Hypertension among incarcerated individuals in the Ashanti Region of Ghana: examining prevalence and correlates based on the Social Cognitive Theory

Hypertension remains a major cause of cardiovascular morbidity and mortality. In Ghana, evidence indicates a rising prevalence across adult populations, yet little is known about the situation within prisons, where structural, behavioural, and environmental factors may increase vulnerability. This study, therefore, examined the prevalence of hypertension and its correlates among incarcerated individuals in six prison facilities within the Ashanti Region of Ghana, using the Social Cognitive Theory (SCT). A facility-based cross-sectional study was conducted among 382 incarcerated individuals. Data were collected using anthropometric measurements and closed-ended questionnaires. Guided by SCT, descriptive and inferential statistics, including chi-square tests, modified Poisson regression with robust standard error, and confirmatory factor analysis (CFA), were performed with STATA 17 and IBM SPSS AMOS 29. Overall, 27.2% (95% CI: 22.7–31.7) of inmates were hypertensive. This was associated with behavioural factors (such as medication non-adherence, irregular blood pressure monitoring, smoking, excessive alcohol intake, unmanaged stress, inadequate sleep, and failure to follow health advice), personal factors (including low confidence in managing hypertension, limited ability to make lifestyle changes, poor coping of symptom, inadequate knowledge of risks associated with hypertension, and undervaluing a healthy diet), and environmental factors, (such as discomfort discussing hypertension, lack of support for exercise, absence of medication reminders, and inability to seek help). The structural model demonstrated robust fitness (AGFI = 0.911; CFI = 0.943; GFI = 0.915; IFI = 0.921; NFI = 0.901; RMSEA = 0.062), with strong correlations between personal and environmental factors (r = 0.987), behavioural and environmental factors (r = 0.593), and behavioural and personal factors (r = 0.576). Personal factors had the strongest direct effect on hypertension (β = 0.62), followed by behavioural factors (β = 0.33). Hypertension among incarcerated individuals was influenced by interacting behavioural, personal, and environmental correlates within the SCT framework. Addressing this burden requires integrated prison-based interventions that strengthen healthy behaviour, routine blood pressure monitoring, institutional support systems for physical activity, stress management, and access to care. Implementing coordinated health promotion and hypertension management programs within correctional facilities may help reduce the burden of hypertension among this vulnerable population.