The interplay between knowledge and self-efficacy in hypertension management: a cross-sectional analysis of lifestyle factors among Saudi patients

Background and objectives Hypertension affects 22–23% of Saudi adults, with only 37% achieving adequate blood pressure control. Lifestyle modification requires both disease-specific knowledge and behavioral confidence (self-efficacy), yet their relationship remains underexplored in Middle Eastern populations. This study examined the association between knowledge of lifestyle factors and self-efficacy in hypertension management among Saudi patients and identified factors moderating this relationship. Methods A cross-sectional analytical study was conducted among 180 hypertensive patients recruited from specialized cardiac centers in Northern Saudi Arabia (November-December 2025). To ensure adequate statistical power for complex regression analyses while accommodating potential data quality issues, 180 participants were enrolled (30% above the minimum required sample of 138). Data were collected using validated Arabic instruments: the Hypertension Knowledge Assessment Tool (HKAT, 17 items across four domains, Cronbach's α = 0.80) and the Hypertension Self-Efficacy Scale (HSES, 11 items rated on a 7-point scale, α = 0.83). Hierarchical multiple regression examined predictors of self-efficacy, and subgroup analyses explored moderating factors. Results Participants (67.8% female; mean age 52.8±12.4 years) demonstrated substantial knowledge deficits, with only 30.0% achieving satisfactory scores (≥60% correct). Self-efficacy was adequate (mean score ≥4 on 7-point scale) in 52.2% overall, ranging from 35.0% for exercise to 72.2% for medication adherence. Hierarchical regression ( R 2 = 0.641, p < 0.001) identified lifestyle management knowledge as the strongest predictor (β = 0.35, p < 0.001), with knowledge domains collectively accounting for an additional 25.4% of variance beyond demographic and clinical variables. Educational attainment significantly moderated the knowledge-self-efficacy relationship (β = 0.16, p = 0.002), with university-educated participants showing stronger associations ( r = 0.81) than those with primary education ( r = 0.59, z = 2.15, p = 0.016). Conclusion Disease-specific knowledge is a critical modifiable determinant of self-efficacy in Saudi hypertensive patients. Healthcare providers should implement literacy-adapted, multicomponent interventions targeting identified knowledge gaps to enhance behavioral confidence and optimize blood pressure control.