The Knowledge-Practice Gap in Primordial Hypertension Prevention Through Social Determinants of Health Among Normotensive Adults in Rural South Africa

<b>Background:</b> Hypertension is a leading modifiable risk factor for cardiovascular diseases globally, disproportionately affecting low- and middle-income countries (LMICs), including South Africa. Primordial prevention targeting normotensive individuals plays a key role in reducing lifetime risk. <b>Aim:</b> To assess knowledge, attitudes and practices (KAP) and social determinants of health related to primordial hypertension prevention among normotensive adults in OR Tambo District, Eastern Cape province. <b>Methods:</b> A community-based cross-sectional study was conducted among 245 randomly selected normotensive adults. A validated questionnaire captured socio-demographic characteristics and KAP levels. Data analysis included descriptive statistics, Cronbach's alpha, and chi-square tests (<i>p</i> < 0.05). <b>Results:</b> Participants demonstrated moderate knowledge (53.9%), highly positive attitudes (86.1%), and fair preventive practices (59.6%), highlighting a clear knowledge-practice gap. Higher knowledge was significantly associated with female gender (<i>p</i> < 0.001), older age (<i>p</i> < 0.001), and family history of hypertension (<i>p</i> = 0.001). Positive attitudes correlated with older age (<i>p</i> = 0.018) and higher education (<i>p</i> = 0.008). Knowledge level significantly predicted both positive attitudes (<i>p</i> < 0.001) and preventive practices (<i>p</i> = 0.009). <b>Conclusions:</b> Despite moderate knowledge and positive attitudes, a clear knowledge-practice gap was evident, possibly influenced by social and structural constraints. Strengthening primordial hypertension prevention in rural South Africa requires integrated strategies combining context-specific health education with interventions addressing structural barriers to enable sustainable behaviour change.