Community Perceptions of Hypertension and its Risk Factors and Community-Led Interventions to Address the Social Determinants of Hypertension in Mukono District, Uganda

Abstract

According to WHO, non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, obesity, and cancer are the leading causes of premature death globally. Cardiovascular diseases account for the most annual deaths (44%). Hypertension, also known as high blood pressure, is one of the biggest risk factors for cardiovascular disease. It is also the most common cardiovascular disorder. In Uganda, hypertension is responsible for half a million annual deaths. This paper explores community perceptions of hypertension and its social determinants and community-led interventions to address them in Ddundu parish, Mukono district, Uganda. To identify the community’s perceptions of the social determinants of hypertension, I conducted 13 focus group discussions with community members in the 13 villages that comprise Ddundu parish. To understand community members’ health-seeking behavior and the policy environment for community-led interventions on hypertension, I conducted five in-depth interviews with two health facility in-charges, one nurse, and two policy/community leaders. I used Julio Frenk and Suerie Moon's 2014 social determinants of health framework to analyze the social determinants of hypertension in the parish. I used the WHO Commission on Social Determinants of Health (CSDH) multi-sectoral action on non-communicable diseases framework to derive and operationalize the recommendations from my findings.

According to the community members, stress, diet, and access to health services were the most important risk factors/social determinants for hypertension. Stress was by far the most common risk factor they mentioned. Other risk factors they highlighted were knowledge levels and physical activity. Most social determinants of hypertension fell under the institutional/household level. In line with my results, I developed four community-identified priority areas, namely: 1) increasing awareness of hypertension and its risk factors; 2) increasing access to quality hypertension prevention and treatment services; 3) addressing community stressors; 4) strengthening the capacity of the existing community wellness organization to promote hypertension services in the parish. I then developed nine recommendations under the three WHO CSDH multi-sectoral framework actions that addressed the four community-identified priority areas.