Social-Behavior Barriers to Hypertension Self-Care: Extending the Theory of Planned Behavior

Background: Sustaining hypertension self-care practices presents ongoing challenges, particularly in socially complex and resource-limited settings. While the Theory of Planned Behavior (TPB) is widely used in health behavior research, its applicability in s ocial and behavioral contextsremains underexplored. This study aimed to extend TPB by identifying social-behavioral constructs that influence hypertension self-care behavior. Methods : A qualitative descriptive study was conducted in Jatinangor District, West Java, Indonesia. Twenty-four key informants were purposively selected, including patients with uncontrolled hypertension, family members, community health workers (cadres), and nurses. Data were collected through semi-structured interviews and analysed using thematic content analysis guided TPB constructs. Ethical approval was obtained from Padjadjaran University, and informed consent was provided by all participants. Results: Five themes were identified as barriers to sustainable self-care: 1) Lack of information and misperception (attitude), 2) Low perception of susceptibility and severity (perceived behavioral control), 3) Lack of family support and insufficient workforce (subjective norms), 4) Conventional custom of gathering and culture of eating habits (subjective norms), 5) Doubt of benefits and efficacy (attitude). These themes illustrate how social and behavioral contexts, including family interactions and daily habits, shape TPB constructs. Conclusions: This study contributes to the theoretical development of TPB by embedding social-behavioral constructs that influence hypertension self-care in low-resource settings. Findings highlight the need for socially responsive and family-oriented strategies to strengthen hypertension self-care. These insights are relevant for designing sustainable intervention in LMICs, particularly in Southeast Asia.