Prevalence and Determinants of Adherence to Self-Care Practices Among Hypertensive Patients Attending Rwamagana Level Two Teaching Hospital, Rwanda

Background: Hypertension is highly prevalent in Rwanda, yet long-term blood pressure control hinges on patients’ day-to-day self-care. Objectives: We quantified adherence to six recommended behaviors and explored their determinants among hypertensive outpatients at Rwamagana Level Two Teaching Hospital. Methods: A cross-sectional survey of 385 adults was conducted using the Hypertension Self-Care Activity Level Effects (H-SCALE) instrument. "Good" adherence was defined a priori as practicing ≥4 of the 6 behaviors on ≥80% of the recommended days during the preceding week; otherwise, adherence was "poor." Multivariable logistic regression identified independent predictors. Results: Overall, 39% (95% CI: 34–44%) achieved good adherence. Behavior-specific adherence was highest for smoking abstinence (92%) and medication-taking (68%), but lowest for physical exercise (24%) and weight management (31%). Community-based social support (AOR = 1.86, 95% CI: 1.20–2.89) and tertiary education (AOR = 1.73, 95% CI: 1.11–2.70) increased the odds of good adherence, whereas endorsement of cultural beliefs conflicting with biomedical care reduced it (AOR = 0.54, 95% CI: 0.35–0.82). Conclusion: Fewer than four in ten patients consistently follow essential self-care recommendations, with physical activity emerging as the greatest gap. Interventions grounded in the WHO Self-Care Framework that strengthen community support, counter harmful cultural beliefs, and create exercise-friendly environments are urgently needed to improve blood pressure control in Rwanda.