Multi-pronged biobehavioural intervention strategies for prevention and control of hypertension: A systematic review of education-based community trials

Abstract

Background: Hypertension contributes to preventable morbidity and mortality, especially in low- and middle-income countries with strained healthcare services. Factors such as diet, inactivity, stress, and low treatment adherence worsen this challenge. Community-based education programmes can address hypertension prevention and management. This review thus examines multi-pronged bio-behavioural education interventions outside healthcare facilities. Methods: Multiple electronic databases were searched for community-based education programmes from inception (1996) to May 2025. Eligible studies evaluated community, workplace, or home-based education programmes that combined lifestyle advice, self-regulation strategies, and self-monitoring. Randomised and non-randomised designs were included if they reported blood pressure outcomes in adults without restriction to baseline hypertension status. Primary outcomes comprised changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Data were extracted by a trained assistant, and independently verified by the primary reviewer. Meta-analyses were conducted using random effects models. Risk of bias was assessed using the Cochrane ROBINS-I and RoB-2 tools. Results: Seventeen studies with 5532 participants met the inclusion criteria. Interventions typically incorporated dietary education, physical activity guidance, stress control techniques, and blood pressure self-monitoring. Programme duration ranged from 4 weeks to 12 months. Pooled results showed a reduction in SBP of 6.42 mmHg (95% CI -9.69 to -3.16) and a reduction in DBP of 3.04 mmHg (95% CI -6.02 to -0.07). Effects were larger in randomised trials and in interventions lasting 6 months or longer. The overall risk of bias was moderate. Conclusion: Community bio-behavioural education programmes may improve blood pressure and complement pharmacological care, particularly where clinical access is limited. However, very high heterogeneity indicates that effects vary across settings and interventions. Further well-designed studies with longer follow-up are needed to confirm durability and guide implementation. Registration: The study is registered with PROSPERO, an international register of systematic reviews (ID: CRD420251034159).