Role of the Health Belief Model in the Management of Hypertension: A Systematic Review

Role of the Health Belief Model in the Management of Hypertension: A Systematic Review | 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 Systematic Review Role of the Health Belief Model in the Management of Hypertension: A Systematic Review Mohammad Tanvir Islam, Shohael Mahmud Arafat, Arna Chowdhury, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7061263/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Oct, 2025 Read the published version in Cureus → Version 1 posted You are reading this latest preprint version Abstract Background: Theory-driven behavioral models such as the health belief model (HBM) offer predictive and influential insights into hypertension management. This study aims to explore the role of the health belief model in hypertension management, with a focus on blood pressure control, medication adherence, and self-management. Methods: This review included English full-text quantitative studies on HBM and hypertension management in low- and middle-income countries (LMICs), excluding qualitative, mixed methods, protocols, and nonoriginal data. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was carried out across six electronic databases—PubMed, APA PsycINFO, CINAHL, Scopus, Embase, and the Cochrane Library—between September 26 and October 2, 2023, to identify relevant published studies. The risk of bias was assessed via the RoB-2 and JBI Critical Appraisal Tools. Data was extracted into an Excel data sheet for result synthesis and tabulation. Results: An initial total of 1,064 articles were identified for review. Following the removal of duplicates and a full-text assessment, 24 articles with a sample size of 6106 met the inclusion criteria. The application of interventions based on the HBM constructs was associated with reduced blood pressure, improved medication adherence, and self-management. Most studies have shown that perceived susceptibility, severity, and self-efficacy are positively associated with BP reduction, whereas perceived barriers have a negative impact on adherence. Perceived susceptibility and self-efficacy are also frequently linked to better self-management. Conclusion The HBM has the potential to predict health behaviors among individuals with hypertension. Interventions based on the HBM offer potential for effective hypertension control. Health Belief Model Hypertension Nonpharmacological therapy BP control Medication adherence Self-management Figures Figure 1 Figure 2 1. Introduction Hypertension is a global threat, leading to significant cardiovascular morbidity and affecting one in every three people [ 1 ]. Controlling hypertension can significantly reduce the risk of cardiovascular events, stroke, renal and retinal complications, and all-cause mortality [ 2 , 3 ]. In the past few decades, high-income countries have experienced a decline in hypertension rates, low- and lower-middle-income countries continue to face a high prevalence [ 4 ]. In Low- and Middle-Income Countries (LMICs), undetected hypertension has become a pressing concern, with a prevalence ranging from 15–55%, and only 10% of diagnosed cases achieve the target blood pressure (BP) reduction [ 5 – 11 ]. Medication adherence, which refers to the extent to which a patient follows prescribed medications, dietary guidelines, and lifestyle changes, is a critical factor in managing hypertension [ 12 ]. Suboptimal adherence to hypertension treatment presents a significant challenge in low- and middle-income countries [ 13 ]. In addition, individuals with hypertension in these regions often exhibit poor self-management of their condition [ 14 ]. Self-management is a dynamic process involving daily activities that help individuals monitor and manage disease-related events and adopt healthy lifestyle behaviors [ 15 ]. Research has demonstrated that self-management plays a significant role in improving both medication adherence and blood pressure reduction [ 16 ]. Understanding health behaviors is key to promoting effective, long-term management at both individual and societal levels [ 17 ]. The incorporation of theoretical models in interventions to control chronic illnesses such as diabetes and hypertension has proven to be more effective [ 18 ]. Conner and Norman (1996) described health behavior as an action aimed at preventing or detecting disease or improving overall well-being [ 19 ]. Several theories explain health-promoting behaviors, including the Health Belief Model (HBM), Transtheoretical Model (TTM), Social Cognitive Theory, Self-Regulation Theory, and Social Ecological Theory, with HBM being the most widely applied [ 20 ]. The HBM was developed by Rosenstock and his team in the 1950s and has since become one of the most highlighted behavioral theories in the following decades [ 21 – 24 ]. The model consists of six components: 1. perceived susceptibility, 2. perceived severity, 3. perceived benefit, 4. perceived barrier, 5. cues to action, and 6. self-efficacy. The initial model started with four components, and later, ‘self-efficacy’ and ‘cue-to-action’ were incorporated as integral parts of the model [ 25 ]. The model aims to explain how an individual's beliefs impact their involvement in health-related behaviors. On the basis of the model's components, a person may be motivated to engage in behaviors to control hypertension if they believe they are at risk of developing the condition (Percieved susceptibility), understand the potential serious health consequences of the disease (Percieved severity), believe that taking preventive health measures can reduce these risks (Percieved benefit), and recognize possible obstacles to adopting these measures (Percieved barriers). External factors, such as cues, can also influence a person’s decision to adopt these behaviors, while their confidence in managing their health independently (self-management) is another crucial aspect of the model [ 26 ]. In addition to these core components, sociodemographic factors, such as age, sex, and health literacy, can influence a person's perception of illness [ 27 ]. Previous reviews of the health belief model have explored its role in preventive measures such as screening for different illnesses [ 28 – 30 ]. Reviews and meta-analyses have examined the effectiveness of the HBM in predicting health behaviors [ 23 , 24 , 31 , 32 ]. A systematic review also assessed its impact on medication adherence [ 33 ]. None of these studies focused on investigating the role of HBM or HBM-based interventions in the management of hypertension. Since its introduction, numerous studies have highlighted the impact of interventions based on the Health Belief Model (HBM) in managing hypertension [ 34 – 36 ]. However, review articles summarizing these effects and identifying the strengths and limitations of the use of HBM in hypertension management are lacking. Given the high incidence and poor control of hypertension in resource-limited countries, it is crucial to identify an effective model that can address this issue. Therefore, our research question was whether HBM has any role in the management of hypertension, particularly among individuals from LMICs. The primary objective of this systematic review was to explore the role of HBM in controlling hypertension in low- and middle-income countries (LMICs) and, secondarily, to assess its impact on treatment adherence and self-management, which are key factors in determining treatment success. 2. Methods We reviewed studies providing information on the associations between HBM constructs and hypertension in the adult population. A protocol (PROSPERO 2023 CRD42023467247) was registered for this systematic review and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Supplementary File: 1). 2.1. Inclusion and exclusion criteria The inclusion criteria for this systematic review were (1) articles providing information on the association of HBM with hypertension management; (2) the study population was hypertensive adult individuals in LMICs; (3) full-text articles in English; and (4) primary articles with quantitative study designs: cross-sectional, longitudinal, and intervention studies and relevant gray literature. Articles were excluded if they (1) did not fulfill the objectives of the review; (2) study population below 18 years old; (3) did not provide original data (e.g., research reports, reviews, editorials, dissertations, etc.); or (4) were protocol studies. 2.2. Literature search and study selection This review systematically searched six electronic databases: PubMed, American Psychological Association (APA) PsycINFO, CINAHL, Scopus, Embase, and the Cochrane Library. The search strings were developed around two key concepts: hypertension and the health belief model . The database search involved three stages. First, we developed search strings for PubMed (see Box 1) to ensure that all relevant documents were included. Using these initial strings, we then created the final search strings, which were applied to each database (Supplementary file 2). Finally, we searched reference lists and other articles in the gray literature to ensure that the comprehensive search included studies meeting the inclusion criteria. The search was conducted between September 26 and October 2, 2023, covering relevant published articles without any date restrictions. During the search process, we used truncations, wildcards, Boolean operators, and Medical Subject Headings to find relevant documents. Box 1 PubMed search strings (("hypertension"[mh] OR "high blood pressur*"[all] OR "blood pressur*"[all] OR "BP"[all] OR "elevated blood pressur*"[all] OR "raised blood pressur*"[all]) AND ("Health belief model"[mh] OR "Health belief model"[all])) The titles from all the databases were exported into Mendeley reference management software, version 1.19.8, for compilation, and duplicates were removed. The compiled list was then imported into Rayyan, a web-based application for screening articles in systematic reviews. Three independent reviewers (M.R.I., K.O., and A.C.) participated in all stages of the screening process within Rayyan, followed by a full-text assessment for relevance and quality. In cases of disagreement during the screening process, the first author resolved any issues (M.T.I). 2.3. Interventions: This systematic review examined experimental studies that used interventions based on different constructs of the HBM as well as other quantitative studies that did not utilize any specific intervention but were used as a framework, questionnaire formulation, or other methods. Comparators for the experimental studies included either no intervention, standard care, or alternative approaches. 2.4. Outcomes: The primary outcome of this study was BP reduction, and the secondary outcomes were changes in medication adherence scores and self-management scores. 2.5. Data extraction and management After the identification of the studies for this review, the authors held a roundtable workshop to learn how to accurately extract the relevant data and variables. A pilot test was conducted by the independent reviewers, and refinements were made on the basis of feedback. All the authors read some of the full-text articles and decided which variables should be extracted for this review. Data extraction was subsequently performed and documented in an Excel spreadsheet by two authors (A.C. & K.O.) (Supplementary File: 3). The first author (M.T.I.) reviewed the data extracted, and any differences were settled by consensus. The following information was extracted and summarized from the selected articles: author(s), year of publication, article title, journal name, study design, and study objectives. The extracted data also included location, sample size, study population, age group, data collection methodology, intervention, and outcomes. A comprehensive evaluation of the selected articles was carried out, emphasizing the application of the HBM. The constructs of the HBM were identified across all studies. Data were also extracted to examine the role of six components of the HBM in relation to hypertension, the frequency with which these constructs were explained, and the concepts they represented. In addition to simply determining the use of the HBM, the analysis explored how the different components of the model were applied to lower blood pressure, promote self-care behaviors, and ensure drug adherence. 2.6. Quality assessment and risk of bias The risk of bias was evaluated via the revised Cochrane risk of bias tool (RoB-2) for RCTs (n = 6). Two RCT studies were found to have a low risk, 3 showed some concerns, and only one had a high risk of bias (Fig. 1 ). Assessment of the remaining 18 studies was performed on the basis of the Joanna Briggs Institute (JBI) Critical Appraisal Tools with individual checklists for cross-sectional, cohort, and quasi-experimental studies. Scorings of JBI tool assessments were performed following the approach outlined by Manosroi et al., 2022 [ 37 ]. Among the 18 studies included, 12 had a moderate risk of bias, whereas 6 had a low risk of bias. Detailed information on the JBI checklists is available in Supplementary File 4. Two authors (A.C. & K.O.) conducted the quality assessment, and the first author (M.T.I.) reviewed it. 2.7. Data synthesis This review aims primarily to narratively synthesize studies, their participants, the application of HBM, and the outcomes generated with hypertension management. Studies were categorized into 3 domains: BP reduction, medication adherence, and self-management. Outcome measures were presented in tabulated forms, visualizing the associations of different constructs of the HBM with the domains as statistically significant or clinically relevant. Changes in blood pressure were evaluated by comparing the mean values taken before and after the intervention. Changes in the mean score were used to evaluate medication adherence and self-management outcomes. “Missing Constructs” & “Not Mentioned” labels were used to denote nonreported & nonutilized HBM components. 3. Results 3.1. Search results We initially identified 1,064 articles for further review. After 112 duplicates were eliminated and a preliminary screening of titles and abstracts was conducted, the number of articles was reduced to 89. A full-text screening of these articles was then performed, resulting in the inclusion of 22 articles. Sixty-six articles were excluded for various reasons. Additionally, two articles were added through a review of bibliographies, bringing the total number of included articles to 24 (Fig. 2 ). 3.2. Characteristics of the included studies Geographically, 11 of these studies were from Iran [ 34 , 35 , 38 – 46 ], 6 from China [ 36 , 47 – 51 ], 2 from Egypt [ 52 , 53 ], and 1 each from India [ 54 ], Pakistan [ 55 ], Indonesia [ 56 ], Ghana [ 57 ], and Brazil [ 58 ]. The studies covered a 20-year period, with 13 from the 2010s and 11 from 2020 to 2023. The study population comprised adults aged 18 years and above. These articles comprised a sample size of 6106, with individual study sample sizes varying from 58 to 745. Of the 24 studies, 6 employed RCTs, four were quasi-experimental studies, 12 were cross-sectional, and the remaining two were pre- and post-intervention and nested cohort studies. 3.3. HBM constructs presented in the study As the HBM has evolved over time, the number of components utilized in the studies has varied [ 25 ]. Not all studies incorporated the full set of HBM constructs, and the authors did not provide explanations for the exclusion criteria. Specifically, 14 studies utilized all six constructs of the health belief model, 8 studies incorporated five constructs, and the remaining studies included only four components in their analysis. The most frequently missing constructs were 'cues to action' and 'self-efficacy', followed by 'perceived susceptibility' and 'perceived severity'. 3.4. Relationships among the constructs of the HBM with different domains 3.4.1. Blood pressure reduction This review examined the associations between different constructs of the HBM and interventions based on them in reducing BP (Table 1 ). Among the 9 studies reviewed, five were randomized controlled trials [ 34 , 35 , 40 , 47 , 48 , 55 ], two were quasi-experimental studies [ 38 , 45 ], and one each was a pre- and post-intervention and nested cohort study [ 36 , 52 ]. All the studies were conducted in different parts of Asia and Africa. In addition to the HBM, social cognitive theory was used in one study [ 55 ]. The components of the interventions varied, including comprehensive reminder systems, workshop sessions, health counseling, telephone follow-up, etc. The duration of the intervention ranged from 2 weeks to 6 months, reflecting a diverse range of program intensities and timelines. The most common constructs that exhibited a positive association with a reduction in BP were perceived susceptibility, severity, and self-efficacy. BP measurements in these studies were taken following standard guidelines. Most of the intervention studies described pre- and post-SBP and DBP to observe significant changes. Following the interventions, seven of the studies reported a significant reduction in blood pressure (p value < 0.05) [ 34 – 36 , 47 , 48 , 52 , 55 ]. Two of them showed no remarkable decrease in blood pressure [ 38 , 45 ]. 3.4.2. Medication adherence The relationship between the HBM model and medication adherence was examined in 11 studies (Table 2 ). Among them, three studies were randomized controlled trials (RCTs) [ 40 , 47 , 55 ]; only one was a pre- and post-intervention study [ 52 ]; and the rest were cross-sectional [ 49 , 50 , 53 – 57 ]. Of these, eight studies were conducted in Asian countries, and three were conducted in African nations. Four reviewed studies implemented HBM-based interventions supplemented with educational sessions, calendar handbooks, SMS reminders, and follow-ups over durations ranging from 2 to 6 months [ 40 , 47 , 52 , 55 ]. Additionally, one study used social cognitive theory with the HBM [ 55 ]. Among the HBM variables, perceived barriers had the most frequent construct, showing a significant negative association in 9 studies. Perceived susceptibility exhibited a stronger positive association in 8 studies. Four interventional studies demonstrated statistically significant improvements in medication adherence, with remarkable -intervention mean scores, medication compliance rates, and adherence levels over time [ 40 , 47 , 52 , 55 ]. 3.4.3. Self-management Table 3 shows that eleven studies evaluated the role of the HBM model in self-management. Of these, five studies were cross-sectional [ 39 , 42 , 44 , 51 , 58 ], three were quasi-experimental [ 43 , 45 , 46 ], two were RCTs [ 47 , 48 ], and the remaining was a nested cohort [ 36 ]. Ten of these studies were conducted in East Asian and Southwestern Asian countries, and one was conducted in South America. HBM-based interventions such as training sessions, educational sessions, lectures, educational films, group discussions, educational pamphlets, and educational intervention programs were used in six studies, with durations ranging from 2 weeks to 6 months [ 36 , 43 , 45 – 48 ]. These studies also revealed statistically significant increases in self-management, health behavior, and self-care scores after the intervention (p < 0.05). Among the HBM components, perceived susceptibility [ 39 , 42 , 45 , 46 , 51 , 58 ] and self-efficacy [ 39 , 42 – 45 , 51 ] strongly influenced self-management in six studies. Table 1 Association of interventions based on different constructs of the HBM with BP reduction Author, Year & Reference Country and Sample Size Study Design Association with different constructs of HBM Intervention Effect of Intervention on BP Perceived susceptibility Perceived severity Perceived benefit Perceived barrier Cues to action Self-efficacy Pre intervention Post intervention Saffari, 2023 [ 35 ] Iran, 120 RCT + + + - + + HBM-based education program Over 6 weeks Mean ± SD of Intervention group: SBP : 145.70 ± 10.80 mmHg DBP : 88.80 ± 7.30 mmHg, & Control group: SBP : 144.20 ± 9.90 mmHg DBP : 88.00 ± 7.40 mmHg Mean ± SD of Intervention group: SBP : 139.40 ± 8.40 mmHg DBP : 85.90 ± 6.40 mmHg, & Control group: SBP : 145.20 ± 10.00 mmHg DBP : 87.70 ± 7.0 mmHg ANCOVA test (p value) SBP : 97.3 (< 0.001) DBP : 22.4 (< 0.001) Noroozi, 2022 [ 34 ] Iran, 200 RCT + + + - MC + HBM-based education program 8 workshop sessions in 8 weeks on blood pressure Mean ± SD of Intervention group: SBP : 136.15 ± 13.74 mmHg DBP : 81.46 ± 8.95 mmHg & Control group: SBP : 136.16 ± 16.78 mmHg DBP : 81.20 ± 10.06 mmHg Mean ± SD of Intervention group: SBP : 133.86 ± 14.84 mmHg DBP : 80.60 ± 8.29 mmHg & Control group: SBP : 136.10 ± 16.64 mmHg DBP : 81.25 ± 10.05 mmHg Mean difference in intervention group: SBP : 2.29 mmHg, DBP:1.04 mmHg & in control group: SBP :0.90 mmHg, DBP:0.75 mmHg In intervention group SBP (p value = 0.02) DBP (p value = 0.03) Afshari, 2022 [ 45 ] Iran, 100 QES + + NS NS NS + HBM-based education program 3 training sessions in 2 weeks each lasting 1 hour Mean ± SD of Intervention groups: 151.99 ± 1.98 mmHg Control groups:152.94 ± 2.53 mmHg. No significant difference between the intervention vs. control groups (P > 0.05). Wang, 2020 [ 47 ] China, 174 RCT NM NM NM NM MC NM Intervention group: Usual care and (CRS-HBM) for 6 months including: 1.Health belief education 2.The HBM calendar handbook 3.Weekly short message services 4.Telephone follow-up interviews. Control: usual care Mean ± SD of Intervention group: SBP : 142.91 ± 14.05 mmHg DBP : 80.33 ± 9.12 mmHg & Control group: SBP : 138.65 ± 18.36 mmHg DBP : 83.32 ± 13.86 mmHg Mean ± SD of Intervention group: SBP : 132.14 ± 10.67 mmHg DBP : 79.57 ± 7.41 mmHg & Control group: SBP : 137.37 ± 13.73 mmHg DBP : 83.07 ± 9.70 mmHg SBP (p value < 0.05) DBP (p value = 0.927) Saffari, 2020 [ 38 ] Iran, 58 QES + + + - NS + HBM-based education program 5 educational sessions Mean ± SD: SBP : 132.3 ± 26.8 mmHg DBP : 85.1 ± 19.7 mmHg (p value = 0.163) Mean ± SD of Intervention group: SBP : 126.2 ± 24.9 mmHg & Control group: DBP : 83.5 ± 18.8 mmHg SBP (p value = 0.063) DBP (p value = 0.235),Not significant Zhang, 2020 [ 36 ] China, 174 Nested Cohort NM NM NM NM MC NM (CRS-HBM) for 6 months including: 1.Health belief education 2.The HBM calendar handbook 3.Weekly short message services 4.Telephone follow-up interviews. Mean ± SD of Intervention group: BP control: 41 ± 53.95 mmHg & Control group: BP control: 38 ± 50.67 mmHg (p value = 0.163) Mean ± SD of Intervention group: BP control: 64 ± 84.2 mmHg & Control group: BP control: 37 ± 49.33 mmHg (p value < .001) On BP control Direct positive effect (β = .356, p < .001) Indirect positive effects (β = .183, p = .009) Wan, 2018 [ 48 ] China, 174 RCT NM NM NM NM NM NM Intervention group: Usual stoke education and (CRS-HBM) for 6 months including: 1.Health belief education 2.The HBM calendar handbook 3.Weekly short message services 4.Telephone follow-up interviews. Control group: usual stroke education Mean ± SD of Intervention group: SBP : 143.21 ± 13.96 mmHg DBP : 80.53 ± 9.02 mmHg & Control group: SBP : 138.96 ± 18.37 mmHg DBP : 79.40 ± 11.00 mmHg Mean difference in intervention group: SBP: -9.86 mmHg, DBP: -0.59 mmHg & in control group: SBP: -1.38 mmHg, DBP:+3.10 mmHg From baseline to follow-up: Intervention group: SBP (P value < 0.001) DBP (P value = 0.583) Control group: SBP (P value = 0.558) DBP (P value = 0.038) Allah and Khalil, 2016 [ 52 ] Egypt, 186 Pre-post- intervention study + + + - + + Intervention group: HBM-based education program Control group: Traditional health education on hypertension and compliance to medication and lifestyle regimen. Mean ± SD: SBP : 169.3 ± 19.4 mmHg DBP: 97.6 ± 7.3 mmHg (p value < 0.001) Mean ± SD of Intervention group: SBP : 150.2 ± 14.5 mmHg & Control group: DBP: 87.1 ± 6.4 mmHg (p value < 0.001) There was statistically significant difference between BP in the two groups before and after intervention (p value < 0.001) Kamal, 2015 [ 55 ] Pakistan, 162 RCT NM NM NM NM NM NM Intervention group: 1. HBM-based education + Social Cognitive Theory 2.Usual care 3.Reminder health information SMS for 2 months. Control: Usual care Mean SD of Intervention group: DBP: 80 mmHg Control group: DBP: 80.6 mmHg Mean SD of Intervention group: DBP: 77.9 mmHg & Control group: DBP: 80.5 mmHg Mean difference Intervention group:DBP: -2.6 mmHg. Control group: DBP: -0.1 mmHg SBP (p value = 0.678) DBP (p value = 0.06) Not significant 1.CRS-HBM = Comprehensive Reminder System-HBM; 2.(Study design: RCT = Randomized Controlled Trial, QES = Quasi-experimental study) 3. + =Positively significant; 4.- =Negatively significant; 5. MC = Missing Construct; 6. N/A = Not Applicable; 7. NM = An association was not mentioned; 8. NS = not significant) Table 2 Association of medication adherence with different constructs of the HBM or interventions based on them Author, Year & Reference Country and Sample Size Study Design Association with different constructs of HBM Intervention Effect of Intervention on medication adherence Perceived susceptibility Perceived severity Perceived benefit Perceived barrier Cues to action Self-efficacy Wang, 2020 [ 47 ] China, 174 RCT NM NM NM NM MC NM Intervention group: Usual care and (CRS-HBM) for 6 months including: 1.Health belief education 2.The HBM calendar handbook 3.Weekly short message services 4.Telephone follow-up interviews. Control group: usual care including 1. Health education 2.Stroke prevention handout 3.Telephone follow-up by nurses, 4.Follow-up by doctors. Analyses of Variance Between Groups in Change Scores from Baseline to 3- and 6-Month Follow-up Intervention group: Baseline: 2.96 ± 0.99 3 months: 3.88 ± 0.24 6 months: 3.87 ± 0.39 & in Control group: Baseline: 3.26 ± 0.86 3 months: 3.52 ± 0.67 6 months: 3.34 ± 0.81 For the medication adherence dimension of health behaviors, the time effect, the intervention effect, and the interaction effect of time and group were all statistically significant (p < 0.05) Yazdanpanah, 2019 [ 40 ] Iran, 60 RCT + + + - + + HBM-based education program 8 educational sessions One hour twice a week Post-test mean score of medication adherence: Intervention group: 6.7 ± 0.5 Control group 3.7 ± 1.0 Mean score of medication adherence in the intervention group had significantly increased in the post-test phase (P˂0.001) based on the within-group results of the paired t-test. Allah and Khalil, 2016 [ 52 ] Egypt, 186 Pre- & post- intervention study + + + - + + Intervention group: HBM-based education program Control group: Traditional health education on hypertension and compliance to medication and lifestyle regimen Marked improvement in the HBM group in medication compliance (59.9–79.6%) and overall compliance (61.3–79.6%) A significant difference was present by comparing pre & post-test results in HBM group (p < 0.05). Kamal, 2015 [ 55 ] Pakistan, 162 RCT NM NM NM NM NM NM Intervention group: 1. HBM-based education + Social Cognitive Theory 2. Usual care 3. Reminder health information SMS for 2 months Control group: Usual care Morisky medication adherence score Intervention group: Baseline: 6.6 ± 0.17 2 months: 7.4 ± 0.93 & in Control group: Baseline: 6.6 ± 0.16 2 months: 6.7 ± 1.32 Adjusted difference a (95%CI) 0.54(0.22–0.85). This difference was found to be statistically significant (p < 0.01) Suhat, 2022 [ 56 ] Indonesia, 180 CS + + NS - MC MC N/A N/A Obirikorang, 2018 [ 57 ] Ghana, 678 CS + + + - + MC N/A N/A Yang, 2016 [ 49 ] China, 745 CS MC + NS - NS + N/A N/A Mahrous, 2015 [ 53 ] Egypt, 135 CS + NS + - + MC N/A N/A Venkatachalam, 2015 [ 54 ] India, 473 CS + NS + - + + N/A N/A Yue, 2015 [ 50 ] China, 232 CS + NS NS - + + N/A N/A Kamran A, 2014 [ 41 ] Iran, 671 CS + + + - NM + N/A N/A 1.(Study design: CS = Cross-sectional, RCT = Randomized Controlled Trial); 2.CRS-HBM = Comprehensive Reminder System-HBM; 3. + = Positively significant; 4. - = Negatively significant; 5. MC = Missing Construct; 6. NM = An association was not mentioned; 7. NS = not significant; 8. N/A = Not applicable; 9.a = Adjusted for baseline adherence score, number of pills prescribed daily, dosing frequency, age, gender, employment status, education, use of alarms, missing physician appointments in the previous year, and block design Table 3 Association of self-management with different constructs of the HBM or interventions based on them Author, Year & Reference Country and Sample Size Study Design Constructs of Health Belief Model on self-management Intervention Effect of Intervention on Self-management Perceived susceptibility Perceived severity Perceived benefit Perceived barrier Cues to action Self-efficacy Afshari, 2022 [ 45 ] Iran, 100 QES + + NS NS NS + HBM-based education program 3 training sessions in 2 weeks Each lasting one hour Mean Score of Self-care Behaviors: Intervention group: Before Intervention: 10.50 ± 2.25 After Intervention: 12.02 ± 2.50 p = 0.337 Control group: Before Intervention: 11.45 ± 2.03 After Intervention: 11.36 ± 1.96 p = 0.044 After training there was an increase in mean scores of self-care in the intervention group with a significant difference between the two groups (p < 0.05). Naeemi, 2022 [ 43 ] Iran, 99 QES NS NS + NS + + HBM-based educational intervention Three 60-minute training sessions during 3 weeks in 4 groups Mean Score of Self-care score: Intervention group: Before Intervention: 60.02 ± 12.2 3 months after Intervention: 79.4 ± 7.2 Control group: Intervention group: Before Intervention: 59.1 ± 9.9 3 months after Intervention: 59.7 ± 10 Paired t-test showed that in the experimental group, the mean scores of self-care three months after the intervention were significantly higher than before the intervention (p < 0.001). Wang, 2020 [ 47 ] China, 174 RCT NM NM NM NM MC NM Intervention group: Usual care and (CRS-HBM) for 6 months including: 1.Health belief education 2.The HBM calendar handbook 3.Weekly short message services 4.Telephone follow-up interviews. Control group: usual care including 1. Health education 2.Stroke prevention handout 3.Telephone follow-up by nurses, 4.Follow-up by doctors. Total score of health behavior: Intervention group: Baseline: 2.53 ± 0.52 3 months: 3.16 ± 0.31 6 months: 3.23 ± 0.35 Control group: Baseline: 2.50 ± 0.42 3 months: 2.80 ± 0.38 6 months: 2.75 ± 0.40 A repeated measures analysis of variance showed that the time effect, the intervention effect, and the interaction effect of time and group were all statistically significant (P < 0.001) Zhang, 2020 [ 36 ] China, 174 Nested Cohort NM NM NM NM MC NM (CRS-HBM) for 6 months including: 1.Health belief education 2.The HBM calendar handbook 3.Weekly short message services 4.Telephone follow-up interviews. HPLP Ⅱ Total score Intervention group: Baseline: 2.55 ± 0.51 6 months: 3.23 ± 0.35 Control group: Baseline: 2.54 ± 0.44 6 months: 2.75 ± 0.40 6 months after discharge, both groups showed improvement in health behaviors & when groups were compared in their total HPLP Ⅱ score, the intervention group showed statistically significant improvement than the control group. Direct positive effect (β = .391, p < .001) Indirect positive effects (β = .186, p = .002) Wan, 2018 [ 48 ] China, 174 RCT NM NM NM NM NM NM Intervention group: Usual stoke education and (CRS-HBM) for 6 months including: 1.Health belief education 2.The HBM calendar handbook 3.Weekly short message services 4.Telephone follow-up interviews. Control group: Usual stroke education Total score of health behavior over time and between groups: Intervention group: Baseline: 2.54 ± 0.52 3 months: 3.16 ± 0.32 Changes: 0.61 ± 0.41* Control group: Baseline: 2.51 ± 0.42 3 months: 2.79 ± 0.38 Changes: 0.28 ± 0.42* Three months post-discharge, both groups showed improved health behaviors, yet when the groups were compared in their total HPLP II score, the difference was statistically significantly higher for the intervention group (P < 0.001). Khorsandi, 2017 [ 46 ] Iran, 91 QES + + + - NS NS HBM-based education program p values of changes in mean score after the intervention of different constructs: Susceptibility: 0.041 Awareness: 0.013 Benefit: 0.001 Barrier: 0.001 Practice: 0.001 Self-efficacy: 0.010 Action: 0.001 Sadeghi, 2022 [ 42 ] Iran, 200 CS + NS + - NS + N/A N/A Zareban, 2022 [ 44 ] Iran, 527 CS NS MC + - NS + N/A N/A Larki, 2021 [ 39 ] Iran, 152 CS + + NS NS MC + N/A N/A Ma, 2018 [ 51 ] China, 382 CS + + + - MC + N/A N/A Barros, 2014 [ 58 ] Brazil, 133 CS + + NS NS MC MC N/A N/A 1. (Study design: CS = Cross-sectional, QES = Quasi-experimental study, RCT = Randomized Controlled Trial), 2.CRS-HBM = Comprehensive Reminder System-HBM; 3.HPLP Ⅱ Total score = Health Promoting Lifestyle Profile II; 4.*= t Test or Mann-Whitney U test between groups, p < 0.05; 5.+ = Positively significant; 6.- = Negatively significant; 7. MC = Missing Construct; 8. NM = An association was not mentioned; 9. NS = Not significant; 10. N/A = Not applicable 4. Discussion This review aimed to investigate the role of the HBM in hypertension. By assessing its role in various aspects of hypertension management, the review identified significant associations between HBM and outcomes such as blood pressure reduction, medication adherence, and self-management. Among the 24 articles included in this study, only 13 employed all six constructs of the HBM. The construct most frequently omitted was 'cue to action', which has been identified as the least utilized construct in various other studies [ 24 ]. Three (03) of the studies implemented multifaceted interventions, which included calendar handbooks, weekly short messages, telephone follow-ups, and other methods in addition to HBM education sessions [ 36 , 47 , 48 ]. Our study did not examine whether interventions using multifaceted components were more effective than those using a single component, although one systematic review revealed no difference in effectiveness between the two [ 59 ]. Only one study utilized more than one behavioral theory as a framework for intervention [ 55 ]. Even though incorporating multiple behavioral change theories could enhance effectiveness, this study did not explore that approach [ 60 ]. The HBM serves as an effective intervention framework for health education and is delivered through methods such as workshops, digital reminder systems, or face-to-face lessons, resulting in a notable reduction in blood pressure across numerous studies [ 34 – 36 , 47 , 48 , 52 ]. One study reported no significant reduction in blood pressure; however, the absence of a control group might limit the ability of the results to be compared [ 38 ]. Additionally, the shorter intervention period and follow-up assessment in one study may help explain the lack of significant results in terms of blood pressure reduction [ 45 ]. Although not statistically significant, a reduction in diastolic blood pressure was observed in a study by Kamal and colleagues [ 55 ]. They also incorporated social cognitive theory alongside the health belief model, so it is unclear whether using the HBM alone would have led to different outcomes. In this review, we found that interventions based on the HBM can significantly help hypertensive people adhere to medication [ 40 , 47 , 52 , 55 ]. Our findings are similar to those of another review in which most of the included studies reported significant outcome [ 33 ]. Adherence is adversely affected by perceived barriers [ 61 – 63 ]. Our study revealed that barriers were persistently significantly associated in all studies, followed by perceived susceptibility. Previous reviews also found them to be reported that these factors were the most common construct for medication adherence, although they reported that perceived benefit was another predominant construct [ 33 ]. Unlike the abovementioned review, this study did not measure the effect size of the outcomes, which may have limited our ability to detect similar findings. Perceived barriers have also been found to have the most significant negative influence on adherence in other chronic conditions [ 61 – 63 ]. Among the 11 studies reviewed, 6 employed the HBM as an intervention and demonstrated significant improvements in self-management health behaviors [ 36 , 43 , 45 – 48 ]. Previous research has also highlighted the effectiveness of HBM-based interventions in promoting self-care behaviors [ 64 , 65 ]. Additionally, a prior review identified positive associations between HBM constructs and health behaviors [ 32 ]. In our study, the constructs most significantly associated with self-care were perceived susceptibility and self-efficacy [ 39 , 42 – 46 , 51 , 57 ]. Our findings align with previous research findings where these constructs were found to be the most significant ones [ 66 – 68 ]. Unlike previous reviews, this study provided a detailed analysis of BP reduction effectiveness and incorporated medication adherence and self-management, which are closely related to successful BP control. However, the review also raises several issues that require further investigation. In most of the studies, the intervention duration ranged from as short as 2 weeks to up to 6 months. This wide variation in duration warrants future research to determine the minimum effective time for interventions. Additionally, it remains unclear how long the effects of these interventions last after they are discontinued. Previous studies suggest that the positive impacts of such interventions can persist for up to five years, alleviating concerns about long-term consequences [ 69 ]. A longitudinal analysis of the outcomes from these studies could provide clearer insights into this matter. A comparison of studies involving different behavioral theory-based interventions should also be conducted to determine which intervention yields the best results. This study has several limitations that are important to acknowledge. Studies in languages other than English were excluded, potentially introducing language bias. The use of constructs across the studies is heterogeneous, with some studies incorporating all of them and others omitting one or two. However, the researchers did not provide any explanation for why certain constructs were excluded from those studies. A limitation of this study is that it did not measure the effect size of the outcome variables, hindering a comprehensive evaluation of the results. Modifying factors related to blood pressure management were not discussed. Many of the studies did not address the health literacy and education level of the participants, which could impact their overall ability to understand the various constructs involved. Additionally, the HBM may be less effective in different sociocultural contexts if it is not culturally adapted. 5. Conclusions The HBM has the potential to predict health behaviors among individuals with hypertension. Interventions grounded in this model hold promise for effective hypertension management. The extensive expertise acquired from these studies may influence policy initiatives intended to promote a more proactive approach to cardiovascular health at the societal level in addition to promoting patient-centered care in clinical practice. Abbreviations HBM Health Belief Model LMICs Low- and middle-income countries PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses BP Blood pressure TTM Transtheoretical Model JBI Critical Appraisal Tools Joanna Briggs Institute Critical Appraisal Tools RoB-2 Revised Cochrane risk-of-bias tool for randomized trials (Risk-of-bias 2) CRS-HBM Comprehensive Reminder System-HBM RCT Randomized Controlled Trial Declarations Authors’ contribution: Mohammad Tanvir islam (MTI): Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Resources, Software, Supervision, Visualization, Writing – original draft, Writing – review and editing. Shohael Mahmud Arafat (SMA): Conceptualization, Project administration, Supervision, Writing – review and editing. Arna Chowdhury (AC): Conceptualization, Data curation, Formal analysis, Methodology, Software, Visualization, Writing – original draft, Writing – review and editing. Keertika Orchi (KO): Conceptualization, Data curation, Formal analysis, Methodology, Software, Visualization, Writing – original draft, Writing – review and editing. Shahana Sultana (SS): Data curation, Formal analysis, Methodology, Writing – original draft. Tanjela Bushra (TB): Data curation, Formal analysis, Methodology, Writing – original draft. Md Redwanul Islam (MRI): Data curation, Formal analysis, Software, Methodology, Writing – original draft. Khandakar Fatema (KF): Conceptualization, Data curation, Methodology, Writing – original draft. Md Maruf Haque Khan (MMHK): Conceptualization, Project administration, Methodology, Writing – original draft, Writing – review and editing. Md Atiqul Haque (MAH): Conceptualization, Formal analysis, Methodology, Project administration, Resources, Software, Supervision, Writing – original draft, Writing – review and editing Acknowledgement: We acknowledge Dr. Tanvir Turin Chowdhury (Associate Professor, Department of Family Medicine and Cumming School of Medicine, University of Calgary, Canada) for his guidance and Ayesha Tabassum Swarna for her contribution to the process of writing this review. Funding The authors did not receive any funds for this review. Competing interests The authors declare that they have no competing interests. Patient consent for publication Not applicable. Ethics approval Not applicable. Data availability statement All data relevant to the study are included and available in this article or uploaded as supplementary material. References Wandile PM. Hypertension and comorbidities: A silent threat to global health. Hypertens Comorbidities [Internet]. 2024 Feb 6 [cited 2024 Apr 4];1(1):1–7. 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Available from: https://www.bmj.com/content/345/bmj.e3953 Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding Patients’ Adherence-Related Beliefs about Medicines Prescribed for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework. PLOS ONE [Internet]. 2013 Dec 2 [cited 2024 Apr 22];8(12):e80633. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080633 Al-Noumani H, Wu JR, Barksdale D, Sherwood G, AlKhasawneh E, Knafl G. Health beliefs and medication adherence in patients with hypertension: A systematic review of quantitative studies. Patient Educ Couns [Internet]. 2019 Jun [cited 2024 Apr 6];102(6):1045–56. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0738399119300692 jadgal KM, zareban I, Alizadeh-Siuki H, Izadirad H. The Impact of Educational Intervention Based on Health Belief Model on Promoting Self-Care Behaviors in Patients with Smear-Positive Pulmonary TB. Iran-J-Health-Educ-Health-Promot [Internet]. 2014;2(2):143 EP – 152. Available from: http://journal.ihepsa.ir/article-1-147-en.html MohammadiDogahe A, Mehrabian F, Ashouri A, Karimy M, Kasmaei P. Designing and Evaluating the Effectiveness of an Educational Intervention Based on the Health Belief Model (HBM) in Promoting Self-Care Behavior Among Healthcare Workers. Jundishapur J Health Sci [Internet]. 2024 Jul 27 [cited 2025 Apr 7];16(3). Available from: https://brieflands.com/articles/jjhs-146632 Firmansyah GF, Salsabil HA, Faculity of Health Science, Universitas Muhammadiyah Surakarta. Meta-Analysis: Application of Health Belief Model in Encouraging Preventive Behavior of Self-Care for Hypertensive Patients. J Health Promot Behav [Internet]. 2022 [cited 2025 Apr 8];7(2):108–18. Available from: https://thejhpb.com/index.php?journal=thejhpb&page=article&op=view&path%5B%5D=357&path%5B%5D=215 Mojtaba A, Gholamreza G, Parisa TT, Robab S, Davood S, Elham G. Health Promoting Self-Care Behaviors and Its Related Factors in Elderly: Application of Health Belief Model. J Educ Community Health [Internet]. 2014 Jul 10 [cited 2025 Apr 7];1(2):20–9. Available from: http://jech.umsha.ac.ir/browse.php?a_id=47&sid=1&slc_lang=en Park JH, Sherman LD, Smith ML, Patterson MS, Prochnow T. The Association Between Health Belief Model Components and Self-Care Practices Among Black/African American Men with Type 2 Diabetes. Int J Environ Res Public Health [Internet]. 2025 Mar 12 [cited 2025 Apr 7];22(3):414. Available from: https://www.mdpi.com/1660-4601/22/3/414 Dukat A, Balazovjech I. A 5-year follow-up of preventive approach to patients with essential hypertension. J Hum Hypertens. 1996;10(Suppl 3):S131–133. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1PRISMA2020Checklist.docx Supplementary file 1: PRISMA 2020 Checklist Supplementaryfile2Searchstrategiesandkeywords.rtf Supplementary file 2: Search strategies and keywords Supplementaryfile3DataextractionExcelspreadsheet.xlsx Supplementary file 3: Excel spreadsheet for data extraction Supplementaryfile4SupplementaryMaterialJBIChecklist.docx Supplementary file 4: Supplementary Material (JBI Checklist) Cite Share Download PDF Status: Published Journal Publication published 07 Oct, 2025 Read the published version in Cureus → Version 1 posted 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. 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extraction\u003c/p\u003e","description":"","filename":"Supplementaryfile3DataextractionExcelspreadsheet.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7061263/v1/1b0120479835e6e12eb49c5a.xlsx"},{"id":89292794,"identity":"d493bcf1-ff1b-4336-9633-56ea7a032246","added_by":"auto","created_at":"2025-08-18 12:45:02","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":26093,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary file 4: Supplementary Material (JBI Checklist)\u003c/p\u003e","description":"","filename":"Supplementaryfile4SupplementaryMaterialJBIChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7061263/v1/3e2269b7ed0bd02ad2e51324.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Role of the Health Belief Model in the Management of Hypertension: A Systematic Review","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHypertension is a global threat, leading to significant cardiovascular morbidity and affecting one in every three people [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Controlling hypertension can significantly reduce the risk of cardiovascular events, stroke, renal and retinal complications, and all-cause mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the past few decades, high-income countries have experienced a decline in hypertension rates, low- and lower-middle-income countries continue to face a high prevalence [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Low- and Middle-Income Countries (LMICs), undetected hypertension has become a pressing concern, with a prevalence ranging from 15\u0026ndash;55%, and only 10% of diagnosed cases achieve the target blood pressure (BP) reduction [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMedication adherence, which refers to the extent to which a patient follows prescribed medications, dietary guidelines, and lifestyle changes, is a critical factor in managing hypertension [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Suboptimal adherence to hypertension treatment presents a significant challenge in low- and middle-income countries [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In addition, individuals with hypertension in these regions often exhibit poor self-management of their condition [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Self-management is a dynamic process involving daily activities that help individuals monitor and manage disease-related events and adopt healthy lifestyle behaviors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Research has demonstrated that self-management plays a significant role in improving both medication adherence and blood pressure reduction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUnderstanding health behaviors is key to promoting effective, long-term management at both individual and societal levels [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The incorporation of theoretical models in interventions to control chronic illnesses such as diabetes and hypertension has proven to be more effective [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Conner and Norman (1996) described health behavior as an action aimed at preventing or detecting disease or improving overall well-being [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Several theories explain health-promoting behaviors, including the Health Belief Model (HBM), Transtheoretical Model (TTM), Social Cognitive Theory, Self-Regulation Theory, and Social Ecological Theory, with HBM being the most widely applied [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe HBM was developed by Rosenstock and his team in the 1950s and has since become one of the most highlighted behavioral theories in the following decades [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The model consists of six components: 1. perceived susceptibility, 2. perceived severity, 3. perceived benefit, 4. perceived barrier, 5. cues to action, and 6. self-efficacy. The initial model started with four components, and later, \u0026lsquo;self-efficacy\u0026rsquo; and \u0026lsquo;cue-to-action\u0026rsquo; were incorporated as integral parts of the model [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The model aims to explain how an individual's beliefs impact their involvement in health-related behaviors. On the basis of the model's components, a person may be motivated to engage in behaviors to control hypertension if they believe they are at risk of developing the condition (Percieved susceptibility), understand the potential serious health consequences of the disease (Percieved severity), believe that taking preventive health measures can reduce these risks (Percieved benefit), and recognize possible obstacles to adopting these measures (Percieved barriers). External factors, such as cues, can also influence a person\u0026rsquo;s decision to adopt these behaviors, while their confidence in managing their health independently (self-management) is another crucial aspect of the model [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition to these core components, sociodemographic factors, such as age, sex, and health literacy, can influence a person's perception of illness [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious reviews of the health belief model have explored its role in preventive measures such as screening for different illnesses [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Reviews and meta-analyses have examined the effectiveness of the HBM in predicting health behaviors [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. A systematic review also assessed its impact on medication adherence [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. None of these studies focused on investigating the role of HBM or HBM-based interventions in the management of hypertension. Since its introduction, numerous studies have highlighted the impact of interventions based on the Health Belief Model (HBM) in managing hypertension [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. However, review articles summarizing these effects and identifying the strengths and limitations of the use of HBM in hypertension management are lacking. Given the high incidence and poor control of hypertension in resource-limited countries, it is crucial to identify an effective model that can address this issue.\u003c/p\u003e\u003cp\u003eTherefore, our research question was whether HBM has any role in the management of hypertension, particularly among individuals from LMICs. The primary objective of this systematic review was to explore the role of HBM in controlling hypertension in low- and middle-income countries (LMICs) and, secondarily, to assess its impact on treatment adherence and self-management, which are key factors in determining treatment success.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eWe reviewed studies providing information on the associations between HBM constructs and hypertension in the adult population. A protocol (PROSPERO 2023 CRD42023467247) was registered for this systematic review and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Supplementary File: 1).\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Inclusion and exclusion criteria\u003c/h2\u003e\n \u003cp\u003eThe inclusion criteria for this systematic review were (1) articles providing information on the association of HBM with hypertension management; (2) the study population was hypertensive adult individuals in LMICs; (3) full-text articles in English; and (4) primary articles with quantitative study designs: cross-sectional, longitudinal, and intervention studies and relevant gray literature. Articles were excluded if they (1) did not fulfill the objectives of the review; (2) study population below 18 years old; (3) did not provide original data (e.g., research reports, reviews, editorials, dissertations, etc.); or (4) were protocol studies.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Literature search and study selection\u003c/h2\u003e\n \u003cp\u003eThis review systematically searched six electronic databases: PubMed, American Psychological Association (APA) PsycINFO, CINAHL, Scopus, Embase, and the Cochrane Library. The search strings were developed around two key concepts: \u003cem\u003ehypertension\u003c/em\u003e and the \u003cem\u003ehealth belief model\u003c/em\u003e. The database search involved three stages. First, we developed search strings for PubMed (see Box 1) to ensure that all relevant documents were included. Using these initial strings, we then created the final search strings, which were applied to each database (Supplementary file 2).\u003c/p\u003e\n \u003cp\u003eFinally, we searched reference lists and other articles in the gray literature to ensure that the comprehensive search included studies meeting the inclusion criteria. The search was conducted between September 26 and October 2, 2023, covering relevant published articles without any date restrictions. During the search process, we used truncations, wildcards, Boolean operators, and Medical Subject Headings to find relevant documents.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBox 1\u0026nbsp;\u003c/strong\u003ePubMed search strings\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e((\u0026quot;hypertension\u0026quot;[mh] OR \u0026quot;high blood pressur*\u0026quot;[all] OR \u0026quot;blood pressur*\u0026quot;[all] OR \u0026quot;BP\u0026quot;[all] OR \u0026quot;elevated blood pressur*\u0026quot;[all] OR \u0026quot;raised blood pressur*\u0026quot;[all]) AND (\u0026quot;Health belief model\u0026quot;[mh] OR \u0026quot;Health belief model\u0026quot;[all]))\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe titles from all the databases were exported into Mendeley reference management software, version 1.19.8, for compilation, and duplicates were removed. The compiled list was then imported into Rayyan, a web-based application for screening articles in systematic reviews. Three independent reviewers (M.R.I., K.O., and A.C.) participated in all stages of the screening process within Rayyan, followed by a full-text assessment for relevance and quality. In cases of disagreement during the screening process, the first author resolved any issues (M.T.I).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3. Interventions:\u003c/h2\u003e\n \u003cp\u003eThis systematic review examined experimental studies that used interventions based on different constructs of the HBM as well as other quantitative studies that did not utilize any specific intervention but were used as a framework, questionnaire formulation, or other methods. Comparators for the experimental studies included either no intervention, standard care, or alternative approaches.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4. Outcomes:\u003c/h2\u003e\n \u003cp\u003eThe primary outcome of this study was BP reduction, and the secondary outcomes were changes in medication adherence scores and self-management scores.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5. Data extraction and management\u003c/h2\u003e\n \u003cp\u003eAfter the identification of the studies for this review, the authors held a roundtable workshop to learn how to accurately extract the relevant data and variables. A pilot test was conducted by the independent reviewers, and refinements were made on the basis of feedback. All the authors read some of the full-text articles and decided which variables should be extracted for this review. Data extraction was subsequently performed and documented in an Excel spreadsheet by two authors (A.C. \u0026amp; K.O.) (Supplementary File: 3). The first author (M.T.I.) reviewed the data extracted, and any differences were settled by consensus. The following information was extracted and summarized from the selected articles: author(s), year of publication, article title, journal name, study design, and study objectives. The extracted data also included location, sample size, study population, age group, data collection methodology, intervention, and outcomes.\u003c/p\u003e\n \u003cp\u003eA comprehensive evaluation of the selected articles was carried out, emphasizing the application of the HBM. The constructs of the HBM were identified across all studies. Data were also extracted to examine the role of six components of the HBM in relation to hypertension, the frequency with which these constructs were explained, and the concepts they represented. In addition to simply determining the use of the HBM, the analysis explored how the different components of the model were applied to lower blood pressure, promote self-care behaviors, and ensure drug adherence.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.6. Quality assessment and risk of bias\u003c/h2\u003e\n \u003cp\u003eThe risk of bias was evaluated via the revised Cochrane risk of bias tool (RoB-2) for RCTs (n\u0026thinsp;=\u0026thinsp;6). Two RCT studies were found to have a low risk, 3 showed some concerns, and only one had a high risk of bias (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Assessment of the remaining 18 studies was performed on the basis of the Joanna Briggs Institute (JBI) Critical Appraisal Tools with individual checklists for cross-sectional, cohort, and quasi-experimental studies. Scorings of JBI tool assessments were performed following the approach outlined by Manosroi et al., 2022 [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e]. Among the 18 studies included, 12 had a moderate risk of bias, whereas 6 had a low risk of bias. Detailed information on the JBI checklists is available in Supplementary File 4. Two authors (A.C. \u0026amp; K.O.) conducted the quality assessment, and the first author (M.T.I.) reviewed it.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e2.7. Data synthesis\u003c/h2\u003e\n \u003cp\u003eThis review aims primarily to narratively synthesize studies, their participants, the application of HBM, and the outcomes generated with hypertension management. Studies were categorized into 3 domains: BP reduction, medication adherence, and self-management. Outcome measures were presented in tabulated forms, visualizing the associations of different constructs of the HBM with the domains as statistically significant or clinically relevant. Changes in blood pressure were evaluated by comparing the mean values taken before and after the intervention. Changes in the mean score were used to evaluate medication adherence and self-management outcomes. \u0026ldquo;Missing Constructs\u0026rdquo; \u0026amp; \u0026ldquo;Not Mentioned\u0026rdquo; labels were used to denote nonreported \u0026amp; nonutilized HBM components.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Search results\u003c/h2\u003e\u003cp\u003eWe initially identified 1,064 articles for further review. After 112 duplicates were eliminated and a preliminary screening of titles and abstracts was conducted, the number of articles was reduced to 89. A full-text screening of these articles was then performed, resulting in the inclusion of 22 articles. Sixty-six articles were excluded for various reasons. Additionally, two articles were added through a review of bibliographies, bringing the total number of included articles to 24 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Characteristics of the included studies\u003c/h2\u003e\u003cp\u003eGeographically, 11 of these studies were from Iran [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40 CR41 CR42 CR43 CR44 CR45\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], 6 from China [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48 CR49 CR50\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], 2 from Egypt [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], and 1 each from India [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], Pakistan [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], Indonesia [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], Ghana [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], and Brazil [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. The studies covered a 20-year period, with 13 from the 2010s and 11 from 2020 to 2023. The study population comprised adults aged 18 years and above. These articles comprised a sample size of 6106, with individual study sample sizes varying from 58 to 745. Of the 24 studies, 6 employed RCTs, four were quasi-experimental studies, 12 were cross-sectional, and the remaining two were pre- and post-intervention and nested cohort studies.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.3. HBM constructs presented in the study\u003c/h2\u003e\u003cp\u003eAs the HBM has evolved over time, the number of components utilized in the studies has varied [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Not all studies incorporated the full set of HBM constructs, and the authors did not provide explanations for the exclusion criteria. Specifically, 14 studies utilized all six constructs of the health belief model, 8 studies incorporated five constructs, and the remaining studies included only four components in their analysis. The most frequently missing constructs were 'cues to action' and 'self-efficacy', followed by 'perceived susceptibility' and 'perceived severity'.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Relationships among the constructs of the HBM with different domains\u003c/h2\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.4.1. Blood pressure reduction\u003c/h2\u003e\u003cp\u003eThis review examined the associations between different constructs of the HBM and interventions based on them in reducing BP (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among the 9 studies reviewed, five were randomized controlled trials [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], two were quasi-experimental studies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], and one each was a pre- and post-intervention and nested cohort study [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. All the studies were conducted in different parts of Asia and Africa. In addition to the HBM, social cognitive theory was used in one study [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. The components of the interventions varied, including comprehensive reminder systems, workshop sessions, health counseling, telephone follow-up, etc. The duration of the intervention ranged from 2 weeks to 6 months, reflecting a diverse range of program intensities and timelines. The most common constructs that exhibited a positive association with a reduction in BP were perceived susceptibility, severity, and self-efficacy.\u003c/p\u003e\u003cp\u003e BP measurements in these studies were taken following standard guidelines. Most of the intervention studies described pre- and post-SBP and DBP to observe significant changes. Following the interventions, seven of the studies reported a significant reduction in blood pressure (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Two of them showed no remarkable decrease in blood pressure [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.4.2. Medication adherence\u003c/h2\u003e\u003cp\u003eThe relationship between the HBM model and medication adherence was examined in 11 studies (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among them, three studies were randomized controlled trials (RCTs) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]; only one was a pre- and post-intervention study [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]; and the rest were cross-sectional [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan additionalcitationids=\"CR54 CR55 CR56\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Of these, eight studies were conducted in Asian countries, and three were conducted in African nations. Four reviewed studies implemented HBM-based interventions supplemented with educational sessions, calendar handbooks, SMS reminders, and follow-ups over durations ranging from 2 to 6 months [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Additionally, one study used social cognitive theory with the HBM [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong the HBM variables, perceived barriers had the most frequent construct, showing a significant negative association in 9 studies. Perceived susceptibility exhibited a stronger positive association in 8 studies. Four interventional studies demonstrated statistically significant improvements in medication adherence, with remarkable -intervention mean scores, medication compliance rates, and adherence levels over time [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.4.3. Self-management\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that eleven studies evaluated the role of the HBM model in self-management. Of these, five studies were cross-sectional [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], three were quasi-experimental [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], two were RCTs [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and the remaining was a nested cohort [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Ten of these studies were conducted in East Asian and Southwestern Asian countries, and one was conducted in South America. HBM-based interventions such as training sessions, educational sessions, lectures, educational films, group discussions, educational pamphlets, and educational intervention programs were used in six studies, with durations ranging from 2 weeks to 6 months [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR46 CR47\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. These studies also revealed statistically significant increases in self-management, health behavior, and self-care scores after the intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Among the HBM components, perceived susceptibility [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] and self-efficacy [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] strongly influenced self-management in six studies.\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\u003eAssociation of interventions based on different constructs of the HBM with BP reduction\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAuthor, Year \u0026amp; Reference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCountry and Sample Size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e\u003cp\u003eAssociation with different constructs of HBM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003eEffect of Intervention on BP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePerceived susceptibility\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePerceived severity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePerceived benefit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePerceived barrier\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCues to action\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003ePre intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003ePost intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSaffari, 2023 [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003eOver 6 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eSBP : 145.70\u0026thinsp;\u0026plusmn;\u0026thinsp;10.80 mmHg\u003c/p\u003e\u003cp\u003eDBP : 88.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.30 mmHg,\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eSBP : 144.20\u0026thinsp;\u0026plusmn;\u0026thinsp;9.90 mmHg\u003c/p\u003e\u003cp\u003eDBP : 88.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.40 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eSBP : 139.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.40 mmHg\u003c/p\u003e\u003cp\u003eDBP : 85.90\u0026thinsp;\u0026plusmn;\u0026thinsp;6.40 mmHg,\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eSBP : 145.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.00 mmHg\u003c/p\u003e\u003cp\u003eDBP : 87.70\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0 mmHg\u003c/p\u003e\u003cp\u003eANCOVA test (p value)\u003c/p\u003e\u003cp\u003eSBP : 97.3 (\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003eDBP : 22.4 (\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNoroozi, 2022 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003e8 workshop sessions in 8 weeks on blood pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eSBP : 136.15\u0026thinsp;\u0026plusmn;\u0026thinsp;13.74 mmHg\u003c/p\u003e\u003cp\u003eDBP : 81.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.95 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eSBP : 136.16\u0026thinsp;\u0026plusmn;\u0026thinsp;16.78 mmHg\u003c/p\u003e\u003cp\u003eDBP : 81.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eSBP : 133.86\u0026thinsp;\u0026plusmn;\u0026thinsp;14.84 mmHg\u003c/p\u003e\u003cp\u003eDBP : 80.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.29 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eSBP : 136.10\u0026thinsp;\u0026plusmn;\u0026thinsp;16.64 mmHg\u003c/p\u003e\u003cp\u003eDBP : 81.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.05 mmHg\u003c/p\u003e\u003cp\u003eMean difference in\u003c/p\u003e\u003cp\u003eintervention group:\u003c/p\u003e\u003cp\u003eSBP : 2.29 mmHg, DBP:1.04 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; in control group:\u003c/p\u003e\u003cp\u003eSBP :0.90 mmHg, DBP:0.75 mmHg\u003c/p\u003e\u003cp\u003eIn intervention group\u003c/p\u003e\u003cp\u003eSBP (p value\u0026thinsp;=\u0026thinsp;0.02)\u003c/p\u003e\u003cp\u003eDBP (p value\u0026thinsp;=\u0026thinsp;0.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfshari, 2022 [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003e3 training sessions in 2 weeks each lasting 1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention groups:\u003c/p\u003e\u003cp\u003e151.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98 mmHg\u003c/p\u003e\u003cp\u003eControl groups:152.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53 mmHg.\u003c/p\u003e\u003cp\u003eNo significant difference between the intervention vs. control groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWang, 2020 [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group: Usual care and (CRS-HBM) for 6 months including:\u003c/p\u003e\u003cp\u003e1.Health belief education\u003c/p\u003e\u003cp\u003e2.The HBM calendar handbook\u003c/p\u003e\u003cp\u003e3.Weekly short message services\u003c/p\u003e\u003cp\u003e4.Telephone follow-up interviews.\u003c/p\u003e\u003cp\u003eControl: usual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eSBP : 142.91\u0026thinsp;\u0026plusmn;\u0026thinsp;14.05 mmHg\u003c/p\u003e\u003cp\u003eDBP : 80.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.12 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eSBP : 138.65\u0026thinsp;\u0026plusmn;\u0026thinsp;18.36 mmHg\u003c/p\u003e\u003cp\u003eDBP : 83.32\u0026thinsp;\u0026plusmn;\u0026thinsp;13.86 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eSBP : 132.14\u0026thinsp;\u0026plusmn;\u0026thinsp;10.67 mmHg\u003c/p\u003e\u003cp\u003eDBP : 79.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eSBP : 137.37\u0026thinsp;\u0026plusmn;\u0026thinsp;13.73 mmHg\u003c/p\u003e\u003cp\u003eDBP : 83.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.70 mmHg\u003c/p\u003e\u003cp\u003eSBP (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\u003cp\u003eDBP (p value\u0026thinsp;=\u0026thinsp;0.927)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSaffari, 2020 [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003e5 educational sessions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD:\u003c/p\u003e\u003cp\u003eSBP : 132.3\u0026thinsp;\u0026plusmn;\u0026thinsp;26.8 mmHg\u003c/p\u003e\u003cp\u003eDBP : 85.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7 mmHg\u003c/p\u003e\u003cp\u003e(p value\u0026thinsp;=\u0026thinsp;0.163)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eSBP : 126.2\u0026thinsp;\u0026plusmn;\u0026thinsp;24.9 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eDBP : 83.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.8 mmHg\u003c/p\u003e\u003cp\u003eSBP (p value\u0026thinsp;=\u0026thinsp;0.063)\u003c/p\u003e\u003cp\u003eDBP (p value\u0026thinsp;=\u0026thinsp;0.235),Not significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhang, 2020 [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNested Cohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(CRS-HBM) for 6 months including:\u003c/p\u003e\u003cp\u003e1.Health belief education\u003c/p\u003e\u003cp\u003e2.The HBM calendar handbook\u003c/p\u003e\u003cp\u003e3.Weekly short message services\u003c/p\u003e\u003cp\u003e4.Telephone follow-up interviews.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eBP control: 41\u0026thinsp;\u0026plusmn;\u0026thinsp;53.95 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eBP control: 38\u0026thinsp;\u0026plusmn;\u0026thinsp;50.67 mmHg\u003c/p\u003e\u003cp\u003e(p value\u0026thinsp;=\u0026thinsp;0.163)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eBP control: 64\u0026thinsp;\u0026plusmn;\u0026thinsp;84.2 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eBP control: 37\u0026thinsp;\u0026plusmn;\u0026thinsp;49.33 mmHg\u003c/p\u003e\u003cp\u003e(p value\u0026thinsp;\u0026lt;\u0026thinsp;.001)\u003c/p\u003e\u003cp\u003eOn BP control\u003c/p\u003e\u003cp\u003eDirect positive effect\u003c/p\u003e\u003cp\u003e(β\u0026thinsp;=\u0026thinsp;.356, p\u0026thinsp;\u0026lt;\u0026thinsp;.001)\u003c/p\u003e\u003cp\u003eIndirect positive effects\u003c/p\u003e\u003cp\u003e(β\u0026thinsp;=\u0026thinsp;.183, p\u0026thinsp;=\u0026thinsp;.009)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWan, 2018 [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group: Usual stoke education and (CRS-HBM) for 6 months including:\u003c/p\u003e\u003cp\u003e1.Health belief education\u003c/p\u003e\u003cp\u003e2.The HBM calendar handbook\u003c/p\u003e\u003cp\u003e3.Weekly short message services\u003c/p\u003e\u003cp\u003e4.Telephone follow-up interviews.\u003c/p\u003e\u003cp\u003eControl group: usual stroke education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Intervention group:\u003c/p\u003e\u003cp\u003eSBP : 143.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.96 mmHg\u003c/p\u003e\u003cp\u003eDBP : 80.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eSBP : 138.96\u0026thinsp;\u0026plusmn;\u0026thinsp;18.37 mmHg\u003c/p\u003e\u003cp\u003eDBP : 79.40\u0026thinsp;\u0026plusmn;\u0026thinsp;11.00 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean difference in intervention group:\u003c/p\u003e\u003cp\u003eSBP: -9.86 mmHg, DBP: -0.59 mmHg \u0026amp; in control group:\u003c/p\u003e\u003cp\u003eSBP: -1.38 mmHg, DBP:+3.10 mmHg\u003c/p\u003e\u003cp\u003eFrom baseline to follow-up: Intervention group:\u003c/p\u003e\u003cp\u003eSBP (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003eDBP (P value\u0026thinsp;=\u0026thinsp;0.583)\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eSBP (P value\u0026thinsp;=\u0026thinsp;0.558)\u003c/p\u003e\u003cp\u003eDBP (P value\u0026thinsp;=\u0026thinsp;0.038)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAllah and Khalil, 2016 [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEgypt, 186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-post- intervention study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eTraditional health education on hypertension and compliance to medication and lifestyle regimen.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD:\u003c/p\u003e\u003cp\u003eSBP : 169.3\u0026thinsp;\u0026plusmn;\u0026thinsp;19.4 mmHg\u003c/p\u003e\u003cp\u003eDBP: 97.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3 mmHg\u003c/p\u003e\u003cp\u003e(p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eSBP : 150.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group:\u003c/p\u003e\u003cp\u003eDBP: 87.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 mmHg\u003c/p\u003e\u003cp\u003e(p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003eThere was statistically significant difference between BP in the two groups before and after intervention (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKamal, 2015 [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePakistan, 162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003e1. HBM-based education\u0026thinsp;+\u0026thinsp;Social Cognitive Theory\u003c/p\u003e\u003cp\u003e2.Usual care\u003c/p\u003e\u003cp\u003e3.Reminder health information SMS for 2 months.\u003c/p\u003e\u003cp\u003eControl: Usual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean SD of\u003c/p\u003e\u003cp\u003eIntervention group: DBP: 80 mmHg\u003c/p\u003e\u003cp\u003eControl group: DBP: 80.6 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean SD of Intervention group: DBP: 77.9 mmHg\u003c/p\u003e\u003cp\u003e\u0026amp; Control group: DBP: 80.5 mmHg\u003c/p\u003e\u003cp\u003eMean difference\u003c/p\u003e\u003cp\u003eIntervention group:DBP: -2.6 mmHg.\u003c/p\u003e\u003cp\u003eControl group: DBP: -0.1 mmHg\u003c/p\u003e\u003cp\u003eSBP (p value\u0026thinsp;=\u0026thinsp;0.678)\u003c/p\u003e\u003cp\u003eDBP (p value\u0026thinsp;=\u0026thinsp;0.06)\u003c/p\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003e1.CRS-HBM\u0026thinsp;=\u0026thinsp;Comprehensive Reminder System-HBM; 2.(Study design: RCT\u0026thinsp;=\u0026thinsp;Randomized Controlled Trial, QES\u0026thinsp;=\u0026thinsp;Quasi-experimental study)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003e3. + =Positively significant; 4.- =Negatively significant; 5. MC\u0026thinsp;=\u0026thinsp;Missing Construct; 6. N/A\u0026thinsp;=\u0026thinsp;Not Applicable; 7. NM\u0026thinsp;=\u0026thinsp;An association was not mentioned; 8. NS\u0026thinsp;=\u0026thinsp;not significant)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\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\u003eAssociation of medication adherence with different constructs of the HBM or interventions based on them\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAuthor, Year \u0026amp; Reference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCountry and Sample Size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e\u003cp\u003eAssociation with different constructs of HBM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEffect of Intervention on medication adherence\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePerceived susceptibility\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePerceived severity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePerceived benefit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePerceived barrier\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCues to action\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWang, 2020 [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group: Usual care and (CRS-HBM) for 6 months including:\u003c/p\u003e\u003cp\u003e1.Health belief education\u003c/p\u003e\u003cp\u003e2.The HBM calendar handbook\u003c/p\u003e\u003cp\u003e3.Weekly short message services\u003c/p\u003e\u003cp\u003e4.Telephone follow-up interviews.\u003c/p\u003e\u003cp\u003eControl group: usual care including\u003c/p\u003e\u003cp\u003e1. Health education\u003c/p\u003e\u003cp\u003e2.Stroke prevention handout\u003c/p\u003e\u003cp\u003e3.Telephone follow-up by nurses,\u003c/p\u003e\u003cp\u003e4.Follow-up by doctors.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eAnalyses of Variance Between Groups in Change Scores from Baseline to 3- and 6-Month Follow-up\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBaseline: 2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\u003cp\u003e3 months: 3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\u003cp\u003e6 months: 3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\u003cp\u003e\u0026amp; in Control group:\u003c/p\u003e\u003cp\u003eBaseline: 3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003cp\u003e3 months: 3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\u003cp\u003e6 months: 3.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003cp\u003eFor the medication adherence dimension of health behaviors, the time effect, the intervention effect, and the interaction effect of time and group were all statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYazdanpanah, 2019 [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003e8 educational sessions\u003c/p\u003e\u003cp\u003eOne hour twice a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003ePost-test mean score of medication adherence: Intervention group: 6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003cp\u003eControl group 3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003cp\u003eMean score of medication adherence in the intervention group had significantly increased in the post-test phase (P˂0.001) based on the within-group results of the paired t-test.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAllah and Khalil, 2016 [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEgypt, 186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre- \u0026amp; post- intervention study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eTraditional health education on hypertension and compliance to medication and lifestyle regimen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMarked improvement in the HBM group in medication compliance (59.9\u0026ndash;79.6%) and overall compliance (61.3\u0026ndash;79.6%)\u003c/p\u003e\u003cp\u003eA significant difference was present by comparing pre \u0026amp; post-test results in HBM group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKamal, 2015 [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePakistan, 162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003e1. HBM-based education\u0026thinsp;+\u0026thinsp;Social Cognitive Theory\u003c/p\u003e\u003cp\u003e2. Usual care\u003c/p\u003e\u003cp\u003e3. Reminder health information SMS for 2 months\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMorisky medication adherence score\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBaseline: 6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\u003cp\u003e2 months: 7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\u003cp\u003e\u0026amp; in Control group:\u003c/p\u003e\u003cp\u003eBaseline: 6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003cp\u003e2 months: 6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\u003cp\u003eAdjusted difference\u003csup\u003ea\u003c/sup\u003e (95%CI)\u003c/p\u003e\u003cp\u003e0.54(0.22\u0026ndash;0.85). This difference was found to be statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuhat, 2022 [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndonesia, 180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObirikorang, 2018 [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGhana, 678\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYang, 2016 [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMahrous, 2015 [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEgypt, 135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVenkatachalam, 2015 [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndia, 473\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYue, 2015 [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKamran A, 2014 [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e1.(Study design: CS\u0026thinsp;=\u0026thinsp;Cross-sectional, RCT\u0026thinsp;=\u0026thinsp;Randomized Controlled Trial); 2.CRS-HBM\u0026thinsp;=\u0026thinsp;Comprehensive Reminder System-HBM; 3.\u003cb\u003e+\u003c/b\u003e = Positively significant; 4.\u003cb\u003e-\u003c/b\u003e = Negatively significant; 5. MC\u0026thinsp;=\u0026thinsp;Missing Construct; 6. NM\u0026thinsp;=\u0026thinsp;An association was not mentioned; 7. NS\u0026thinsp;=\u0026thinsp;not significant; 8. N/A\u0026thinsp;=\u0026thinsp;Not applicable; 9.a\u0026thinsp;=\u0026thinsp;Adjusted for baseline adherence score, number of pills prescribed daily, dosing frequency, age, gender, employment status, education, use of alarms, missing physician appointments in the previous year, and block design\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of self-management with different constructs of the HBM or interventions based on them\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAuthor, Year \u0026amp; Reference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCountry and Sample Size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e\u003cp\u003eConstructs of Health Belief Model on self-management\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEffect of Intervention on Self-management\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePerceived susceptibility\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePerceived severity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePerceived benefit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePerceived barrier\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCues to action\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfshari, 2022 [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003cp\u003e3 training sessions in 2 weeks\u003c/p\u003e\u003cp\u003eEach lasting one hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean Score of Self-care Behaviors:\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBefore Intervention: 10.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e\u003cp\u003eAfter Intervention: 12.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.337\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eBefore Intervention: 11.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\u003cp\u003eAfter Intervention: 11.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.044\u003c/p\u003e\u003cp\u003eAfter training there was an increase in mean scores of self-care in the intervention group with a significant difference between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNaeemi, 2022 [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based educational intervention\u003c/p\u003e\u003cp\u003eThree 60-minute training sessions during 3 weeks in 4 groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMean Score of Self-care score:\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBefore Intervention: 60.02\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e\u003cp\u003e3 months after Intervention: 79.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBefore Intervention: 59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e\u003cp\u003e3 months after Intervention: 59.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003cp\u003ePaired t-test showed that in the experimental group, the mean scores of self-care three months after the intervention were significantly higher than before the intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWang, 2020 [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group: Usual care and (CRS-HBM) for 6 months including:\u003c/p\u003e\u003cp\u003e1.Health belief education\u003c/p\u003e\u003cp\u003e2.The HBM calendar handbook\u003c/p\u003e\u003cp\u003e3.Weekly short message services\u003c/p\u003e\u003cp\u003e4.Telephone follow-up interviews.\u003c/p\u003e\u003cp\u003eControl group: usual care including\u003c/p\u003e\u003cp\u003e1. Health education\u003c/p\u003e\u003cp\u003e2.Stroke prevention handout\u003c/p\u003e\u003cp\u003e3.Telephone follow-up by nurses,\u003c/p\u003e\u003cp\u003e4.Follow-up by doctors.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal score of health behavior:\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBaseline: 2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\u003cp\u003e3 months: 3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003cp\u003e6 months: 3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eBaseline: 2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003cp\u003e3 months: 2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\u003cp\u003e6 months: 2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003cp\u003eA repeated measures analysis of variance showed that the time effect, the intervention effect, and the interaction effect of time and group were all statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhang, 2020 [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNested Cohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e(CRS-HBM) for 6 months including:\u003c/p\u003e\u003cp\u003e1.Health belief education\u003c/p\u003e\u003cp\u003e2.The HBM calendar handbook\u003c/p\u003e\u003cp\u003e3.Weekly short message services\u003c/p\u003e\u003cp\u003e4.Telephone follow-up interviews.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eHPLP Ⅱ Total score\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBaseline: 2.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003cp\u003e6 months: 3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eBaseline: 2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e\u003cp\u003e6 months: 2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003cp\u003e6 months after discharge, both groups showed improvement in health behaviors \u0026amp; when groups were compared in their total HPLP Ⅱ score, the intervention group showed statistically significant improvement than the control group.\u003c/p\u003e\u003cp\u003eDirect positive effect (β\u0026thinsp;=\u0026thinsp;.391, p\u0026thinsp;\u0026lt;\u0026thinsp;.001)\u003c/p\u003e\u003cp\u003eIndirect positive effects (β\u0026thinsp;=\u0026thinsp;.186, p\u0026thinsp;=\u0026thinsp;.002)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWan, 2018 [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eUsual stoke education and (CRS-HBM) for 6 months including:\u003c/p\u003e\u003cp\u003e1.Health belief education\u003c/p\u003e\u003cp\u003e2.The HBM calendar handbook\u003c/p\u003e\u003cp\u003e3.Weekly short message services\u003c/p\u003e\u003cp\u003e4.Telephone follow-up interviews.\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eUsual stroke education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal score of health behavior over time and between groups:\u003c/p\u003e\u003cp\u003eIntervention group:\u003c/p\u003e\u003cp\u003eBaseline: 2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\u003cp\u003e3 months: 3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e\u003cp\u003eChanges: 0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41*\u003c/p\u003e\u003cp\u003eControl group:\u003c/p\u003e\u003cp\u003eBaseline: 2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003cp\u003e3 months: 2.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\u003cp\u003eChanges: 0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42*\u003c/p\u003e\u003cp\u003eThree months post-discharge, both groups showed improved health behaviors, yet when the groups were compared in their total HPLP II score, the difference was statistically significantly higher for the intervention group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKhorsandi, 2017 [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHBM-based education program\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003ep values of changes in mean score after the intervention of different constructs:\u003c/p\u003e\u003cp\u003eSusceptibility: 0.041\u003c/p\u003e\u003cp\u003eAwareness: 0.013\u003c/p\u003e\u003cp\u003eBenefit: 0.001\u003c/p\u003e\u003cp\u003eBarrier: 0.001\u003c/p\u003e\u003cp\u003ePractice: 0.001\u003c/p\u003e\u003cp\u003eSelf-efficacy: 0.010\u003c/p\u003e\u003cp\u003eAction: 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSadeghi, 2022 [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZareban, 2022 [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 527\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarki, 2021 [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIran, 152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMa, 2018 [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina, 382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarros, 2014 [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrazil, 133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e1. (Study design: CS\u0026thinsp;=\u0026thinsp;Cross-sectional, QES\u0026thinsp;=\u0026thinsp;Quasi-experimental study, RCT\u0026thinsp;=\u0026thinsp;Randomized Controlled Trial), 2.CRS-HBM\u0026thinsp;=\u0026thinsp;Comprehensive Reminder System-HBM; 3.HPLP Ⅱ Total score\u0026thinsp;=\u0026thinsp;Health Promoting Lifestyle Profile II; 4.*= t Test or Mann-Whitney U test between groups, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; 5.+ = Positively significant; 6.- = Negatively significant; 7. MC\u0026thinsp;=\u0026thinsp;Missing Construct; 8. NM\u0026thinsp;=\u0026thinsp;An association was not mentioned; 9. NS\u0026thinsp;=\u0026thinsp;Not significant; 10. N/A\u0026thinsp;=\u0026thinsp;Not applicable\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis review aimed to investigate the role of the HBM in hypertension. By assessing its role in various aspects of hypertension management, the review identified significant associations between HBM and outcomes such as blood pressure reduction, medication adherence, and self-management.\u003c/p\u003e\u003cp\u003eAmong the 24 articles included in this study, only 13 employed all six constructs of the HBM. The construct most frequently omitted was 'cue to action', which has been identified as the least utilized construct in various other studies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Three (03) of the studies implemented multifaceted interventions, which included calendar handbooks, weekly short messages, telephone follow-ups, and other methods in addition to HBM education sessions [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Our study did not examine whether interventions using multifaceted components were more effective than those using a single component, although one systematic review revealed no difference in effectiveness between the two [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Only one study utilized more than one behavioral theory as a framework for intervention [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Even though incorporating multiple behavioral change theories could enhance effectiveness, this study did not explore that approach [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe HBM serves as an effective intervention framework for health education and is delivered through methods such as workshops, digital reminder systems, or face-to-face lessons, resulting in a notable reduction in blood pressure across numerous studies [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. One study reported no significant reduction in blood pressure; however, the absence of a control group might limit the ability of the results to be compared [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Additionally, the shorter intervention period and follow-up assessment in one study may help explain the lack of significant results in terms of blood pressure reduction [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Although not statistically significant, a reduction in diastolic blood pressure was observed in a study by Kamal and colleagues [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. They also incorporated social cognitive theory alongside the health belief model, so it is unclear whether using the HBM alone would have led to different outcomes.\u003c/p\u003e\u003cp\u003eIn this review, we found that interventions based on the HBM can significantly help hypertensive people adhere to medication [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Our findings are similar to those of another review in which most of the included studies reported significant outcome [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Adherence is adversely affected by perceived barriers [\u003cspan additionalcitationids=\"CR62\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Our study revealed that barriers were persistently significantly associated in all studies, followed by perceived susceptibility. Previous reviews also found them to be reported that these factors were the most common construct for medication adherence, although they reported that perceived benefit was another predominant construct [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Unlike the abovementioned review, this study did not measure the effect size of the outcomes, which may have limited our ability to detect similar findings. Perceived barriers have also been found to have the most significant negative influence on adherence in other chronic conditions [\u003cspan additionalcitationids=\"CR62\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong the 11 studies reviewed, 6 employed the HBM as an intervention and demonstrated significant improvements in self-management health behaviors [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR46 CR47\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Previous research has also highlighted the effectiveness of HBM-based interventions in promoting self-care behaviors [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Additionally, a prior review identified positive associations between HBM constructs and health behaviors [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In our study, the constructs most significantly associated with self-care were perceived susceptibility and self-efficacy [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43 CR44 CR45\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Our findings align with previous research findings where these constructs were found to be the most significant ones [\u003cspan additionalcitationids=\"CR67\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUnlike previous reviews, this study provided a detailed analysis of BP reduction effectiveness and incorporated medication adherence and self-management, which are closely related to successful BP control. However, the review also raises several issues that require further investigation. In most of the studies, the intervention duration ranged from as short as 2 weeks to up to 6 months. This wide variation in duration warrants future research to determine the minimum effective time for interventions. Additionally, it remains unclear how long the effects of these interventions last after they are discontinued. Previous studies suggest that the positive impacts of such interventions can persist for up to five years, alleviating concerns about long-term consequences [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. A longitudinal analysis of the outcomes from these studies could provide clearer insights into this matter. A comparison of studies involving different behavioral theory-based interventions should also be conducted to determine which intervention yields the best results.\u003c/p\u003e\u003cp\u003eThis study has several limitations that are important to acknowledge. Studies in languages other than English were excluded, potentially introducing language bias. The use of constructs across the studies is heterogeneous, with some studies incorporating all of them and others omitting one or two. However, the researchers did not provide any explanation for why certain constructs were excluded from those studies. A limitation of this study is that it did not measure the effect size of the outcome variables, hindering a comprehensive evaluation of the results. Modifying factors related to blood pressure management were not discussed. Many of the studies did not address the health literacy and education level of the participants, which could impact their overall ability to understand the various constructs involved. Additionally, the HBM may be less effective in different sociocultural contexts if it is not culturally adapted.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe HBM has the potential to predict health behaviors among individuals with hypertension. Interventions grounded in this model hold promise for effective hypertension management. The extensive expertise acquired from these studies may influence policy initiatives intended to promote a more proactive approach to cardiovascular health at the societal level in addition to promoting patient-centered care in clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHBM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHealth Belief Model\u003c/p\u003e\u003c/div\u003e\u003c/div\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\"\u003ePRISMA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBlood pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTTM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTranstheoretical Model\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eJBI Critical Appraisal Tools\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eJoanna Briggs Institute Critical Appraisal Tools\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRoB-2\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRevised Cochrane risk-of-bias tool for randomized trials (Risk-of-bias 2)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRS-HBM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComprehensive Reminder System-HBM\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRandomized Controlled Trial\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMohammad Tanvir islam\u0026nbsp;(MTI):\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Resources, Software, Supervision, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing.\u0026nbsp;\u003cstrong\u003eShohael Mahmud Arafat (SMA):\u003c/strong\u003e Conceptualization, Project administration, Supervision, Writing \u0026ndash; review and editing.\u0026nbsp;\u003cstrong\u003eArna Chowdhury (AC):\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Methodology, Software, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing.\u0026nbsp;\u003cstrong\u003eKeertika Orchi (KO):\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Methodology, Software, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing.\u0026nbsp;\u003cstrong\u003eShahana Sultana (SS):\u003c/strong\u003e Data curation, Formal analysis, Methodology, Writing \u0026ndash; original draft.\u0026nbsp;\u003cstrong\u003eTanjela Bushra (TB):\u003c/strong\u003e Data curation, Formal analysis, Methodology, Writing \u0026ndash; original draft.\u0026nbsp;\u003cstrong\u003eMd Redwanul Islam (MRI):\u003c/strong\u003e Data curation, Formal analysis, Software, Methodology, Writing \u0026ndash; original draft.\u0026nbsp;\u003cstrong\u003eKhandakar Fatema (KF):\u003c/strong\u003e Conceptualization, Data curation, Methodology, Writing \u0026ndash; original draft.\u0026nbsp;\u003cstrong\u003eMd Maruf Haque Khan (MMHK):\u003c/strong\u003e Conceptualization, Project administration, Methodology, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing.\u0026nbsp;\u003cstrong\u003eMd Atiqul Haque (MAH):\u003c/strong\u003e Conceptualization, Formal analysis, Methodology, Project administration, Resources, Software, Supervision, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge Dr. Tanvir Turin Chowdhury (Associate Professor, Department of Family Medicine and Cumming School of Medicine, University of Calgary, Canada) for his guidance and Ayesha Tabassum Swarna for her contribution to the process of writing this review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funds for this review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data relevant to the study are included and available in this article or uploaded as supplementary material.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWandile PM. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://jech.umsha.ac.ir/browse.php?a_id=47\u0026amp;sid=1\u0026amp;slc_lang=en\u003c/span\u003e\u003cspan address=\"http://jech.umsha.ac.ir/browse.php?a_id=47\u0026amp;sid=1\u0026amp;slc_lang=en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark JH, Sherman LD, Smith ML, Patterson MS, Prochnow T. The Association Between Health Belief Model Components and Self-Care Practices Among Black/African American Men with Type 2 Diabetes. Int J Environ Res Public Health [Internet]. 2025 Mar 12 [cited 2025 Apr 7];22(3):414. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/1660-4601/22/3/414\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/1660-4601/22/3/414\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDukat A, Balazovjech I. A 5-year follow-up of preventive approach to patients with essential hypertension. J Hum Hypertens. 1996;10(Suppl 3):S131\u0026ndash;133.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Belief Model, Hypertension, Nonpharmacological therapy, BP control, Medication adherence, Self-management","lastPublishedDoi":"10.21203/rs.3.rs-7061263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7061263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eTheory-driven behavioral models such as the health belief model (HBM) offer predictive and influential insights into hypertension management. This study aims to explore the role of the health belief model in hypertension management, with a focus on blood pressure control, medication adherence, and self-management.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003e This review included English full-text quantitative studies on HBM and hypertension management in low- and middle-income countries (LMICs), excluding qualitative, mixed methods, protocols, and nonoriginal data. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was carried out across six electronic databases\u0026mdash;PubMed, APA PsycINFO, CINAHL, Scopus, Embase, and the Cochrane Library\u0026mdash;between September 26 and October 2, 2023, to identify relevant published studies. The risk of bias was assessed via the RoB-2 and JBI Critical Appraisal Tools. Data was extracted into an Excel data sheet for result synthesis and tabulation.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003e An initial total of 1,064 articles were identified for review. Following the removal of duplicates and a full-text assessment, 24 articles with a sample size of 6106 met the inclusion criteria. The application of interventions based on the HBM constructs was associated with reduced blood pressure, improved medication adherence, and self-management. Most studies have shown that perceived susceptibility, severity, and self-efficacy are positively associated with BP reduction, whereas perceived barriers have a negative impact on adherence. Perceived susceptibility and self-efficacy are also frequently linked to better self-management.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe HBM has the potential to predict health behaviors among individuals with hypertension. Interventions based on the HBM offer potential for effective hypertension control.\u003c/p\u003e","manuscriptTitle":"Role of the Health Belief Model in the Management of Hypertension: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-18 12:44:57","doi":"10.21203/rs.3.rs-7061263/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c9f11f13-e2a8-4c14-8bcd-ac8b26643271","owner":[],"postedDate":"August 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T17:46:00+00:00","versionOfRecord":{"articleIdentity":"rs-7061263","link":"https://doi.org/10.7759/cureus.94139","journal":{"identity":"cureus","isVorOnly":true,"title":"Cureus"},"publishedOn":"2025-10-08 00:00:00","publishedOnDateReadable":"October 8th, 2025"},"versionCreatedAt":"2025-08-18 12:44:57","video":"","vorDoi":"10.7759/cureus.94139","vorDoiUrl":"https://doi.org/10.7759/cureus.94139","workflowStages":[]},"version":"v1","identity":"rs-7061263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7061263","identity":"rs-7061263","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}