Perceived and Actual Risk of Hypertension among Adults in Dar es Salaam Peri-urban, Tanzania: A Community-Based Cross-sectional Study
Abstract
Globally, hypertension is a major public health concern, particularly in low- and middle-income countries like Tanzania, contributing significantly to cardiovascular disease and posing a substantial burden on healthcare systems. Effective risk assessment and management strategies are crucial, and understanding individuals' perceptions of risk is essential for developing effective interventions. This study aimed to compare the perceived risk of hypertension with the actual risk and to identify factors influencing the perception of hypertension risk among 310 non-hypertensive adults in peri-urban areas of Dar es Salaam, Tanzania. Data were collected using a structured questionnaire. Data were analysed using IBM SPSS Statistics for Windows, version 23, employing descriptive and inferential statistics. Independent samples t-tests and Welch's t-tests were used to examine differences in hypertension risk perceptions, while one-way ANOVA and Scheffé's test were used to identify group differences. Hypertension risk scores were calculated using the Framingham Hypertension Risk Prediction Score formula to assess the 1-, 2-, and 4-year risks of developing hypertension, and each was categorised as low, moderate, or high risk. The study found that perceived benefits (64%) were the highest, followed by perceived susceptibility (63.1%), perceived severity (59.2%), perceived cues for action (55.5%), and perceived self-efficacy (55.5%). Significant differences were observed between age and perceived severity (p = 0.01), perceived barriers (p < 0.001), and perceived cues (p = 0.01). Additionally, education was associated with perceived severity (p<0.001). The frequencies of low, moderate, and high 4-year risk scores were 29.0, 24.8, and 46.1%, respectively. However, there was no significant correlation between perceived and actual risk. This study has highlighted the critical gap between perceived and actual risk of developing hypertension among individuals, coupled with a high percentage of individuals at risk of becoming hypertensive. Therefore, the Ministry of Health, in collaboration with non-governmental organisations, should launch educational campaigns to inform the public about the risk factors, complications, and benefits of early detection of hypertension. Additionally, influential community figures, such as religious and community leaders, should advocate for regular hypertension screenings and promote healthy lifestyle choices.
Downloads
References
Afam, G., & Nakalega, A. P. (2024). Hypertension risk perception among young adults in Victoria University, Kampala, Uganda. International Journal of Cardiology Cardiovascular Risk and Prevention, 23, 200327.
Angelo, A. T., Geltore, T. E., Sciences, H., Aman, M., Science, H., Campus, D., Sciences, H., Tepi, M., & Aman, M. (2020). Lifestyle modification practices and associated factors among diagnosed hypertensive patients in Mizan Tepi University Teaching Hospital, Southwest Ethiopia, 2019: a cross-sectional study. PAMJ-Clinical Medicine, 2(156).
Asnakew, Z., Asrese, K., & Andualem, M. (2020). Community risk perception and compliance with preventive measures for COVID-19 pandemic in Ethiopia. Risk Management and Healthcare Policy, 2887-2897.
Bae, S. H., Hwang, O., Jeong, J., & Yang, Y. (2022). Risk Perceptions of Noncommunicable Diseases among Cambodian Adults: A Cross-Sectional Study. Research in Community and Public Health Nursing, 33(2), 259-268.
Boo, S., Oh, H., Froelicher, E. S., & Suh, C. H. (2017). Knowledge and Perception of Cardiovascular Disease Risk among Patients with Rheumatoid Arthritis. PloS one, 12(4), e0176291.
David, H., Omosivie, M., Amarachi, J., Kemdirim, C., Opurum, N., & Uduak, A. (2023). Hypertension: risk perception and health seeking behaviour of long-distance drivers in Port Harcourt. African Health Sciences, 23(4), 315-323.
Fisher, N. D. L., & Curfman, G. (2018). Hypertension — A Public Health Challenge of Global Proportions. Jama, 320(17), 1757–1759. https://doi.org/10.1016/S0140
Glanz, K., Rimer, B. K., Viswanath, K., Champion, V. L., & Skinner, C. S. (2008). The health belief model. Health behaviour and Health Education: Theory, Research, and Practice. San Francisco: John Wiley & Sons, Inc.
Hassen, H. Y., Bowyer, M., Gibson, L., Abrams, S., & Bastiaens, H. (2022). Level of cardiovascular disease knowledge, risk perception and intention towards healthy lifestyle and socioeconomic disparities among adults in vulnerable communities of Belgium and England. BMC Public Health, 22(1), 197.https://doi.org/10.1186/s12889-022-12608-z
Kaba, Z., Khamisa, N., & Tshuma, N. (2017). Age-group differences in risk perceptions of non-communicable diseases among adults in Diepsloot township, Johannesburg, South Africa: A cross-sectional study based on the Health Belief Model. South African Medical Journal, 107(9), 797–804. https://doi.org/10.7196/SAMJ.2017.v107i9.12168
Kazi, D. S., Elkind, M. S. V., Deutsch, A., Dowd, W. N., Heidenreich, P., Khavjou, O., Mark, D., Mussolino, M. E., Ovbiagele, B., Patel, S. S., Poudel, R., Weittenhiller, B., Powell-Wiley, T. M., Joynt Maddox, K. E., & American Heart Association (2024). Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association. Circulation, 150(4), e89–e101. https://doi.org/10.1161/CIR.0000000000001258
Kilic, M. A. H. M. U. T., Ede, H., & Kilic, A. I. (2016). Risk of Hypertension in Yozgat Province, Central Anatolia: Application of the Framingham Hypertension Prediction Risk Score. EMHJ-Eastern Mediterranean Health Journal, 22(4), 244-250.
Kivimaki, M., Batty, G. D., Singh-Manoux, A., Ferrie, J. E., Tabak, A. G., Jokela, M., ... & Shipley, M. J. (2009). Validating the Framingham Hypertension Risk Score: Results from the Whitehall II Study. Hypertension, 54(3), 496-501.
Koohi, F., Steyerberg, E. W., Cheraghi, L., Abdshah, A., Azizi, F., & Khalili, D. (2021). Validation of the Framingham hypertension risk score in a Middle Eastern population: Tehran lipid and glucose study (TLGS). BMC Public Health, 21(1), 790.
Ling, J. M. Y., Ahmad, N., & Aizuddin, A. N. (2023). Risk Perception of Non-Communicable Diseases: A Systematic Review of Its Assessment and Associated Factors. PLoS One, 18(6), e0286518.
Onoruoiza, S. I., Musa, A., Umar, B. D., & Kunle, Y. S. (2015). Using health beliefs model as an intervention to non compliance with hypertension information among hypertensive patient. International Organization of Scientific Research Journal Of Humanities And Social Science, 20(9), 11-16.
Paek, H. J., & Hove, T. (2017). Risk perceptions and risk characteristics. In Oxford research encyclopedia of communication.
Pallangyo, P. (2020). Hypertension in Urban Tanzania : A ticking time bomb. Archivos de Medicina, 16(4), 3.
Parikh, N. I., Pencina, M. J., Wang, T. J., Benjamin, E. J., Lanier, K. J., Levy, D., D’Agostino, R. B., Kannel, W. B., & Vasan, R. S. (2008). A Risk Score for Predicting Near-Term Incidence of Hypertension: The Framingham Heart Study. Annals of Internal Medicine, 148(2), 102-110.
Pasi, H., Isa, Z. M., & Shah, S. A. (2018). Perceived risk of developing cancer in a suburban community in Malaysia. Asian Pacific journal of cancer prevention: APJCP, 19(2), 395-400.
Schutte, A. E., Srinivasapura Venkateshmurthy, N., Mohan, S., & Prabhakaran, D. (2021). Hypertension in low- and middle-income countries. Circulation research, 128(7), 808–826.
Setiyaningsih, R., Tamtomo, D., & Suryani, N. (2016). Health Belief Model: Determinants of Hypertension Prevention Behavior in Adults at a Community Health Center, Sukoharjo, Central Java. Journal of Health Promotion and Behavior, 1(3), 160-171.
The United Republic of Tanzania (URT), Ministry of Finance and Planning, Tanzania National Bureau of Statistics and President’s Office - Finance and Planning, Office of the Chief Government Statistician, Zanzibar. (2022). The 2022 Population and Housing Census: Administrative Units Population Distribution Report; Tanzania, December 2022.
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). Clinical Practice Guidelines 2020 International Society of Hypertension Global Hypertension Practice Guidelines International Society of Hypertension. Hypertension, 75(6), 1334–1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
World Health Organization. (WHO). (2000). Obesity: Preventing and Managing the Global Epidemic. World Health Organization.
Zabler, B., Tsai, P., Fendrich, M., Cho, Y., Taani, M. H., & Schiffman, R. F. (2018). Effect of a nurse case management intervention for hypertension self-management in low-income African Americans. In Contemporary Clinical Trials (Vol. 71, p. 199). Elsevier BV. https://doi.org/10.1016/j.cct.2018.06.011
Copyright (c) 2025 Lilian Leonard Fweja, Akwilina Wendelin Mwanri, Cornelio Nyamhanga Nyaruhucha
This work is licensed under a Creative Commons Attribution 4.0 International License.
