Health Literacy, Primary Healthcare Accessibility and Hypertension Self-Care Management Among Adults in an Urban Slum of New Delhi: A Community-Based Cross-Sectional Study

Background Hypertension is a major public health concern in India, with suboptimal self-care management contributing to poor disease control and increased cardiovascular risk. Health literacy and accessibility to primary healthcare services are increasingly recognized as key factor associated withs influencing chronic disease self-management, particularly in underserved urban populations. Objective To assess the association between health literacy, primary healthcare accessibility, and hypertension self-care management among adults residing in an urban slum. Methods A community-based cross-sectional study was conducted over eight months in the urban slum locality of Kalibari, New Delhi. A total of 572 adults aged ≥ 18 years were included using a systematic household sampling approach. Data were collected using a pretested, structured questionnaire administered via EpiCollect5, covering sociodemographic characteristics, health literacy, healthcare accessibility, and self-care adherence. Hypertension was classified based on prior diagnosis and/or measured blood pressure ≥ 140/90 mmHg. Descriptive statistics, Chi-square test, Spearman correlation, and K-means cluster analysis (k = 3) were performed using SPSS version 31. Results The mean age of participants was 44.3 ± 13.9 years, and 18.9% were hypertensive. Age, socioeconomic status, health literacy, health information-seeking behaviour, and access to primary healthcare were significantly associated with hypertension (*p* < 0.05). Health literacy showed a negative correlation with hypertension status, while age demonstrated a positive correlation. Cluster analysis identified three distinct profiles, including a low literacy-high risk cluster and a high literacy-protective profile. Despite proximity to tertiary care hospitals, variations in healthcare utilization and self-care behaviours were observed. Conclusion Health literacy, healthcare accessibility, and medication adherence were associated with hypertension status in this urban slum population. However, given the cross-sectional design, these associations should not be interpreted as causal. Longitudinal studies using standardized health literacy instruments are warranted to clarify temporal relationships and their relevance to hypertension self-management.