Iran Journal of Nursing

1. Introduction
Epidemiological changes have made chronic diseases increasingly important. Hypertension is also known as a chronic disease. The high prevalence of hypertension worldwide has made the disease a significant health problem in communities. Spiritual health has been proposed as one of the health indicators and predictors of self-care in chronic diseases. The spiritual aspect of health is related to physical, mental, and social health in several ways. For example, in the field of health behaviors, religious commitment and spirituality activate a person's responsibility in health behaviors, such as nutritional and wellbeing behaviors that add physical and psychological effects. Even performing spiritual rituals increase social support, the latter component of which has been recognized as one of the social determinants of health and reduction of stress. Spirituality enhances social interactions and promotes social support as a source of health promotion, facilitation of recovery, reduction of risk factors and stress. Spiritual health plays a major role in the general health of individuals. Unfortunately, researchers pay little attention to spiritual health. This study aimed to determine the relationship between spiritual health and adherence to the treatment regimen in patients with hypertension.
2. Materials and Methods
In this descriptive correlational study, 121 patients with hypertension were selected by continuous sampling method from cardiac clinics affiliated with Iran University of Medical Sciences, Iran, in 2020. The study data were collected through demographic information form and validated Ellison and Paloutzian spiritual health and Hil-Bone diet adherence questionnaires. For data analysis, we performed the statistical tests of the Spearman, independent t test, Chi-square, and analysis of variance using SPSS software version 16. To observe ethical considerations, first, permission was obtained from the Research Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.199). Then, a letter of introduction from the mentioned university was received, and the necessary coordination was made with the management of the studied centers. The research samples were then given the necessary information about the research process. They were reminded that participation in the study was optional and free to do so. The samples were also assured of information confidentiality.
3. Results
This study shows a significant and negative relationship between spiritual health and adherence to the treatment regimen in patients with hypertension (P=0.001, r=-0.05). Other results showed a statistically significant relationship between marital status and education and spiritual health, and there was a statistically significant relationship between the duration of illness and spiritual health. So, married people and children had a higher level of spiritual health, and with increasing the level of education, spiritual health increased significantly. Finally, there was a significant positive relationship between age and spiritual health. Another finding of this study was a significant relationship between individual variables (duration of illness, education, marital status, and age) with adherence to the treatment regimen. In addition, the results showed a statistically significant relationship between occupational status and adherence to the treatment regimen. The results showed a significant direct relationship between education levels with adherence to the treatment regimen. In this study, married people and children had followed the treatment regimen better.
4. Conclusion
Achieving a high level of spiritual health in the present study is not far from the culture of the Iranians, which is religious and inclined to spiritual values. The current study results also show that people in detrimental situations show strengths in their spiritual connections and try to establish mental peace. Achieving spirituality as an aspect of spiritual health seems to affect individuals' physiological and social health positively. As spiritual health increases, adherence to the treatment regimen in patients with hypertension decreases. Having spiritual health for this group of patients leads to less adherence to the treatment regimen. Considering the relationship between following the treatment regimen and reducing the complications caused by the disease and the speed of recovery of the disease, it is necessary that in treating people with hypertension, medical staff pay more attention to improving the patients' adherence to the treatment regimen. To promote the spiritual health of people, their adherence to the treatment regimen must be increased. In nursing education, nursing educators can use the findings of this study to design and implement their training programs so that nursing staff and students be involved with people with hypertension with the concept and importance of following a treatment regimen. 

Ethical Considerations
Compliance with ethical guidelines
This syudy was approved by the ethical committee of the Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.199). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information. They were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This study is extracted from the MA. thesis of the firast author at the Department of Medical Surgical Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran.

Authors' contributions
Conceptualization: Reza Amiri, Marjan Mardani Hamouleh; Research: Mansoureh Ashghali Farahani, Reza Amiri, Analysis: Shima Haghani; Project Management: Marjan Mardani Hamoleh, Mahnaz Qaljeh; Editing and finalization: Marjan Mardani Hamouleh.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We want to thank the Vice-Chancellor for Research, Iran University of Medical Sciences for their help.


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