Published in PLOS One on 2026-05-08, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original study title: Feasibility, acceptability, and fidelity evaluation of a contextualised physical activity and diet intervention for hypertension control in rural South African adults
Original authors: Kganetso Sekome, Francesc Xavier Gómez-Olivé, Hellen Myezwa, Dale W. Esliger, Lauren B. Sherar
Source: PLOS One • DOI 10.1371/journal.pone.0348696
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Despite the known benefits of physical activity and diet modifications for hypertension control, adults in rural South African settings still have high levels of uncontrolled hypertension. This paper outlines an intervention that targets adjusting routine physical activity and diet practices for hypertension control in adults from rural South Africa (HYPHEN). The intervention involved a structured group education, individualised physical activity education, and individualised dietary education. We aimed to evaluate the feasibility, acceptability, and fidelity of HYPHEN for adults aged 40 years and older living with hypertension in rural South Africa. Feasibility was measured by assessing recruitment and retention rates. Acceptability was assessed through interviews after the intervention using pre-determined themes of perceived expectations, benefits, motivation, and barriers concerning the intervention. Fidelity was evaluated by intervention adherence, dosage, quality, and participant responsiveness. Participants were also asked to rate their overall satisfaction on a Likert scale out of 10. Our study demonstrated high level of feasibility, acceptability, and fidelity. Thirty participants were successfully recruited (100% of target), 28 (93%) participants were retained, and 28 (93%) provided complete data. Qualitative data demonstrated high acceptability, with participants reporting that the intervention met expectations, provided benefits, motivated continued engagement, and involved few barriers. Intervention fidelity was high with all three components carried out as planned, minor dosage adjustment, high delivery quality, and 100% participant engagement. The average rating on the Likert scale was 8.6/10 (SD = 2.55). HYPHEN is a feasible and acceptable intervention for hypertension control. Trial registration: Pan African Clinical Trial Registry (pactr.samrc.ac.za) PACTR202306662753321. Retrospectively registered on 29 June 2023.
Introduction
About one in three Africans has hypertension, with its prevalence varying across various regions of the continent and among different age groups [1]. The highest reported prevalence of hypertension was in South Africa (41.6% − 54.1%), while the lowest was in Burkina Faso (15%) [2]. The highest prevalence was reported for individuals aged >75 years [1]. Hypertension prevention and control efforts vary globally; however, a consistent pattern of higher hypertension prevalence is observed in low- and middle-income countries (LMICs) compared to high-income nations [3]. This disparity is largely driven by persistently low rates of hypertension detection and treatment in Africa [4]. The World Health Organization (WHO) African Region is reported to have the highest prevalence of hypertension, whereas the WHO Region of the Americas reports the lowest [5]. Hypertension is a modifiable risk factor that can be controlled through lifestyle changes.
The benefits of physical activity and dietary modifications for hypertension control have been well documented [6–8]. Evidence suggests that adults with chronic diseases can benefit from increasing their physical activity, including increasing the number of steps taken per day [9], increasing the intensity of daily physical activity [10], or simply participating in regular physical activity according to their level of ability [11]. The widely recommended dietary approaches to control hypertension are through the reduction of dietary sodium and adoption of the Dietary Approaches to Stop Hypertension (DASH) diet [12]. The DASH diet recommends that people with hypertension consume vegetables, fruits, and whole grains while limiting sodium, saturated fat, and added sugars.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kganetso Sekome, Francesc Xavier Gómez-Olivé, Hellen Myezwa, Dale W. Esliger, Lauren B. Sherar. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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