self-control, to carry out the intentional behaviors become important factors for success in adherence to preventive behaviors since it has been stated that Thais have low motivation to achieve their goals through hard work.32 Therefore, commitment to active participation supports the view that Thais with prehypertension have a strong need for independence. This independence means the adherent person has less difficulty fitting the regimen into their life. The second component of adherence to preventive behaviors is persistence in practicing preventive behaviors which supports the fact that Thais with prehypertension who perceived preventive behaviors as a top daily priority need to have abilities to translate their intentions into actions. This means that there are numerous ways that an individuals’ resources and environment may be inadequate for carrying out the preventive activities.33 Repeated action provides a test of whether the individuals’ resources and environment are adequate for carrying out the preventive activities. Additionally, frequently performed behavior strengthens the establishment of an automatic or regular behavior by increasing the level of skill and mental capacity as well as reducing the discomfort. Although previous studies found that adherence to preventive activities associated with good selfdiscipline resulted in some frustration, suffering and restriction of individuals’ social lives.13, 34 This finding showed that Thais with prehypertension use “gradual adjustment “or “the Middle Path” as the key to integrating preventive activities into their daily routines such as moderation in consumption, lifestyle and relationships. Thai people usually use Buddhist religious practices such as the Middle Path to control their stress levels.35, 36 Therefore, practicing gradual adjustment as found in this study is an effective strategy for Thais to diminish both extremes of their individual requirements and social life. The last category, “maintenance of desired preventive behaviors” reflected continued regular practice of desired preventive behaviors over the long
term. This involves long-term behavior changes and sensations of well-being. Findings indicate that adherence to preventive behaviors is not a static state but rather, is dynamic. Long-term behavior change is an important indicator of adherence to preventive behaviors where adopting regular preventive behavior patterns does not automatically lead to sustained preventive behavioral change.37 This study also found that the time frame used to define adherence to preventive behaviors varied by interviewee. This is consistent with numerous studies suggesting that the time frame for adherence to preventive behavior is inconsistent even though most health promotion research identifies a period of 6 months of sustained behavior change. The sensations of physical and psychosocial well-being, are also used by Thais with prehypertension to identify that the desired preventive behavior had been maintained. Thais sense of well-being is deeply rooted in cultural values and norms which affect behaviors in daily life. The feeling of well-being reflects images of holism and most Thais believe that, physical, mental and spiritual well-being are intertwined.38 This study has shown that Thais from varying backgrounds with prehypertension view some aspects of well-being and adherence to preventive behaviors similarly. Those interviewed reported that preventive behavior participation was an essential part of well-being of body and mind. They valued the feeling of wellbeing as among the most important aspects of life. This feeling and desire has a strong influence on their behaviors.