Hypertension prevention behavior and its predictors among rural adults in Bangladesh: A community survey using the theory of planned behavior 10.55131/jphd/2026/240208

Main Article Content

Suhala Ashraf Zeba
Munima Haque
Muhammed Ashraful Alam
Hindya O. Al-Maqableh
Shuvashis Saha
Suphawadee Punthumus
Md Samiul Islam

Abstract

Bangladesh faces a rising burden of non-communicable diseases (NCDs), with rural communities being particularly vulnerable due to limited healthcare access. Despite hypertension (HTN) being preventable, the disease is often overlooked in rural areas. This study aimed to assess health practices related to HTN prevention and its determinants among rural Bangladeshi adults using the theory of planned behaviour (TPB) and the World Health Organization's 4X4 NCD prevention model. A community-based survey was conducted with 355 rural participants selected via multi-stage sampling in the latter half of 2023. Data were collected through face-to-face interviews using a validated, pretested questionnaire. The average age of the respondents was 41.5 years, with 66.8% of them being male participants. The findings revealed inadequate knowledge, negative attitudes, and poor self-control regarding HTN prevention. Socioeconomic factors, including gender, income, education, and region, significantly influenced HTN prevention behaviors (p<0.05), while knowledge, attitude, and self-control were strongly linked to HTN prevention practices (p<0.05). The study’s causal model based on the TPB demonstrated a good fit, showing that attitude (β=0.34, p<0.001), motivation (β=0.16, p<0.05), and self-control significantly influenced intention (β=0.34, p<0.001), which strongly predicted hypertension prevention practices (β=0.54, p<0.001). Rural populations displayed reluctance to adopt healthy practices for HTN prevention. Enhancing community awareness and promoting behavioral change, therefore, should be prioritized in policy development to improve HTN prevention practices in rural Bangladesh.

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1.
Suhala Ashraf Zeba, Munima Haque, Alam MA, Hindya O. Al-Maqableh, Shuvashis Saha, Suphawadee Punthumus, Md Samiul Islam. Hypertension prevention behavior and its predictors among rural adults in Bangladesh: A community survey using the theory of planned behavior: 10.55131/jphd/2026/240208. J Public Hlth Dev [internet]. 2026 May 8 [cited 2026 May 10];24(2):117-28. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/276864
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Original Articles
Author Biographies

Suhala Ashraf Zeba, Biotechnology program, Department of Mathematics and Natural Science, BRAC University, Dhaka, Bangladesh

Biotechnology program, Department of Mathematics and Natural Science, BRAC University, Dhaka, Bangladesh

Munima Haque, Biotechnology program, Department of Mathematics and Natural Science, BRAC University, Dhaka, Bangladesh

Biotechnology program, Department of Mathematics and Natural Science, BRAC University, Dhaka, Bangladesh

Muhammed Ashraful Alam, Department of Hospital Administration, Dhaka Medical College Hospital, Dhaka, Bangladesh

Department of Hospital Administration, Dhaka Medical College Hospital, Dhaka, Bangladesh

Hindya O. Al-Maqableh, Health services administration, Faculty of medicine, Yarmouk university, Jordan

Health services administration, Faculty of medicine, Yarmouk university, Jordan

Shuvashis Saha, Refugee Crisis Foundation, Cox’s Bazar, Bangladesh

Refugee Crisis Foundation, Cox’s Bazar, Bangladesh

Suphawadee Punthumus, Department of Family Health, Faculty of Public Health, Mahidol University, Thailand

Department of Family Health, Faculty of Public Health, Mahidol University, Thailand

Md Samiul Islam, Biotechnology program, Department of Mathematics and Natural Science, BRAC University, Dhaka, Bangladesh

Biotechnology program, Department of Mathematics and Natural Science, BRAC University, Dhaka, Bangladesh

References

World Health Organization (WHO). Hypertension [Internet]. Available from: https://www.who.int/news-room/ fact-sheets/detail/hypertension.

Management-Screening, Diagnosis and Treatment (MND). A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013 [Internet]. Geneva: World Health Organization; 2013. Available from: https://www.who.int/publications/i/item/a-global-brief-on-hypertension-silent-killer-global-public-health-crisis-world-health-day-2013.

World Health Organization. Noncommunicable diseases: Mortality [Internet]. 2024 Dec 23. Available from: https://www.who.int/news-room/ fact-sheets/detail/noncommunicable-diseases.

Chowdhury MA, Uddin MJ, Haque MR, Ibrahimou B. Hypertension among adults in Bangladesh: Evidence from a national cross-sectional survey. BMC Cardiovasc Disord. 2016;16:22. doi:/ 10.1186/s12872-016-0197-3.

Iqbal A, Ahsan KZ, Jamil K, Haider MM, Khan SH, Chakraborty N, Streatfield PK. Demographic, socioeconomic, and biological correlates of hypertension in an adult population: evidence from the Bangladesh demographic and health survey 2017–18. BMC Public Health. 2021 Jun 26;21(1):1229.

Chowdhury MA, Islam M, Rahman J, Uddin MT, Haque MR, Uddin MJ. Changes in prevalence and risk factors of hypertension among adults in Bangladesh: An analysis of two waves of nationally representative surveys. Plos one. 2021 Dec 2;16(12):e0259507.

Schwartz LN, Shaffer JD, Bukhman G. The origins of the 4 × 4 framework for noncommunicable disease at the World Health Organization. SSMPopul Health. 2021;13:100731.doi:10.1016/ j.ssmph.2021.100731.

Pan American Health Organization. Noncommunicable diseases [Internet]. PAHO/WHO; 2024. Available from: https://www.paho.org/en/topics/noncommunicable-diseases.

Sultana P, Akter S, Rahman MM, Alam MS. Prevalence and predictors of current tobacco smoking in Bangladesh. J Biostat Biometric App. 2015;1(1):1-8.doi:10.15744/2455-765x.1.102.

Chowdhury R, Naheed A, Monower MM, Shahzad S, Raqib R, Tasmin I, Spackman S, Kaptoge S, Pennells L, Butterworth AS, Danesh J. Conventional and regionally distinctive risk factors for first-onset myocardial infarction: the Bangladesh Risk of Acute Vascular Events (BRAVE) case–control study. Lancet Reg Health Southeast Asia. 2025 Jan 1;32:100206.

Huda SA, Sharmin Z, Dutta S, Tura FA, Mumu KF. Epidemiology of Hypertension and Associated Risk Factors in a Rural Cohort from Southeastern Bangladesh. Bangladesh J Food Nutr. 2025 Apr 3;2(2):4–13.

Khan MJ, Sayma, Ali MU, Ganesan B, Hasan SMM, Winser SJ. Estimated prevalence of physical inactivity and sedentary behaviour among adults in Bangladesh: Nationally representative STEPS survey, 2018. Eur J Physiother. 2023;26(3):170-75. doi:10.1080/ 21679169.2023.2220355.

Islam JY, Zaman MM, Bhuiyan MR, Hasan MM, Ahsan HN, Rahman MM, et al. Alcohol consumption among adults in Bangladesh: Results from STEPS 2010. WHO South East Asia J Public Health. 2017;6(1):67-74. doi: 10.4103/2224-3151.206168.

Goel S, Verma M, Mohapatra A, Popovic S. Raising awareness around trends in noncommunicable diseases and their risk factors to promote global prevention and control. Front Public Health. 2025 Jan 28;13:1553630.

Siddique AB, Hosen MS, Akter H, Hossain SM, Al Mamun M. Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVDs) among older individuals of rural Bangladesh: findings from a face-to-face interview. Front Public Health. 2024 May 24;12: 1336531. doi:10.3389/fpubh.2024. 1336531

Hagger MS, Polet J, Lintunen T. The reasoned action approach applied to health behavior: Role of past behavior and tests of some key moderators using meta-analytic structural equation modeling. Soc Sci Med. 2018;213:85-94. doi:10.1016/j.socscimed.2018.07. 038.

La Barbera F, Ajzen I. Control interactions in the theory of planned behavior: Rethinking the role of subjective norm. Eur J Psychol. 2020;16(3):401-17. doi:10.5964/ejop. v16i3.2056.

Bosnjak M, Ajzen I, Schmidt P. The theory of planned behavior: Selected recent advances and applications. Eur J Psychol. 2020;16(3):352-56. doi: 10.5964/ejop.v16i3.3107.

Sheeran P, Maki A, Montanaro E, Avishai-Yitshak A, Bryan A, Klein WM, et al. The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis. Health Psychol. 2016;35(11):1178-88. doi:10.1037/ hea0000387.

Paul B, Kirubakaran R, Isaac R, Dozier M, Grant L, Weller D; RESPIRE Collaboration. A systematic review of the theory of planned behaviour interventions for chronic diseases in low health-literacy settings. J Glob Health. 2023;13:04079. doi:10.7189/ jogh.13.04079.

Kline RB. Principles and practice of structural equation modeling. 4th ed. New York: Guilford Press; 2016.

Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. Harlow: Pearson Education; 2014.

Bloom BS, Thomas HJ, Madaus GF. Handbook on formative and summative evaluation of student learning. USA, NY: McGraw-Hill; 1971.

Promma N. Prevalence and risk factors associated with hypertension among the Hmong people in Phayao Province, Thailand. J Public Health Dev. 2024 Dec 31;23(1):40–56. doi:10.55131/ jphd/2025/230104

Maluwa C, Kapira S, Chuljerm H, Parklak W, Kulprachakarn K. Determinants of hypertension-related knowledge, attitude, and practices (KAP) among caregivers in Neno, rural Malawi: A cross-sectional study. Heliyon. 2025 Jan 15;11(1).

Miller R, Goodman C. Performance of retail pharmacies in low- and middle-income Asian settings: A systematic review. Health Policy Plan. 2016;31(7):940-53. doi:10.1093/ heapol/czw007.

Ahmed SM, Naher N, Hossain T, Rawal LB. Exploring the status of retail private drug shops in Bangladesh and action points for developing an accredited drug shop model: A facility-based cross-sectional study. J of Pharm Policy and Pract. 2017;10: 1-12.doi:10.1186/s40545-017-0108-8.

Menezes MM, Lopes CT, Nogueira Lde S. Impact of educational interventions in reducing diabetic complications: A systematic review. Rev Bras Enferm.2016;69(4):773-84. doi: 0.1590/0034-7167.2016690422i.

BeLue R. The role of family in non-communicable disease prevention in Sub-Saharan Africa. Glob Health Promot. 2017;24(3):71-4. doi:10.1177/ 1757975915614190.

Fritz M, Grimm M, Hanh HT, Koot JAR, Nguyen GH, Nguyen TP, et al. Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: A quasi-experimental study. BMJ Glob Health. 2024;9(5):e015053. doi:10.1136/ bmjgh-2024-015053.

Kane J, Landes M, Carroll C, Nolen A, Sodhi S. A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa. BMC Fam Pract. 2017;18(1):46.doi:10.1186/s12875-017-0613-5.

Rawal LB, Kanda K, Biswas T, Tanim MI, Poudel P, Renzaho AMN, et al. Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: A qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level. BMJ Open. 2019;9(10):e029562. doi:10.1136/bmjopen-2019-029562.

Johnson C, Mohan S, Praveen D, et al. Protocol for developing the evidence base for a national salt reduction programme for India. BMJ Open 2014;4:e006629. doi: 10.1136/bmjopen-2014-006629

Public Health England. Salt reduction: targets for 2017 [Internet]. London: GOV.UK; 2017. Available from: https://www.gov.uk/government/publications/salt-reduction-targets-for-2017.