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Impact of Community Pharmacy Blood Pressure Checks on Hypertension Screening Uptake among Adults in Nigeria

Abstract

Hypertension is a major public health concern and an important risk factor for cardiovascular disease, stroke, kidney disease, and premature mortality in Nigeria. Many adults with elevated blood pressure may remain unaware of their condition because hypertension can occur without obvious symptoms and routine health screening may be underutilized. Limited access to healthcare facilities, financial barriers, long waiting times, inadequate awareness, and low perceived need for preventive health checks may further contribute to missed opportunities for early detection. Community pharmacies are widely distributed and may provide convenient points for basic health screening and referral. Community pharmacy blood pressure checks may therefore improve access to blood pressure assessment and encourage adults to participate in hypertension screening. Against this background, this study investigates the impact of community pharmacy blood pressure checks on hypertension screening uptake among adults in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Social Ecological Model. The Health Belief Model explains how adults' perceptions of susceptibility to hypertension, perceived severity, perceived benefits of blood pressure checks, perceived barriers, and cues to action may influence participation in hypertension screening. Andersen's Behavioral Model explains healthcare utilization through predisposing characteristics, enabling resources, and perceived or evaluated health needs, providing a framework for understanding factors that influence the use of community pharmacy screening services. The Social Ecological Model emphasizes the influence of individual, interpersonal, community, healthcare, and environmental factors on access to and utilization of preventive health services. Collectively, these theoretical perspectives provide a suitable framework for explaining how community pharmacy blood pressure checks may influence hypertension screening uptake among adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above who reside in selected urban, semi-urban, and rural communities and have access to participating community pharmacies in Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, pharmacies, and eligible adults. Community pharmacy blood pressure checks will be assessed using indicators such as availability of blood pressure measurement services, frequency of blood pressure checks, accessibility of screening points, availability and condition of validated blood pressure devices, presence of trained pharmacy personnel, provision of screening information, recording of blood pressure results, referral arrangements, and follow-up procedures. Hypertension screening uptake will be assessed using indicators such as participation in blood pressure checks, number of adults screened, repeat screening, attendance for recommended follow-up assessment, referral completion, and newly identified individuals with elevated blood pressure requiring further clinical evaluation. Data will be collected using structured questionnaires, standardized blood pressure screening forms, pharmacy screening registers, referral records, healthcare facility records where available, and relevant community pharmacy programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening exposure, blood pressure findings, and patterns of hypertension screening uptake. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of community pharmacy blood pressure checks on hypertension screening uptake. Where a quasi-experimental design is adopted, screening uptake before and after implementation of pharmacy-based blood pressure checks may be compared with that of a comparison group or community to determine changes associated with the intervention. Appropriate diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community pharmacy blood pressure checks have a significant positive impact on hypertension screening uptake among adults in Nigeria. Adults who have access to convenient blood pressure screening services within community pharmacies are expected to demonstrate greater participation in hypertension screening than adults without comparable access. Community pharmacies may reduce geographical and financial barriers and provide convenient opportunities for adults to have their blood pressure assessed during routine visits for medicines and other health products. Early identification of elevated blood pressure may encourage timely referral for confirmatory assessment, clinical diagnosis, lifestyle counselling, and appropriate treatment where required. Pharmacy-based screening may also increase public awareness that hypertension can occur without noticeable symptoms and that regular blood pressure assessment is important. However, inadequate availability of validated equipment, limited staff training, lack of standardized screening protocols, poor referral and follow-up systems, low public awareness, and inconsistent recording of screening results may reduce effectiveness. The study therefore expects accessible, standardized, appropriately conducted, and well-integrated community pharmacy blood pressure screening services to contribute significantly to improved hypertension screening uptake among adults in Nigeria. The study is expected to contribute to the literature on community pharmacy services, hypertension screening, blood pressure monitoring, cardiovascular disease prevention, preventive healthcare, pharmacy-based public health interventions, and community health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Pharmacy Council of Nigeria, state ministries of health, community pharmacists, primary healthcare centres, hospitals, public health practitioners, professional pharmacy organizations, development partners, and policymakers regarding strategies for expanding accessible hypertension screening services. The study will also provide evidence-based recommendations for strengthening community pharmacy screening programmes, ensuring the availability of validated blood pressure devices, training pharmacy personnel in standardized blood pressure measurement and referral procedures, improving screening documentation, establishing effective referral and follow-up systems, and integrating community pharmacy hypertension screening with broader primary healthcare and cardiovascular disease prevention programmes across Nigeria.

Keywords: Community pharmacy, blood pressure checks, hypertension screening, screening uptake, hypertension, cardiovascular disease prevention, community health, preventive healthcare, adults, Nigeria, public health.