Self-Care Management for Hypertension in Southeast Asia: A Scoping Review

Figures & data

Table 1 Keywords for Databases

No	Database	Keywords	Articles	Access Date
1	Medline	((((“Hypertension”[Mesh]) OR ((((hypertensive) OR (high blood pressure)) OR (blood pressure)) OR (hypertens))) AND ((“Self Care”[Mesh]) OR ((self-care practice) OR (self-management)))) OR ((“Life Style”[Mesh]) OR (lifestyle management))) AND ((“Asia, Southeastern”[Mesh]) OR ((southeast asia) OR (indonesia)))	712	August 10, 2021
2	CINAHL	(MH “Hypertension”) OR “high blood pressure” OR “hypertensive” AND self-care practice OR lifestyle management AND southeast asia OR Indonesia	243	August 10, 2021
3	Embase	“hypertension”/exp OR hypertensive OR “high blood pressure” AND “self care”/exp OR “self-care practice” OR “self-management” OR “lifestyle”/exp OR “healthy lifestyle”/exp AND “southeast asia”/exp OR “indonesia”/exp	45	August 10, 2021
4	Scopus	(TITLE-ABS-KEY (hypertension) OR TITLE-ABS-KEY (“high blood pressure”) OR TITLE-ABS-KEY (hypertensive) AND TITLE-ABS-KEY (“self-care”) OR TITLE-ABS-KEY (“self-management”) OR TITLE-ABS-KEY (“lifestyle management”) AND TITLE-ABS-KEY (“southeast asia”) OR TITLE-ABS-KEY (indonesia)) AND PUBYEAR > 2005	17	August 10, 2021
5	Web of Science Core Collection	(((((((TS=(hypertension)) OR TS=(“high blood pressure”)) OR TS=(hypertensive)) AND TS=(“self-care practice”)) OR TS=(“self-management”)) OR TS=(“lifestyle management”)) AND TS=(“southeast asia”)) OR TS=(indonesia)	118	August 10, 2021
6	PsycINFO	DE “Hypertension” OR “high blood pressure” OR “hypertensive” AND DE “self-care” OR “self-management” OR “lifestyle management”	182	August 10, 2021
7	Global Health	(hypertension) OR (high blood pressure) OR (hypertensive) AND (self-care practice) OR (self-management) OR (lifestyle management) AND yr:[2006 TO 2021]Refinements:Document type = Journal articleAND Geographic Location = Vietnam OR Malaysia OR Singapore OR Thailand OR Indonesia	138	August 10, 2021
8	Global Index Medicus	(tw:(hypertension)) OR (tw:(high blood pressure)) OR (tw:(hypertensive)) AND (tw:(self-care practice)) OR (tw:(self-management)) OR (tw:(lifestyle management)) AND (tw:(southeast asia)) OR (tw:(indonesia))	31	August 10, 2021
9	Cochrane Library	Hypertension OR “high blood pressure” OR hypertensive AND “self-care practice” OR “lifestyle management”	133	August 10, 2021
10	Garuda	Search hipertensi OR tekanan darah tinggi OR tekanan darah AND self-care AND self-management AND gaya hidup, by abstract	48	August 10, 2021
11	Google Scholar	“Hypertension” OR “high blood pressure” OR “hypertensive” AND “self-care practice” OR “self-management” OR “lifestyle management” AND “southeast asia” OR “Indonesia”	41	August 1, 2021

Table 2 Eligibility Criteria for Articles

Criterion	Inclusion
Population	Studies focused on adult (18 years and over) hypertensive patients
Concept	Self-care management methods
Context	Conducted in SEA, a subregion of Asia and consists of eleven countries: Brunei, Malaysia, Indonesia, Thailand, Singapore, the Philippines, Vietnam, Laos, Cambodia, Myanmar, and East Timor^Citation91

Figure 1 PRISMA flowchart.

Notes: Adapted from Tricco AC, Lillie E, Zarin W et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med.2018;169(7);467–473.¹³

Table 3 Articles Exploring Self-Care Management for Hypertension (Quantitative and Mixed Method Studies)

Author, Year	Aim	Sample (n, M Age, Range) and Setting	Findings	Self-Care Management
Sulastri et al^Citation20 (2012) Indonesia^a	To investigate the relationship of obesity with the incidence of hypertension among Minangkabau ethnic	n=204 (range=35–65) Urban area	Obese (56.6%) and central obesity (54.9%)	Traditional: Bodyweight management with a cultural approach
Herwati & Sartika^Citation21 (2014) Indonesia^a	To determine the relationship between diet and exercise habits with controlled blood pressure among hypertensive patients	n=78 Urban area	Poor diet pattern (59.5%) and poor exercise habit (85.1%)	Traditional: Dietary intake and physical exercise
Santoso et al^Citation22 (2015) Indonesia	To determine predictors of physical activity among older people with hypertension	n= 174, M age= 66 years (range=60–85) Rural area	Inadequate physical activity (44.2%)	Traditional: physical exercise
Adriaansz et al^Citation23 (2016) Indonesia^a	To identify the correlation between food intake and hypertension incidence among older people	n=47 Urban Area	High salt intake (88.2%) and high fat intake 70.5%	Traditional: Dietary sodium and fat intake
Nurdiantami et al^Citation24 (2018) Indonesia	To investigate the association of general and central obesity with hypertension in women	n=313,714, ≥18 years old National	Less active (52.9%), never smoke (95.6%), overweight (31.1%), obese (13.9%)	Traditional: Physical exercise, tobacco cessation Body weight management
Diana et al^Citation25 (2018) Indonesia	To explore the risk factors of hypertension among married couples	n=112 couples, (range=40–59) Rural area	Overweight and obese (35.8%), high body fat (38.4%), and high visceral fat (33.8%)	Traditional: Bodyweight management
Rahmawati & Bajorek^Citation28 (2018) Indonesia	To explore how and where people obtain their anti-hypertensive medications	n=384, M age = 65.7 years (range= 45–90) Rural area	Traditional medicines only (68.5%), both traditional and antihypertensive medication (33.6%)	Traditional: Medication adherence
Rahmawati & Bajorek^Citation27 (2017) Indonesia	To identify medication adherence and hypertension knowledge and their predictive factors	n=384, M age = 65.7 years (range= 45–90) Rural area	Medication adherence (11%)	Traditional: Medication adherence
Rahmawati & Bajorek^Citation26 (2018) Indonesia	To describe the use of traditional medicines and to identify factors associated with hypertension	n=384, M age = 65.7 years (range= 45–90) Rural area	Anti-hypertensive medications from public or private healthcare services (52.9%)	Traditional: Medication adherence
Pertiwi et al^Citation29 (2018) Indonesia	To determine the factors associated with the visit-to-visit variability of blood pressure among hypertensive patients	n=74, M age= 62.70 years (range= 45–81) Rural area	Sodium intake (mg/day) was 1387.14 ±451.98 and BMI was 25.49 ± 4.07	Traditional: Dietary sodium intake and bodyweight management
Noventi & Kartini^Citation30 (2019) Indonesia	To examine the relationship between the Healthy Lifestyle Index score to the occurrence of hypertension in	n= 90 (range= 30–80) Multi setting: mountainous, coastal, and urban area	Smoking from mountainous (53%), coastal (6.7%) and urban (53%) communities Unhealthy dietary habit from mountainous (20%), coastal (70%) and urban (60%) communities Active physical activity from mountainous (20%), coastal (63%), and urban (73%) communities Obese from mountainous (53%), coastal (13%), and urban (70%) communities	Traditional: Physical exercise, Dietary intake, tobacco cessation, bodyweight management
Sutini et al^Citation75 (2018) Indonesia	To determine the association of hypertension self-management with the incidence of stroke in patients with hypertension	n= 88 Rural area	Self-management: Poor diet (56.8%), poor exercise (34.1%), good stress (84.1%), good alcohol (97.7%), good smoking (84.1%), poor medication adherence (22.7%)	Traditional: Physical exercise, Dietary intake, Medication adherence, tobacco cessation, alcohol consumption, Alternative: Stress relieving
Simanullang^Citation31 (2018) Indonesia ^a	To analyze the relationship of lifestyle and hypertension prevalence among older people	n=60 Urban area	Low physical activity (81.7%), unhealthy lifestyle (58.3%), and smoking (45%)	Traditional: Physical exercise and tobacco cessation
Lestari et al^Citation32 (2019) Indonesia	To examine the relationship between medication adherence and hypertension status	n=55 M age= 62.9 years Urban area	Salt consumption (1540±257.7 mg), unregular exercise (>73.9%), and did not adhere to medication (78.1%)	Traditional: Dietary intake, physical exercise, medication adherence
Priscilia & Sartika^Citation33 (2019) Indonesia	To measure the effect of sleep duration on physical activity of hypertensive patients	n=97 (range= 30–65) Urban area	Less active (32%) and overweight (61.9%)	Traditional: Physical exercise and bodyweight management
Islami et al^Citation34 (2019) Indonesia	To examine the relationship between diet quality and mental emotional disorder status with the prevalence of hypertension in women	n=143 (range =35 −55) Rural area	Low diet quality (86.1%)	Traditional: Dietary intake
Pangastuti et al^Citation35 (2019) Indonesia	To compare sodium intake, physical activities, and psychological problems in patients with hypertension	n= 81 (rural) 74 (urban) M age= 57.8 (rural) and 60.7 (urban) years Rural and urban area	Excessive sodium intake from rural (32%) and urban (28.4%), vigorous activity level from rural (59%) and urban (27%), normal level of stress from rural (98.8%) and urban (95.9%)	Traditional: Dietary intake, physical exercise, Alternative: stress-relieving
Ridha et al^Citation36 (2019) Indonesia	To analyze the relationship between fruit and vegetable intake among older people	n=138 Urban area	Consumed fruit ≤ 2x/day (48.2%), consumed vegetables ≤ 3x/day (51.7%), overweight/obese (29.9%)	Traditional: Dietary intake and body weight management
Farapti et al^Citation37 (2017) Indonesia	To analyze the association between both urinary and dietary (Na/K) ratio and BP among older women	n=51, M age = 56.98 year Urban area	The Urinary Na/K ratio of hypertensive patients was 6.01±1.89 [mmol/mmol]	Traditional: Dietary sodium intake
Adiyasa & Cruz^Citation38 (2020) Indonesia	To analyze the correlation between self-care behavior and self-efficacy of adults with hypertension	n=120 ≥ 40 years old Urban area	Medication adherence (mean score 3.93), Healthy dietary (mean score 3.63), Physical activities (mean score 3.52) were considered good.	Traditional: Medication adherence, dietary intake, physical exercise
Livana & Basthomi^Citation39 (2020) Indonesia	To determine the triggering factors associated with hypertension	n=428 M age = 47 years (range= 25–60) Rural area	Moderate level of obesity (43.2%)	Traditional: Bodyweight management
Prihandana et al^Citation40 (2020) Indonesia^a	To determine patients’ self-care behavior toward hypertension	n=250 Urban area	Overweight (30.0%), obese (36%), low level of medication adherence (68%), high intensity of physical exercise (59.2%), did not exercise regularly (46.5), do not adhere to the recommended diet (58.8%), manage stress by praying (59.6)	Traditional: bodyweight management, medication adherence, physical exercise, dietary intake Alternative: stress-relieving
Nugroho & Erniastutik^Citation41 (2020) Indonesia	To determine the associated factors with hypertensive middle-aged patients in Indonesia	n=5401 (range= 45–59) National	Current smoker (19.5), low physical activity (24%), Obese (17.7%)	Traditional: tobacco cessation, physical exercise, bodyweight management
Gusty & Merdawati^Citation42 (2020) Indonesia^a	To assess hypertension self-care behaviors and their associated factors among hypertensive patients	n=260 M age= 60 Urban area	Medication adherence (37.7%), low-salt diet (16.9%), physical activity (10.4%), not smoking (73.8%), body weight management (20.8%), did not consume alcohol (100%)	Traditional: Dietary intake, physical exercise, tobacco cessation, bodyweight management, and alcohol consumption
Defianna et al^Citation43 (2021) Indonesia	To examine the prevalence of hypertension and associated factors among adult men and women	n= 4328 ≥18 years old. Rural area	High physical activity (71%), never smoke (69.5%), abdominal obesity (61.4%)	Traditional: Physical exercise, tobacco cessation, bodyweight management
Ramli et al^Citation44 (2012) Malaysia	To assess medication adherence among patients undergoing hypertensive treatment	n=653 M age= 57.84 years (range= 32–84) Urban area	Medication adherence (53.4%), obese (40.1%), overweight (38.9%), smokers (8.4%), alcohol users (5.5%)	Traditional: Medication adherence, bodyweight management, tobacco cessation, and alcohol consumption
Salihah & Mei^Citation45 (2017) Malaysia	To determine the knowledge, awareness, and perception towards hypertension among residents in nursing homes	n=200 M age= 70.6 years Nursing home, Urban area	Exercise regularly (46.5%), normal weight (58.0%), not smoking (85.0%)	Traditional: Medication adherence, physical exercise, bodyweight management, tobacco cessation,
Salim et al^Citation46 (2019) Malaysia	To determine self-care profiles and their determinants among hypertensive patients	n=730 M age = 59.5 years ≥18 years Urban area	Overweight (32.9%), obese (48.6), The mean total HTN-SCP score was 124.2 (SD 22.8) out of 180.	Traditional: Bodyweight management, other unspecified self-care behavior
Lim & Yong^Citation47 (2019) Malaysia	To examine and compare the risk factors of hypertension	n=24,632 National	Obese and overweight: undiagnosed and known hypertension Physically inactive, ex-smokers and drinkers: known hypertension	Traditional: Bodyweight management, physical exercise, tobacco cessation, alcohol consumption
Wu et al^Citation48 (2009) Singapore	To examine demographic and cardiovascular disease risk factors associated with awareness, treatment and control of hypertension in a multi-ethnic Asian population.	n=5022 (Range 24–94) National	Hypertensive medication (84.4%), BMI ≥ of 27.5 (58.2%), daily smoker (43.7%), alcohol drinker (53.0%)	Traditional: Medication adherence, bodyweight management, tobacco cessation, and alcohol consumption
Malhotra et al^Citation49 (2010) Singapore	To assess the prevalence and correlates of hypertension and awareness, treatment, and control among older people	n=4,441 National	Moderate risk of BMI (40.5%), high risk of BMI (23.4%)	Traditional: Bodyweight management
Son et al^Citation50 (2012) Vietnam	To estimate mean blood Pressure, the prevalence of hypertension, and its awareness, treatment and control	n= 9832, Mage= 42.7 years (range=25–100) National	Overweight (38.1%), obese (50.9%)	Traditional: Bodyweight management
Do et al^Citation51 (2015) Vietnam	To identify the prevalence of hypertension and prehypertension and its determinants.	n=17,199, M age = 44 years (range=25–64) National	Men (24.5%) and Women (17.5%) were current smokers. Men (25.1%) and Women (15.8%) did not drink alcohol	Traditional: Alcohol consumption, tobacco cessation
Nguyen et al^Citation52 (2020) Vietnam	To explore the rate of uncontrolled hypertension and identified associated factors	n=220 Hospital, urban area	Did not smoke (87.7%), alcohol drinkers (28.6%), overweight/obesity (58%), did not adhere to medication (99.6%), did not follow a low-salt diet (50.5%), exercised regularly (85.0%)	Traditional: Tobacco cessation, Alcohol consumption, bodyweight management, medication adherence, dietary intake, physical exercise
Ko-Ko-Zaw et al^Citation53 (2011) Myanmar	To determine the prevalence of hypertension and its associated factors	n=4616 ≥20 National	Medication consumption (32%), current smokers (24.9%), alcohol drinkers (47.1%), moderate physical activity (47%), overweight (29.9%), obese (11.8%)	Traditional: Medication adherence, tobacco cessation, alcohol consumption, physical exercise, bodyweight management
Han et al^Citation54 (2015) Myanmar	To determine the prevalence of the adherence and to identify the factors related to medication adherence among hypertensive patients	n=216, M age= 52.8 years Hospital, Urban area	Poor medication adherence (49.1%)	Traditional: Medication adherence,
Oo et al^Citation55 (2018) Myanmar	To describe the relationships between personal and environmental factors and health behaviors in persons with hypertension	n=104, M age= 53.27 years (range= 21 to 80) Urban area	Moderate level of health behaviors (70.59 ± 12.39)	Unspecified
Haung et al^Citation56 (2020) Myanmar	To identify the prevalence of self-care behaviors and their associated factors among hypertensive patients	n=410 M age= 55.4 years (range =30–70) Rural area	Did not adhere to medication (75.9%), low diet quality (62.2%), inadequate physical activity (75.1%), poor bodyweight management (90.5%), smoking (49.8%), did not drink alcohol (97.8%)	Traditional: Medication adherence, dietary intake, physical exercise, bodyweight management, tobacco cessation, and alcohol consumption
Apidechkul^Citation57 (2018) Thailand	To determine the prevalence of hypertension and its associated factors among older people	n=749 M age= 70.1 years (range= 60–100) Rural area	Smoking (17.4%), drinking alcohol (13.3%), consumed salty food (85%), less active (58.7%), overweight (57.3%)	Traditional: Tobacco cessation, alcohol consumption, dietary intake, physical exercise, and body weight management
Visanuyothin et al^Citation58 (2018) Thailand	To determine the prevalence of hypertension and associated factors between appearance and home blood pressure	n=125 M age= 63 years (range= 35–70) Urban area	Most patients had a Waist Circumference (WC) higher than the normal limit, BMIs ≥23 kg/m2, nondrinkers and nonsmokers	Traditional: Bodyweight management, tobacco cessation, alcohol consumption
Meelab et al^Citation59 (2019) Thailand	To determine the prevalence of uncontrolled hypertension and to assess its relationship with patient characteristics	n=406 M age = 63.6 years aged ≥18 years Rural area	Never smoke (83.5%), never drink alcohol (71.9%), without any medication (17.7%), overweight (42.6%), obese (10.3%)	Traditional: Tobacco cessation, alcohol consumption, medication adherence, and bodyweight management
Chotisiri et al^Citation60 (2016) Thailand	To explore hypertension knowledge, attitudes, and practices	n=144 M age = 66.1 years (range= 55–80) Rural area	Overweight (43.8%), consumed healthy diet (3–4 days/week) (50%), had physical exercise 1–2 times/week (91.0%), stress-relieving activities 1–2 times/week (87.5%)	Traditional: bodyweight management, dietary intake, physical exercise Alternative: stress-relieving
Somprasong et al^Citation61 (2020) Thailand	To estimate the prevalence of HT and to determine the factors associated with HT among individuals from hill tribes	n=1287 M age=52.2 years (range=35–90) Rural area	Overweight (67.7%), smoking (10.5%), were alcohol drinkers (11.5%), did not exercise (54.9%) used a lot of salt for cooking (35.5%), used a lot of oil for cooking (32.2%)	Traditional: Bodyweight management, tobacco cessation, alcohol consumption, physical exercise, dietary intake with a cultural approach
Rusmevichientong et al^Citation62 (2021) Thailand	To examine the dietary-salt-related determinants associated with the risk of hypertension	n=376 M age=59.69 Rural area	Overweight (42.7%), obese (23.8%), consumed 5 days a week high dietary salt food (34.6%), often/always taste the food before seasoning, read the amount of salt on the nutrition label, did not add salt/fish sauce to the food (53.5%)	Traditional: Bodyweight management and dietary intake
Pengpid et al^Citation63 (2019) Laos	To determine the national prevalence of hypertension and its awareness, treatment, and control	n=2543, M age=38.7 years (range= 18–64) National	Medication consumption (18.2%), older age taking an herbal remedy (12.8%)	Traditional: Medication adherence
Wee et al^Citation64 (2021) Singapore and Malaysia.	To compare hypertension self-care profiles in two populations in primary care settings from Singapore and Malaysia.	n= 1123 M age= 63.6 years (Singapore) 60.4 years (Malaysia) ≥40 years National	On three or more than four antihypertensive medications: Malaysia (20.9%) and Singapore (14.3%) Overweight: Malaysia (34.3%) and Singapore (33.9) Obese: Malaysia (47.8%) and Singapore (43.1%) The mean total score of HTN-SCP: Malaysia (Mean 184.1, SD 22.8) and Singapore (mean 189.9, SD 27.6)	Traditional: Medication adherence and bodyweight management
Rahman et al^Citation76 (2015) Malaysia, Indonesia, Thailand, and The Philippines	To gain a deeper understanding of hypertension management in Asia (Malaysia, Indonesia, Thailand, and The Philippines)	n= 110 (range= 35–65) Urban area	Motivations for implementing hypertension management. See Table 2.	Unspecified

Note: ^aArticle in Bahasa; HTN-SCP: hypertension self-care profile.

Table 4 Articles Exploring Self-Care Management for Hypertension (Qualitative Studies)

Author, Year	Aim	Sample (n, M Age, Range) and Setting	Findings	Self-Care Management
Mizutani et al^Citation74 (2016) Indonesia	To explore healthy-lifestyle behaviors as perceived by Muslim married couples with hypertension	n=12 couples, M age = 51.2 years (range= 40–64) Rural area	Eating behavior, physical activity, resting, not smoking, managing stress, seeking health information, seeking health care, caring for other people, and fulfilling an obligation to God were implemented healthy lifestyle	Traditional: Physical exercise, Dietary intake, tobacco cessation, stress-relieving Alternative: spiritual fulfillment, resting
Rahmawati & Bajorek^Citation65 (2017) Indonesia	To explore perspectives of hypertension from people who do not consume their medication	n=30, ≥45 years Rural area	Reluctance to take anti-hypertensive medications. Details at Table 2	Traditional: Medication adherence
Kurnia et al^Citation66 (2018) Indonesia	To explore the experiences of barriers to hypertension management in the Minangkabau ethnic group	n=12 Urban area	Lack of self-motivation in the management of hypertension. Details in Table 2.	Traditional: Dietary intake Alternative: stress-relieving with a cultural approach
Berek & Afiyanti^Citation67 (2020) Indonesia	To explore inhibiting and barrier of hypertensive patient self-care compliant	n=5 (range=43–70) Urban area	Inhibiting and barrier of self-care. See Table 2	Traditional: Medication adherence, dietary intake
Sulistyaningrum et al^Citation68 (2021) Indonesia	To understand the behavior of hypertensive patients	n=6 Hospital, N/A	Participants have implemented A low salt diet, cessation of cigarette and alcohol consumption, increase in activity and exercise, regulation of sleep and rest needs, application of stress control methods, and hypertension treatment and care	Traditional: Dietary intake, tobacco cessation, alcohol consumption, physical exercise treatment adherence Alternative: sleep and resting, stress-relieving
Shima et al^Citation69 (2014) Malaysia	To explore patients’ experiences with hypertension and reasons for not following self-care recommendations	n=25 M age= 49 years Rural area	Reasons for not following self-care recommendations. See Table 2.	Traditional: Medication adherence, dietary intake, physical exercise
Tan et al^Citation70 (2017) Malaysia	To explore hypertensive patients’ perspectives on medication usage and hypertension management	n=17 Urban area	Poor medication adherence and Herbal consumption was chosen over medication	Traditional: Medication adherence
Tan et al^Citation71 (2019) Singapore	To explore the perceived social and physical environments of low socio-economic status of older people with hypertension	n=22 Urban area	Social and physical environments of hypertensive older patients. See Table 2	Traditional: Culturally diet intake, physical exercise, medication adherence
Woodham et al^Citation72 (2018) Thailand	To understand reasons for poor adherence and home self-management of hypertensive older people	n=30 (range =60–79) Rural area	Reasons for poor medication adherence. See Table 2.	Traditional: Medication adherence
Sadang et al^Citation73 (2021) Philippines	To explore the common self-care hypertension practices of the Meranao tribe during the Covid-19 pandemic	n=10 Rural area	Self-care practice: use of herbal remedies, Compliance with prescribed medications, Dietary control, physical activity active.	Traditional: Medication adherence, dietary intake, physical exercise with a cultural approach

Table 5 The Facilitating and Inhibiting Factors of Self-Care Management for Hypertension

Factors	Theme	Sub-Theme	Sources	Quotations
Facilitating	Internal sources	Put reminder not to forget	Tan et al;^Citation70 Tan et al^Citation71	I keep it in a plastic bag. I will write or record in a book when taking medicine to avoid forgetting because I am a stroke patient;^Citation70 p.4).
		Motivation to avoid progression	Tan et al;^Citation71 Mizutani et al;^Citation74 Sulistyaningrum et al;^Citation68 Rahman et al^Citation76	If you do not protect yourself, who would protect? Others cannot protect you … If [you have] high blood pressure and do not control yourself, if [you] collapse … heart does not die, body dies … So, you just lay there and it’s awful … and become a burden to others;^Citation71 p.6)
	External Sources	Having discussion partner	Tan et al;^Citation70	I prefer to share my medication problem with member of the NGO because they know me well;^Citation70 p.4).
		Organized activities by the health center	Berek & Afiyanti;^Citation67 Mizutani et al;^Citation74 Rahmawati & Bajorek;^Citation65 Tan et al;^Citation70 Tan et al^Citation71	…. at the public health center, usually every Saturday there is an elderly exercise program, so I joined there …;^Citation67 p.27.
Inhibiting	Internal sources	Self-care practice is not a priority	Shima et al;^Citation69 Berek & Afiyanti;^Citation67 Rahmawati & Bajorek^Citation65	Taking medication is not a priority in my daily routine;^Citation69 p.1601.
		Side effects and feeling tired of medication	Shima et al;^Citation69 Tan et al;^Citation70 Berek & Afiyanti;^Citation67 Woodham et al;^Citation72 Rahmawati & Bajorek;^Citation65 Rahman et al^Citation76	I got tired easily and had no mood. I also experienced neatness, palpitations, and sweating with the medication;^Citation69 p.1601.
		No sign and symptoms	Woodham et al;^Citation72 Sadang et al;^Citation73 Rahmawati & Bajorek;^Citation65 Rahman et al^Citation76	I do not feel like I need to take medicine because I do not have any signs or symptoms. I do not have headache or anything. I do not see reason why I need to take medicine;^Citation72 p.86.
		Financial barrier	Mizutani et al;^Citation74 Sadang et al;^Citation73 Rahmawati & Bajorek;^Citation65 Rahman et al;^Citation76 Kurnia et al^Citation66	I want a variation of menu, but I cannot afford it. I have similar menu for breakfast, lunch, and dinner;^Citation74 p.20.
		Time barrier	Mizutani et al;^Citation74 Berek & Afiyanti;^Citation67 Kurnia et al;^Citation66 Tan et al^Citation71	I am too busy for my life … I work from 9.00 to 17.00. I want to walk in the morning before working, but I cannot because I am busy;^Citation74 p.20.
	External Sources	Not adjusted to the culture	S. T. Tan et al;^Citation71 Kurnia et al^Citation66	They advise taking this like … Oat, green veggies that Chinese like to take as soup, steamed fish … We Malays cannot eat like that … You know Malays must eat with chilies, without chilies we cannot eat right;^Citation71 p.6.
		Distance barrier	Tan et al;^Citation70 S. T. Tan et al;^Citation71 Mizutani et al;^Citation74 Rahmawati & Bajorek^Citation65	I have problem in getting transportation because hospital is too far;^Citation70 p.4.
		Lack of support from family	Shima et al;^Citation69 Berek & Afiyanti;^Citation67 Kurnia et al^Citation66	My wife still cooks food high in salt and fats although she knows I have hypertension;^Citation69 p.1601.
		Lack of knowledge	Rahmawati & Bajorek;^Citation65 Rahman et al^Citation76	Honestly, I expect the midwife to give me specific instructions about medicines that can decrease my blood pressure. The truth is, the midwife never told me to take any hypertensive medications;^Citation65 p.237.

Figure 2 The framework of hypertension self-care practices inhibiting and facilitating factors in South East Asia. *Factors of not adhering to medication. **Factors of poor physical exercise. ***Factors of overweight/obese and poor/low-quality dietary intake.

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