Digital health literacy and self-efficacy in relation to blood pressure control among adults with hypertension: a cross-sectional study in Ashanti Region, Ghana

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Abstract Background Digital health literacy (DHL) and self-efficacy are increasingly recognized as important behavioural determinants of hypertension management, yet evidence on their combined association with blood pressure control in sub-Saharan Africa remains limited. This study investigated the cross-sectional association between DHL, self-efficacy for hypertension self-management, and blood pressure control among adults living with hypertension in Mampong Municipality. Methods A cross-sectional study was conducted among 360 adults living with hypertension in Mampong Municipality. DHL was measured using the 8-item eHealth Literacy Scale (eHEALS; Cronbach’s α = 0.871), and self-efficacy (SE) using the 8-item Self-Efficacy for Hypertension Self-Management Scale (SE-HTA; α = 0.783). Multivariable logistic regression was used to examine associations between study variables and uncontrolled blood pressure. Model performance was assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC). Results Out of the 360 participants, 74.2% had uncontrolled blood pressure. Higher DHL was associated with lower odds of uncontrolled blood pressure (AOR = 0.923 per one-point increase; 95% CI: 0.878–0.971; p = 0.002). Similarly, higher self-efficacy was associated with lower odds of uncontrolled blood pressure (AOR = 0.912 per one-point increase; 95% CI: 0.858–0.968; p = 0.003). Older age, lower educational attainment, unemployment, rural residence, longer duration of hypertension, comorbidity, and attendance at health centres were associated with higher odds of uncontrolled blood pressure (all p < 0.05). The final model demonstrated excellent discrimination (AUC = 0.919; 95% CI: 0.890–0.947) with good calibration (Hosmer-Lemeshow p = 0.709) and an overall classification accuracy of 86.9%. Conclusion Higher digital health literacy and self-efficacy are associated with better blood pressure control among adults living with hypertension in Mampong Municipality. The findings highlight these factors as potentially important considerations in hypertension management and may inform the development of digital and behavioural support strategies in similar settings. However, the cross-sectional design does not establish causality. Longitudinal and interventional studies are needed to determine whether improvements in DHL and self-efficacy lead to better blood pressure control. External validation is also needed before the predictive performance of the model can be generalized to other populations.

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