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Effect of Community-Based Hypertension Risk Assessment on Hypertension Risk Detection among Adults in Nigeria

Abstract

Hypertension is a major public health concern in Nigeria and an important risk factor for cardiovascular disease, stroke, chronic kidney disease, and premature mortality. Many adults may have elevated blood pressure or important hypertension risk factors without being aware of their health status, particularly because hypertension can remain asymptomatic for prolonged periods. Risk factors such as obesity, physical inactivity, unhealthy dietary practices, excessive salt intake, harmful alcohol consumption, tobacco use, family history, advancing age, and psychosocial stress may increase the likelihood of developing hypertension. Community-based hypertension risk assessment provides an opportunity to identify adults with elevated blood pressure and other risk factors through accessible health outreach programmes, primary healthcare centres, community health campaigns, mobile health services, and other community platforms. Early identification of hypertension risk may facilitate blood pressure monitoring, lifestyle modification, health education, clinical assessment, and appropriate referral before complications develop. However, inadequate community screening coverage, limited availability of trained healthcare personnel and equipment, low awareness, financial barriers, geographical inaccessibility, and weak referral and follow-up systems may limit the effectiveness of community-based hypertension risk assessment in Nigeria. Against this background, this study investigates the effect of community-based hypertension risk assessment on hypertension risk detection among adults in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how adults' perceptions of susceptibility to hypertension, perceived severity, perceived benefits of risk assessment, perceived barriers, and cues to action may influence participation in community-based hypertension risk assessment. The Social Ecological Model emphasizes the influence of individual, household, community, socioeconomic, behavioural, and environmental factors on hypertension risk, health-related behaviours, healthcare-seeking practices, and access to preventive services. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective community-based hypertension risk assessment and prevention programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based hypertension risk assessment may influence hypertension risk detection among adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 18 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible adults. Community-based hypertension risk assessment will be measured using indicators such as availability of risk assessment services, assessment coverage, frequency of community assessment activities, blood pressure measurement, assessment of body mass index and waist circumference, evaluation of dietary practices, physical activity, tobacco and alcohol use, family history, age-related risk, and other relevant cardiovascular risk factors. Hypertension risk detection will be assessed using indicators such as identification of elevated blood pressure, multiple hypertension risk factors, newly identified individuals at increased risk of hypertension, blood pressure categories, overall hypertension risk status according to an appropriate recognized assessment framework, referrals for repeat blood pressure measurement or clinical evaluation, and linkage to preventive or healthcare services. Data will be collected using structured questionnaires, community risk assessment registers, blood pressure records, anthropometric assessment forms, healthcare facility records, referral registers, and relevant community health programme documents. Descriptive statistics will be used to summarize participants' characteristics, risk factors, assessment coverage, blood pressure findings, and patterns of hypertension risk detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of community-based hypertension risk assessment on hypertension risk detection. Where appropriate, hypertension risk detection rates before and after implementation of community-based risk assessment activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based hypertension risk assessment has a significant positive effect on hypertension risk detection among adults in Nigeria. Adults who participate in community-based hypertension risk assessment are expected to have a higher likelihood of having previously unrecognized hypertension risk factors or elevated blood pressure identified than adults without access to such services. Community-based assessment may facilitate early identification of individuals who require closer blood pressure monitoring and provide opportunities for lifestyle counselling, dietary modification, increased physical activity, weight management, reduction of tobacco and harmful alcohol use, and appropriate clinical referral. Bringing risk assessment services closer to adults may reduce geographical, financial, and time-related barriers and encourage participation in preventive healthcare. Community health education may also improve awareness of hypertension risk factors and encourage healthier behaviours and regular blood pressure assessment. Early identification of individuals at increased risk may support preventive interventions and potentially reduce the future burden of hypertension and related cardiovascular complications. Conversely, inadequate assessment coverage, limited equipment, shortage of trained healthcare workers, low community participation, financial constraints, and weak referral and follow-up systems may reduce the effectiveness of community-based hypertension risk assessment. The study therefore expects accessible and well-organized community-based hypertension risk assessment to contribute significantly to improved detection of hypertension risk among adults in Nigeria. The study is expected to contribute to the literature on community-based hypertension risk assessment, hypertension risk detection, cardiovascular risk prevention, adult health, non-communicable disease prevention, community health services, preventive healthcare, health promotion, and public health in Nigeria. 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, primary healthcare centres, community health workers, cardiologists, public health practitioners, development partners, and policymakers regarding strategies for strengthening hypertension prevention and early detection. The study will also provide evidence-based recommendations for expanding community-based hypertension risk assessment programmes, improving access to regular blood pressure measurement, strengthening community health education, promoting healthy dietary and physical activity practices, increasing availability of trained healthcare personnel and appropriate equipment, strengthening referral and follow-up systems, and integrating hypertension risk assessment into comprehensive community-based non-communicable disease prevention programmes across Nigeria.

Keywords: Community-based hypertension risk assessment, hypertension risk detection, adults, hypertension, blood pressure, cardiovascular risk, non-communicable disease prevention, community health services, preventive healthcare, health promotion, Nigeria, public health.