Cultural Influences on Hypertension Self-Care in Southeast Asia: A Systematic Review

Ni Putu Ayu Ratna Dewi; Nursalam; Sriyono; Komang Ardidhana Nugraha Putra; Titik Suharti

doi:10.60099/prijnr.2026.280292

Authors

Ni Putu Ayu Ratna Dewi Faculty of Nursing, Airlangga University, Surabaya, Indonesia. https://orcid.org/0000-0002-6840-4234
Nursalam Faculty of Nursing, Airlangga University, Indonesia. https://orcid.org/0000-0002-9052-6983
Sriyono Faculty of Nursing, Airlangga University, Indonesia. https://orcid.org/0000-0002-6533-1973
Komang Ardidhana Nugraha Putra Faculty of Health, Institute of Technology and Health Bali, Bali, Indonesia. https://orcid.org/0000-0001-6598-6841
Titik Suharti Faculty of Health and Natural Sciences, Sunan Gresik University, Indonesia. https://orcid.org/0009-0004-2927-9401

DOI:

https://doi.org/10.60099/prijnr.2026.280292

Keywords:

Cultural competence, Hypertension, Self-care, Southeast Asia, Systematic review

Abstract

Hypertension is a significant public health burden, and cultural factors influence the perception and management of hypertension in Southeast Asia. However, regional synthesis of evidence remains limited, hindering the development of culturally appropriate and scalable interventions. This study examined how cultural beliefs and practices influence hypertension self-care behaviors among adults with hypertension in selected Southeast Asia countries. Five electronic databases (PubMed, Scopus, Web of Science, ProQuest, and SAGE Journals) were searched in 2025 for studies published from 1 January 2015 to 31 March 2025. Eligible studies included adults (≥18 years) with hypertension in Southeast Asia settings and reported cultural influences on self-care. Two reviewers conducted a narrative synthesis with thematic coding (third-party adjudication for disagreements), and methodological quality was assessed using the critical evaluation tools from the Joanna Briggs Institute. Twelve studies involving 2,252 participants were included, and the protocol was registered in PROSPERO (CRD420250656487).

Five themes emerged: illness perceptions, traditional and spiritual self-care practices, dietary traditions, sociocultural barriers to engagement with biomedical care, and community-based approaches. Examples included preferences for natural or spiritual practices in Malaysia, herbal and spiritual rituals that delay biomedical engagement in Indonesia, and the illness metaphor malapot na dugo (“thick blood”) that shapes treatment decisions in the Philippines. Communal dietary practices and collective decision-making also influenced the negotiation of self-care within families and communities. Hypertension self-care in Southeast Asia is embedded in collectivist and culturally specific contexts. For community nursing practice, culturally responsive assessment, communication, and family–community engagement are essential to support adherence and integrate cultural practices with evidence-based care. Policy should support culturally safe care; further research in underrepresented settings is needed.

References

World Health Organization. Global report on hypertension. 1st ed. World Health Organization; 2023. p. 1–291.

Edmealem A, Geleta E, Mengesha Z, Tegegne B, Ademe S, Liknaw T. Blood pressure self-monitoring practice and associated factors among adult hypertensive patients on follow-up at South Wollo Zone Public Hospitals, Northeast Ethiopia. Open Heart. 2023;10(1):e002274. doi:10.1136/openhrt-2023-002274.

Nawi AM, Mohammad Z, Jetly K, Abd Razak MA, Ramli NS, Wan Ibadullah WAH, et al. The prevalence and risk factors of hypertension among the urban population in Southeast Asian countries: a systematic review and meta-analysis. Int J Hypertens. 2021;1–14. doi:10.1155/2021/6657003.

Schutte AE, Venkateshmurthy NS, Mohan S, Prabhakaran D. Hypertension in low- and middle-income countries. Circ Res. 2021;128(7):808–826. doi:10.1161/CIRCRESAHA.120.318729.

Jung SY, Moon KJ. Factors affecting self-care among community-dwelling hypertensive older adults: a cross-sectional study. Nurs Open. 2023;10(6):3892–905. doi:10.1002/nop2.1647.

World Health Organization. Hypertension [Internet]. 2021 [cited 2025 Sep 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension.

Barus M, Novitarum L, Sitinjak BS. Description of self care management in hypertension patients. Int J ObGyn Heal Sci. 2023;1(2):73–8. doi:10.35335/obgyn.v1i2.69.

Jariyasakulwong P, Wattanakitkrileart D, Pongthavornkamol K, Piaseu N, Roubsanthisuk W. Factors influencing self-care practices and blood pressure among individuals with uncontrolled hypertension: a cross-sectional study. Patient Prefer Adherence. 2025;19:1–17. doi:10.2147/PPA.S497555.

Mahmood S, Jalal Z, Hadi MA, Orooj H, Shah KU. Non-adherence to prescribed antihypertensives in primary, secondary and tertiary healthcare settings in Islamabad, Pakistan: a cross-sectional study. Patient Prefer Adherence. 2020;14:73–85. doi:10.2147/PPA.S235517.

Endrias EE, Geta T, Desalegn B, Ataro BA, Israel E, Kebede C, et al. Exploring experiences and perspectives of patients on hypertension management in Southern Ethiopia: a phenomenological study. BMC Health Serv Res. 2024;24(1). doi:10.1186/s12913-024-12111-8.

Wahab NAA, Bakry MM, Ahmad M, Noor ZM, Ali AM. Exploring culture, religiosity and spirituality influence on antihypertensive medication adherence among specialised population: a qualitative ethnographic approach. Patient Prefer Adherence. 2021;15(August):2249–65. doi:10.2147/PPA.S319469.

Nazeri NS, Mohamad N, Redzuan M, Mulud ZA. Social support and self-care practice among patients with hypertension in a teaching hospital. Malaysian J Med Heal Sci. 2022;18(8):281–90. doi:10.47836/mjmhs18.8.36.

Bujawati E, Sukmawati, Nildawati, Ansar DI, Mustafa Z, Basr S, et al. Cultural penetration in preventing hypertension in the Ammatoa Kajang tribe community, Bulukumba, South Sulawesi. Soc Med. 2024;17(1):35–9. doi:10.71164/socialmedicine.v17i1.2024.1549.

Lasco G, Mendoza J, Renedo A, Seguin ML, Palafox B, Palileo-Villanueva LM, et al. Nasa dugo ('It's in the blood'): Lay conceptions of hypertension in the Philippines. BMJ Glob Health. 2020;5(7):1–8. doi:10.1136/bmjgh-2020-002295.

Giang NH, Lan NTP, Anh LTK, Plancikova D, Rusnakova V, Thang NT, et al. Factors influencing adoption of self-monitoring of blood pressure among hypertensive patients in primary healthcare in Vietnam: a cross-sectional facility-based study. BMC Prim Care. 2025;26(1). doi:10.1186/s12875-025-02871-5.

Satrianegara MF, Juhannis H, Lagu AMHR, Habibi, Sukfitrianty, Alam S. Cultural traditional and special rituals related to the health in Bugis Ethnics Indonesia. Gac Sanit. 2021;35:S56–8. doi:10.1016/j.gaceta.2020.12.016.

Wong WJ, Thi H, Vu T. Hypertension in adults with diabetes in Southeast Asia: a systematic review. J Clin Hypertens. 2025;27(e14936):1–16. doi:10.1111/jch.14936.

Bawornthip P, Driscoll A, Khaw D, Hutchinson A. Effectiveness of health promotion programs on blood pressure in people with hypertension and prehypertension in Southeast Asian populations: systematic review and meta-analysis. Nurs Open. 2025;12(e70252):1–17. doi:10.1002/nop2.70252.

Irwan AM, Potempa K, Abikusno N, Syahrul S. Self care management for hypertension in Southeast Asia: a scoping review. J Multidiscip Healthc. 2022;15:2015–2032. doi:10.2147/JMDH.S367638.

Orem DE. Nursing: Concepts of practice. 6th ed. St. Louis: Mosby; 2001.

Sringernyuang L, Sottiyotin T. “Ya Luk Ka Tan Yoo”: an ethnography of filial piety culture, medication usage, and health perceptions of the elderly in rural Southern Thailand. Int J Environ Res Public Health. 2022;19(19):1–10. doi:10.3390/ijerph191912134.

Palileo-Villanueva LM, Palafox B, Amit AML, Pepito VCF, Ab-Majid F, Ariffin F, et al. Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines. BMC Complement Med Ther. 2022;22(1):1–13. doi:10.1186/s12906-022-03730-x.

Tan PPS, Sandhu RS, Zain SM, Hall D, Tan NC, Lim HM, et al. Health motivations and perceived barriers are determinants of self-care behaviour for the prevention of hypertension in a Malaysian community. PLoS One. 2022;17(12):1–17. doi:10.1371/journal.pone.0278761.

Padmi LSAJ, Achjar KAH, Gama IK, Mustika IW, Lestari AS, Sudiantara K, et al. The relationship between cultural food of metuakan and megibung with the incidence of hypertension at Karangasem I Health Center, Karangasem District, Bali, Indonesia. Heal Dyn. 2025;2(2):78–84. doi:10.33846/hd20205.

Rahmawati R, Bajorek B. Factors affecting self-reported medication adherence and hypertension knowledge: a cross-sectional study in rural villages, Yogyakarta Province, Indonesia. Chronic Illn. 2017;0(0):1–16. doi:10.1177/1742395317739092.

Rahmawati R, Bajorek B. The use of traditional medicines to lower blood pressure: a survey in rural areas in Yogyakarta province, Indonesia. Australas Med J. 2018;11(3):153–62. doi:10.21767/AMJ.2018.3269.

Ningsih AP, Nurdin N, Puspitha A, Malasari S, Kadar K. The effect of culture-based education in improving knowledge of hypertension patients in Makassarese community in Indonesia. Enferm Clin. 2020;30(S2):55–9. doi:10.1016/j.enfcli.2019.09.003.

Kurnia V, Suza D, Ariani Y. Experience of barriers to hypertension management in Minangkabau ethnic group in Payakumbuh, Indonesia: a phenomenological study. Belitung Nurs J. 2018;4(2):154–60. doi:10.33546/bnj.313.

Yatim HM, Wong YY, Neoh CF, Lim SH, Hassali MA, Hong YH. Factors influencing patients’ hypertension self-management and sustainable self-care practices: a qualitative study. Public Health. 2019;173:5–8. doi:10.1016/j.puhe.2019.04.020.

Chantakeeree C, Sormunen M, Jullamate P, Turunen H. Health-promoting behaviors among urban and rural older Thai adults with hypertension: a cross-sectional study. PRIJNR [Internet]. 2021 Mar 27 [cited 2025 Apr 4];25(2):242–54. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/243253.

Roslan KHD, Syswianti DS. The effect of peer support group on the quality of life of adults with hypertension. J Med Cendikia. 2023;11(2):172–180. doi:10.33482/jmc.v11i02.271.

Miezah D, Hayman LL. Culturally tailored lifestyle modification strategies for hypertension management: a narrative review. Am J Lifestyle Med. 2024;20(1):46–54. doi:10.1177/15598276241297675.

Ab Hamid MR, Buhari SS, Noor HM, Azizan N ‘Ain, Malek KA, Mohd Asmawi UM, et al. Development and validation of D-PATH website to improve hypertension management among hypertensive patients in Malaysia. Digit Heal. 2024;10:1–9. doi:10.1177/2055207624124266.

Khabiri R, Jahangiry L, Abbasian M, Majidi F, Farhangi MA, Sadeghi-bazargani H, et al. Spiritually based interventions for high blood pressure: a systematic review and meta-analysis. J Relig Health. 2024;63(5):3474–500. doi:10.1007/s10943-024-02034-3.