Knowledge, Attitudes and Practices related to Hypertension in Low- and Middle-income Countries: A Systematic Review

Abstract

This study aimed to collect and analyze qualitative data on knowledge, attitude and practice (KAP) towards hypertension (HTN) among adults in low and middle-income countries (LMICs), in order to better inform future research or policy interventions. Studies were included in the review if they examined HTN KAP of adults located in LMICs as defined by the World Bank, using qualitative methods. The databases searched were MEDLINE, CINAHL, Embase, Scopus, Global Health, and LILACS. Data was collected on participants’ knowledge of HTN causes, symptoms, and risk factors, sources of HTN information, beliefs and practices regarding checking blood pressure regularly, perceived importance/danger of HTN, and behaviour concerning HTN modifiable risk factors. A total of 16 qualitative studies were included from ten countries. Overall, there were numerous cultural and psycho-social understandings, both correct and incorrect, of HTN. Social support from community and family members were a crucial aspect of HTN KAP, as the most common source of HTN information and a factor in decisions regarding blood pressure checks and lifestyle changes. Urbanicity was perceived to worsen HTN outcomes through heightened social stress, physical inactivity, and other barriers, which also differed according to sex. In general, this review has two important implications. First, community- and gender-based initiatives are needed to address barriers to lifestyle changes related to HTN risk factors. Second, growth and development in LMICs must mitigate these barriers at their root causes of poverty and inequality. Possible limitations include the generalisation of findings due to the heterogeneity of included studies, and the LMIC classification due to wide inequalities in some high income countries, both of which highlight the need for further qualitative research in low-resource settings.