Psychosocial and Environmental Determinants Health-Seeking Behavior in Hypertension Care Globally: A Scoping Review.

Background Hypertension or high blood pressure is one of the most prevalent and pressing noncommunicable diseases globally. It contributes significantly to cardiovascular morbidity, stroke, renal dysfunction and premature mortality. According to the Global Burden of Disease (GBD) and World Health Organisation (WHO) studies, about 1.28 billion individuals worldwide are living with hypertension with an uneven distribution. Nearly about two-thirds of people living with the condition resides in low- and middle-income countries (WHO, 2023). The prevalence rate varies considerably across regions. In Africa, recent pooled estimates reveal that more than 32.9% of adults aged 25 and older have hypertension, a situation worsened by limited awareness, inadequate screening and restricted access to care services (Olowoyo et al., 2025). In South and East Asia, accelerating urbanization and shifting dietary and physical activity patterns have resulted in prevalence rates ranging from 10.8% to 48.3% in some populations, with a notable disparity between men and women (Shariff et al., 2024). Meanwhile, in North America, some studies approximate that one in three adults lives with hypertension despite widespread health education efforts and availability of antihypertensive therapies. The persistent inequities in treatment adherence and control rates among marginalized groups suggest that structural and behavioural barriers continue to impede optimal care (WHO, 2023). The clinical consequences of poorly controlled hypertension are both severe and extensive. Sustained elevation of blood pressure is a principal risk factor for ischemic heart disease, haemorrhagic stroke, chronic kidney disease and vascular cognitive decline. Each year, according to WHO and CDC, hypertension is estimated to contribute to over 10 million deaths globally. Management typically involves both pharmacologic therapies such as angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, diuretics and beta-blockers as well as lifestyle modifications that address salt intake, weight management and physical activity. While these interventions have proven efficacy, their success in real-world settings is often undermined by poor long-term adherence. To bridge the treatment gap, integrated care models that combine regular monitoring, patient education and culturally tailored behavioural support have shown the potential in enhancing blood pressure control and patient engagement. Moreover, a critical distinction must be made between the biological aetiology of hypertension and the behavioural processes involved in seeking care. Multiple factors such as genetics, metabolic disorders and lifestyle patterns contribute to the onset of hypertension. The emphasis of this review is understanding what drives individuals after developing the condition to engage with healthcare systems. This review centres on the determinants influencing care-seeking behaviour in diagnosed individuals. This is essential for addressing behavioural interventions aimed at reducing disease burden. Despite global advances in hypertension diagnosis and treatment, a substantial proportion of individuals in resource-limited settings fail to actively seek or maintain care. Evidence points to an underexplored yet critical gap in how psychosocial and environmental determinants shape health-seeking decisions. Without clearly understanding these drivers and barriers, public health programs risk remaining misaligned with the communities they aim to serve perpetuating avoidable health disparities and poor disease outcomes. The purpose of this scoping review is to synthesize findings on the psychosocial and environmental factors that influence health-seeking behaviour among individuals diagnosed with hypertension. The review seeks to examine studies across diverse geographic and cultural contexts and also identify key behavioural drivers, contextual enablers and barriers to care utilization. This synthesis will help uncover patterns and gaps in the current literature and contribute to the design of targeted evidence-informed interventions. This review offers valuable contributions to policy, practice and research. For policymakers, it provides direction for behavioural health strategies and community outreach. In nursing practice, it informs the design of patient-centred care models that address access and adherence challenges. While in researchers, it highlights knowledge gaps and guides future studies on behaviour-driven interventions for noncommunicable diseases in low- and middle-income countries where hypertension is most prevalent.