Exploring the social and behavioral barriers to hypertension self-care among indonesian adults: a qualitative study based on the theory of planned behavior

BACKGROUND: Sustaining hypertension self-care practices presents ongoing challenges, particularly in socially complex and resource-limited settings. Although the Theory of Planned Behavior (TPB) is widely used in health behavior research, its applicability in social and behavioral contexts remains underexplored. This study aimed to extend the TPB by identifying social-behavioral constructs that influence self-care behavior in hypertension. METHODS: A qualitative descriptive study was conducted in Jatinangor District, West Java, Indonesia. Adult participants included patients with uncontrolled hypertension, family members, community health workers (cadres), and health workers. Twenty-four key informants who fulfilled these criteria were recruited for the study. Data were collected through semi-structured interviews and analysed using thematic content analysis guided by TPB constructs. Ethical approval was obtained from the Padjadjaran University, and informed consent was obtained from all participants. RESULTS: Five themes were identified as barriers to sustainable self-care: 1) lack of information and misperception (attitude), 2) low perception of susceptibility and severity (perceived behavioral control), 3) lack of family support and insufficient workforce (subjective norms), 4) conventional customs of gathering and culture of eating habits (subjective norms), and 5) doubt about the benefits and efficacy of hypertension treatment (attitude). These themes illustrate how social and behavioral contexts, including family interactions and daily habits, shape TPB constructs. CONCLUSIONS: This study contributes to the theoretical development of TPB by embedding social-behavioral constructs that influence hypertension self-care in low-resource settings. These findings highlight the need for socially responsive and family-oriented strategies to strengthen self-care for hypertension. These insights are relevant for designing sustainable intervention in low- and middle-income countries (LMICs), particularly in Southeast Asia.