Exploring the challenges of hypertension and pre-diabetes co-management in older adults: a community nursing assessment in Eastern Indonesian coastal communities

Purpose This study aimed to explore the challenges of co-managing hypertension and pre-diabetes among older adults in coastal communities of Kendari City, Southeast Sulawesi, Indonesia, and to identify factors influencing disease management from a community nursing perspective. Design/methodology/approach A cross-sectional community nursing assessment was conducted from February to April 2026 across multiple coastal and coastal-mining communities in Kendari City. A total of 327 older adult respondents (≥45 years) with hypertension and/or pre-diabetes were assessed using structured community health nursing instruments. Data were analysed using descriptive statistics and bivariate analyses. Findings The majority of respondents were female (72.5%), married (78.3%), with low educational attainment (primary school or less: 45.3%), and predominantly engaged in informal employment. Most participants (68.2%) had hypertension as their primary diagnosis, while 31.8% had co-existing pre-diabetes. Medication adherence was suboptimal, with only 34.6% reporting routine adherence. Barriers to effective co-management included limited health literacy, inadequate family support, transportation difficulties, prolonged waiting times at primary health care facilities and preference for traditional medicine over pharmacological treatment. Body mass index indicated that 42.5% of respondents were overweight, yet lifestyle modification adherence remained poor. Originality/value This study provides novel evidence from an under-researched coastal community setting in Eastern Indonesia, highlighting the intersection of geographical isolation, socioeconomic vulnerability, and health care system constraints in chronic disease co-management. The findings underscore the need for culturally adapted, community-embedded nursing interventions that address the unique challenges of older adults in resource-limited coastal environments.