Determinants of Self-Management Practices among Hypertensive Patients at Northern Region Hospital, Ghana: A Cross-sectional Study

Abstract

Introduction: Hypertension remains a leading cause of cardiovascular morbidity and mortality globally, with a growing burden in sub-Saharan Africa. In Ghana, despite policy interventions, blood pressure control rates remain suboptimal. Self-management, including medication adherence, dietary changes, physical activity, and home blood pressure monitoring, is critical for long-term control. Yet, its practice is not well understood in Northern Ghana. Aim: The study aims to assess hypertension self-management and identify factors associated with good self-management among patients at Northern Region Hospital. Methods: A facility-based cross-sectional study was conducted among 285 hypertensive patients aged ≥18 years using a structured interviewer-administered questionnaire adapted from validated tools. Self-management behaviors were evaluated across six domains, and a composite score was used to classify participants as having good or poor self-management. Bivariate and multivariable logistic regression analyses were performed to identify independent predictors of good self-management. A p-value less than 0.05 is considered statistically significant. Results: The study recruited 285 hypertensive patients with a mean age of 56.4 years. The majority were female (60%) and married (57.9%). Only 45.3% of participants demonstrated good overall self-management. While 74.4% adhered to prescribed medications and 78.6% kept clinic appointments, adherence to lifestyle-related behaviors was much lower: 44.6% limited salt intake, 39.3% engaged in physical activity at least three times per week, and only 28.8% monitored their blood pressure at home. Multivariable analysis showed that good self-management was significantly associated with being female (AOR = 1.5, 95% CI: 1.01–2.22), havin secondary (AOR = 1.9, 95% CI: 1.10–3.29) or tertiary education (AOR = 2.5, 95% CI: 1.45–4.30), possessing good knowledge of hypertension (AOR = 2.9, 95% CI: 1.90–4.40), having family support (AOR = 1.8, 95% CI: 1.20–2.70), and being a non-smoker (AOR = 0.4, 95% CI: 0.18–0.87). Conclusion: Hypertension self-management in Northern Ghana is suboptimal, particularly in relation to lifestyle behaviors. Tailored interventions promoting health education, family involvement, and behavioral support, especially for men and those with lower education, are urgently needed to improve long-term outcomes.