Determinants and Lived Experiences of Hypertension Among Market Women at Sunyani Wednesday Market: A Qualitative Study

Determinants and Lived Experiences of Hypertension Among Market Women at Sunyani Wednesday Market: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants and Lived Experiences of Hypertension Among Market Women at Sunyani Wednesday Market: A Qualitative Study Benedicta Princess Dotse, Clement Naayaara Zuuri, Moses Peter Ofoe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8167010/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted 17 You are reading this latest preprint version Abstract Background Hypertension continues to be a major cause of illness and death worldwide, with its prevalence rising quickly in low- and middle-income countries. In Ghana, market women are a crucial socio-economic group that are disproportionately exposed to risk factors for hypertension, yet few comprehensive studies have focused on this population. Objective This study aimed to explore the determinants of hypertension among market women at the Sunyani Wednesday Market, focusing on qualitative insights into their lived experiences, health behaviors, and challenges in accessing care. Methods A qualitative descriptive study was carried out using purposive sampling to select 30 market women aged 25–60 years. Data were gathered through semi-structured interviews and were analyzed thematically. Results Five major themes emerged: Market women showed strong awareness of hypertension, often identifying it as a community health concern and sharing personal or observed experiences; their diets frequently included high-salt and fried foods, and they faced occupational stress from competition, financial insecurity, and long hours. Physical activity was limited, especially formal exercise, and access to healthcare was challenged by cost, distance, and waiting times. Many preferred traditional herbal remedies due to cultural and economic factors. These combined issues increase the risk of hypertension and make effective management difficult. Conclusion Hypertension among Sunyani market women is driven by poor diet, work stress, low physical activity, and limited healthcare access, requiring culturally tailored interventions in education, workplace support, healthcare, and community engagement to improve heart health and equity. Hypertension market women Ghana dietary practices occupational stress 1.0 Introduction Hypertension remains a leading and preventable cause of global illness and death, significantly increasing the risk of cardiovascular diseases like stroke, myocardial infarction, heart failure, and chronic kidney disease (CKD) [ 1 , 2 ] . The burden of hypertension has grown significantly over recent decades, especially in low- and middle-income countries (LMICs), where rapid urbanization, demographic shifts, and lifestyle changes have led to a rise in prevalence rates [ 3 ] . In sub-Saharan Africa, including Ghana, hypertension prevalence has been reported to range widely from 19% to nearly 50% depending on the population studied and measurement methods used [ 4 – 6 ] . These figures reveal a concerning trend associated with more sedentary lifestyles, poor dietary habits (high salt, fat, and processed food consumption), rising obesity rates, and ongoing psychosocial stressors [ 7 , 8 ] . Market women are a crucial socio-economic group within Ghana’s informal sector, especially in urban centers like Sunyani, Accra, and Kumasi. These women often face numerous occupational hazards, such as standing for long periods, intense physical labor, irregular eating habits, exposure to environmental pollutants, and heavy financial and family responsibilities [ 9 , 10 ] . Furthermore, they often encounter high levels of occupational stress, including income insecurity and social pressures, which have been linked to the development of hypertension through neuroendocrine mechanisms [ 11 ] . Despite these known risks, comprehensive epidemiological and qualitative studies specifically examining hypertension prevalence, awareness, treatment, and control among market women are still limited in Ghana. Recent cohort research by [ 12 ] , highlights that market women frequently underrecognize hypertension as a serious health issue and face barriers to healthcare access, including limited health literacy, cultural beliefs, and economic constraints. Additionally, in a qualitative study by [ 13 ] , explorations show that their perceptions of hypertension are often linked to stress, fatigue, and lifestyle challenges, highlighting the need for culturally sensitive health promotion interventions tailored to their specific circumstances. Addressing these gaps is essential for developing effective community-based screening, education, and management programs to lower cardiovascular risk in this vulnerable population. This study investigates the contributing factors and lived experiences of hypertension among market women at the Sunyani Wednesday Market, emphasizing qualitative insights into their health practices and obstacles to healthcare access. The results will offer evidence to guide policymakers and health professionals in designing targeted interventions that improve cardiovascular health and promote equity for market women in urban Ghana. 2.0 Methods 2.1 Study Design This study used a qualitative descriptive design, which is especially effective for capturing participants’ perspectives and lived experiences in their natural settings with minimal researcher interpretation or theoretical influence [ 14 ] . This method enables detailed, rich descriptions of phenomena as experienced by participants, offering clear insights accessible to both researchers and practitioners [ 15 ] . Qualitative descriptive designs have become increasingly valued in health research for their practical flexibility, especially when the aim is to inform practice and policy by providing an authentic view of participants’ perspectives without the complexity of deeper phenomenological or grounded theory analyses [ 16 ] . By focusing on participants’ own words and meanings, this design helps minimize potential bias from more interpretive methods, ensuring that findings are rooted in the real-world contexts of the study population. 2.2 Study Setting Sunyani Wednesday Market is a lively trading center in Sunyani, the capital of Ghana’s Bono Region. Though it operates daily, it reaches its busiest point and attracts the most customers every Wednesday, drawing traders and buyers from all over the region. The market has an energetic, dynamic feel, with women traders mainly selling a variety of items such as fresh foods, clothing, household goods, and handcrafted products. It functions as an essential economic hub and a social space where cultural and personal exchanges thrive. The significant presence of women in this informal sector underscores their vital role in local trade and community well-being. 2.3 Study Participants and Sampling Using purposive sampling, 30 market women aged 25 to 60 years were recruited for the study. To ensure they had enough experience and familiarity with the Sunyani Wednesday Market, participants were selected if they had worked there for at least one year. The study included women both with and without self-reported hypertension to gain a broad range of perspectives on health, work, and lifestyle. Before data collection, all participants received information about the study’s aims, procedures, and confidentiality, and voluntarily gave informed consent in line with ethical research practices. 2.4 Data Collection The semi-structured interview guide (Supplementary File 1) was developed by the research team based on prior qualitative studies [ 17 , 18 ] and an extensive review of literature on hypertension, women’s health, and the lived experiences of market women in similar sociocultural contexts. The guide was structured to elicit rich narratives on participants’ knowledge, daily experiences, lifestyle practices, stressors, and health-seeking behaviours related to hypertension. Semi-structured interviews lasting 30 to 45 minutes were conducted with each participant in both Twi and English to ensure comfort and clear communication. The interview guide carefully covered key topics such as participants’ knowledge of hypertension, lifestyle habits including diet and physical activity levels, perceived stress related to work and daily life, personal or observed experiences with hypertension, and access to healthcare services. All interviews were audio-recorded with participants’ consent for accuracy. The recordings were then transcribed verbatim, and where needed, translated from Twi to English to support thorough analysis while maintaining the authenticity of participants’ responses. 2.5 Data Analysis Thematic content analysis was used to systematically examine the qualitative data, supported by NVivo software, which organized and managed the transcripts effectively. Two researchers independently conducted initial coding to improve reliability and reduce subjective bias. These coders identified meaningful parts of the text and assigned preliminary codes that reflected participants’ experiences and perceptions. After independent coding, the researchers engaged in iterative discussions to compare codes, resolve disagreements, and refine the coding framework. Through this collaborative process, broader themes and subthemes were developed inductively, capturing the main patterns within the data. Consensus was reached on the final thematic structure, ensuring a rigorous and credible representation of the participants’ perspectives. 2.6 Ethical Considerations Ethical approval for this study was obtained from the Local Ethics Committee of the College of Nursing and Midwifery, Tanoso, Ahafo-Ghana, on April 15, 2025 (no number was issued). Permission to conduct the study was sought and granted by the market leaders, acknowledging their authority and role within the community. Participants were fully informed about the study’s objectives, procedures, and measures to protect their confidentiality. Written informed consent was obtained from each participant before data collection. They were assured that all information provided would be kept strictly confidential and used solely for research purposes. Additionally, participants were made aware of their voluntary participation and their right to withdraw from the study at any time without negative consequences or loss of benefits. 2.7 Methodological Rigor To ensure trustworthiness and quality, the study rigorously applied Lincoln and Guba’s criteria [ 19 ] : credibility was established through prolonged engagement and member checking; transferability was improved with detailed descriptions of the research context; dependability was maintained with a comprehensive audit trail; and confirmability was achieved by involving independent researchers in data coding and employing triangulation methods to reduce bias. 3.0 Results 3.1: Sociodemographic Characteristics of Participants The study participants (n = 30) were mostly middle-aged, with 40.0% aged 35–44 years and 26.7% aged 25–34 years. Smaller groups were aged 45–54 years (23.3%) and 55–60 years (10.0%). Most women were married (70.0%), while single women made up 16.7%, and widowed or divorced women accounted for 13.3%. Regarding education, most had only basic education (60.0%), with 20.0% having no formal schooling and another 20.0% having completed secondary education or higher. In terms of market experience, nearly half (43.3%) had been trading for 4 to 6 years, 33.3% had over 6 years of experience, and 23.3% had been trading for 1 to 3 years. Overall, this group mainly consists of married, middle-aged women with basic education and moderate to extensive trading experience (Table 1 ). Table 1 Sociodemographic Characteristics of Participants Characteristic Frequency (n = 30) Percentage (%) Patient IDs Age (years) 25–34 8 26.7 P1, P2, P3, P4, P5, P6, P7, P8 35–44 12 40.0 P9 to P20 45–54 7 23.3 P21 to P27 55–60 3 10.0 P28, P29, P30 Marital Status Married 21 70.0 P1 to P21 Single 5 16.7 P22 to P26 Widowed/Divorced 4 13.3 P27 to P30 Educational Level No formal education 6 20.0 P1 to P6 Basic education 18 60.0 P7 to P24 Secondary or higher 6 20.0 P25 to P30 Years Trading at Market 1–3 years 7 23.3 P1 to P7 4–6 years 13 43.3 P8 to P20 > 6 years 10 33.3 P21 to P30 3.2: Themes and Subthemes from Market Women’s Perspectives on Hypertension The table outlines key themes and subthemes related to hypertension among market women, along with brief descriptions. The first theme, Awareness and Perceived Prevalence, includes acknowledgment that hypertension is common among market women and shared personal or observed experiences of the condition. The second theme, Dietary Practices, emphasizes frequent consumption of high-salt foods such as salted fish and processed items, as well as a preference for fried and convenience foods. The Occupational Stress theme addresses stress related to competition, finances, workload, and the physical demands of standing long hours while trading. The Physical Activity theme highlights periods of inactivity during slow market hours and limited participation in formal exercise. Lastly, Healthcare Access and Beliefs identifies barriers like cost, distance, and waiting times to accessing medical care, along with a preference for traditional herbal remedies due to cultural or economic reasons (Table 2 ). Table 2 Themes and Subthemes Identified Theme Subthemes Description Awareness and Perceived Prevalence Recognition of hypertension as common Many participants knew hypertension affects market women often. Personal and observed experiences Stories of self and peers living with hypertension. Dietary Practices High salt intake Frequent use of salted fish and processed foods. Fried and processed foods Preference for convenience foods high in fat and salt. Occupational Stress Trading-related stress Stress from competition, finances, and workload. Physical demands of market work Long hours standing and trading. Physical Activity Periods of inactivity Sitting during slow market hours. Limited formal exercise Few participants engaged in structured physical activity. Healthcare Access and Beliefs Barriers to medical care Cost, distance, and waiting times limit access. Use of traditional medicine Preference for herbal remedies due to culture or cost. 3.2.1 Awareness and Perceived Prevalence Participants showed a broad awareness and recognized the widespread nature of hypertension, understanding it as a common health problem among market women. Many shared personal or observed stories of themselves or peers living with hypertension, emphasizing its impact in their community. Recognition of hypertension as common Many participants acknowledged that hypertension is a widespread health issue among market women. For example, P4 shared, “I see many women here who have high blood pressure; it is very common among us.” Similarly, P15 stated, “Almost every market woman I know has to be careful about blood pressure.” Personal and observed experiences Several respondents recounted personal or peer experiences with hypertension. P9 mentioned, “My sister was diagnosed last year, and I sometimes feel the symptoms too.” P22 added, “I have seen friends faint because of high blood pressure.” 3.2.2 Dietary Practices Regarding dietary habits, frequent intake of high-salt foods like salted fish and processed products was common. Additionally, there was a clear preference for fried and convenience foods, which are often high in fat and salt, possibly increasing the risk of hypertension. High salt intake Frequent consumption of salted fish and processed foods was common. P2 explained, “Salted fish is part of our meals almost every day; it adds flavor and lasts longer.” P7 said, “We use a lot of salt and stock cubes in cooking, especially for quick meals.” Fried and processed foods There was a preference for fried and convenience foods, often high in fat and salt. P12 remarked, “When I’m busy, I buy fried snacks because they are quick and easy.” P19 noted, “Sometimes we eat fried foods sold here in the market; it’s what’s available.” 3.2.3 Occupational Stress Occupational stress was identified as a key factor, with participants mentioning stress from market competition, financial pressures, and workload demands. The physical aspect of market work, such as long hours spent standing and trading, was also noted as stressors that could affect health. Trading-related stress Stress related to competition, finances, and workload was frequently reported. P5 shared, “The competition is tough; sometimes I worry if I will make enough money for my family.” P17 expressed, “Money issues and customers can be very stressful.” Physical demands of market work Many noted the toll of standing and working long hours. P10 said, “By the end of the day, my feet hurt from standing and selling all day.” P28 added, “The long hours here really tire my body.” 3.2.4 Physical Activity Regarding physical activity, reports indicated periods of inactivity, especially during slow market hours when women tend to sit for long durations. Few participants participated in any formal or structured exercise routines, showing limited overall physical activity. Periods of inactivity Participants described sitting during slow market hours. P3 shared, “When there are few customers, we just sit and wait; there is not much movement then.” P24 said, “Sometimes we spend hours just sitting because there’s no work.” Limited formal exercise Few participants engaged in structured physical activity outside work. P6 stated, “I don’t have time or energy to do exercise after market.” P20 admitted, “Exercise is not part of my routine; I’m too tired.” 3.2.5 Healthcare Access and Beliefs Finally, healthcare access and beliefs showed barriers like cost, distance to facilities, and long wait times that limit women’s ability to get medical care. A cultural preference for traditional medicine was also clear, with many choosing herbal remedies because of cultural beliefs or affordability. Barriers to medical care Cost, distance, and waiting times were common obstacles. P11 explained, “Going to the clinic is expensive and far, so I only go when I am very sick.” P26 noted, “The hospital is too far and the queues too long.” Use of traditional medicine Many preferred herbal remedies for cultural or economic reasons. P8 said, “I use herbal medicines because they are cheaper and have been trusted in my family.” P30 mentioned, “Herbs help me better than hospital drugs sometimes.” 4.0 Discussion This study aimed to examine the contributing factors and causes of hypertension among market women at the Sunyani Wednesday Market, focusing on their lived experiences, health behaviors, and obstacles to care. The thematic analysis provided key insights into participants’ awareness, dietary habits, occupational stress, physical activity, and access to healthcare, offering a comprehensive understanding of factors affecting hypertension in this group. The results of this study showed that market women have a strong awareness of hypertension as a common health problem. Many participants recognized that hypertension is widespread in their community, which matches data from other urban African areas. For instance, [ 20 ] reported similarly high hypertension awareness in Ghanaian urban populations, noting that increasing urbanization and lifestyle changes have amplified cardiovascular risk factors. Likewise, a recent study by [ 21 ] on urban women in Accra, it was found that over 70% of participants were aware of hypertension and its symptoms, reflecting growing public consciousness of the condition in Ghana’s cities. This awareness often stemmed from personal or vicarious experiences, with many women sharing symptoms or diagnoses either firsthand or through close friends. Such lived experiences help strengthen understanding and alertness, similar to findings from a study in Nigeria, where community members’ familiarity with hypertensive relatives increased awareness and perceived seriousness of the condition [ 22 ] . However, contrasting evidence exists. Some studies report low awareness levels, particularly among rural populations or lower socio-economic groups. For example, [ 21 , 23 ] found that only 35% of rural Ghanaian women had adequate knowledge of hypertension, suggesting disparities based on geography and education. Similarly, a study in Ethiopia by [ 24 ] revealed limited awareness among market women despite high disease prevalence, attributed to low literacy and poor health communication infrastructure. These contrasts highlight the heterogeneity in hypertension awareness across different settings and populations. While awareness is foundational for prevention and early management, it alone may not ensure effective control of hypertension [ 25 ] highlighted that in many low-resource settings, including sub-Saharan Africa, barriers such as limited healthcare access, financial constraints, and insufficient health literacy impede translating awareness into behavioral changes or treatment adherence. Similarly, despite awareness, our participants expressed challenges such as cultural reliance on traditional medicine and limited engagement with formal health services, suggesting that knowledge must be coupled with accessible support and empowerment to have a meaningful impact on outcomes. The relatively high level of awareness seen in this study may be due to increased health promotion efforts, the rising prevalence of hypertension in Ghana, and improved media coverage in recent years. Urban market women, who engage with a wide range of people and environments, may also have greater exposure to health information compared to rural populations. However, ongoing socioeconomic and systemic obstacles still hinder progress beyond raising awareness. While high awareness provides a strong base for prevention and management, significant risks remain if barriers such as healthcare costs, limited access, and cultural beliefs are not addressed. These issues can result in undiagnosed or poorly managed hypertension, leading to worse public health outcomes, especially given its connection to major conditions like heart disease, stroke, and kidney failure. To effectively reduce the hypertension burden, particularly among high-risk groups like market women, interventions must extend beyond awareness—offering accessible screening, affordable treatment, and culturally appropriate education. The study revealed that high salt intake and consumption of fried and processed foods are prevalent dietary habits among market women. Participants reported frequent use of salted fish and seasoning cubes, which contribute to excessive sodium intake. This finding concurs with research by [ 26 , 27 ] , who found that urban Ghanaian populations regularly consume high-sodium diets, partly due to traditional cooking practices and accessibility of processed foods. Additionally, a study in other African countries by [ 28 – 30 ] highlighted similar dietary patterns among women traders, linking high salt and fat consumption to an increased prevalence of hypertension. The preference for fried and convenience foods reflects the demanding lifestyle of market women, who often prioritize quick and affordable meals over nutritional quality. This aligns with global findings where busy urban populations increasingly rely on processed foods, escalating cardiovascular risks [ 31 ] Excessive salt and fat intake are established contributors to hypertension and other cardiovascular diseases [ 32 ] The entrenched dietary habits among market women underscore the urgent need for culturally tailored nutritional education that emphasizes salt reduction and healthier alternatives. Without intervention, these practices could exacerbate hypertension-related morbidity and strain local healthcare systems. Promoting affordable, nutritious options could mitigate these risks and improve cardiovascular health outcomes in this vulnerable group. Occupational stress from competition, financial insecurity, and physical demands emerged as a significant determinant of hypertension risk. Participants described psychological stressors related to market competition and economic pressures, consistent with findings by [ 33 , 34 ] , who reported that informal sector workers in West Africa face chronic stress affecting cardiovascular health. The physical strain of long hours standing and trading compounds these stressors, corroborating evidence linking prolonged occupational exertion with hypertension [ 35 ] . Such combined psychosocial and physical stress is known to elevate blood pressure through neuroendocrine pathways [ 36 ] , explaining why market women may experience higher hypertension prevalence. Sustained occupational stress may accelerate hypertension development and worsen disease outcomes. This underscores the need for workplace interventions addressing stress management, ergonomic improvements, and support networks for market women. By reducing occupational stressors, it may be possible to lower hypertension incidence and improve overall well-being among this population. Participants in this study reported frequent periods of physical inactivity, particularly during slow business hours when there were fewer customers in the market. Although their daily work as market women often involves standing, walking, and lifting goods, these activities tend to be intermittent and are often punctuated by long stretches of sitting or remaining stationary. Moreover, most participants indicated that they did not engage in any form of structured or formal exercise such as walking for leisure, jogging, aerobics, or participating in sports. These findings are consistent with the work of [ 37 ] , who observed that urban women in Ghana generally participate minimally in structured physical activities. According to their study, barriers such as demanding work schedules, time constraints, and physical fatigue after long hours in the market contributed significantly to low levels of formal exercise among these women. The daily routines of market traders, while physically demanding at times, do not substitute for regular, sustained moderate-intensity exercise necessary for cardiovascular health. The World Health Organization, in 2020, as indicated by [ 38 ] , underscores the importance of regular physical activity as both a preventive and therapeutic strategy for hypertension and other non-communicable diseases. WHO guidelines recommend that adults should engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week, along with muscle-strengthening activities [ 39 ] . However, the evidence from this study suggests that the work-related activities performed by market women fall short of these recommendations, as their activity is sporadic and not sustained for long enough periods to yield significant cardiovascular benefits. This gap highlights an important public health challenge: although market work involves some physical effort, it does not provide the protective effects against hypertension and related conditions that regular, structured physical activity offers. Interventions aimed at improving the cardiovascular health of market women should therefore not only focus on removing barriers to formal exercise but also raise awareness about how simple, sustained physical activities—such as brisk walking, dancing, or group exercise sessions—can be easily incorporated into daily routines to enhance health outcomes. Barriers to healthcare access, such as cost, distance, and long waiting times, were significant challenges for participants. Similar obstacles have been widely documented in sub-Saharan Africa, restricting hypertension diagnosis and treatment adherence [ 40 ] . The preference for traditional medicine, motivated by cultural beliefs and affordability, further complicates formal healthcare engagement, as noted by [ 41 , 42 ] . Such healthcare-seeking behaviors can delay treatment initiation and lead to poor hypertension outcomes. Barriers to healthcare access and reliance on traditional remedies hinder timely hypertension diagnosis and effective management. These issues can result in uncontrolled hypertension and a higher risk of complications like stroke and kidney disease. Improving healthcare infrastructure, subsidizing care costs, and involving traditional healers in hypertension education may enhance care uptake and outcomes among market women. Limitations This study is limited by its small sample size, reliance on self-reported data, and qualitative design, which restricts generalizability and the ability to establish causal relationships. Additionally, the absence of quantitative blood pressure measurements prevents a direct link between behaviors and clinical hypertension. Future research with larger samples, mixed methods, and clinical assessments is recommended to strengthen the evidence. 5.0 Conclusion This study emphasizes that hypertension is well known among market women in Sunyani, but various behavioral, occupational, and systemic factors help sustain it. High salt and fat intake, work-related stress, limited physical activity, and barriers to formal healthcare all contribute to increased hypertension risk. Tackling these issues requires a comprehensive, culturally sensitive approach that includes education, occupational support, improved healthcare access, and community involvement. By focusing on these factors, customized interventions can more effectively promote cardiovascular health and fairness among market women in urban Ghana. Abbreviations LMICs Low- and Middle-Income Countries CVD Cardiovascular Disease CKD Chronic Kidney Disease SSA Sub-Saharan Africa WHO World Health Organization NCDs Non-Communicable Diseases Declarations ETHICAL APPROVAL AND CONSENT TO PARTICIPATE The study protocol was reviewed and approved by the Local Ethics Committee of the College of Nursing and Midwifery, Tanoso, Ghana, on April 15, 2025 (no number was issued). CONSENT FOR PUBLICATION Not applicable CONFLICT OF INTEREST Authors declare no conflict of interest FINANCIAL SUPPORT Nil Author Contribution C.N.Z.: Conceived and designed the study; developed the study protocol; conducted data collection; performed data analysis; drafted the initial manuscript; and contributed substantially to revisions and final approval.B.P.D.: Contributed to study design and methodology; participated in data analysis and interpretation; critically reviewed and revised the manuscript for intellectual content; and approved the final version for submission.M.P.O.: Assisted with literature review and development of data collection tools; supported data coding and thematic analysis; reviewed the manuscript for accuracy and clarity; and approved the final manuscript.All authors read and approved the final manuscript and agree to be accountable for all aspects of the work. Acknowledgement The authors thank all participants, especially the study participants, as well as everyone who played a key role in supporting and producing this paper. Data Availability “The datasets generated and/or analyzed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.” References Kario K, Okura A, Hoshide S, Mogi M. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens Res. 2024;47(5):1099–102. Goorani S, Zangene S, Imig JD, Hypertension. A Continuing Public Healthcare Issue. Int J Mol Sci [Internet] 2024 [cited 2025 Jul 2];26(1):123. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11720251/ Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. Okello S, Muhihi A, Mohamed SF, Ameh S, Ochimana C, Oluwasanu AO et al. Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA). BMC Public Health 2020;20(1). Akpa OM, Okekunle AP, Ovbiagele B, Sarfo FS, Akinyemi RO, Akpalu A, et al. Factors associated with hypertension among stroke-free indigenous Africans: Findings from the SIREN study. J Clin Hypertens. 2021;23(4):773–84. Kamdem F, Bika Léle EC, Hamadou B, Obe Meyong MAP, Fenkeu Kweban J, Moussa O, et al. Prevalence and risk factors of pre-hypertension and high blood pressure among adolescents in Cameroonian schools. J Clin Hypertens. 2023;25(9):845–52. Monda A, de Stefano MI, Villano I, Allocca S, Casillo M, Messina A et al. Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review. Foods 2024, Vol 13, Page 2627 [Internet] 2024 [cited 2025 Jul 2];13(16):2627. Available from: https://www.mdpi.com/2304-8158/13/16/2627/htm Garg RK. The alarming rise of lifestyle diseases and their impact on public health: A comprehensive overview and strategies for overcoming the epidemic. J Res Med Sci [Internet] 2025 [cited 2025 Jul 2];30(1):1. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11974594/ Adjokatse IT, Oduro-Okyireh T, Manford M, HEALTH PROBLEMS ASSOCIATED WITH MARKET, WOMEN IN CLOSED AND OPEN SPACE MARKET AREAS. Afr J Appl Res. 2022;8(1):97–107. Dramani JB, Frimpong PB, Ofori-Mensah KA. Modelling the informal sector and energy consumption in Ghana. Social Sci Humanit Open 2022;6(1). Marwaha K. Examining the Role of Psychosocial Stressors in Hypertension. J Prev Med Public Health. 2022;55(6):499–505. Loreto L, Linares-Jimenez FG, de Zeeuw J, de Winter AF. Health literacy and hypertension-related multimorbidity: unravelling the mediating role of self-management - insights from the lifelines cohort study. BMC Public Health 2025;25(1). Sambah F, McBain-Rigg K, Seidu AA, Emeto TI. A Qualitative Study on the Barriers and Enablers to Effective Hypertension Management in Ghana. Healthc (Switzerland) 2025;13(5). Leavy P. Research Design: Quantitative, Qualitative, Mixed Methods, Arts-Based, and Community-Based Participatory Research Approaches. 2017. Hall S, Liebenberg L. Qualitative Description as an Introductory Method to Qualitative Research for Master’s-Level Students and Research Trainees. Int J Qual Methods [Internet] 2024 [cited 2025 Jul 1];23:1–5. Available from: https://journals.sagepub.com/doi/pdf/ 10.1177/16094069241242264 Lim WM. What Is Qualitative Research? An Overview and Guidelines. Australasian Mark J 2024. Busetto L, Wick W, Gumbinger C. How to use and assess qualitative research methods. Neurological Research and Practice 2020 2:1 [Internet] 2020 [cited 2025 Nov 29];2(1):14-. Available from: https://link.springer.com/article/ 10.1186/s42466-020-00059-z DeJonckheere M, Vaughn LM. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med Community Health [Internet] 2019 [cited 2025 Nov 29];7(2):e000057. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6910737/ Enworo OC. Application of Guba and Lincoln’s parallel criteria to assess trustworthiness of qualitative research on indigenous social protection systems. Qualitative Res J. 2023;23(4):372–84. Bosu WK, Bosu DK. Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis. PLoS One [Internet] 2021 [cited 2025 Jul 7];16(3):e0248137. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248137 Kyei N. Prevalence of Hypertension and its Awareness in Ghana. Int J High School Res. 2023;5(5):95–8. Mahmoud Z, Orji AA, Okoye CF, Ameh FO, Jamro-Comer E, Isah A et al. Facilitators and barriers to optimal home blood pressure management in patients with hypertensive disorders of pregnancy in a tertiary care facility in Abuja, Nigeria: a qualitative research study. BMC Health Serv Res 2023;23(1). Dai B, Addai-Dansoh S, Nutakor JA, Osei-Kwakye J, Larnyo E, Oppong S et al. The prevalence of hypertension and its associated risk factors among older adults in Ghana. Front Cardiovasc Med 2022;9. Adamu AA, Godesso A, Birhanu Z. Health Literacy in Ethiopia: Evidence Synthesis and Implications. J Multidiscip Healthc [Internet] 2023 [cited 2025 Jul 7];16:4071. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10729771/ Byiringiro S, Hinneh T, Chepkorir J, Tomiwa T, Commodore-Mensah Y, Marsteller J et al. Healthcare system barriers and facilitators to hypertension management in Ghana. Ann Glob Health 2024;90(1). Kushitor SB, Alangea DO, Aryeetey R, de-Graft Aikins A. Dietary patterns among adults in three lowincome urban communities in Accra, Ghana. PLoS ONE 2023;18(11 November). Menyanu EK, Corso B, Minicuci N, Rocco I, Russell J, Ware LJ et al. Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3. BMC Nutr 2020;6(1). Modou N, Motoula Latou LN, Maimouna T, Dia AD, Seck SM. Dietary salt intake and kidney function in rural Senegalese populations: a cross-sectional study. J Health Popul Nutr 2024;43(1). Vignesh A, Amal TC, Shanmugam A, Vasanth K, Selvakumar S. Effects of dietary approaches to prevent hypertension and enhance cardiovascular health. Discover Food 2025;5(1). Osoro I, Rajanandh MG. A comprehensive review on cardiovascular disorders development due to salt intake: an emphasis on policy implementation. Health Res Policy Syst 2025;23(1). Pinto VRA, Campos RF, de Rocha A, Emmendoerfer F, Vidigal ML, da Rocha MCTR. SJSS, Perceived healthiness of foods: A systematic review of qualitative studies. Future Foods 2021;4. Godbharle S, Kesa H, Jeyakumar A, Shambharkar P. Socio-demographic and economic factors associated with the consumption of processed foods in South Africa – Evidence from Demographic and Health Survey VII. Public Health. 2024;226:190–8. Khonde Kumbu R, Matondo H, Labat A, Kianu B, Godin I, Kiyombo G et al. Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review. BMC Public Health [Internet] 2023 [cited 2025 Jul 14];23(1):1–12. Available from: https://bmcpublichealth.biomedcentral.com/articles/ 10.1186/s12889-023-17248-5 Abraham AY, Ohemeng FNA, Ohemeng W. Health Problems Associated with Market Women in Closed and Open Space Market Areas. AFRICAN JOURNAL OF APPLIED RESEARCH [Internet] 2022 [cited 2025 Jul 18];8(1):97–107. Available from: https://www.ajaronline.com/index.php/AJAR/article/view/447 Adjobimey M, Mikponhoué R, Frimège DF, Cissé IM, Tchibozo C, Hountohotegbe E et al. Hypertension and Work Stress among City Hall Workers, Bohicon, Benin. Occupational Diseases and Environmental Medicine [Internet] 2022 [cited 2025 Jul 14];10(2):102–15. Available from: https://www.scirp.org/journal/paperinformation?paperid=117222 Henein MY, Vancheri S, Longo G, Vancheri F. The Impact of Mental Stress on Cardiovascular Health—Part II. Journal of Clinical Medicine 2022, Vol 11, Page 4405 [Internet] 2022 [cited 2025 Jul 14];11(15):4405. Available from: https://www.mdpi.com/ 2077-0383/11/15/4405/htm. Asiamah N, Kouveliotis K, Eduafo R, Borkey R. Associations between vigorous physical activity, social ties, social support, and self-reported health among older adults in Accra, Ghana. PLOS Global Public Health 2023;3(2). Wattanapisit A, Ng CJ, Angkurawaranon C, Wattanapisit S, Chaovalit S, Stoutenberg M. Summary and application of the WHO 2020 physical activity guidelines for patients with essential hypertension in primary care. Heliyon 2022;8(10). RECOMMENDATIONS - WHO Guidelines on Physical Activity and Sedentary Behaviour. - NCBI Bookshelf [Internet]. [cited 2025 Jul 18];Available from: https://www.ncbi.nlm.nih.gov/books/NBK566046/ Jobe M, Beye SM, Gaye ND, Ka MM, Perel P, Perkins AD et al. Hypertension in Sub-Saharan Africa: Burden, Barriers and Priorities for Improving Treatment Outcomes. Circ Res [Internet] 2025 [cited 2025 Jul 14];137(1):106. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12175831/ Chali BU, Hasho A, Koricha NB. Preference and Practice of Traditional Medicine and Associated Factors in Jimma Town, Southwest Ethiopia. Evid Based Complement Alternat Med [Internet] 2021 [cited 2025 Jul 18];2021:9962892. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8181118/ Abukari S, Abdul-Manan S, Alice Bavoh E. Pregnancy and Plants: Investigating Factors Affecting Herbal Medicine Utilization among Expecting Mothers in North Gonja District. Int J Womens Health Wellness. 2024;10(1):164. Additional Declarations No competing interests reported. Supplementary Files InterviewGuide.pdf Cite Share Download PDF Status: Published Journal Publication published 19 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 02 Mar, 2026 Reviews received at journal 27 Feb, 2026 Reviews received at journal 19 Feb, 2026 Reviewers agreed at journal 19 Feb, 2026 Reviewers agreed at journal 16 Feb, 2026 Reviewers agreed at journal 16 Feb, 2026 Reviewers agreed at journal 15 Feb, 2026 Reviews received at journal 30 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 10 Dec, 2025 Reviewers agreed at journal 10 Dec, 2025 Reviewers invited by journal 08 Dec, 2025 Editor assigned by journal 03 Dec, 2025 Editor invited by journal 03 Dec, 2025 Submission checks completed at journal 02 Dec, 2025 First submitted to journal 02 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8167010","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":558468395,"identity":"a5cab00e-e9e1-4773-8a1f-e935662d6c2d","order_by":0,"name":"Benedicta Princess Dotse","email":"","orcid":"","institution":"COLLEGE OF NURSING AND MIDWIFERY, TANOSO","correspondingAuthor":false,"prefix":"","firstName":"Benedicta","middleName":"Princess","lastName":"Dotse","suffix":""},{"id":558468399,"identity":"fcce1e70-9cf4-4ec2-b571-732e77b4acd3","order_by":1,"name":"Clement Naayaara Zuuri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDACdiT2gQ9Ago0dl1IYYAaTBmDy4AyQFmZStDDzIERwA/5m5qMbPu74Y29wI/fhYZtf2+T5mBkYP3zMwa1F4jBb2s2ZZwyYDW6kGxzO7btt2MbMwCw5cxtuLQbMPGa3edsM2AxupDEczu25zQjUwsbMi1cL/7fbf9sMeMBaLHtu2xOhhYcNaLKBBFgLw4/biQS1AP1idrO3zdhA8swzhoO9DbeT25gZm/H6hb+9+dmNn21y9nzH05g//Phz23Z+e/PBDx/xaEEFjG1gsoFY9SDwhxTFo2AUjIJRMFIAAIlrTh3E1TYOAAAAAElFTkSuQmCC","orcid":"","institution":"COLLEGE OF NURSING AND MIDWIFERY, TANOSO","correspondingAuthor":true,"prefix":"","firstName":"Clement","middleName":"Naayaara","lastName":"Zuuri","suffix":""},{"id":558468402,"identity":"ca3ca1c3-accf-41d0-8ab2-38d431f40282","order_by":2,"name":"Moses Peter Ofoe","email":"","orcid":"","institution":"St. Michael’s Catholic Nursing and Midwifery Training College","correspondingAuthor":false,"prefix":"","firstName":"Moses","middleName":"Peter","lastName":"Ofoe","suffix":""}],"badges":[],"createdAt":"2025-11-20 17:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8167010/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8167010/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-026-27066-0","type":"published","date":"2026-03-19T15:57:49+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97973059,"identity":"0380f6c1-106f-4cb1-8d9d-0c2df07ebb5a","added_by":"auto","created_at":"2025-12-11 11:05:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":265892,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/60461ef7e05bd7e296f56c67.docx"},{"id":97973055,"identity":"48ebd038-7d99-4e82-846b-5ea36c4da3fa","added_by":"auto","created_at":"2025-12-11 11:05:01","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6101,"visible":true,"origin":"","legend":"","description":"","filename":"2b581d0ed07c4c22aa4c9a0f5595d5b7.json","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/78546073679f95c25757348b.json"},{"id":98423006,"identity":"2a1f176c-3ca3-43e9-9e97-950252ec23d3","added_by":"auto","created_at":"2025-12-17 16:31:44","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":146247,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewGuide.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/7acc75eee7523ec6a0c84b9e.pdf"},{"id":98424153,"identity":"6faf2f4a-743f-4acd-9ecf-1b3a0e36158f","added_by":"auto","created_at":"2025-12-17 16:33:00","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106696,"visible":true,"origin":"","legend":"","description":"","filename":"2b581d0ed07c4c22aa4c9a0f5595d5b71enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/3988e0456757bc2811f6ecbb.xml"},{"id":97973057,"identity":"ec992f0c-aa04-4226-95ce-435a258b973b","added_by":"auto","created_at":"2025-12-11 11:05:01","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103369,"visible":true,"origin":"","legend":"","description":"","filename":"2b581d0ed07c4c22aa4c9a0f5595d5b71structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/6f051a5dbfdce7113aedbbbf.xml"},{"id":97973061,"identity":"ea5f15ad-743d-44c1-b0be-b36ff1b55d39","added_by":"auto","created_at":"2025-12-11 11:05:02","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114099,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/5ca7c0bcb5dd021772eb3a51.html"},{"id":105223421,"identity":"1f49e6c4-e81b-4fb7-a25e-838137f596fd","added_by":"auto","created_at":"2026-03-23 16:06:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":922713,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/dd215c1a-20a9-43c4-8f80-27ac5379996a.pdf"},{"id":98423019,"identity":"477d8f87-257f-496d-a986-a2b93ceec3cf","added_by":"auto","created_at":"2025-12-17 16:31:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":146247,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewGuide.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8167010/v1/894b51273ebe5c67f8ddab2e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants and Lived Experiences of Hypertension Among Market Women at Sunyani Wednesday Market: A Qualitative Study","fulltext":[{"header":"1.0 Introduction","content":"\u003cp\u003eHypertension remains a leading and preventable cause of global illness and death, significantly increasing the risk of cardiovascular diseases like stroke, myocardial infarction, heart failure, and chronic kidney disease (CKD) \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The burden of hypertension has grown significantly over recent decades, especially in low- and middle-income countries (LMICs), where rapid urbanization, demographic shifts, and lifestyle changes have led to a rise in prevalence rates \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. In sub-Saharan Africa, including Ghana, hypertension prevalence has been reported to range widely from 19% to nearly 50% depending on the population studied and measurement methods used \u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. These figures reveal a concerning trend associated with more sedentary lifestyles, poor dietary habits (high salt, fat, and processed food consumption), rising obesity rates, and ongoing psychosocial stressors \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMarket women are a crucial socio-economic group within Ghana\u0026rsquo;s informal sector, especially in urban centers like Sunyani, Accra, and Kumasi. These women often face numerous occupational hazards, such as standing for long periods, intense physical labor, irregular eating habits, exposure to environmental pollutants, and heavy financial and family responsibilities \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Furthermore, they often encounter high levels of occupational stress, including income insecurity and social pressures, which have been linked to the development of hypertension through neuroendocrine mechanisms \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Despite these known risks, comprehensive epidemiological and qualitative studies specifically examining hypertension prevalence, awareness, treatment, and control among market women are still limited in Ghana.\u003c/p\u003e\u003cp\u003eRecent cohort research by \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, highlights that market women frequently underrecognize hypertension as a serious health issue and face barriers to healthcare access, including limited health literacy, cultural beliefs, and economic constraints. Additionally, in a qualitative study by \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, explorations show that their perceptions of hypertension are often linked to stress, fatigue, and lifestyle challenges, highlighting the need for culturally sensitive health promotion interventions tailored to their specific circumstances. Addressing these gaps is essential for developing effective community-based screening, education, and management programs to lower cardiovascular risk in this vulnerable population.\u003c/p\u003e\u003cp\u003eThis study investigates the contributing factors and lived experiences of hypertension among market women at the Sunyani Wednesday Market, emphasizing qualitative insights into their health practices and obstacles to healthcare access. The results will offer evidence to guide policymakers and health professionals in designing targeted interventions that improve cardiovascular health and promote equity for market women in urban Ghana.\u003c/p\u003e"},{"header":"2.0 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Design\u003c/h2\u003e\u003cp\u003eThis study used a qualitative descriptive design, which is especially effective for capturing participants\u0026rsquo; perspectives and lived experiences in their natural settings with minimal researcher interpretation or theoretical influence \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. This method enables detailed, rich descriptions of phenomena as experienced by participants, offering clear insights accessible to both researchers and practitioners \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Qualitative descriptive designs have become increasingly valued in health research for their practical flexibility, especially when the aim is to inform practice and policy by providing an authentic view of participants\u0026rsquo; perspectives without the complexity of deeper phenomenological or grounded theory analyses \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. By focusing on participants\u0026rsquo; own words and meanings, this design helps minimize potential bias from more interpretive methods, ensuring that findings are rooted in the real-world contexts of the study population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Study Setting\u003c/h2\u003e\u003cp\u003eSunyani Wednesday Market is a lively trading center in Sunyani, the capital of Ghana\u0026rsquo;s Bono Region. Though it operates daily, it reaches its busiest point and attracts the most customers every Wednesday, drawing traders and buyers from all over the region. The market has an energetic, dynamic feel, with women traders mainly selling a variety of items such as fresh foods, clothing, household goods, and handcrafted products. It functions as an essential economic hub and a social space where cultural and personal exchanges thrive. The significant presence of women in this informal sector underscores their vital role in local trade and community well-being.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Study Participants and Sampling\u003c/h2\u003e\u003cp\u003eUsing purposive sampling, 30 market women aged 25 to 60 years were recruited for the study. To ensure they had enough experience and familiarity with the Sunyani Wednesday Market, participants were selected if they had worked there for at least one year. The study included women both with and without self-reported hypertension to gain a broad range of perspectives on health, work, and lifestyle. Before data collection, all participants received information about the study\u0026rsquo;s aims, procedures, and confidentiality, and voluntarily gave informed consent in line with ethical research practices.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Data Collection\u003c/h2\u003e\u003cp\u003eThe semi-structured interview guide (Supplementary File 1) was developed by the research team based on prior qualitative studies \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e and an extensive review of literature on hypertension, women\u0026rsquo;s health, and the lived experiences of market women in similar sociocultural contexts. The guide was structured to elicit rich narratives on participants\u0026rsquo; knowledge, daily experiences, lifestyle practices, stressors, and health-seeking behaviours related to hypertension. Semi-structured interviews lasting 30 to 45 minutes were conducted with each participant in both Twi and English to ensure comfort and clear communication. The interview guide carefully covered key topics such as participants\u0026rsquo; knowledge of hypertension, lifestyle habits including diet and physical activity levels, perceived stress related to work and daily life, personal or observed experiences with hypertension, and access to healthcare services. All interviews were audio-recorded with participants\u0026rsquo; consent for accuracy. The recordings were then transcribed verbatim, and where needed, translated from Twi to English to support thorough analysis while maintaining the authenticity of participants\u0026rsquo; responses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data Analysis\u003c/h2\u003e\u003cp\u003eThematic content analysis was used to systematically examine the qualitative data, supported by NVivo software, which organized and managed the transcripts effectively. Two researchers independently conducted initial coding to improve reliability and reduce subjective bias. These coders identified meaningful parts of the text and assigned preliminary codes that reflected participants\u0026rsquo; experiences and perceptions. After independent coding, the researchers engaged in iterative discussions to compare codes, resolve disagreements, and refine the coding framework. Through this collaborative process, broader themes and subthemes were developed inductively, capturing the main patterns within the data. Consensus was reached on the final thematic structure, ensuring a rigorous and credible representation of the participants\u0026rsquo; perspectives.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Ethical Considerations\u003c/h2\u003e\u003cp\u003eEthical approval\u003c/strong\u003e for this study was obtained from the Local Ethics Committee of the College of Nursing and Midwifery, Tanoso, Ahafo-Ghana, on April 15, 2025 (no number was issued). Permission to conduct the study was sought and granted by the market leaders, acknowledging their authority and role within the community. Participants were fully informed about the study\u0026rsquo;s objectives, procedures, and measures to protect their confidentiality. Written informed consent was obtained from each participant before data collection. They were assured that all information provided would be kept strictly confidential and used solely for research purposes. Additionally, participants were made aware of their voluntary participation and their right to withdraw from the study at any time without negative consequences or loss of benefits.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Methodological Rigor\u003c/h2\u003e\u003cp\u003eTo ensure trustworthiness and quality, the study rigorously applied Lincoln and Guba\u0026rsquo;s criteria \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e: credibility was established through prolonged engagement and member checking; transferability was improved with detailed descriptions of the research context; dependability was maintained with a comprehensive audit trail; and confirmability was achieved by involving independent researchers in data coding and employing triangulation methods to reduce bias.\u003c/p\u003e\u003c/div\u003e"},{"header":"3.0 Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.1: Sociodemographic Characteristics of Participants\u003c/h2\u003e\u003cp\u003eThe study participants (n\u0026thinsp;=\u0026thinsp;30) were mostly middle-aged, with 40.0% aged 35\u0026ndash;44 years and 26.7% aged 25\u0026ndash;34 years. Smaller groups were aged 45\u0026ndash;54 years (23.3%) and 55\u0026ndash;60 years (10.0%). Most women were married (70.0%), while single women made up 16.7%, and widowed or divorced women accounted for 13.3%. Regarding education, most had only basic education (60.0%), with 20.0% having no formal schooling and another 20.0% having completed secondary education or higher. In terms of market experience, nearly half (43.3%) had been trading for 4 to 6 years, 33.3% had over 6 years of experience, and 23.3% had been trading for 1 to 3 years. Overall, this group mainly consists of married, middle-aged women with basic education and moderate to extensive trading experience (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic Characteristics of Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePatient IDs\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP1, P2, P3, P4, P5, P6, P7, P8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP9 to P20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP21 to P27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e55\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP28, P29, P30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP1 to P21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP22 to P26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed/Divorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP27 to P30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP1 to P6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP7 to P24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP25 to P30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears Trading at Market\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP1 to P7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026ndash;6 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP8 to P20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;6 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP21 to P30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2: Themes and Subthemes from Market Women\u0026rsquo;s Perspectives on Hypertension\u003c/h2\u003e\u003cp\u003eThe table outlines key themes and subthemes related to hypertension among market women, along with brief descriptions. The first theme, Awareness and Perceived Prevalence, includes acknowledgment that hypertension is common among market women and shared personal or observed experiences of the condition. The second theme, Dietary Practices, emphasizes frequent consumption of high-salt foods such as salted fish and processed items, as well as a preference for fried and convenience foods. The Occupational Stress theme addresses stress related to competition, finances, workload, and the physical demands of standing long hours while trading. The Physical Activity theme highlights periods of inactivity during slow market hours and limited participation in formal exercise. Lastly, Healthcare Access and Beliefs identifies barriers like cost, distance, and waiting times to accessing medical care, along with a preference for traditional herbal remedies due to cultural or economic reasons (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes and Subthemes Identified\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubthemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAwareness and Perceived Prevalence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecognition of hypertension as common\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMany participants knew hypertension affects market women often.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePersonal and observed experiences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStories of self and peers living with hypertension.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDietary Practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh salt intake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequent use of salted fish and processed foods.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFried and processed foods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreference for convenience foods high in fat and salt.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupational Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrading-related stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStress from competition, finances, and workload.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical demands of market work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLong hours standing and trading.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical Activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriods of inactivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSitting during slow market hours.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLimited formal exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFew participants engaged in structured physical activity.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare Access and Beliefs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBarriers to medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCost, distance, and waiting times limit access.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse of traditional medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreference for herbal remedies due to culture or cost.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Awareness and Perceived Prevalence\u003c/h2\u003e\u003cp\u003eParticipants showed a broad awareness and recognized the widespread nature of hypertension, understanding it as a common health problem among market women. Many shared personal or observed stories of themselves or peers living with hypertension, emphasizing its impact in their community.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRecognition of hypertension as common\u003c/strong\u003e\u003cp\u003eMany participants acknowledged that hypertension is a widespread health issue among market women. For example, P4 shared, \u003cem\u003e\u0026ldquo;I see many women here who have high blood pressure; it is very common among us.\u0026rdquo;\u003c/em\u003e Similarly, P15 stated, \u003cem\u003e\u0026ldquo;Almost every market woman I know has to be careful about blood pressure.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePersonal and observed experiences\u003c/strong\u003e\u003cp\u003eSeveral respondents recounted personal or peer experiences with hypertension. P9 mentioned, \u003cem\u003e\u0026ldquo;My sister was diagnosed last year, and I sometimes feel the symptoms too.\u0026rdquo;\u003c/em\u003e P22 added, \u003cem\u003e\u0026ldquo;I have seen friends faint because of high blood pressure.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Dietary Practices\u003c/h2\u003e\u003cp\u003eRegarding dietary habits, frequent intake of high-salt foods like salted fish and processed products was common. Additionally, there was a clear preference for fried and convenience foods, which are often high in fat and salt, possibly increasing the risk of hypertension.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHigh salt intake\u003c/strong\u003e\u003cp\u003eFrequent consumption of salted fish and processed foods was common. P2 explained, \u003cem\u003e\u0026ldquo;Salted fish is part of our meals almost every day; it adds flavor and lasts longer.\u0026rdquo;\u003c/em\u003e P7 said, \u003cem\u003e\u0026ldquo;We use a lot of salt and stock cubes in cooking, especially for quick meals.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFried and processed foods\u003c/strong\u003e\u003cp\u003eThere was a preference for fried and convenience foods, often high in fat and salt. P12 remarked, \u003cem\u003e\u0026ldquo;When I\u0026rsquo;m busy, I buy fried snacks because they are quick and easy.\u0026rdquo;\u003c/em\u003e P19 noted, \u003cem\u003e\u0026ldquo;Sometimes we eat fried foods sold here in the market; it\u0026rsquo;s what\u0026rsquo;s available.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Occupational Stress\u003c/h2\u003e\u003cp\u003eOccupational stress was identified as a key factor, with participants mentioning stress from market competition, financial pressures, and workload demands. The physical aspect of market work, such as long hours spent standing and trading, was also noted as stressors that could affect health.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrading-related stress\u003c/strong\u003e\u003cp\u003eStress related to competition, finances, and workload was frequently reported. P5 shared, \u003cem\u003e\u0026ldquo;The competition is tough; sometimes I worry if I will make enough money for my family.\u0026rdquo;\u003c/em\u003e P17 expressed, \u003cem\u003e\u0026ldquo;Money issues and customers can be very stressful.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePhysical demands of market work\u003c/strong\u003e\u003cp\u003eMany noted the toll of standing and working long hours. P10 said, \u003cem\u003e\u0026ldquo;By the end of the day, my feet hurt from standing and selling all day.\u0026rdquo;\u003c/em\u003e P28 added, \u003cem\u003e\u0026ldquo;The long hours here really tire my body.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.2.4 Physical Activity\u003c/h2\u003e\u003cp\u003eRegarding physical activity, reports indicated periods of inactivity, especially during slow market hours when women tend to sit for long durations. Few participants participated in any formal or structured exercise routines, showing limited overall physical activity.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePeriods of inactivity\u003c/strong\u003e\u003cp\u003eParticipants described sitting during slow market hours. P3 shared, \u003cem\u003e\u0026ldquo;When there are few customers, we just sit and wait; there is not much movement then.\u0026rdquo;\u003c/em\u003e P24 said, \u003cem\u003e\u0026ldquo;Sometimes we spend hours just sitting because there\u0026rsquo;s no work.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLimited formal exercise\u003c/strong\u003e\u003cp\u003eFew participants engaged in structured physical activity outside work. P6 stated, \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t have time or energy to do exercise after market.\u0026rdquo;\u003c/em\u003e P20 admitted, \u003cem\u003e\u0026ldquo;Exercise is not part of my routine; I\u0026rsquo;m too tired.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.2.5 Healthcare Access and Beliefs\u003c/h2\u003e\u003cp\u003eFinally, healthcare access and beliefs showed barriers like cost, distance to facilities, and long wait times that limit women\u0026rsquo;s ability to get medical care. A cultural preference for traditional medicine was also clear, with many choosing herbal remedies because of cultural beliefs or affordability.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eBarriers to medical care\u003c/strong\u003e\u003cp\u003eCost, distance, and waiting times were common obstacles. P11 explained, \u003cem\u003e\u0026ldquo;Going to the clinic is expensive and far, so I only go when I am very sick.\u0026rdquo;\u003c/em\u003e P26 noted, \u003cem\u003e\u0026ldquo;The hospital is too far and the queues too long.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eUse of traditional medicine\u003c/strong\u003e\u003cp\u003eMany preferred herbal remedies for cultural or economic reasons. P8 said, \u003cem\u003e\u0026ldquo;I use herbal medicines because they are cheaper and have been trusted in my family.\u0026rdquo;\u003c/em\u003e P30 mentioned, \u003cem\u003e\u0026ldquo;Herbs help me better than hospital drugs sometimes.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4.0 Discussion","content":"\u003cp\u003eThis study aimed to examine the contributing factors and causes of hypertension among market women at the Sunyani Wednesday Market, focusing on their lived experiences, health behaviors, and obstacles to care. The thematic analysis provided key insights into participants\u0026rsquo; awareness, dietary habits, occupational stress, physical activity, and access to healthcare, offering a comprehensive understanding of factors affecting hypertension in this group.\u003c/p\u003e\u003cp\u003eThe results of this study showed that market women have a strong awareness of hypertension as a common health problem. Many participants recognized that hypertension is widespread in their community, which matches data from other urban African areas. For instance, \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e reported similarly high hypertension awareness in Ghanaian urban populations, noting that increasing urbanization and lifestyle changes have amplified cardiovascular risk factors. Likewise, a recent study by \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e on urban women in Accra, it was found that over 70% of participants were aware of hypertension and its symptoms, reflecting growing public consciousness of the condition in Ghana\u0026rsquo;s cities. This awareness often stemmed from personal or vicarious experiences, with many women sharing symptoms or diagnoses either firsthand or through close friends. Such lived experiences help strengthen understanding and alertness, similar to findings from a study in Nigeria, where community members\u0026rsquo; familiarity with hypertensive relatives increased awareness and perceived seriousness of the condition \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. However, contrasting evidence exists. Some studies report low awareness levels, particularly among rural populations or lower socio-economic groups. For example, \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e found that only 35% of rural Ghanaian women had adequate knowledge of hypertension, suggesting disparities based on geography and education. Similarly, a study in Ethiopia by \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e revealed limited awareness among market women despite high disease prevalence, attributed to low literacy and poor health communication infrastructure. These contrasts highlight the heterogeneity in hypertension awareness across different settings and populations. While awareness is foundational for prevention and early management, it alone may not ensure effective control of hypertension \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e highlighted that in many low-resource settings, including sub-Saharan Africa, barriers such as limited healthcare access, financial constraints, and insufficient health literacy impede translating awareness into behavioral changes or treatment adherence. Similarly, despite awareness, our participants expressed challenges such as cultural reliance on traditional medicine and limited engagement with formal health services, suggesting that knowledge must be coupled with accessible support and empowerment to have a meaningful impact on outcomes.\u003c/p\u003e\u003cp\u003eThe relatively high level of awareness seen in this study may be due to increased health promotion efforts, the rising prevalence of hypertension in Ghana, and improved media coverage in recent years. Urban market women, who engage with a wide range of people and environments, may also have greater exposure to health information compared to rural populations. However, ongoing socioeconomic and systemic obstacles still hinder progress beyond raising awareness. While high awareness provides a strong base for prevention and management, significant risks remain if barriers such as healthcare costs, limited access, and cultural beliefs are not addressed. These issues can result in undiagnosed or poorly managed hypertension, leading to worse public health outcomes, especially given its connection to major conditions like heart disease, stroke, and kidney failure. To effectively reduce the hypertension burden, particularly among high-risk groups like market women, interventions must extend beyond awareness\u0026mdash;offering accessible screening, affordable treatment, and culturally appropriate education.\u003c/p\u003e\u003cp\u003eThe study revealed that high salt intake and consumption of fried and processed foods are prevalent dietary habits among market women. Participants reported frequent use of salted fish and seasoning cubes, which contribute to excessive sodium intake. This finding concurs with research by \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, who found that urban Ghanaian populations regularly consume high-sodium diets, partly due to traditional cooking practices and accessibility of processed foods. Additionally, a study in other African countries by\u003csup\u003e[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e highlighted similar dietary patterns among women traders, linking high salt and fat consumption to an increased prevalence of hypertension. The preference for fried and convenience foods reflects the demanding lifestyle of market women, who often prioritize quick and affordable meals over nutritional quality. This aligns with global findings where busy urban populations increasingly rely on processed foods, escalating cardiovascular risks\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e Excessive salt and fat intake are established contributors to hypertension and other cardiovascular diseases\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e The entrenched dietary habits among market women underscore the urgent need for culturally tailored nutritional education that emphasizes salt reduction and healthier alternatives. Without intervention, these practices could exacerbate hypertension-related morbidity and strain local healthcare systems. Promoting affordable, nutritious options could mitigate these risks and improve cardiovascular health outcomes in this vulnerable group.\u003c/p\u003e\u003cp\u003eOccupational stress from competition, financial insecurity, and physical demands emerged as a significant determinant of hypertension risk. Participants described psychological stressors related to market competition and economic pressures, consistent with findings by \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, who reported that informal sector workers in West Africa face chronic stress affecting cardiovascular health. The physical strain of long hours standing and trading compounds these stressors, corroborating evidence linking prolonged occupational exertion with hypertension \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Such combined psychosocial and physical stress is known to elevate blood pressure through neuroendocrine pathways \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e, explaining why market women may experience higher hypertension prevalence. Sustained occupational stress may accelerate hypertension development and worsen disease outcomes. This underscores the need for workplace interventions addressing stress management, ergonomic improvements, and support networks for market women. By reducing occupational stressors, it may be possible to lower hypertension incidence and improve overall well-being among this population.\u003c/p\u003e\u003cp\u003eParticipants in this study reported frequent periods of physical inactivity, particularly during slow business hours when there were fewer customers in the market. Although their daily work as market women often involves standing, walking, and lifting goods, these activities tend to be intermittent and are often punctuated by long stretches of sitting or remaining stationary. Moreover, most participants indicated that they did not engage in any form of structured or formal exercise such as walking for leisure, jogging, aerobics, or participating in sports. These findings are consistent with the work of \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e, who observed that urban women in Ghana generally participate minimally in structured physical activities. According to their study, barriers such as demanding work schedules, time constraints, and physical fatigue after long hours in the market contributed significantly to low levels of formal exercise among these women. The daily routines of market traders, while physically demanding at times, do not substitute for regular, sustained moderate-intensity exercise necessary for cardiovascular health.\u003c/p\u003e\u003cp\u003eThe World Health Organization, in 2020, as indicated by \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e, underscores the importance of regular physical activity as both a preventive and therapeutic strategy for hypertension and other non-communicable diseases. WHO guidelines recommend that adults should engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week, along with muscle-strengthening activities \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. However, the evidence from this study suggests that the work-related activities performed by market women fall short of these recommendations, as their activity is sporadic and not sustained for long enough periods to yield significant cardiovascular benefits. This gap highlights an important public health challenge: although market work involves some physical effort, it does not provide the protective effects against hypertension and related conditions that regular, structured physical activity offers. Interventions aimed at improving the cardiovascular health of market women should therefore not only focus on removing barriers to formal exercise but also raise awareness about how simple, sustained physical activities\u0026mdash;such as brisk walking, dancing, or group exercise sessions\u0026mdash;can be easily incorporated into daily routines to enhance health outcomes.\u003c/p\u003e\u003cp\u003eBarriers to healthcare access, such as cost, distance, and long waiting times, were significant challenges for participants. Similar obstacles have been widely documented in sub-Saharan Africa, restricting hypertension diagnosis and treatment adherence \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. The preference for traditional medicine, motivated by cultural beliefs and affordability, further complicates formal healthcare engagement, as noted by \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. Such healthcare-seeking behaviors can delay treatment initiation and lead to poor hypertension outcomes. Barriers to healthcare access and reliance on traditional remedies hinder timely hypertension diagnosis and effective management. These issues can result in uncontrolled hypertension and a higher risk of complications like stroke and kidney disease. Improving healthcare infrastructure, subsidizing care costs, and involving traditional healers in hypertension education may enhance care uptake and outcomes among market women.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study is limited by its small sample size, reliance on self-reported data, and qualitative design, which restricts generalizability and the ability to establish causal relationships. Additionally, the absence of quantitative blood pressure measurements prevents a direct link between behaviors and clinical hypertension. Future research with larger samples, mixed methods, and clinical assessments is recommended to strengthen the evidence.\u003c/p\u003e"},{"header":"5.0 Conclusion","content":"\u003cp\u003eThis study emphasizes that hypertension is well known among market women in Sunyani, but various behavioral, occupational, and systemic factors help sustain it. High salt and fat intake, work-related stress, limited physical activity, and barriers to formal healthcare all contribute to increased hypertension risk. Tackling these issues requires a comprehensive, culturally sensitive approach that includes education, occupational support, improved healthcare access, and community involvement. By focusing on these factors, customized interventions can more effectively promote cardiovascular health and fairness among market women in urban Ghana.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCVD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCardiovascular Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChronic Kidney Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSub-Saharan Africa\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNCDs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNon-Communicable Diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eETHICAL APPROVAL AND CONSENT TO PARTICIPATE\u003c/h2\u003e\u003cp\u003e The study protocol was reviewed and approved by the Local Ethics Committee of the College of Nursing and Midwifery, Tanoso, Ghana, on April 15, 2025 (no number was issued).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCONSENT FOR PUBLICATION\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCONFLICT OF INTEREST\u003c/h2\u003e\u003cp\u003eAuthors declare no conflict of interest\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eFINANCIAL SUPPORT\u003c/h2\u003e\u003cp\u003eNil\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eC.N.Z.: Conceived and designed the study; developed the study protocol; conducted data collection; performed data analysis; drafted the initial manuscript; and contributed substantially to revisions and final approval.B.P.D.: Contributed to study design and methodology; participated in data analysis and interpretation; critically reviewed and revised the manuscript for intellectual content; and approved the final version for submission.M.P.O.: Assisted with literature review and development of data collection tools; supported data coding and thematic analysis; reviewed the manuscript for accuracy and clarity; and approved the final manuscript.All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank all participants, especially the study participants, as well as everyone who played a key role in supporting and producing this paper.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003e\u0026ldquo;The datasets generated and/or analyzed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.\u0026rdquo;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKario K, Okura A, Hoshide S, Mogi M. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens Res. 2024;47(5):1099\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoorani S, Zangene S, Imig JD, Hypertension. A Continuing Public Healthcare Issue. Int J Mol Sci [Internet] 2024 [cited 2025 Jul 2];26(1):123. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11720251/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC11720251/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkello S, Muhihi A, Mohamed SF, Ameh S, Ochimana C, Oluwasanu AO et al. Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA). BMC Public Health 2020;20(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkpa OM, Okekunle AP, Ovbiagele B, Sarfo FS, Akinyemi RO, Akpalu A, et al. Factors associated with hypertension among stroke-free indigenous Africans: Findings from the SIREN study. J Clin Hypertens. 2021;23(4):773\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKamdem F, Bika L\u0026eacute;le EC, Hamadou B, Obe Meyong MAP, Fenkeu Kweban J, Moussa O, et al. Prevalence and risk factors of pre-hypertension and high blood pressure among adolescents in Cameroonian schools. J Clin Hypertens. 2023;25(9):845\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMonda A, de Stefano MI, Villano I, Allocca S, Casillo M, Messina A et al. Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review. Foods 2024, Vol 13, Page 2627 [Internet] 2024 [cited 2025 Jul 2];13(16):2627. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2304-8158/13/16/2627/htm\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2304-8158/13/16/2627/htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarg RK. The alarming rise of lifestyle diseases and their impact on public health: A comprehensive overview and strategies for overcoming the epidemic. J Res Med Sci [Internet] 2025 [cited 2025 Jul 2];30(1):1. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11974594/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC11974594/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdjokatse IT, Oduro-Okyireh T, Manford M, HEALTH PROBLEMS ASSOCIATED WITH MARKET, WOMEN IN CLOSED AND OPEN SPACE MARKET AREAS. Afr J Appl Res. 2022;8(1):97\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDramani JB, Frimpong PB, Ofori-Mensah KA. Modelling the informal sector and energy consumption in Ghana. Social Sci Humanit Open 2022;6(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarwaha K. Examining the Role of Psychosocial Stressors in Hypertension. J Prev Med Public Health. 2022;55(6):499\u0026ndash;505.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLoreto L, Linares-Jimenez FG, de Zeeuw J, de Winter AF. Health literacy and hypertension-related multimorbidity: unravelling the mediating role of self-management - insights from the lifelines cohort study. BMC Public Health 2025;25(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSambah F, McBain-Rigg K, Seidu AA, Emeto TI. A Qualitative Study on the Barriers and Enablers to Effective Hypertension Management in Ghana. Healthc (Switzerland) 2025;13(5).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeavy P. Research Design: Quantitative, Qualitative, Mixed Methods, Arts-Based, and Community-Based Participatory Research Approaches. 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHall S, Liebenberg L. Qualitative Description as an Introductory Method to Qualitative Research for Master\u0026rsquo;s-Level Students and Research Trainees. Int J Qual Methods [Internet] 2024 [cited 2025 Jul 1];23:1\u0026ndash;5. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.sagepub.com/doi/pdf/\u003c/span\u003e\u003cspan address=\"https://journals.sagepub.com/doi/pdf/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/16094069241242264\u003c/span\u003e\u003cspan address=\"10.1177/16094069241242264\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLim WM. What Is Qualitative Research? An Overview and Guidelines. Australasian Mark J 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBusetto L, Wick W, Gumbinger C. How to use and assess qualitative research methods. Neurological Research and Practice 2020 2:1 [Internet] 2020 [cited 2025 Nov 29];2(1):14-. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s42466-020-00059-z\u003c/span\u003e\u003cspan address=\"10.1186/s42466-020-00059-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeJonckheere M, Vaughn LM. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med Community Health [Internet] 2019 [cited 2025 Nov 29];7(2):e000057. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC6910737/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC6910737/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEnworo OC. Application of Guba and Lincoln\u0026rsquo;s parallel criteria to assess trustworthiness of qualitative research on indigenous social protection systems. Qualitative Res J. 2023;23(4):372\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBosu WK, Bosu DK. Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis. PLoS One [Internet] 2021 [cited 2025 Jul 7];16(3):e0248137. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248137\u003c/span\u003e\u003cspan address=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248137\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKyei N. Prevalence of Hypertension and its Awareness in Ghana. Int J High School Res. 2023;5(5):95\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahmoud Z, Orji AA, Okoye CF, Ameh FO, Jamro-Comer E, Isah A et al. Facilitators and barriers to optimal home blood pressure management in patients with hypertensive disorders of pregnancy in a tertiary care facility in Abuja, Nigeria: a qualitative research study. BMC Health Serv Res 2023;23(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDai B, Addai-Dansoh S, Nutakor JA, Osei-Kwakye J, Larnyo E, Oppong S et al. The prevalence of hypertension and its associated risk factors among older adults in Ghana. Front Cardiovasc Med 2022;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdamu AA, Godesso A, Birhanu Z. Health Literacy in Ethiopia: Evidence Synthesis and Implications. J Multidiscip Healthc [Internet] 2023 [cited 2025 Jul 7];16:4071. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC10729771/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC10729771/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eByiringiro S, Hinneh T, Chepkorir J, Tomiwa T, Commodore-Mensah Y, Marsteller J et al. Healthcare system barriers and facilitators to hypertension management in Ghana. Ann Glob Health 2024;90(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKushitor SB, Alangea DO, Aryeetey R, de-Graft Aikins A. Dietary patterns among adults in three lowincome urban communities in Accra, Ghana. PLoS ONE 2023;18(11 November).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMenyanu EK, Corso B, Minicuci N, Rocco I, Russell J, Ware LJ et al. Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3. BMC Nutr 2020;6(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eModou N, Motoula Latou LN, Maimouna T, Dia AD, Seck SM. Dietary salt intake and kidney function in rural Senegalese populations: a cross-sectional study. J Health Popul Nutr 2024;43(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVignesh A, Amal TC, Shanmugam A, Vasanth K, Selvakumar S. Effects of dietary approaches to prevent hypertension and enhance cardiovascular health. Discover Food 2025;5(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOsoro I, Rajanandh MG. A comprehensive review on cardiovascular disorders development due to salt intake: an emphasis on policy implementation. Health Res Policy Syst 2025;23(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePinto VRA, Campos RF, de Rocha A, Emmendoerfer F, Vidigal ML, da Rocha MCTR. SJSS, Perceived healthiness of foods: A systematic review of qualitative studies. Future Foods 2021;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGodbharle S, Kesa H, Jeyakumar A, Shambharkar P. Socio-demographic and economic factors associated with the consumption of processed foods in South Africa \u0026ndash; Evidence from Demographic and Health Survey VII. Public Health. 2024;226:190\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhonde Kumbu R, Matondo H, Labat A, Kianu B, Godin I, Kiyombo G et al. Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review. BMC Public Health [Internet] 2023 [cited 2025 Jul 14];23(1):1\u0026ndash;12. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpublichealth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpublichealth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-023-17248-5\u003c/span\u003e\u003cspan address=\"10.1186/s12889-023-17248-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbraham AY, Ohemeng FNA, Ohemeng W. Health Problems Associated with Market Women in Closed and Open Space Market Areas. AFRICAN JOURNAL OF APPLIED RESEARCH [Internet] 2022 [cited 2025 Jul 18];8(1):97\u0026ndash;107. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ajaronline.com/index.php/AJAR/article/view/447\u003c/span\u003e\u003cspan address=\"https://www.ajaronline.com/index.php/AJAR/article/view/447\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdjobimey M, Mikponhou\u0026eacute; R, Frim\u0026egrave;ge DF, Ciss\u0026eacute; IM, Tchibozo C, Hountohotegbe E et al. Hypertension and Work Stress among City Hall Workers, Bohicon, Benin. Occupational Diseases and Environmental Medicine [Internet] 2022 [cited 2025 Jul 14];10(2):102\u0026ndash;15. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scirp.org/journal/paperinformation?paperid=117222\u003c/span\u003e\u003cspan address=\"https://www.scirp.org/journal/paperinformation?paperid=117222\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenein MY, Vancheri S, Longo G, Vancheri F. The Impact of Mental Stress on Cardiovascular Health\u0026mdash;Part II. Journal of Clinical Medicine 2022, Vol 11, Page 4405 [Internet] 2022 [cited 2025 Jul 14];11(15):4405. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e2077-0383/11/15/4405/htm.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAsiamah N, Kouveliotis K, Eduafo R, Borkey R. Associations between vigorous physical activity, social ties, social support, and self-reported health among older adults in Accra, Ghana. PLOS Global Public Health 2023;3(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWattanapisit A, Ng CJ, Angkurawaranon C, Wattanapisit S, Chaovalit S, Stoutenberg M. Summary and application of the WHO 2020 physical activity guidelines for patients with essential hypertension in primary care. Heliyon 2022;8(10).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRECOMMENDATIONS - WHO Guidelines on Physical Activity and Sedentary Behaviour. - NCBI Bookshelf [Internet]. [cited 2025 Jul 18];Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK566046/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK566046/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJobe M, Beye SM, Gaye ND, Ka MM, Perel P, Perkins AD et al. Hypertension in Sub-Saharan Africa: Burden, Barriers and Priorities for Improving Treatment Outcomes. Circ Res [Internet] 2025 [cited 2025 Jul 14];137(1):106. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC12175831/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC12175831/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChali BU, Hasho A, Koricha NB. Preference and Practice of Traditional Medicine and Associated Factors in Jimma Town, Southwest Ethiopia. Evid Based Complement Alternat Med [Internet] 2021 [cited 2025 Jul 18];2021:9962892. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC8181118/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC8181118/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbukari S, Abdul-Manan S, Alice Bavoh E. Pregnancy and Plants: Investigating Factors Affecting Herbal Medicine Utilization among Expecting Mothers in North Gonja District. Int J Womens Health Wellness. 2024;10(1):164.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, market women, Ghana, dietary practices, occupational stress","lastPublishedDoi":"10.21203/rs.3.rs-8167010/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8167010/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHypertension continues to be a major cause of illness and death worldwide, with its prevalence rising quickly in low- and middle-income countries. In Ghana, market women are a crucial socio-economic group that are disproportionately exposed to risk factors for hypertension, yet few comprehensive studies have focused on this population.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to explore the determinants of hypertension among market women at the Sunyani Wednesday Market, focusing on qualitative insights into their lived experiences, health behaviors, and challenges in accessing care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA qualitative descriptive study was carried out using purposive sampling to select 30 market women aged 25\u0026ndash;60 years. Data were gathered through semi-structured interviews and were analyzed thematically.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFive major themes emerged: Market women showed strong awareness of hypertension, often identifying it as a community health concern and sharing personal or observed experiences; their diets frequently included high-salt and fried foods, and they faced occupational stress from competition, financial insecurity, and long hours. Physical activity was limited, especially formal exercise, and access to healthcare was challenged by cost, distance, and waiting times. Many preferred traditional herbal remedies due to cultural and economic factors. These combined issues increase the risk of hypertension and make effective management difficult.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eHypertension among Sunyani market women is driven by poor diet, work stress, low physical activity, and limited healthcare access, requiring culturally tailored interventions in education, workplace support, healthcare, and community engagement to improve heart health and equity.\u003c/p\u003e","manuscriptTitle":"Determinants and Lived Experiences of Hypertension Among Market Women at Sunyani Wednesday Market: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 11:04:53","doi":"10.21203/rs.3.rs-8167010/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-02T09:22:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T09:46:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T18:26:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198279934406700034206696498100498212821","date":"2026-02-19T15:22:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229674493385093797004211377281014307220","date":"2026-02-16T21:03:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13715567464663681710173624401198541252","date":"2026-02-16T14:23:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20199090112820733444512888223879159543","date":"2026-02-15T22:21:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T13:33:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164994951045479563979611025184056573240","date":"2025-12-11T14:38:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291306491432417416860934437910005692597","date":"2025-12-11T09:25:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174350999261744413928938798065555732528","date":"2025-12-10T22:01:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25388670042928841593393576830622763403","date":"2025-12-10T15:52:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-08T14:17:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T13:40:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-03T07:29:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-02T08:11:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-12-02T07:38:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c976af8-6b85-47ef-8336-9908e9b6add5","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:02:58+00:00","versionOfRecord":{"articleIdentity":"rs-8167010","link":"https://doi.org/10.1186/s12889-026-27066-0","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-03-19 15:57:49","publishedOnDateReadable":"March 19th, 2026"},"versionCreatedAt":"2025-12-11 11:04:53","video":"","vorDoi":"10.1186/s12889-026-27066-0","vorDoiUrl":"https://doi.org/10.1186/s12889-026-27066-0","workflowStages":[]},"version":"v1","identity":"rs-8167010","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8167010","identity":"rs-8167010","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}