual has
experienced a specific negative condition, the higher
the level of self-efficacy they will have to overcome
their problems. In addition, the treatment group also
received logotherapy. So, the level of self-efficacy in
the respondents in the treatment group was better than
in the control group.
The findings of this research correspond with that
of Agustini (2016), who mentions that someone who
finds the meaning of life has good self-efficacy and
accept their health condition. Another study
conducted by DeWitz (2004) also states that the
discovery of a life goal affects a person’s self-
efficacy. This can drive motivation, cognitive ability,
and action to achieve the desired goal (Bandura,
1994). This statement is in accordance with research
by Ariani (2014), who states that someone who has a
good motivation will have a greater chance of having
good self-efficacy. Bandura (2004) explains that the
process of establishing one's self-efficacy depends on
the demands and goals they want to achieve.
Discovering the purpose of life is very important for
a patient with hypertension as a motivator following
their long-term treatment. Strong motivation will lead
to high self-efficacy to continue their treatment.
The regulation of blood pressure in the control
group, in the pre- and post-test examination, showed
an increase in the mean of systolic blood pressure.
Meanwhile, diastolic blood pressure tended to
remain. Data on the difference between pre- and post-
test examinations of systolic blood pressure also
showed that most of the respondents experienced an
increase in systolic blood pressure with the highest
increase of +20 mmHg, whereas the average diastolic
pressure in most respondents remained (there was no
difference). An increase in systolic blood pressure
can occur as individuals grow older. Respondents
with an increase of systolic blood pressure were older
than those with declining systolic blood pressure,
mostly over 60 years old. Harrison, Wilson and
Kasper (2005) state that as a person grows older,
higher blood pressure will be experienced. This is
consistent with the theory that systolic blood pressure
will usually increase in the elderly due to the
decreasing elasticity of blood vessels. When the
elasticity of arteries decreases, it will not flex, and
tends to be rigid causing an increase in systolic
pressure (Widyanto & Triwibowo, 2013). Potter et al.
(2016) also mention that the increase in systolic
pressure is more significant than diastolic pressure
because of reduced arterial elasticity.
Data tabulation on the treatment group showed a
decrease in the mean of systolic and diastolic blood
pressure on post-test examination. The results
indicated that most respondents experienced a
reduction with the highest difference at -30 mmHg
and the lowest at -10 mmHg. The decrease in systolic
and diastolic blood pressure can occur due to an
increase in respondents’ level of self-efficacy.
Respondents who experienced decreased systolic or
diastolic blood pressure tended to have improved self-
Logotherapy Increase Self-efficacy and Improve Blood Pressure’s Regulation in Patients with Hypertension
211

efficacy. However, Respondent 7 experienced an
increase in his self-efficacy score, but his blood
pressure continued to increase with a difference of
+24 on the systolic measurement during the post-test.
This could be because the respondent was 62 years
old (elderly); age can also have an effect on
respondent's cardiovascular system. Junaidi (2010)
explains that incidences of hypertension increase
rapidly at age 50 and above, with prevalence at
69.7%. LeMone and Burke (2008) also mention that
adults’ blood pressure tends to increase with age. The
elderly have increased systolic pressure due to
reduced elasticity of blood vessels.
The statistical analysis has shown that there was
no significant difference in respondents’ blood
pressure between the pre- and post-test
measurements, in both systolic and diastolic pressure.
On the other hand, the treatment group had shown
significant differences in this. It can be concluded that
logotherapy can change the regulation of blood
pressure in patients with hypertension. Fatimah
(2009) mentions that logotherapy is effective as an
adjunctive therapy to decrease the blood pressure of
patients with hypertension. Logotherapy is one form
of psychotherapy through counselling to discover the
meaning of life. Folkman and Lazarus (1988) explain
that psychotherapy is expected to increase the coping
power of patients. Coping power, which can be
established and developed through education and
training, can lead to lowering blood pressure. The
provision of logotherapy can be used to improve
coping mechanisms by providing education through
the counselling process, so that patients with
hypertension can discover the positive meaning of
their lives, have good coping mechanisms, and
perform long-term treatment to keep their blood
pressure within a normal range.
Analysis, using the Mann Whitney Test, indicates
a significant difference in systolic and diastolic blood
pressure in post-test measurements between the two
groups. The results also showed that after two weeks
of logotherapy, the mean of systolic and diastolic
blood pressure in the treatment group was lower than
in the control group. Results indicated that systolic
and diastolic blood pressure in the treatment group
decrease further than in the control group.
The mean of systolic blood pressure in the control
group increased in the post-test, but the difference
was less compared to the pre-test score. This can be
affected by the age of the respondents. Table 1
exhibited the characteristics of respondents in the
control group. Most of them were 55 to 64 years old.
Adult blood pressure tends to increase along with age.
So, elderly people tend to experience increased
systolic pressure due to a reduction in the elasticity of
blood vessels (LeMone & Burke, 2008). No
significant differences in blood pressure can be seen
because of the thickening and stiffening in blood
pressure as part of aging process. Half of arterial
stiffening incidences that happen during the aging
process can be caused by the reduction of
endothelium dependent relaxation, resulting in a
decreasing flow of blood vessels, so blood pressure
remains stable.
Other factors that influenced the difference in
systolic and diastolic blood pressure between the
control and treatment groups was the administration
of logotherapy. The treatment group that followed
logotherapy for two weeks experienced a lowering of
blood pressure and an increase in their self-efficacy
score. An increase in self-efficacy will enhance
patients’ adherence to follow their treatment
programs. Resultantly, their blood pressure may
decrease. The results reflect work by Warren-
Dindlow and Huber (2013) who suggest that patients
with hypertension, who have good self-efficacy, will
significantly motivate themselves to improve
adherence to treatment regimens, consume a low-salt
diet, engage in physical activity, and maintain their
weight so their blood pressure can be controlled.
Findings by Nadziroh (2016) explain that a person
who is confident in their ability to solve problems will
choose to perform useful and effective actions to do
so. The theory of Folkman and Lazarus (1988)
mentions that the provision of psychotherapy in the
form of logotherapy can increase patients’ coping
power. Mulyata (2002) also mentions that the
development of coping power can result in the
reduction of blood pressure in patients. Meliala
(2004) also states that logotherapy works by
providing influences that may affect blood pressure,
such as behavioral, cognitive, psychological, and
physiological factors.
By looking at the research findings, the researcher
believes that improving coping mechanisms will lead
to better self-efficacy. A good coping mechanism will
motivate a person to act to achieve their desired goal.
The goal of patients with hypertension was to
maintain their blood pressure within a normal range.
Patients with hypertension, who were able to find
their purpose of life, will have a strong confidence in
facing their disease, so patients with hypertension
will be more adherent in undergoing long-term
treatment programs.
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5 CONCLUSIONS
Most respondents with hypertension experienced an
increase of self-efficacy after the logotherapy because
they found the meaning in their life. The regulation of
blood pressure in patients with hypertension
decreased into the normal range after following
logotherapy because their self-efficacy to adhere the
management of hypertension had increased.
Logotherapy affects patients’ self-efficacy and blood
pressure regulation because it can motivate them to
manage their hypertension. So, their blood pressure
will remain stable.
Patients with hypertension were advised to remain
committed to the meaning of life that they had already
chosen and remain consistent in maintaining their
self-efficacy against long-term hypertension
treatment. This way, the success of treatment can be
achieved and blood pressure can be controlled.
Nurses can use logotherapy as a new intervention to
improve the adherence of patients with hypertension
in following their treatment. Healthcare centers also
can use logotherapy as a routine program to improve
patient adherence, especially patients undergoing
long-term treatment.
Further research can be conducted to evaluate the
effect of logotherapy on other diseases as well as
hypertension, with more attention to confounding
factors (age, education, and long-suffering) and a
larger sample size. In addition, the frequency of
logotherapy meetings could be increased because
with more meetings, respondents are expected to
achieve further regarding the meaning of life.
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