- Research article
- Open Access
The association between self-efficacy and self-care in essential hypertension: a systematic review
BMC Family Practice volume 22, Article number: 44 (2021)
The successful management of hypertension requires sustained engagement in self-care behaviour such as adhering to medication regimens and diet. Bandura’s Social Cognitive Theory suggests that self-efficacy is a major determinant of engagement in self-care behaviour. Self-efficacy refers to an individual’s belief in their capacity to execute behaviours necessary to produce specific performance attainments. This systematic review of observational studies aims to summarise and evaluate the quality of evidence available to support the association between self-efficacy and engagement in self-care behaviour in hypertension.
Searches were performed of the Pubmed, MEDLINE, CINAHL and OpenSIGLE databases from database inception to January 2020. Reference lists and individual journals were also hand searched. Observational studies in English quantifying self-efficacy and self-care behaviour in hypertensive adults were included. The quality of included articles was assessed with the National Institute of Health Quality Assessment Tool for observational studies.
The literature search identified 102 studies, of which 22 met the inclusion criteria for full-text review. There were 21 studies which reported that higher self-efficacy was associated with engagement in self-care behaviours including medication adherence (n = 9), physical activity (n = 2) and dietary changes (n = 1). Of these, 12 studies were rated as ‘good’ on the quality assessment tool and 10 were ‘fair’. A common limitation in these studies was a lack of objectivity due to their reliance on self-reporting of engagement in self-care behaviour.
Our review suggests an association between self-efficacy and self-care. However, the evidence supporting this association is of low to medium quality and is limited by heterogeneity. Our findings suggest the need for further well-designed interventional studies to investigate this association.
Essential hypertension is prevalent globally. Hypertension is diagnosed when an individual is found to have a clinic blood pressure of 140/90 mmHg (millimetres of mercury) or higher, or an ambulatory blood pressure daytime average or home blood pressure average of 135/85 mmHg (millimetres of mercury) or higher . Hypertension increases the risk of cardiovascular events and is a major cause of premature death worldwide . The World Health Organisation estimated that 1.13 billion people worldwide had hypertension in 2019, which has significantly increased from 594 million in 1975 . The prevalence of hypertension ranges from 30.0 to 71.6% among adults and older individuals . However, hypertension remains poorly controlled worldwide. In 2010, only 13.8% of adults worldwide had controlled hypertension . Therapeutics alone are insufficient to optimise blood pressure control in these adults; they are also recommended to make lifestyle changes to better control their chronic disease .
Self-care encompasses the actions that individuals take to lead a healthy lifestyle, care for their chronic illness and to prevent further illness . In hypertension, these self-care behaviours recommended for optimal disease control include: (a) adhering to anti-hypertensive medication, (b) adhering to a healthy diet low in salt, (c) engaging in adequate physical activity, (d) smoking cessation and (e) consuming alcohol in moderation . In randomised controlled trials, dietary changes, exercise interventions and interventions to reduce alcohol consumption have been shown to produce a significant reduction in blood pressure .
Self-care adherence is low among adults with hypertension . They are often unwilling to make the recommended behavioural changes . The percentage of respondents reporting non-adherence to medications ranged from 24.1% (in the Netherlands) to 70.3% (in Hungary) in a cross-sectional study involving nine European countries performed in 2015. In England and Wales, 41.5 and 38.1% respectively of adults with hypertension reported non-adherence . In the United States of America, a study done among African-Americans reported that only 52.2% of participants engaged in adequate physical activity, while 22.0% adhered to diet recommendations. Only slightly more than half (58.6%) the participants were adherent to their medication regimen .
One of the barriers to self-care was identified as a lack of motivation for behaviour change . Self-efficacy may be a key to improving motivation and thereby, engagement in self-care behaviour in hypertension. Self-efficacy refers to “an individual’s belief in his or her capacity to execute behaviours necessary to produce specific performance attainments” . Bandura’s Social Cognitive Theory suggests that self-efficacy influences motivation and the ability to engage in self-care behaviours . According to this theory, personal cognitive and affective factors (such as belief and self-efficacy) and environmental factors (such as social support) contribute to a dynamic, ongoing process which influences self-care behaviour. Individuals with higher perceived self-efficacy are able to motivate themselves to engage regularly in self-care behaviour and overcome obstacles which prevent them from performing these behaviours, for example, a lack of time or desire to perform the behaviour . They are more likely to start engaging in self-care behaviour and to maintain it over the long term . In this way, enhanced self-efficacy is associated with improved health status in the areas affected by these self-care behaviours . Lorig’s work shows that in the management of chronic disease such as arthritis, a higher self-efficacy is associated with improved health outcomes such as decreased pain and fatigue .
Engagement in self-care behaviour may also be hindered by the lack of symptoms in essential hypertension. In Lorig’s self-management programme, originally designed for arthritis and later generalised to chronic disease, self-care behaviour is intended to decrease symptoms such as pain and depression [17, 18]. Without symptoms to serve as a prompt, individuals may have less impetus to engage in self-care behaviour.
The relationship between self-efficacy and self-care is also compounded by the variety of behavioural changes required for the optimal management of essential hypertension. Self-efficacy is task-specific ; self-efficacy on one task may not influence self-efficacy on another. Additionally, each self-care behaviour has its barriers to regular performance. For example, the barriers to medication adherence (concerns about side effects, costs of medications ) are different from the barriers to smoking cessation (anxiety, easy access to cigarettes ).
Thus, this systematic review aims to summarise and evaluate the quality of evidence available to support the association between self-efficacy and engagement in self-care behaviour in hypertension.
A protocol detailing the search methods employed was registered on PROSPERO (registration number CRD42020171290).
Searches were carried out on the following databases: PubMed, MEDLINE and CINAHL, and the grey literature database OpenSIGLE. The databases were searched from database inception to January 2020. Terms were combined using Boolean logic commands: (“hypertension” [ti] AND (“self-efficacy” [ti] OR “self-efficacy” [ab])).
The journals were hand-searched from January 2010 or its inception (whichever was later) to the latest issue as of January 2020. The reference lists of the selected articles were also hand-searched. The literature search process as described was performed by two authors (Felicia Clara Tan and Prawira Oka) independently. The results from each author were compared; no discrepancies were identified.
Study selection and quality appraisal
The inclusion criteria for the articles are:
(a) full-text observational studies published in English.
(b) involve adult participants aged 18 years and over with essential hypertension.
(c) measure the relationship between participants’ level of self-efficacy and their performance of one or more of the following self-care behaviours: (a) adhering to anti-hypertensive medication, (b) adhering to a healthy diet low in salt (c) engaging in adequate physical activity, (d) smoking cessation and (e) consuming alcohol in moderation. Other types of research studies and those not related to essential hypertension nor any of the specified self-care behaviour and self-efficacy were excluded.
Two authors (Felicia Clara Tan and Prawira Oka) screened articles against inclusion and exclusion criteria independently, with disagreements resolved by an independent arbitrator (Ngiap Chuan Tan). In screening each article against the inclusion and exclusion criteria, the full text of each article was reviewed by each author independently. A total of 80 papers, including sub-studies, were rejected for failing to meet all the inclusion criteria. A total of 22 articles were eventually examined in this review. The process of article selection is detailed in Fig. 1.
To evaluate the quality of these articles, each article was graded using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies by two independent authors (Felicia Clara Tan and Prawira Oka) . Their results were compared and discrepancies identified and resolved by an independent arbitrator (Ngiap Chuan Tan). The outcome of the grading is presented in Table 1.
The full text of each selected article was reviewed to extract key information for summarising into a table. This included the design of the study, population sampled, instruments used, outcomes measured (including which domains of self-care behaviour were studied) and the main conclusions (Table 2). Key findings from the included studies were narratively synthesised.
Searches in Pubmed, MEDLINE, CINAHL and OpenSIGLE yielded 86, 50, 49 and zero articles in English respectively. Hand searching of journals yielded one article while hand searching of the reference lists of selected articles yielded four articles. After eliminating duplicates, a combined total of 102 articles were identified. There were 22 articles which met all the eligibility criteria for inclusion in this review and were examined in full text. Key information from each article is summarised in Table 2.
Of the 22 cross-sectional studies included, ten were performed in Asia [22, 24, 27, 31, 33, 36, 37, 40,41,42], three in the Middle East [23, 25, 32], five in the United States of America [26, 28, 29, 37, 43], two in Europe [30, 39], one in Africa  and one in Australia . All the studies involved adults, of which four [24, 36, 40, 42] involved exclusively elderly adults aged 60 or older. Of the 22 studies, 13 studies [23, 25, 27, 29, 31, 32, 34, 36, 38,39,40,41,42] involved participants recruited from healthcare settings while eight [22, 24, 26, 28, 33, 37, 43, 69] involved participants recruited from the community.
The 22 studies used a variety of instruments to measure their outcomes and studied samples from a variety of populations. Of the 22 studies, 21 reported that higher self-efficacy was associated with engagement in self-care behaviours. The remaining study  found no association between self-efficacy and engagement in self-care behaviours.
There were nine studies which reported an association between self-efficacy and general self-care behaviour [25, 28, 31, 36,37,38, 40, 41, 43], while 12 studies reported an association between specific self-care behaviours and self-efficacy for those behaviours. Among these 12 studies, nine reported an association between self-efficacy and medication adherence [22,23,24, 26, 29, 32, 35, 39, 42], two reported an association between self-efficacy and physical activity [33, 34] and one reported an association between self-efficacy and adherence to recommended diet .
There were two studies which reported no association between self-efficacy and specific self-care behaviours . One  found that self-efficacy did not predict whether a person avoided being sedentary; the other  reported no significant association between self-efficacy for adherence to recommended diet and adherence to medication.
Quality of included articles
All the included articles were judged to be of at least fair overall quality. All of them had a clearly stated research question. Most of them clearly specified and defined their study population, ensured participants were recruited from the same or similar populations, examined different levels of exposure, used clearly defined, valid and reliable exposure and outcome measures and adjusted for potential confounding variables. The most common flaws among the articles were a failure to obtain a high participation rate among eligible individuals and the lack of blinding. Additionally, none of the articles measured the association between self-efficacy and engagement in self-care behaviour over a period of time, as they were all cross-sectional studies.
The studies by Nafradi et al. and Idowu et al. were originally judged to be “poor” and “fair” by one of the reviewers respectively. The quality of these two studies were judged by the second reviewer to be “fair” and “good” respectively. The difference in judgement of quality for the study by Nafradi et al. was due to a difference in opinion regarding blinding and the validity of the instrument measuring the outcome. The difference in judgement of quality for the study by Idowu et al. was due to a difference in opinion regarding the validity of the instruments used to measure the exposure and outcome. After arbitration, the final judgement of the quality of these two studies by Nafradi et al. and Idowu et al. are “fair” and “good” respectively.
This review reveals a low to moderate level of association between self-efficacy and self-care behaviours in hypertension. The implication for clinical practice is that adults with high self-efficacy are more likely to adhere to self-care in their management of hypertension.
This is a comprehensive and thorough synthesis of the available literature evaluating the association between self-efficacy and the performance of self-care behaviours in hypertension. It involved extensive database and hand searching that includes grey literature. It includes recently-published studies (from 2010 to 2019) which employ a variety of instruments and study a variety of populations. Thus, it is useful as a comprehensive summary of key findings regarding self-efficacy and self-care over the last decade. This summary may aid in planning interventions which aim to improve self-care through improving self-efficacy. By highlighting areas where further investigation is required, it is also useful in directing future research.
We have excluded articles not published in English. Authors who did not find positive results may have published their work in smaller, local journals not in English. Such articles could have been omitted from review because of the restriction to English language articles. Thus, there is a risk of introducing bias by including only English language articles. Certain databases e.g. EMBASE were not accessible because of limitations on institutional access, thus articles published only in those databases could have been omitted from review.
All the studies included were cross-sectional, which do not have the dimension of time. Observational studies examine observations but are unable to establish causative relationships. Overall, the level of evidence in observational studies is lower compared to other study designs, for example, a randomised controlled trial [70, 71]. Nonetheless, they are easy to conduct and often provide early data on the association to design subsequent adequately-powered controlled trials.
The results also provide no data on the relationship between self-efficacy and engagement in self-care over the long term. None of the studies included followed up on participants after data collection. Further research is needed to determine the sustained association between self-efficacy and self-care behaviour as hypertension is a chronic disease.
The included studies relied on self-reporting of self-care behaviour, which can be affected by recall bias. The level and types of engagement in self-care behaviour may fluctuate from day to day, which poses further challenges in its combined measurements using conventional questionnaires and tracking devices. A major limitation of the included studies was their failure to assess engagement in self-care behaviour using objective measurements. The instruments involved participants self-reporting their self-care behaviour without a record of objective measurements, such as calorie expenditure or minutes of physical exercise performed. This further increases the risk of recall bias.
Many of the included studies were also limited by flaws in their methodology. Most of them employed convenience sampling or failed to report their participation rate of eligible persons. Therefore, it is uncertain whether the samples they studied were representative of the population of interest. All the studies did not report that their assessors were blinded to the exposure status of their participants. The lack of blinding could have increased the risk of bias.
Most studies did not show an incremental association between self-efficacy and self-care behaviour. In six [25, 28, 31, 37, 40, 41] studies, the scores reflecting each self-care behaviour were simply added up and analysed as a total score. The optimum level of self-efficacy remains unclear for improved process or clinical outcomes in essential hypertension.
Meta-analysis could not be performed as the data was highly heterogeneous, with many different instruments used to measure self-efficacy and the performance of self-care. Better standardisation of the instruments used to measure self-efficacy and self-care and greater consensus on the instruments used may allow for quantitative analysis to be performed in future reviews.
Comparison with existing literature
The finding that self-efficacy is correlated with self-care is consistent with Bandura’s proposition in the Social Cognitive Theory that self-efficacy drives self-care behaviour . Individuals with low self-efficacy are less likely to engage in self-care behaviour. This is consistent with Bandura’s suggestion that self-efficacy influences behaviour by influencing individuals’ motivation for behavioural change . Individuals with low self-efficacy have low motivation to change their behaviour. It is also consistent with previous studies investigating self-care behaviours in adults with hypertension which reported that self-care performance is low because individuals lack the motivation to change their lifestyles .
Implications for practice and research
Individuals with essential hypertension require life-long commitments to self-care behaviour ; the results of this review suggest that elevating their self-efficacy is pivotal to support their continuous self-care behaviour. The idea of self-managing chronic disease with behavioural changes has gained traction as part of a discipline termed lifestyle medicine. Lifestyle medicine involves gaining skills and competency in adopting behaviours to promote health and addressing behaviours detrimental to health. It presents a novel approach in the treatment and prevention of non-communicable disease .
Psychosocial interventions to raise or maintain individuals’ self-efficacy should be incorporated into the armamentarium of treatment measures to optimise their blood pressure control. Examples of techniques healthcare providers can use to improve self-efficacy for making behavioural changes include motivational interviewing  and providing evaluative feedback . Another intervention which healthcare providers can employ is the use of health coaches. Health coaching interventions have been shown to produce improvements in self-efficacy as well as engagement in behaviours such as undertaking physical activity and reducing dietary fat .
An area that requires further research is the complex relationship between self-efficacy and engagement in multiple self-care behaviours in individuals who are attempting to engage in multiple behavioural changes simultaneously. As self-efficacy is task-specific, engagement in each self-care behaviour would be driven by self-efficacy for that behaviour. Can interventions which target individuals’ self-efficacy increase self-efficacy for each of these behaviours simultaneously? Do some interventions work better at increasing self-efficacy for certain types of behaviour? This might be investigated with randomised controlled trials designed to test the effectiveness of an intervention in improving self-efficacy for multiple self-care behaviours simultaneously, or with a trial designed to test the effectiveness of various interventions in improving self-efficacy for a specific self-care behaviour.
This review provides some evidence to support the association between self-efficacy and self-care behaviours in hypertension. This is consistent with Bandura’s theory that self-efficacy influences motivation and participation in self-care , which may in turn translate to improved health outcomes . However, well-designed trials involving complex interventions are needed to prove that increasing self-efficacy will result in sustained combined self-care behaviour and favourable outcomes in essential hypertension.
Availability of data and materials
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
Millimetres of mercury
National Institute of Health
- et al.:
National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. NICE. 2019; Available from: https://www.nice.org.uk/guidance/ng136/chapter/recommendations. [cited 2020 Feb 26].
World Health Organisation. Hypertension [Internet]: World Health Organisation; 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 26 Feb 2020.
Gillespie CD, Hurvitz KA. Centers for Disease Control and Prevention (CDC). Prevalence of hypertension and controlled hypertension - United States, 2007-2010. MMWR Suppl. 2013;62(3):144–8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24264505. [cited 2016 Dec 27].
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Circulation. 2016.
Kennedy A, Rogers A, Bower P. Support for self care for patients with chronic disease. Br Med J. 2007;335(7627):968–70.
NICE. NICE clinical guideline 127: Hypertension: Clinical management of primary hypertension in adults. 2011;(August).
Zare S, Rezaee R, Aslani A, Shirdeli M, Kojuri J. Moving toward community based telehealth services using mhealth for hypertensive patients. Int J Technol Assess Health Care. 2019;10.
Zinat Motlagh SF, Chaman R, Sadeghi E, Ali Eslami A. Self-care behaviors and related factors in hypertensive patients. Iran Red Crescent Med J [Internet]. 2016;18(6):e35805 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27621938. [cited 2020 Feb 27].
Morrison VL, Holmes EAF, Parveen S, Plumpton CO, Clyne W, De Geest S, et al. Predictors of self-reported adherence to antihypertensive medicines: A multinational, cross-sectional survey. Value Heal [Internet]. 2015;18(2):206–16. https://doi.org/10.1016/j.jval.2014.12.013.
Warren-Findlow J, Seymour RB. Prevalence rates of hypertension self-care activities among African Americans. J Natl Med Assoc [Internet]. 2011;103(6):503–12 Available from: /pmc/articles/PMC3390197/?report=abstract. [cited 2020 Aug 29].
Flynn SJ, Ameling JM, Hill-Briggs F, Wolff JL, Bone LR, Levine DM, et al. Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members. Patient Prefer Adherence. 2013;7:741–9.
Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman; 1997. p. 604.
Bandura A. Social foundations of thought and action: A social cognitive theory: Prentice-Hall, Inc; 1986.
Bandura A. New Developments in Goal Setting and Task Performance. In: Locke EA, Latham GP, editors. New Developments in Goal Setting and Task Performance: New York; 2013. p. 147–8.
Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989;32(1).
Osborne RH, Wilson T, Lorig KR, McColl GJ. Does self-management lead to sustainable health benefits in people with arthritis? A 2-year transition study of 452 Australians. J Rheumatol. 2007;34(5):1112–17.
Lorig K. Chronic disease Self-management. Am Behav Sci. 1996;39(6):676–83.
Lorig K, Holman H. Patient Self-management : A key to effectiveness and efficiency in Care of Chronic Disease in care to effectiveness of chronic disease and. Public Health Rep. 2004;119(June):239–43.
1 Guidance | Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence | Guidance | NICE.
Monteiro Ferra JR, Vieira AC, Carvalho JS, Matos C, Nogueira F. Barriers to smoking cessation: the patient’s perspective. In: European Respiratory Journal [Internet]: European Respiratory Society (ERS); 2019;54:PA2852. Available from: https://erj.ersjournals.com/content/54/suppl_63/PA2852. [cited 2020 Aug 29].
Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies - NHLBI, NIH [Internet]. [cited 2016 Dec 27]. Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort
Ahn YH, Ham OK. Factors Associated With Medication Adherence Among Medical-Aid Beneficiaries With Hypertension. West J Nurs Res. 2016;38(10):1298–312 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27272159. [cited 2019 mar 9].
Al-Noumani H, Wu J-R, Barksdale D, Knafl G, AlKhasawneh E, Sherwood G. Health Beliefs and Medication Adherence in Omanis With Hypertension. J Cardiovasc Nurs. 2018;33(6):1 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30130358. [cited 2019 mar 9].
Bae SG, Kam S, Park KS, Kim K-Y, Hong N-S, Kim K-S, et al. Factors related to intentional and unintentional medication nonadherence in elderly patients with hypertension in rural community. Patient Prefer Adherence. 2016;10:1979–89 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27729776. [cited 2019 mar 9].
Bahari G, Scafide K, Krall J, Mallinson RK, Weinstein AA. Mediating role of self-efficacy in the relationship between family social support and hypertension self-care behaviours: A cross-sectional study of Saudi men with hypertension. Int J Nurs Pract. 2019;25(6):e12785.
Breaux-Shropshire TL, Brown KC, Pryor ER, Maples EH. Relationship of Blood Pressure Self-Monitoring, Medication Adherence, Self-Efficacy, Stage of Change, and Blood Pressure Control among Municipal Workers with Hypertension. Workplace Health Saf. 2012;60(7):303–11 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22767462. [cited 2019 mar 10].
Chang AK, Sok SR. Predictors of sedentary behavior in elderly Koreans With Hypertension. J Nurs Res. 2015;23(4):262–70.
Ea EE, Colbert A, Turk M, Dickson VV. Self-care among Filipinos in the United States who have hypertension. Appl Nurs Res [Internet]. 2018;39:71–6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29422180. [cited 2019 mar 9].
Elder K, Ramamonjiarivelo Z, Wiltshire J, Piper C, Horn WS, Gilbert KL, et al. Trust, medication adherence, and hypertension control in southern African American men. Am J Public Health. 2012;102(12):2242–5.
Gacek M. Individual differences as predictors of dietary patterns among menopausal women with arterial hypertension. Prz Menopauzalny. 2014;18(2):101–8.
Giena VP, Thongpat S, Nitirat P. Predictors of health-promoting behaviour among older adults with hypertension in Indonesia. Int J Nurs Sci. 2018;5(2):201–5. https://doi.org/10.1016/j.ijnss.2018.04.002.
Heydari H, Kamran A, Ss A, Biria M, Malepour A. Determinants of patient′s adherence to hypertension medications: Application of health belief model among rural patients. Ann Med Health Sci Res. 2014;4(6):922 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25506487. [cited 2019 mar 10].
Hu HH, Li G, Arao T. The association of family social support, depression, anxiety and self-efficacy with specific hypertension self-care behaviours in Chinese local community. J hum Hypertens. 2015;29(3):198–203 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25008000.
Idowu O, Adeniyi A, Atijosan O, Ogwumike O. Physical inactivity is associated with low self efficacy and social support among patients with hypertension in Nigeria. Chronic Illn. 2013;9(2):156–64 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23175759.
Khalesi S, Irwin C, Sun J. Dietary Patterns, Nutrition Knowledge, Lifestyle, and Health-Related Quality of Life: Associations with Anti-Hypertension Medication Adherence in a Sample of Australian Adults. High Blood Press Cardiovasc Prev. 2017;24(4):453–62 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28884295. [cited 2019 mar 9].
Lee E, Park E. Self-care behavior and related factors in older patients with uncontrolled hypertension. Contemp Nurse. 2017;53(6):607–21 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28831843. [cited 2019 mar 9].
Lee JE, Han HR, Song H, Kim J, Kim KB, Ryu JP, et al. Correlates of self-care behaviors for managing hypertension among Korean Americans: A questionnaire survey. Int J Nurs Stud [Internet]. 2010;47(4):411–7. https://doi.org/10.1016/j.ijnurstu.2009.09.011.
Ma C. An investigation of factors influencing self-care behaviors in young and middle-aged adults with hypertension based on a health belief model. Hear Lung. 2018;47(2):136–41 Available from: [cited 2019 mar 9]. http://www.ncbi.nlm.nih.gov/pubmed/29395265.
Náfrádi L, Galimberti E, Nakamoto K, Schulz PJ. Intentional and unintentional medication non-adherence in hypertension: the role of health literacy, empowerment and medication beliefs. J Public health Res. 2016;5(3):762 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28083523. [cited 2019 mar 9].
Namwong A, Panuthai S, Suwanprapisa T, Khampolsiri T. A casual model of Adherence to therapeutic regimens Among Thai older adults with Hypertension. Pacific Rim Int J Nurs Res. 2015;19(2):107–21.
Pinprapapan E, Panuthai S, Vannarit T, Srisuphan W. Casual Model of Adherence to Therapeutic Regimens among Thais with Hypertension. Pacific Rim Int J Nurs Res. 2013;17(3):268–81 Available from: http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,uid,shib&db=rzh&AN=2012239026&site=ehost-live.
Son Y-J, Won MH. Depression and medication adherence among older Korean patients with hypertension: Mediating role of self-efficacy. Int J Nurs Pract. 2017;23(3):e12525 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28194846. [cited 2019 mar 9].
Warren-Findlow J, Seymour RB, Brunner Huber LR. The Association Between Self-Efficacy and Hypertension Self-Care Activities Among African American Adults. J Community Health [Internet]. 2012;37(1):15–24 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21547409. [cited 2019 mar 10].
Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. The Self-Efficacy Scale: Construction and Validation. Psychol Rep. 1982;51(2):663–71. [cited 2019 Mar 14]. https://doi.org/10.2466/pr0.19126.96.36.1993.
Oh HS. Health Promoting Behaviors and Quality of Life of Korean Women with Arthritis. J Nurses Acad Soc. 1993;23(4):617. [cited 2019 Mar 14]. https://doi.org/10.4040/jnas.19188.8.131.527.
Fernandez S, Chaplin W, Schoenthaler AM, Ogedegbe G. Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans. J Behav Med. 2008;31(6):453–62.
Bae SG, Jeon HJ, Yang HS, Kim BK, Park KS. Medication Adherence and its Predictors in Community Elderly Patients with Hypertension. Korean J Heal Promot. 2015;15(3):121. https://doi.org/10.15384/kjhp.2015.15.3.121 [cited 2019 Mar 14].
Han H-R, Lee H, Commodore-Mensah YKM. Development and Validation of the Hypertension Self-Care Profile: A Practical Tool to Measure Hypertension Self-Care. J Cardiovasc Nurs. 2014;29(3):E11-E20.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74 Available from: http://www.ncbi.nlm.nih.gov/pubmed/3945130. [cited 2019 mar 16].
Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc sport. 1992;63(1):60–6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/1574662.
Lee PS, Chang SO. The Study on the Effect of Stage Based Exercise Motivational Intervention Program for the Elderly. J Korean Acad Nurs. 2001;31:818–34 Available from: http://pesquisa.bvsalud.org/bvsvs/resource/pt/wpro-195932.
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci sports Exerc. 2003;35(8):1381–95 Available from: http://www.ncbi.nlm.nih.gov/pubmed/12900694.
Oh JY, Yang YJ, Kim BS, Kang JH. Validity and reliability of Korean version of international physical activity questionnaire (IPAQ) short form. J Korean Acad Fam Med. 2007;28(7):532–41.
Hays RD, Kravitz RL, Mazel RM, Sherbourne CD, DiMatteo MR, Rogers WH, et al. The impact of patient adherence on health outcomes for patients with chronic disease in the medical outcomes study. J Behav Med. 1994;17(4):347–60. [cited 2019 Mar 10]. https://doi.org/10.1007/BF01858007.
Ogedegbe G, Mancuso CA, Allegrante JP, Charlson ME. Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients. J Clin Epidemiol. 2003;56(6):520–9.
Hu H, Li G, Arao T. Validation of a Chinese version of the Self-efficacy for managing chronic disease 6-item scale in patients with Hypertension in primary care. ISRN Public Health. 2013;2013:1–6.
International Physical Activity Questionnaire. 2002;(May 2001):1–4. Available from: www.ipaq.ki.se. Accessed 29 Mar 2020.
Sallis JF, Pinski RB, Grossman RM, Patterson TL, Nader PR. The development of self-efficacy scales for healthrelated diet and exercise behaviors. Health Educ Res. 1988;3(3):283–92. [cited 2019 Mar 12]. https://doi.org/10.1093/her/3.3.283.
Smith W, Mitchell P, Reay EM, Webb K, Harvey PW. Validity and reproducibility of a self-administered food frequency questionnaire in older people. Aust N Z J Public Health. 1998;22(4):456–63 Available from: http://www.ncbi.nlm.nih.gov/pubmed/9659773. [cited 2019 mar 12].
Culig J, Leppée M. From Morisky to Hill-Bone; self-reports scales for measuring adherence to medication. Coll Antropol. 2014;38(1):55–62 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24851597. [cited 2019 mar 12].
Lee YW. A Study of the Effect of an Efficacy Expectation Promoting Program on Self-Efficacy and Self-Care. Korean J Adult Nurs. 1995;7 Available from: http://www.ana.or.kr/class/doc.php?year=1995&month=9&volumn=7&issue=2&spage=212. [cited 2019 Mar 12].
Bloomfield R, Young LD, Graves J. Racial differences in perceptions concerning hypertension and its consequences. South Med J. 1993;86(7):767–70 Available from: http://www.ncbi.nlm.nih.gov/pubmed/8322083.
Horne R. The Medication Adherence report scale (MARS). Brighton: University of Brighton; 2000.
Park M. Effects of Interactive Pictorial Education on Community Dwelling Older Adult’s Self Efficacy and Knowledge for Safe Medication. J Korean Acad Nurs. 2011;41(6):795 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22310864. [cited 2019 mar 12].
Son Y-J, Kim S-H, Park J-H. Role of depressive symptoms and self-efficacy of medication adherence in Korean patients after successful percutaneous coronary intervention. Int J Nurs Pract. 2014;20(6):564–72 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24118689. [cited 2019 mar 12].
Lorig K, Stewart A, Ritter P, Gonzalez V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. - PsycNET [Internet]. Thousand Oaks, CA: SAGE Publications; 1996. Available from: https://psycnet.apa.org/record/1996-98103-000. [cited 2019 Mar 16]
National Institute on Alcohol Abuse and Alcoholism (NIAAA). The Physician’s Guide to Helping Patients With Alcohol Problems. Washington, DC; 2003. p. 95–3769.
Khalesi S, Sharma S, Irwin C, Sun J. Dietary patterns, nutrition knowledge and lifestyle: associations with blood pressure in a sample of Australian adults (the Food BP study). J Hum Hypertens. 2016;30(10):581–90 Available from: http://www.nature.com/articles/jhh201622. [cited 2019 Mar 12].
Grading levels of evidence - CIAP Clinical Information Access Portal [Internet]. [cited 2020 Mar 21]. Available from: https://www.ciap.health.nsw.gov.au/training/ebp-learning-modules/module1/grading-levels-of-evidence.html
McNair P, Lewis G. Levels of evidence in medicine. Int J Sports Phys Ther. 2012;7(5):474–81 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23091779. [cited 2020 mar 21].
He J, Muntner P, Chen J, Roccella EJ, Streiffer RH, Whelton PK, et al. Factors Associated With Hypertension Control in the General Population of the United States. Arch Intern Med. 2002;162(9):1051. Available from: [cited 2016 Dec 27]. https://doi.org/10.1001/archinte.162.9.1051.
Kushner RF, Sorensen KW. Lifestyle medicine: The future of chronic disease management [Internet]. Vol. 20, Current Opinion in Endocrinology, Diabetes and Obesity. Curr Opin Endocrinol Diabetes Obes. 2013;20:389–95 Available from: https://pubmed.ncbi.nlm.nih.gov/23974765/. [cited 2020 Aug 29].
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. New York: Guilford Press; 2012.
Gangloff B, Mazilescu CA. Normative characteristics of perceived self-efficacy. Soc Sci. 2017;6(4):139.
Gierisch J, Hughes J, Edelman D. The Effectiveness of Health Coaching. Washington (DC): Department of Veterans Affairs (US); 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK487700/
Many thanks to Dr. Pei Lin Hu and Dr. Edwin Shih-Yen Chan for giving us their advice on the methodology of this review.
This review is not funded and is part of the scholarly programme for the Family Medicine Residents in SingHealth Polyclinics. HDM is an NIHR Academic Clinical Lecturer. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health and Social Care.
Ethics approval and consent to participate
No ethics approval is required as this is a systematic review. The protocol was submitted for registration on PROSPERO.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Tan, F.C.J.H., Oka, P., Dambha-Miller, H. et al. The association between self-efficacy and self-care in essential hypertension: a systematic review. BMC Fam Pract 22, 44 (2021). https://doi.org/10.1186/s12875-021-01391-2
- Essential hypertension
- Systematic review