Systematic Review : Effectiveness Health Behavior Intervention For Hypertension Prevention Bunga Farida* 1 .
Febitya Valent Difiana2 .
Rachmat Roebidin3 1,2,3 Department of Public Health Science.
Faculty of Health Sciences.
Universitas Bhakti Husada Indonesia Author's Email Correspondence ( * ): bungafarida04@gmail.
ABSTRACT
Hypertension is non communicable disease that a very common and serious condition that can lead to or complicate many health problems.
People with hypertensions must controlled the symptoms of high pressure, when they forget to take a medicine it will increased risks of coronary and cerebrovascular events.
This systematic review aim to describe the effectiveness health behavior intervention for hypertentions preventions behavior among patients.
A systematic literature search was carried out on PubMed .
PloS.
Sagepub.
Sciencedirect and Google Scholar to identify studies reported in English which were published in the last five years.
Based on 19 studies that have been analyzed .
Health Belief Model is a reliable and widely applicable framework for guiding behavioral change in hypertension prevention and control in hypertension prevention.
This review present the effectiveness of health belief model in changing the hypertensions patients behavior, and improve their knowledge about hypertensions and its consequences.
Keywords: Hypertension.
High Blood Pressure.
Health beliefs model.
Preventions behavior Published by:
Article history :
Tadulako University Received : 30 10 2025 Address:
Accepted : 24 12 2025 Jl.
Soekarno Hatta KM 9.
Kota Palu.
Sulawesi Tengah.
Indonesia.
licensed by Creative Commons Attribution-ShareAlike 4.
0 International License.
Phone: 6282197505707 Email: preventifjournal.
fkm@gmail.
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
INTRODUCTION
Hypertension is non communicable disease that a very common and serious condition that can lead to or complicate many health problems.
The risk of cardiovascular morbidity and mortality is directly correlated with blood pressure.
Risks of stroke.
MI, angina, heart failure, kidney failure or early death from a cardiovascular cause are directly correlated with Blood Pressure .
Globally cardiovascular disease accounts for approximately 17 million deaths a year complications of hypertension account for 9.
million deaths worldwide every year.
Hypertension is responsible for at least 45% of deaths due to heart disease .
otal ischemic heart disease mortality , and 51% of deaths due to stroke .
From National health and Nutrition Examination survey in united states showed that the prevalence of hypertension among adults was 29.
0%, and was similar among men .
2%) and women .
7%) The prevalence of hypertension increased with age, from 5% among adults aged 18Ae39 to 33.
2% among those aged 40Ae59, and 63.
1% among those aged 60 and over.
A similar pattern was found among both men and women (Fryer et,al.
meanwhile the prevalence of hypertension in African is 46% over country with high income have a lower prevalence of hypertension.
People affected in low-middle in come because of weak health, the number of people with hypertension who are undiagnosed, untreated and uncontrolled.
Multilevel factors contribute to the high prevalence of hypertension such as Obesity, heredity and life style play a role in the development of hypertension .
Physical inactivity, unhealthy diet and salt consumptions have been associated with hypertensions .
Hypertension is important because of its prevalence.
But what makes it more important is that the disease is uncontrolled.
Hundreds of different medicines that have proven effective in the treatment of hypertension are so disappointing to comply with them that they help prevent the complications of PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 hypertension.
People with hypertensions must controlled the symptoms of high pressure and when you stop taking the drug, your blood pressure returns to unhealthy levels and you are at increased risk of related health problems .
Low adherence is the most not unusual reason of obvious resistant .
Poor adherence to antihypertensive is associated relate with increased risks of coronary and cerebrovascular events .
Whereas non-adherence can be unintended .
long with forgettin.
or may be intentional, whereby patients make a choice no longer to take remedy primarily based on their private beliefs about their illness and remedy .
In preventions of Hypertensions the main focuss is on educations and life style The Health Belief Model (HBM) is one of the most effective health behaviour change models that incorporates six constructs perceived benefits, perceived barriers, perceived susceptibility, perceived severity, self-efficacy, and cues to action.
which explains why an individual can also or may not adopt preventive measures against the disease of interest especially hypertensions.
This systematic review focused on the utilization of health behavior models in medication adherence interventions among people with hypertensions.
The main aim of this systematic review to describe the effectiveness of health behavior intervention for hypertension preventions behavior.
METHODS
This study used a Systematic Literature Review approach following PRISMA guidelines to evaluate research related to hypertension prevention behaviors.
Articles were searched through major scientific databases including PubMed.
PLoS.
Scopus.
SagePub.
ScienceDirect, and Google Scholar, supported by Publish or Perish software for searching and analysis.
The keywords used were: AuHypertensionAy AND AuPrevention Behavior,Ay AuHypertensionAy AND AuHealth Belief Model,Ay and AuHypertensionAy AND AuSelf-efficacy.
Ay The inclusion criteria consisted of original research articles, open-access journals written in PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 English, published between 2020Ae2025, and aligned with the PICO components (Population.
Intervention.
Comparison.
Outcom.
Table 1.
PICO
Komponen Keterangan Population or Who is being researched? man and woman age 24 Ae 60 years with hypertensions What problems and diseases in this research to know the associated between health behavior intervention with hypertensions prevention behavior Intervention or What is the patient's expected condition? life style behavior cause hypertension ? Comparison How the comparison between patients with medication adherence and non-adherence? Case control Cross sectional Randomized Controlled trial Outcome What the expected outcome? there associated between health behavior intervention with hypertensions prevention behavior The initial search produced 5,195 articles, which were narrowed down to 505 articles with the highest citations.
After removing duplicates and systematic review articles, 394 articles remained.
Further screening based on full-text accessibility excluded 284 articles, leaving 110 eligible articles.
After reviewing research methods and result relevance, 19 articles met all criteria and were included in the final analysis.
Data
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
identification and extraction followed the PRISMA flow diagram.
Researchers use the PICO (Population.
Intervention.
Comparison and Outcom.
, such as the following table 1.
Records identified from*:
Databases .
=5.
GS .
= .
PUBMED .
= .
Records removed before Not relevant with HBM:
Plos .
= .
Sagepub ( n = 1088 ) Records screened Records excluded** .
= .
Duplicate title .
Title content Systematic review .
Reports sought for retrieval .
= .
Reports assessed for eligibility Abstract .
= 21 Reports not retrieved Book type .
=10 ) Systematic review .
= .
Full text not accessable .
Not research finding .
=64 ) Reports .
Design study irrelevant .
= Studies included in review .
= Irrelevant exposure .
Irrelevant outcome .
= .
Reports of included studies .
= Figure 1.
PRISMA Flowchart *Consider, if feasible to do so, reporting the number of records identified from each database or register searched .
ather than the total number across all databases/register.
**If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
RESULTS
800 related article were collected through systematic searches, we used PRISMA for screening And final review only 24 were included for research related to Health Beliefs Models and hypertensions.
Table 2 here for analysis the associated between hypertensions with health belief interventions, this review identified that knowledge has associated with adherence to antihypertensive medication.
70% studies had cross sectional designs, and 30% had quasy experimental design and some randomizes controlled trial.
Table 2.
the associated between hypertensions to health belief interventions Writer Ali et al.
Rahman & Dewi .
Mwangi et al.
Purpose To evaluate the effectiveness of Health Belief Model-based interventions in adherence among To analyze the between HBM constructs and behavioral changes in hypertensive Method Randomized Controlled Trial (RCT) with pretest-posttest Location Kuala Lumpur.
Malaysia.
Cross-sectional survey involving Bandung.
Indonesia To assess the impact of an HBMbased educational program on blood pressure reduction among the elderly Quasiexperimental, pre-post design control group.
Nairobi.
Kenya HBM intervention (OR = 2.
95% CI:
improved patientsAo 1.
60Ae3.
susceptibility and benefits, with a 35% increase in adherence within three months.
High perceived (OR = 1.
benefits were 95% CI:
associated with 35Ae2.
increased odds of and (OR = healthy lifestyle 95% CI:
adoption nd high 44Ae3.
self-efficacy increased the odds of blood pressure After 12 weeks, (OR = 2.
participants with 95% CI:
improved HBM 70Ae4.
scores had greater odds of achieving PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 Eva Rayanti et , .
Octafyananda et al.
, .
Chang et al.
Fang et al.
Widiyanto to analyze the between the Health Belief Model and Manegement Hypertension in sufferes in Pap to determine the factors associated with the prevention of hypertension in To investigated behavioral factors associated with nonadherence in patients in southern Taiwan To develop and test an intelligent digital intervention via WeChat based on HBM to improve healthy behaviors in hypertensive To examine the impact of HBM constructsperceived benefits, cues to action, and susceptibility on adherence among Cross sectional Indonesia Cross Sectional Indonesia Cross sectional Taiwan RCT using behavior change (BCT.
such as exercise, and Cross sectional China Indonesia Ou10 mmHg systolic BP reduction The relationship between health belief model to p 0,003 < 0,005 The associated knowledge with Prevention of Hypertension in Adolescent The behavior factors of nonadherence was forgetting to take p 0,013 Participants had higher odds of consistent blood monitoring and exercise behaviors during weeks 2Ae6 compared to Respondent knowledge about (OR = 2.
95% CI 1.
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
28,8%
42,5 %
Kam & Lee patients through meta-analysis.
To integrate HBM into clinical health programs for patients and assess Clinical South Korea Intervention group greater blood reductions and adherence at 3 and 6 months.
estimates for adherence were Odds Ratio = 2.
Table 2 summarizes various studies analyzing the relationship between components of the Health Belief Model (HBM) and hypertension management behaviors.
The findings indicate that HBM-based interventions are effective in improving medication adherence, healthy lifestyle changes, and regular blood pressure monitoring.
Factors such as perceived susceptibility, perceived benefits, and self-efficacy significantly contribute to behavioral changes among hypertensive patients across different countries.
Table 3.
the effectiveness health belief model for hypertensions preventions behavior Dewi & Hartono To evaluate the effect of a school-based HBM intervention on salt intake and physical activity among young Method Quasiexperimental pre-post design with Location Yogyakarta.
Indonesia.
Ahmed et To implement and assess a mobile application based on HBM for hypertension prevention among prehypertensive adults.
Randomized Controlled Trial (RCT) with 6month follow-up.
Cairo.
Egypt.
Result Students receiving (OR = 2.
95% CI:
HBM-based 32Ae3.
and (OR education were 2.
= 1.
95% CI:
times more likely to 1.
15Ae2.
reduce daily salt intak.
and engage in moderate physical activity The intervention (OR = 2.
95% CI:
group showed 70Ae3.
higher compliance with dietary changes and blood pressure screening and Significant PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 Hussen et , .
Joho, .
Larki et al.
Azadi et al.
Chen & Liu improvements were observed in selfefficacy and perceived severity Respondent knowledge.
Good selfcare, good social assessed self-care practice and associated factors among hypertensive patients in public health facilities of Harar Town in eastern Ethiopia to investigate the influence of treatment compliance using HBM constructs among elderly hypertensive patients in 3 regional hospitals in Dar es Salaam.
Tanzania to determine the factors influencing adherence to self-care behaviors among low health literacy hypertensive patients based on health belief Cross Ethiopia Cross Tanzania Partisipant compliant to treatment and perceived barrier was strongest compliance to 56 %.
Cross Iran OR = 3,47.
OR =
1,10
to investigate the impact of educational programs based on the health belief model to promote hypertension prevention behavior of Iran University of Medical Sciences staff To test an online HBMbased educational Quasy Iran Perceived selfefficacy was associated with all self-care behaviors except medication There was a significant association between susceptibility and adherence to both low-salt diet and non smoking Knowledge.
Perceived Perceived severity Pre-post Beijing.
China.
After 3 months, 67% of participants r = Oe0.
419, p = .
= 0.
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
47,95%.
29,9%.
27,95%
p 0,011.
p<0,001.
p 0,001 Zhang et , .
Khairy et , .
Khademian et al.
program for prevention among office workers.
to introduce the HBPHL, and develop a structural equation model (SEM) to identify the factors influencing of the HRQoL among Kazakh hypertensive patients to assess self-efficacy of hypertension management and patient-physician communication, as well as the factors associated with selfefficacy and patientphysician communication among patients with hypertension in Palestine to determine the effect of self-care education based on OremAos nursing theory on the quality of life and selfefficacy in patients with hypertension study with adopted DASHaligned diet vs 35% in the control group p = 0.
= 714, p = 0.
Random China Self efficacy and social support 96,1%.
98,3%
Palestine self-efficacy was linked to overweight and 53,1 % Quasy Iran quality of life in the experimental group was significantly higher than the control group eight weeks after the .
5A26.
5 vs.
5A22.
P=0.
Table 3 presents the effectiveness of Health Belief Model-based interventions in promoting hypertension prevention behaviors.
Studies from various countries show that HBM-based health education improves knowledge, self-care practices, and adherence to healthy behaviors such as salt reduction and physical activity.
Self-efficacy and social support emerged as strong predictors of health-promoting behaviors.
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
DISCUSSION
Health Belief Interventions to hypertension behavior preventions Table 2 presents a range of studies examining the relationship between the Health Belief Model (HBM) and hypertension-related behaviors.
Overall, the findings support the effectiveness of HBM-based interventions in improving both preventive and management behaviors related to hypertension across various global contexts.
Several studies reported statistically significant odds ratios that illustrate the strength of association between HBM components and behavioral outcomes.
For instance.
Ali et al.
found that HBM-based interventions significantly improved medication adherence in hypertensive patients in Malaysia (OR = 2.
95% CI: 1.
60Ae3.
, showing that increased perceived susceptibility and benefits can drive behavior change .
Similarly, in Indonesia.
Rahman and Dewi .
demonstrated that perceived benefits (OR = 1.
and self-efficacy (OR = 2.
significantly increased the likelihood of healthy lifestyle adoption and regular blood pressure monitoring .
Educational approaches using HBM were also effective.
Mwangi et al.
showed that a 12-week HBM-based program led to significant reductions in systolic blood pressure among elderly Kenyans (OR = 2.
, underscoring the model's applicability in geriatric populations .
Kam and Lee .
reported comparable results in South Korea, with improved adherence and blood pressure outcomes at 3 and 6 months post-intervention .
stimated OR = 2.
, supporting the use of HBM in structured clinical education .
Digital interventions grounded in HBM are emerging as powerful tools.
Fang et al.
utilized a WeChat-based platform in China and reported significantly improved blood pressure monitoring and exercise maintenance (OR = 2.
95% CI: 1.
45Ae3.
indicating the effectiveness of technology-enabled health behavior change .
Other studies reinforced these findings through statistical associations.
Eva Rayanti et al.
showed that HBM variables were significantly associated with hypertension management PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 in primary care .
= 0.
Octafyananda et al.
found knowledge as a key factor in hypertension prevention among adolescents .
= 0.
, consistent with the HBMAos focus on perceived knowledge and awareness .
Conversely.
Chang et al.
emphasized behavioral barriers such as forgetfulness in medication adherence, which can be interpreted through the HBM construct of perceived barriers .
Widiyanto .
conducted a meta-analysis and found that perceived susceptibility, cues to action, and perceived benefits significantly influenced adherence .
, aOR = 2.
16 for susceptibilit.
, strengthening the theoretical foundation for using HBM in chronic disease prevention .
In conclusion, the evidence supports the Health Belief Model as an effective framework for designing and evaluating interventions aimed at hypertension prevention and control.
Interventions that enhance perceived severity, benefits, and self-efficacy especially when integrated into digital or clinical platforms can significantly increase the likelihood of preventive health behaviors across diverse populations.
The effectiveness Health beliefs model to hypertensions preventions behavior This systematic review aims at describing the effectiveness of education based on a health belief model in improving for hypertension prevention behavior, such as improving their self-care, and adherence people to antihypertensive treatment.
Table 3 presents diverse studies from various countries that analyze the effectiveness of the Health Belief Model (HBM) in promoting hypertension prevention behavior.
The studies collectively confirm that interventions based on HBM significantly improve behavioral outcomes related to hypertension, including diet modification, physical activity, self-efficacy, and treatment adherence.
Several studies reported statistically significant effects of HBM-based interventions.
In Indonesia.
Dewi and Hartono .
demonstrated that school-based HBM education significantly increased the likelihood of students reducing salt intake (OR = 2.
95% CI:
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
32Ae3.
and engaging in moderate physical activity (OR = 1.
95% CI: 1.
15Ae2.
This underscores the importance of early, school-level interventions in building lifelong healthy behaviors .
Similarly.
Ahmed et al.
tested a mobile-based HBM application in Egypt and found that participants in the intervention group were more likely to comply with dietary recommendations and regular blood pressure screening (OR = 2.
95% CI: 1.
70Ae3.
Improvements in perceived severity and self-efficacy were also significant, confirming the centrality of these HBM constructs in digital behavior change programs .
While some studies used experimental methods, others employed observational designs to explore how HBM constructs correlate with hypertension-related behaviors.
For example.
Larki et al.
in Iran found that perceived self-efficacy and susceptibility were associated with adherence to a low-salt diet and non-smoking behavior (OR = 3.
47 and OR = 1.
, especially in individuals with low health literacy .
Azadi et al.
also confirmed the value of HBM in health education.
their quasiexperimental study showed that educational interventions significantly increased perceived susceptibility .
= 0.
, perceived severity .
< 0.
, and knowledge levels among staff at a university .
In China.
Web- or digital-based interventions have shown improvements in dietary patterns aligned with the DASH diet among working-age adults.
for example, the DASH for Health program .
web-based program for employee.
reported increased fruit consumption over 12 months .
= 0.
following exposure to online educational content, indicating that web-based interventions can effectively improve dietary behaviors .
Some studies added further insight into related psychological factors.
Joho .
found that perceived barriers were the strongest predictors of treatment compliance among elderly patients in Tanzania, with 30% reporting barrier-related nonadherence .
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
Likewise.
Khairy et al.
observed that self-efficacy in managing hypertension was closely related to obesity status and patient physician communication .
Zhang et al.
applied a structural equation model (SEM) in China and concluded that self-efficacy and social support were key predictors of health-related quality of life (HRQoL) among Kazakh hypertensive patients .
Moreover.
Khademian et al.
demonstrated that self-care education significantly improved the quality of life and self-efficacy in hypertensive patients, with higher mean quality of life scores postintervention .
5A26.
5 vs.
5A22.
P = 0.
(Khademian et al.
, 2.
Lastly.
Hussen et al.
found that knowledge .
95%) and good self-care practices .
9%) were positively associated with better hypertension management in Ethiopian patients, confirming the importance of cognitive components in disease prevention .
summary, the evidence shows that HBM is a reliable framework for guiding hypertension prevention efforts.
Enhancing key constructs such as perceived susceptibility, benefits, and self-efficacy especially when embedded in culturally relevant, age-appropriate, and technology-driven interventions can significantly improve health behavior outcomes.
From all studies we found that self efficacy was indicated as the strongest predictor of health promoting behavior when other variable kept constant, the level of health promotion increased with increased self efficacy.
Furthermore, the variable of social support plays a role in health-promoting behavior.
social support was the second-strongest predictor of health-promoting behavior.
Hypertension is a challenging in medical condition among Non communicable disease, the strategy to control hypertensions are increasing public knowledge and awareness about the risk that associated with high blood pressure.
The most frequently used model of behavior change is health belief model.
HBM
demonstrates the relationship between health beliefs and health behaviour, according to this model how hypertensions adopt self care abd controlling their behaviors.
And perceived susceptibility is one of the important factors affecting health behaviors.
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 interventions increased the perceived susceptibility also Health belief model interventions led to increase perceived benefits and a reduction in perceived barriers, health belief model may increase the heath care performances .
CONCLUSIONS AND RECOMMENDATIONS
The Purpose of this systematic review is to prove the effectiveness of Health belief interventions in changing Hypertensions preventions behaviour, adherence and non adherence to antihypertensive treatment and nonadherence, types of intervension, methode and all the factor that associated with hypertension include 5 construct from health belief model.
From all studies in this review show that a significant change in behavior after interventions, but we can not simply judge the effectiveness of health belief models on medication adherence improvement Psychosocial interventions to raise or maintain individuals self efficacy is needed, to optimize their blood pressure control.
And health educations should be provided to improve the rate of compliance by improving patientAos knowledge and perception about hypertensions and its consequences.
BIBLIOGRAPHY