Developing A Multilevel Community Nursing Framework to Improve Self-Management among Older Adults with Hypertension: A Qualitative Meta-Synthesis
DOI:
https://doi.org/10.37287/ijghr.v8i5.2444Keywords:
community nursing, hypertension, meta-synthesis, older adults, self-managementAbstract
Hypertension is a leading cause of cardiovascular morbidity among older adults. Although community nursing interventions have improved blood pressure control, most focus on individual behaviour and overlook the interactions among individual, family, community, and healthcare system factors. To synthesize qualitative evidence on determinants of hypertension self-management among older adults and develop a Multilevel Community Nursing Framework. A qualitative evidence synthesis using a meta-synthesis approach was conducted following PRISMA 2020 and ENTREQ guidelines. Five electronic databases were searched for qualitative studies published between January 2018 and June 2026. Study quality was assessed using CASP. Data were analysed using Thomas and Harden's thematic synthesis involving line-by-line coding, descriptive theme development, and analytical theme generation. Six qualitative studies met the inclusion criteria. Six analytical themes emerged: (1) individual capability and health literacy, (2) self-efficacy and behavioural adaptation, (3) family engagement and social support, (4) community participation and social capital, (5) accessibility and responsiveness of primary healthcare services, and (6) technology-assisted community nursing interventions. These themes indicate that successful hypertension self-management is shaped by multilevel interactions extending beyond individual behaviour. The proposed Multilevel Community Nursing Framework provides an evidence-based model for integrating individual, family, community, healthcare, and technological determinants into community nursing practice to improve self-management and blood pressure control among older adults with hypertension.
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