The Role of Health Literacy on Hypertension and Medication Adherence in Blood Pressure Control Among Hypertensive Patients in Eastern Harare

Abstract

Hypertension is a leading cause of non-communicable disease mortality and morbidity globally. This is despite that blood pressure can be controlled optimally through lifestyle modification and good medication adherence. Knowledge of disease and medication adherence are key factors in hypertension control. However, the knowledge of disease and adherence in hypertension patients treated at City of Harare clinics is not known. Harare faces a heightened burden of hypertension. An analytical cross-sectional study was conducted among adults(>18years) with hypertension receiving treatment in Harare East clinics from December 2024 to February 2025. Systematic sampling was used to select study participants, and a pre-tested interviewer administered questionnaire was used to collect data-on demographics, hypertension knowledge, and medication adherence. Patient clinical records were used to obtain blood pressure values and chi-squared tests were used to determine associations between study variables. Among 161 participants (mean age 57.7 years, 75.8% female), 52.8% had good hypertension knowledge, and 31.7% demonstrated good medication adherence. While most knew hypertension symptoms (95%), knowledge gaps existed regarding the nature of hypertension as well as lifestyle factors. A significant association was found between employment status (p=0.024) and educational attainment (p=0.003) with medication adherence, where higher education and being employed correlated with better adherence. Significantly, medication adherence was strongly associated with good BP control (p<0.001) There was a significant association between knowledge of hypertension disease, and medication adherence. No significant association however was observed between hypertension knowledge and BP control (p=0.300). Hypertensive patients in the Eastern District of Harare generally possess good knowledge of hypertension symptoms but exhibit knowledge deficits regarding the nature of hypertension including normal blood pressure values and lifestyle management factors. Whilst good medication adherence significantly impacts BP control, most participants showed average medication adherence. Good adherence is influenced by employment and education. Interventions targeting improved medication adherence, particularly among unemployed and less educated individuals, are crucial for effective hypertension management.