INTRODUCTION:

Hypertension, defined as blood pressure ≥140/90 mmHg, affects over 1.13 billion adults globally, with 31.1% prevalence in low- and middle-income countries (LMICs)¹. Despite being a leading modifiable risk factor for cardiovascular mortality, only 54% of hypertensive adults are diagnosed, 42% treated, and 21% achieve blood pressure control globally². This gap is particularly pronounced in rural areas where health literacy and access to care are limited³.

The WHO South-East Asia Region, including India, saw hypertension prevalence rise from 29% to 32% between 1990–2019, with 144 million additional cases⁴. In 2019, 652 million men and 626 million women worldwide had hypertension, with LMICs bearing 72% of the burden⁵. India’s national prevalence aligns with these regional trends, though rural-specific data remains sparse⁶.

Studies in Ethiopia and Indonesia reveal 51.3% of hypertensive patients exhibit poor self-care practices, strongly correlated with inadequate knowledge (OR=4.51)⁷. Only 52.5% of patients with sufficient hypertension knowledge demonstrate adequate self-care, highlighting the critical role of education⁸. Rural populations face compounded challenges, including limited access to screening (23% awareness rates in LMICs) and socioeconomic barriers to lifestyle modifications⁹.

WHO emphasizes scalable interventions like community education to improve hypertension control, citing success in Costa Rica and Vietnam where programs increased treatment rates by 30%¹⁰. Structured education improves medication adherence (18% to 47% in LMICs), dietary compliance, and stress management—key factors in blood pressure reduction¹¹.

While national data indicates a 32% prevalence of hypertension in India’s Southeast Asia region, there is an urgent need for Rajasthan-specific studies to understand regional variations¹². The burden of hypertension in rural Udaipur likely mirrors national trends but is further exacerbated by unique challenges such as low health literacy, with 47% of rural Indians unaware of hypertension¹³, limited access to BP monitors (only 1.3 devices per 10,000 people in rural India), and cultural dietary patterns high in salt and fats¹⁴. Addressing these gaps, this study evaluates how a tailored community-based health education programme can enhance knowledge and self-care practices among underserved populations in Udaipur. The findings provide critical insights for improving hypertension management strategies in low- and middle-income countries (LMICs), emphasizing the role of targeted health interventions in bridging healthcare disparities.

PROBLEM STATEMENT:

A study to evaluate the impact of community-based health education programme on knowledge and self-care practices regarding hypertension among adults in selected rural areas of Udaipur district.

OBJECTIVES:

1. To assess the pre-existing knowledge and self-care practices regarding hypertension among adults in selected rural areas.

2. To implement a community-based health education programme on hypertension management.

3. To evaluate the effectiveness of the programme by comparing pre-test and post-test knowledge and self-care practices scores.

4. To determine the association between pre-test knowledge and self-care practices with selected demographic variables.

HYPOTHESES:

· H₀ (Null Hypothesis): There is no significant difference in knowledge and self-care practices regarding hypertension among adults before and after the implementation of the community-based health education programme.

· H₁ (Alternative Hypothesis): There is a significant improvement in knowledge and self-care practices regarding hypertension among adults after the implementation of the community-based health education programme.

· H₂ (Alternative Hypothesis): There is a significant association between knowledge and self-care practices score regarding hypertension among adults after the implementation of the community-based health education programme.

ASSUMPTIONS:

· Adults in rural areas have inadequate knowledge and self-care practices regarding hypertension.

· Community-based health education programmes can enhance knowledge and promote positive behavioral changes.

· Educated individuals are more likely to adopt healthier lifestyle practices for hypertension management.

DELIMITATIONS:

· The study is limited to adults residing in selected rural areas of Udaipur district.

· Only those who are diagnosed or at risk of hypertension will be included.

· The study period is restricted to a specific duration for data collection and intervention implementation.

CONCEPTUAL FRAMEWORK:

This study is based on Rosenstock’s Health Belief Model (HBM), which explains health-related behaviors based on individuals’ perceptions of susceptibility, severity, benefits, and barriers to taking preventive actions. The framework will guide the implementation and evaluation of the community-based health education programme.

MATERIALS AND METHODS:

Research Approach:

The quantitative evaluative approach was used in the present study.

Research Design:

Quasi-experimental (pre-test and post-test design with a control group).

Setting of the Study:

Selected rural areas of Udaipur district.

Sample and Sampling technique:

100 (50 experimental and 50 control) Adults aged 18 years and above were selected by purposive sampling technique

Variables:

Dependent Variables:

· Knowledge regarding hypertension (measured through a structured questionnaire).

· Self-care practices related to hypertension (measured through a self-care checklist).

Independent Variable:

Community-Based Health Education Programme on hypertension management.

Description of tool:

· Part I: Demographic data

· Part II: Structured questionnaire for knowledge assessment.

· Part III: Self-care practices checklist for practice assessment.

Content validity of tool:

The content validity of the tools was established by a panel of five experts, which included four nursing educators from different specialties and one statistician. Their evaluation ensured the appropriateness, relevance, and clarity of the items included in the structured knowledge questionnaire and self-care practices checklist.

Reliability of the tool:

A pilot study was conducted to assess the clarity, feasibility, and reliability of the instrument. Permission was obtained from the competent authorities, and a pre-test of the structured knowledge questionnaire and self-care practices checklist was conducted among five adults with hypertension residing in a selected rural area. The reliability coefficient (r-value) of the tool was found to be 0.95, indicating a high level of reliability. The results were statistically significant at p < 0.05, confirming the tool’s consistency in measuring knowledge and self-care practices regarding hypertension.

Data collection: The data collection was carried out in two phases:

· Pre-test: A structured knowledge questionnaire and a self-care practices checklist were administered to assess participants' baseline knowledge and self-care practices regarding hypertension.

· Intervention: On the same day, a Community-Based Health Education Programme on hypertension was implemented, covering aspects such as causes, risk factors, complications, dietary modifications, medication adherence, and lifestyle changes.

· Post-test: After seven days, a post-test was conducted using the same structured knowledge questionnaire and self-care practices checklist to evaluate the effectiveness of the health education programme.

Analysis and interpretation:

The collected data were analyzed using both descriptive and inferential statistics.

· Descriptive statistics such as mean, standard deviation, frequency, and percentage were used to summarize the demographic data and pre-test and post-test scores.

· Inferential statistics such as paired t-test and chi-square test were used to assess the effectiveness of the health education programme and determine associations between knowledge/self-care practices and selected demographic variables.

RESULT:

SECTION-I: Description of samples demographic data of both group experimental and control group.

SECTION-II: Distribution of samples according to grading of pre-test and post-test knowledge score in both experimental and control group.

SECTION-III: Distribution of samples according to grading of pre-test and post-test practice score in both experimental and control group.

SECTION-IV: Evaluate the effectiveness of community-based health education programme on hypertension in terms of knowledge and practice among experimental group.

SECTION-V: Association between the pre-test knowledge and practice score with their selected demographic variables in experimental group.

SECTION-VI: Association between the pre-test knowledge and practice score with their selected demographic variables in control group.

Table-1: Frequency and percentage distribution of samples based on demographic data in both group experimental and control group

S. No.	Demographic Variables		Experimental Group (n=50)		Control Group (n=50)
S. No.	Demographic Variables		Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
1	Age (in years)	18-30	15	30.00	17	34.00
		31-45	19	38.00	22	44.00
		46-60	10	20.00	7	14.00
		>60	6	12.00	4	8.00
2	Gender	Male	32	64.00	29	58.00
2	Gender	Female	18	36.00	21	42.00
3	Educational Status	No formal education	18	36.00	20	40.00
		Primary education	22	44.00	17	34.00
		Secondary education	6	12.00	12	24.00
		Higher education	4	8.00	1	2.00
4	Occupation	Unemployed	22	44.00	11	22.00
		Daily wage laborer	10	20.00	19	38.00
		Self-employed	13	26.00	13	26.00
		Government/Private Employee	5	10.00	7	14.00
5	Family History of Hypertension	Yes	29	58.00	33	66.00
5	Family History of Hypertension	No	21	42.00	17	34.00
6	Duration of Hypertension	<1 year	18	36.00	21	42.00
		1-5 years	24	48.00	26	52.00
		>5 years	8	16.00	3	6.00
7	Previous Knowledge about Hypertension	Yes	22	44.00	30	60.00
7	Previous Knowledge about Hypertension	No	29	58.00	20	40.00

Table-2: Frequency and percentage distribution of samples based on grading of pre-test and post-test knowledge score in both group experimental and control group

Level of Knowledge	Experimental Group (n=50)				Control Group (n=50)
	Pre-test		Post-test		Pre-test		Post-test
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Inadequate Knowledge	36	72.00	0	0.00	41	82.00	30	60.00
Moderate Knowledge	14	28.00	22	44.00	9	18.00	20	40.00
Adequate Knowledge	0	0.00	28	56.00	0	0.00	0	0.00
TOTAL	50	100.00	50	100.00	50	100.00	50	100.00

Table-3: Frequency and percentage distribution of samples based on grading of pre-test and post-test practice score in both group experimental and control group

Level of Practices	Experimental Group (n=50)				Control Group (n=50)
	Pre-test		Post-test		Pre-test		Post-test
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Poor Practices	40	80.00	0	0.00	42	84.00	35	70.00
Average Practices	10	20.00	22	44.00	8	16.00	15	30.00
Good Practices	0	0.00	28	56.00	0	0.00	0	0.00
TOTAL	50	100.00	50	100.00	50	100.00	50	100.00

Table-4 presents the mean, standard deviation (SD), mean percentage, mean difference, and ‘t’ value of pre-test and post-test knowledge and practice scores for the experimental group. The pre-test mean knowledge score was 9.52(32.73%), which increased to 21.30(71.00%) in the post-test, showing a mean difference of 11.48. The calculated ‘t’ value (16.2254) was higher than the tabulated value (1.684), indicating a statistically significant improvement (p<0.05). Similarly, the pre-test mean practice score was 4.22(28.13%), which increased to 10.58(70.53%) in the post-test, with a mean difference of 6.36. The calculated ‘t’ value for practice (18.5012) also exceeded the tabulated value, confirming a significant enhancement in self-care practices after the intervention. Hence, the study findings suggest that the community-based health education program was effective in improving knowledge and self-care practices regarding hypertension. The research hypothesis (H₁) is accepted, and the null hypothesis (H₀) is rejected.

Table-5 displays the mean, standard deviation (SD), mean percentage, mean difference, and ‘t’ value of pre-test and post-test knowledge and practice scores for the control group. The pre-test mean knowledge score was 9.08 (30.27%), which slightly increased to 10.10 (33.67%) in the post-test, with a mean difference of 3.40. The calculated ‘t’ value (1.6618) was lower than the tabulated value (1.684), indicating no statistically significant improvement (p > 0.05). Similarly, the pre-test mean practice score was 4.06 (27.07%), which slightly increased to 4.70 (31.33%) in the post-test, with a mean difference of 4.27. The calculated ‘t’ value (1.6051) also did not exceed the tabulated value, suggesting no significant enhancement in self-care practices. These findings indicate that in the absence of the community-based health education program, there was no substantial improvement in knowledge and self-care practices regarding hypertension. The findings indicate a significant improvement in knowledge and self-care practices regarding hypertension among the experimental group after the community-based health education program, as the calculated ‘t’ values exceeded the tabulated values (p<0.05). In contrast, the control group showed no significant improvement. Thus, the research hypothesis (H₁) is accepted, and the null hypothesis (H₀) is rejected, confirming the effectiveness of the intervention.

Section-V: Association Between the Pre-Test Knowledge and Practice Score with Their Selected Demographic Variables in Experimental Group:

The association between pre-test knowledge scores and selected demographic variables in the experimental group was analyzed using the chi-square test. The results indicate that gender (χ² = 5.294, p<0.05), educational status (χ²=8.312, p<0.05), family history of hypertension (χ²=3.894, p<0.05), duration of hypertension (χ²=7.323, p < 0.05), and previous knowledge about hypertension (χ² = 5.362, p<0.05) showed a significant association with pre-test knowledge scores. However, age (χ² = 6.545) and occupation (χ²=2.15) did not show a significant association (p>0.05). Similarly, the association between pre-test practice scores and selected demographic variables was analyzed. The results show a significant association between educational status (χ² = 10.11, p<0.05), occupation (χ² =8.187, p < 0.05), family history of hypertension (χ² = 9.314, p < 0.05), duration of hypertension (χ² = 8.294, p < 0.05), and previous knowledge about hypertension (χ² = 7.146, p < 0.05) with pre-test practice scores. However, age (χ² = 3.215) and gender (χ² = 2.151) did not show a significant association (p > 0.05). The findings indicate a significant association between pre-test knowledge and practice scores with selected demographic variables such as educational status, family history of hypertension, duration of hypertension, and previous knowledge about hypertension. Since the chi-square test results show statistical significance (p < 0.05) for these variables, the research hypothesis (H₂) is accepted, and the null hypothesis is rejected.

Section-Vi: Association Between the Pre-Test Knowledge and Practice Score with Their Selected Demographic Variables in Control Group:

The analysis of the association between pre-test knowledge scores and selected demographic variables in the control group revealed that educational status (χ² = 11.21, p < 0.05) and duration of hypertension (χ² = 6.75, p<0.05) showed a significant relationship with knowledge levels. This indicates that individuals with higher education and longer durations of hypertension tend to have better knowledge about hypertension. However, no significant association was found between knowledge scores and other variables such as age, gender, occupation, family history of hypertension, and previous knowledge. Similarly, the analysis of pre-test practice scores in relation to demographic factors showed that occupation (χ² = 8.401, p<0.05) and family history of hypertension (χ² = 8.36, p<0.05) were significantly associated with self-care practices for hypertension management. This suggests that individuals with a specific occupational background and those with a family history of hypertension are more likely to adopt better self-care practices. However, other variables, including age, gender, educational status, duration of hypertension, and previous knowledge, did not show a significant association with practice scores. These findings suggest that in the control group, educational status and duration of hypertension significantly influence knowledge levels, whereas occupation and family history of hypertension impact self-care practices. This highlights the need for targeted educational interventions to enhance knowledge and improve self-care behaviors among individuals with hypertension.

DISCUSSION:

The present study assessed the effectiveness of a community-based health education programme on knowledge and self-care practices regarding hypertension among adults in selected rural areas. The findings revealed a significant improvement in both knowledge and self-care practices post-intervention, indicating the positive impact of structured educational interventions. The results of this study align with those of Sharma et al. (2020), who conducted a similar intervention-based study among rural hypertensive patients and reported a significant increase in knowledge scores post-intervention (p<0.05). Similarly, a study by Singh et al. (2019) emphasized the effectiveness of community health education in improving adherence to hypertension management strategies, supporting the present study’s findings. Moreover, our study observed a marked improvement in self-care practices, consistent with the results of a quasi-experimental study by Patel and Mehta (2021), which demonstrated that tailored education programmes significantly enhance patients’ ability to manage hypertension through lifestyle modifications. However, contrasting findings were noted in a study by Kumar et al. (2018), where the intervention resulted in only a moderate improvement in knowledge levels, possibly due to differences in sample demographics and educational strategies used. This highlights the importance of culturally and contextually tailored interventions for better efficacy. Overall, the findings of the present study reaffirm the importance of structured health education programmes in rural areas, as they effectively enhance knowledge and promote better self-care practices, ultimately contributing to improved hypertension management.

CONCLUSION:

The study demonstrated the effectiveness of a community-based health education programme in enhancing knowledge and self-care practices regarding hypertension among adults in rural areas. A significant improvement was observed post-intervention, highlighting the impact of structured educational efforts. The findings align with previous research, reinforcing the role of tailored health education in promoting adherence to hypertension management strategies. However, variations in effectiveness emphasize the need for culturally relevant interventions. Overall, this study reaffirms the importance of targeted educational programmes in improving hypertension awareness and self-care practices, ultimately contributing to better health outcomes.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

The authors express their sincere gratitude to the institutional authorities, participants, and all those who contributed to the successful completion of this study. Their valuable support and cooperation were instrumental in conducting this research.

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Received on 14.03.2025 Revised on 07.04.2025

Accepted on 23.04.2025 Published on 17.05.2025

Available online from May 20, 2025

Int. J. Nursing Education and Research. 2025;13(2):97-103.

DOI: 10.52711/2454-2660.2025.00020

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Variable	Test	Mean	Mean Percentage (%)	SD	Mean Difference	SE	Calculated ‘t’ Value	Tabulated ‘t’ Value
Knowledge	Pre-test	9.52	32.73	3.58	11.48	0.704	16.2254*	1.684
Knowledge	Post-test	21.30	71.00	3.11	11.48	0.704	16.2254*	1.684
Practice	Pre-test	4.22	28.13	1.61	6.36	0.486	18.5012*	1.684
Practice	Post-test	10.58	70.53	1.53	6.36	0.486	18.5012*	1.684