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Effect of Community-Based Blood Pressure Screening on Hypertension Detection among Market Traders in Nigeria

Abstract

Hypertension is a major public health challenge and an important risk factor for cardiovascular disease, stroke, kidney disease, and premature mortality. Because hypertension may remain asymptomatic for long periods, many affected individuals may be unaware of their condition until complications develop. Community-based blood pressure screening provides an opportunity to identify elevated blood pressure among individuals who may not routinely access healthcare facilities and to facilitate early confirmation, referral, and management. Market traders constitute an important population for community-based screening because their occupational activities may involve long working hours, limited opportunities for routine healthcare visits, occupational stress, sedentary periods, and other lifestyle factors that may influence cardiovascular health. Community-based blood pressure screening refers to organized blood pressure assessment conducted within community settings outside conventional healthcare facilities, including markets, with appropriate referral for individuals with abnormal readings. Hypertension detection refers to the identification of individuals with elevated blood pressure who subsequently undergo appropriate assessment and confirmation of hypertension by qualified healthcare professionals. In Nigeria, limited awareness of hypertension, inadequate routine screening, financial barriers, and competing occupational demands may contribute to undiagnosed hypertension among adults. Community-based screening may reduce some of these barriers by bringing preventive health services directly to populations within their everyday environments. Against this background, this study investigates the effect of community-based blood pressure screening on hypertension detection among market traders in Nigeria. The study is anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Preventive Health Model. The Health Belief Model explains participation in blood pressure screening through perceived susceptibility to hypertension, perceived severity of its complications, perceived benefits of early detection, perceived barriers, and cues to action. Andersen's Behavioral Model provides a framework for understanding healthcare utilization through predisposing characteristics, enabling resources, and healthcare needs, with community-based screening serving as an enabling preventive-health resource. The Preventive Health Model explains participation in screening based on perceived health risks, expected benefits, personal barriers, and motivation to undertake preventive health actions. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based blood pressure screening may influence hypertension detection among market traders in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from market traders in selected Nigerian markets using structured questionnaires, standardized blood pressure measurement procedures, screening records, and referral documentation. A multistage sampling technique will be employed to select states, local government areas, markets, market associations or sections, and eligible adult traders. Where feasible, traders will be assessed before and after participation in a structured community-based blood pressure screening programme, with a comparison group included where appropriate. Blood pressure screening will be conducted using validated and appropriately calibrated automated or manual blood pressure devices following standardized measurement procedures. Traders with elevated blood pressure readings will be appropriately counselled and referred for repeat assessment and clinical confirmation rather than being classified as hypertensive solely on the basis of a single screening measurement. Hypertension detection will be assessed using indicators such as newly identified elevated blood pressure, successful referral for confirmatory assessment, newly confirmed hypertension among previously undiagnosed traders, and linkage to appropriate healthcare services. Additional information will be collected on participants' age, sex, educational level, occupation-related characteristics, family history of hypertension, previous blood pressure screening, healthcare utilization, and relevant lifestyle factors. Descriptive statistics will be used to summarize participants' characteristics, screening participation, blood pressure findings, referral patterns, and hypertension detection rates. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of community-based blood pressure screening on hypertension detection. Where appropriate, hypertension detection before and after implementation of the screening programme will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that community-based blood pressure screening has a significant positive effect on hypertension detection among market traders in Nigeria. Market traders who participate in organized community-based screening are expected to have a greater likelihood of discovering previously undiagnosed elevated blood pressure and receiving appropriate referral for further clinical assessment. Conducting screening within market environments is expected to reduce some barriers associated with travelling to healthcare facilities, time constraints, and limited opportunities for routine health assessments. The screening programme is also expected to improve traders' awareness of hypertension and encourage appropriate follow-up and healthcare-seeking behaviour among individuals with abnormal blood pressure findings. However, detection alone may not guarantee successful diagnosis and long-term management because traders may face financial barriers, limited access to healthcare, transportation difficulties, inadequate follow-up, or lack of awareness regarding the need for confirmatory assessment. Consequently, community-based screening should be linked to effective referral, diagnosis, treatment, counselling, and follow-up services. The study is expected to contribute to the literature on community-based screening, hypertension detection, cardiovascular disease prevention, market traders' health, preventive healthcare, community health, health promotion, and public health in Nigeria by providing empirical evidence on the effectiveness of bringing blood pressure screening services closer to occupational communities. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, healthcare facilities, market associations, community health workers, nurses, pharmacists, physicians, public health practitioners, non-governmental organizations, development partners, and policymakers regarding strategies for improving early detection of hypertension. The study will also provide evidence-based recommendations for expanding community-based blood pressure screening programmes, conducting regular screening within markets, strengthening referral and follow-up systems, improving cardiovascular-health education, training community health workers in standardized blood pressure measurement, and linking individuals with abnormal findings to affordable hypertension diagnosis and management services in Nigeria.

Keywords: Community-based blood pressure screening, hypertension detection, market traders, Nigeria, blood pressure, hypertension, cardiovascular health, preventive healthcare, community health, health screening, early detection, health promotion, public health.