Integrating climate change adaptation into hypertension care: an evidence based framework for climate resilient primary healthcare and public health planning in Limpopo Province, South Africa

Background Climate change poses a growing public health challenge, particularly for individuals living with chronic conditions such as hypertension. Climate related stressors, including extreme heat and cold, may adversely affect blood pressure control and self-management, highlighting the need for context specific adaptation strategies. Purpose This study aimed to develop evidence based coping strategies to support hypertensive patients in adapting to climate change and managing the health effects of changing weather conditions, contributing to Sustainable Development Goal (SDG) 3 (Good Health and Well-being) and SDG 13 (Climate Action). Methods The strategies were developed from the empirical findings of a mixed-methods study guided by Roy’s Adaptation Model and Thompson’s Five Stage Strategy Development Framework. Data were collected from 244 hypertensive patients using self-developed questionnaires and from 15 patients through semi structured interviews in selected districts of Limpopo Province, South Africa. Quantitative data were analysed using SPSS version 28, while qualitative data were analysed using Tesch’s eight step method. Findings were integrated using a joint display to identify areas of convergence, divergence, and expansion. The resulting strategies were subsequently reviewed through one round of Modified Delphi consultation to establish expert consensus regarding their clarity, relevance, feasibility, practicality, and applicability. Findings The study identified limited awareness of climate change and its health impacts, challenges in hypertension management during extreme temperatures, inconsistent coping practices, and a lack of structured adaptation guidance. These findings informed the development of seven evidence-based strategies addressing climate informed healthcare, self-management during extreme weather, behavioural and lifestyle modification, information and coping, patient education and empowerment, climate resilient lifestyle practices, and emergency preparedness. Collectively, the strategies translate patient experiences into a structured approach for strengthening adaptive capacity, resilience, and climate responsive hypertension management. Implications The developed framework provides a practical approach for integrating climate adaptation into hypertension management and strengthening climate-resilient primary healthcare. It offers a patient-centred model that can inform health service planning, community engagement, policy development, and chronic disease programmes while supporting progress towards SDGs 3 and 13.