Bridging the Knowledge–Practice Gap in Hypertension Management: A Community-Engaged Systems Approach in Disadvantaged Rural Community

Abstract

Background: Hypertension is a major contributor to cardiovascular morbidity and mortality globally, with particularly poor control in disadvantaged communities. Although awareness is generally high, sustaining lifestyle changes and treatment adherence remains difficult. This study examined socioeconomic, behavioural, and health system factors associated with hypertension management and explored the role of community-engaged health education in strengthening primary health care. Methods: A cross-sectional descriptive study was conducted among 107 adults with hypertension attending public primary health care facilities. Data were collected using structured questionnaires covering socioeconomic status, health system access, medication adherence, lifestyle practices, and knowledge and attitudes. Descriptive statistics summarized participant characteristics, while chi-square tests and multivariable logistic regression identified factors associated with clinic attendance, dietary adherence, lifestyle practices, and self-management. Results: Awareness of hypertension (86.9%) and trust in clinic care (91.6%) were high; however, a clear knowledge practice gap was evident. Although 79.4% acknowledged the importance of lifestyle changes, only 45.8% followed a hypertension-specific diet. Structural barriers included low income (39.3% earning <R3 000/month) and long distances to clinics (46.7% living ≥5 km away). Health worker advice strongly predicted dietary adherence (OR = 6.36, p = 0.001), lifestyle adherence (OR = 4.24, p = 0.006), and overall self-management (OR = 12.46, p = 0.024), whereas knowledge alone did not. Conclusions: Hypertension management is constrained more by structural and health system factors than by lack of awareness. Strengthening primary health care counselling and community-based health education may improve sustained lifestyle change and outcomes.