This study set out to determine knowledge, attitude, and perceptions towards hypertension amongst middle-aged adults drawn from the AWI-Gen study in the Navrongo HDSS. The study determined that there were high levels of general knowledge but low awareness of hypertension across both arms of the study. Yet, both arms also indicated some awareness of relevant risk factors, such as an unhealthy diet, alcohol consumption, and increased emotional stress. In addition, the majority of participants reported having general concerns for their overall health; however, they lack confidence in their personal ability to control their blood pressure. Notably, the quantitative responses indicated a preference for orthodox medications, whereas the focus group discussions revealed that most participants would seek alternative means for hypertension treatment, namely herbal remedies and traditional foods.
The prevalence of hypertension in this study was 22.3%, which is higher than the 2009 recording of 19.3%7, but lower than 24.5% recorded in 2017 amongst participants in the Navrongo HDSS.8 The lower number recorded in this study could be due to the small sample size and awareness that was instituted by the AWI-Gen study.11 Following the community feedback sessions embarked by the AWI-Gen team, we were expecting to record a higher awareness, treatment and control levels. Amongst those reported as hypertensive, only 21.4% of men and 34.6% of women were aware of their status.
While the majority of these individuals were determined to be on treatment for hypertension (90% of women; 80% of men), only 37.8% of men had achieved controlled blood pressure and more than 50% of women (62.2%) had achieved controlled BP. Looking more broadly, only 1 out of 10 hypertensive adults in the study area are being adequately managed.8 The subsequent discussions postulated that the low levels of hypertension awareness may be accredited to low literacy and inadequate understanding of lifestyle factors. Policy reviews also indicate that inadequate health system strengthening has undermined hypertension-related risk factor surveillance, thus hindering opportunities for promising interventions.10
Studies on the effectiveness of health education interventions aimed to increase knowledge and consequent management and prevention of hypertension show immense promise globally. Various experimental and quasi-experimental studies that employed therapeutic patient education interventions have indicated improvements in lifestyle factors associated with hypertension.14–17 It’s important to note, however, that interventions across existing literature vary considerably in mode and scope of education employed. In general, educational interventions appear to most effectively improve blood pressure levels when supplemented with self-monitored blood pressure (SMBP).16 SMBP, however, requires reliable access to at-home devices for measurement of BP, which is often difficult to maintain in rural settings like KND.
Our recent findings highlight the difficulty in educational programs achieving progress without augmenting it with other integrated programming. Blood pressure control also appears to be correlated with the presence of other risk factors. A study conducted in south-east Nigeria that employed educational interventions without supplementation with SMBP saw significant improvements in key lifestyle and risk factors associated with hypertension; specifically, physical activity, sleep pattern and quality, substance use, healthy diet, and medication adherence.15
Moreover, several of these lifestyle factors have proven to be predictors of BP control within urban Ghanaian communities.18 In particular, increased physical activity, alcohol and smoking abstinence, increased consumption of fruits and vegetables, and reduced consumption of carbohydrates, meat, and fat, appear to have a positive influence on blood pressure control.18 In addition, verbal educational interventions have shown improvements in health literacy and consequent adherence to medication among individuals with hypertension.19
Strengths and limitations
In conjunction with the aforementioned quantitative findings, the complementary qualitative data present opportunities for educational interventions to shape targeted information for the specific needs of the studied communities. This was an appropriate means of data collection because it allowed community members to collectively reflect on their feelings towards hypertension. This methodology provided the research team with insights on community-wide ideologies, stigmas, and concerns regarding hypertension.
The qualitative approach also allowed the research team to witness how individuals discuss hypertension amongst one another, albeit in an unnatural environment, which has helped the team to have in-depth and normative information on the topic. Overall, the study gives us first-hand information on the impact of community feedback of results on participants. A key limitation is the risk of recall bias but this was mitigated as we verified reported hypertension status with previous and current blood pressure measurements.