Application of the Health Belief Model using the PRECEDE-PROCEED framework for community-based hypertension control in rural Bangladesh: a cluster randomized trial protocol

Background. Hypertension is a leading cause of cardiovascular morbidity and premature death in low- and middle-income countries (LMICs), where blood-pressure control remains poor because of suboptimal medication adherence, unhealthy lifestyle behaviours, and structural barriers to care. Theory-driven Health Belief Model (HBM) interventions have shown promise, but most treat the six HBM constructs as interchangeable predictors. Formative mixed-methods work by our group in the same population indicates that the constructs do not operate uniformly: perceived barriers and cues to action are associated with systolic blood pressure (SBP) through medication adherence, self-efficacy through pathways