“We don’t care because we are not sick”: understanding youths perceptions of hypertension in urban South Africa

The growing burden of cardiovascular disease (CVD) in Sub-Saharan Africa (SSA) is largely driven by hypertension, with risk factors including poor diet, physical inactivity, tobacco use, psychological stress, and limited healthcare access. Early-life exposure to these risks contributes to adverse biological markers that increase hypertension susceptibility in adulthood. This study aimed to explore how young people in Soweto, Johannesburg, perceive hypertension risk, using the Health Belief Model (HBM) to understand their beliefs, attitudes, and barriers to prevention. This study explored youth perceptions of hypertension in Soweto, Johannesburg, using focus group discussions (FGDs) with 62 participants aged 18–25, guided by the HBM. Thematic analysis was conducted to identify key beliefs, attitudes, and barriers to prevention. Participants largely underestimated their hypertension risk, perceiving youth as a protective factor and associating the condition primarily with older adults or those already diagnosed. While some acknowledged genetic predisposition, stress, and lifestyle factors as contributors, many saw hypertension as low severity and distant from their immediate concerns. Barriers to preventative action included social norms, stigma, financial constraints, and limited access to health-promoting resources. External cues, such as family influence and community awareness, were stronger motivators for behaviour change than personal risk assessment, while self-efficacy in adopting preventive behaviours was low. Findings highlight a gap in youth awareness and engagement in hypertension prevention, driven by misperceptions of risk and limited access to enabling resources. Targeted interventions must address these misconceptions, enhance perceived severity, and leverage community and familial influences to promote early prevention and sustained behaviour change.