{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T13:39:22Z","timestamp":1756993162821,"version":"3.37.3"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:00:00Z","timestamp":1660694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"K. MATSUSHITA FOUNDATION","award":["19-048"],"award-info":[{"award-number":["19-048"]}]},{"name":"Program of Collaborative Research at the Centre for Southeast Asian Studies"},{"name":"Program of Collaborative Research at the Centre for Southeast Asian Studies"},{"DOI":"10.13039\/501100005683","name":"Kyoto University","doi-asserted-by":"publisher","award":["Ishizue 2022"],"award-info":[{"award-number":["Ishizue 2022"]}],"id":[{"id":"10.13039\/501100005683","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"crossref","award":["JP19H01075"],"award-info":[{"award-number":["JP19H01075"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection of hypertension is critical for preventing cardiovascular disease. However, health-seeking behavior, including blood pressure measurement, is infrequently investigated in Bhutan. Therefore, this study investigated factors related to blood pressure measurement in Bhutan. We performed a secondary data analysis of a target population of 1,962 individuals using data from the \u201c2014 Bhutan STEPS survey data\u201das a cross-sectional study. Approximately 26% of those with hypertension who were detected during the STEPS survey had never had their blood pressure measured. Previous blood pressure measurement was significantly associated with age and working status in men (self-employed [odds ratio (OR): 0.219, 95% CI: 0.133\u20130.361], non-working [OR: 0.114, 95% CI: 0.050\u20130.263], employee [OR: 1.000]). Previous blood pressure measurement was significantly associated with higher income in women (Quartile-2 [OR: 1.984, 95% CI: 1.209\u20133.255], Quartile-1 [OR: 2.161, 95% CI: 1.415\u20133.299], Quartile-4 [OR: 1.000]). A family history of hypertension (OR: 2.019, 95% CI: 1.549\u20132.243) increased the likelihood of having experienced a blood pressure measurement in both men and women. Multivariate logistic regression showed that people with unhealthy lifestyles (high salt intake [adjusted odds ratio (AOR): 0.247, 95% confidence interval (CI): 0.068\u20130.893], tobacco use [AOR: 0.538, 95% CI: 0.380\u20130.761]) had a decreased likelihood of previous blood pressure measurement. To promote the early detection of hypertension in Bhutan, we suggest that more attention be paid to low-income women, non-working, self-employed, and low-income men, and a reduction of barriers to blood pressure measurement. Before the STEPS survey, a substantial number of hypertensive people had never had their blood pressure measured or were unconcerned about their health. As a result, we propose that early blood pressure monitoring and treatment for people with hypertension or at higher risk of hypertension be given increased emphasis.<\/jats:p>","DOI":"10.1371\/journal.pone.0271914","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T17:38:10Z","timestamp":1660757890000},"page":"e0271914","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Social and behavioral factors related to blood pressure measurement: A cross-sectional study in Bhutan"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4038-1189","authenticated-orcid":true,"given":"Hiromi","family":"Kohori Segawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hironori","family":"Uematsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6243-0020","authenticated-orcid":true,"given":"Nidup","family":"Dorji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ugyen","family":"Wangdi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chencho","family":"Dorjee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pemba","family":"Yangchen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susumu","family":"Kunisawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryota","family":"Sakamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4613-2159","authenticated-orcid":true,"given":"Yuichi","family":"Imanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,8,17]]},"reference":[{"key":"pone.0271914.ref001","unstructured":"World Health Organization. Global action plan for the prevention and control of non-communicable disease 2013\u20132020. Available from https:\/\/www.who.int\/publications\/i\/item\/9789241506236"},{"key":"pone.0271914.ref002","article-title":"Non-communicable diseases and their risk factors","author":"World Health Organization","year":"2017","journal-title":"Major NCDs and their Risk factors"},{"key":"pone.0271914.ref003","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.phrs.2017.11.003","article-title":"Hypertension and cardiovascular risk: General aspects","volume":"129","author":"SE Kjeldsen","year":"2018","journal-title":"Pharmacol Res"},{"issue":"1","key":"pone.0271914.ref004","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1161\/HYPERTENSIONAHA.113.01374","article-title":"Social Epidemiology of Hypertension in Middle-Income Countries","volume":"62","author":"S Basu","year":"2013","journal-title":"Hypertension"},{"journal-title":"NCD country profile","year":"2011","author":"World Health Organization","key":"pone.0271914.ref005"},{"journal-title":"NCD country profile;","year":"2018","author":"World Health Organization","key":"pone.0271914.ref006"},{"key":"pone.0271914.ref007","unstructured":"World Health Organization and Ministry of Health in Bhutan. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan\u2013 2014. Available from https:\/\/apps.who.int\/iris\/handle\/10665\/204659"},{"issue":"1","key":"pone.0271914.ref008","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1186\/s12889-017-4989-x","article-title":"Alarming prevalence and clustering of modifiable noncommunicable disease risk factors among adults in Bhutan: a nationwide cross-sectional community survey","volume":"17","author":"D Pelzom","year":"2017","journal-title":"BMC Public Health"},{"key":"pone.0271914.ref009","article-title":"Non-communicable Disease Division, Department of Public Health","author":"Ministry of Health in Bhutan","year":"2017","journal-title":"Package of Essential NCD (PEN) protocol for BHUs"},{"issue":"6","key":"pone.0271914.ref010","doi-asserted-by":"crossref","first-page":"e0234257","DOI":"10.1371\/journal.pone.0234257","article-title":"A qualitative study on knowledge, perception, and practice related to non-communicable diseases in relation to happiness among rural and urban residents in Bhutan","volume":"15","author":"H Kohori-Segawa","year":"2020","journal-title":"PLoS One"},{"key":"pone.0271914.ref011","unstructured":"National Statistics Bureau in Bhutan. Statistical yearbook 2021"},{"key":"pone.0271914.ref012","unstructured":"The constitution of Bhutan 2008."},{"journal-title":"2015 GNH survey report a Compass towards a Just and Harmonious Society","year":"2016","author":"Centre for Bhutan Studies & GNH Research","key":"pone.0271914.ref013"},{"journal-title":"Population and Housing Census of Bhutan","year":"2005","author":"National Statistics Bureau in Bhutan","key":"pone.0271914.ref014"},{"journal-title":"WHO STEPS Surveillance Manual","year":"2017","author":"World Health Organization","key":"pone.0271914.ref015"},{"volume-title":"Silent killer, global public health crisis","year":"2013","author":"World Health Organization","key":"pone.0271914.ref016"},{"key":"pone.0271914.ref017","doi-asserted-by":"crossref","first-page":"b1665","DOI":"10.1136\/bmj.b1665","article-title":"Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies","volume":"338","author":"MR Law","year":"2009","journal-title":"Bmj"},{"issue":"10053","key":"pone.0271914.ref018","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1016\/S0140-6736(16)31679-8","article-title":"Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","year":"2016","journal-title":"Lancet"},{"key":"pone.0271914.ref019","doi-asserted-by":"crossref","first-page":"g4490","DOI":"10.1136\/bmj.g4490","article-title":"Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies","volume":"349","author":"X Wang","year":"2014","journal-title":"Bmj"},{"issue":"24","key":"pone.0271914.ref020","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"FC Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"pone.0271914.ref021","doi-asserted-by":"crossref","first-page":"g4164","DOI":"10.1136\/bmj.g4164","article-title":"Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data","volume":"349","author":"MV Holmes","year":"2014","journal-title":"Bmj"},{"key":"pone.0271914.ref022","doi-asserted-by":"crossref","first-page":"f1326","DOI":"10.1136\/bmj.f1326","article-title":"Effect of lower sodium intake on health: systematic review and meta-analyses","volume":"346","author":"NJ Aburto","year":"2013","journal-title":"Bmj"},{"issue":"2","key":"pone.0271914.ref023","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1038\/sj.jhh.1001307","article-title":"A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen","volume":"16","author":"T Tanaka","year":"2002","journal-title":"J Hum Hypertens"},{"issue":"1","key":"pone.0271914.ref024","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/HJH.0000000000001879","article-title":"Assessing whether a spot urine specimen can predict 24-h urinary sodium excretion accurately: a validation study","volume":"37","author":"Y Zhang","year":"2019","journal-title":"J Hypertens"},{"issue":"4","key":"pone.0271914.ref025","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An Ecological Perspective on Health Promotion Programs","volume":"15","author":"KR McLeroy","year":"1988","journal-title":"Health Education Quarterly"},{"issue":"6","key":"pone.0271914.ref026","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/1466424006070466","article-title":"A health map for the local human habitat","volume":"126","author":"H Barton","year":"2006","journal-title":"Journal of the Royal Society for the Promotion of Health"},{"issue":"2","key":"pone.0271914.ref027","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/109019818801500203","article-title":"Social learning theory and the Health Belief Model","volume":"15","author":"IM Rosenstock","year":"1988","journal-title":"Health Educ Q"},{"issue":"9833","key":"pone.0271914.ref028","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1016\/S0140-6736(12)60525-X","article-title":"Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study","volume":"379","author":"L Perreault","year":"2012","journal-title":"Lancet"},{"key":"pone.0271914.ref029","doi-asserted-by":"crossref","first-page":"i5953","DOI":"10.1136\/bmj.i5953","article-title":"Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis","volume":"355","author":"Y Huang","year":"2016","journal-title":"Bmj"},{"issue":"9945","key":"pone.0271914.ref030","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/S0140-6736(14)60460-8","article-title":"Global, regional, and national prevalence of overweight and obesity in children and adults during 1980\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"M Ng","year":"2014","journal-title":"Lancet"},{"issue":"1","key":"pone.0271914.ref031","first-page":"46","article-title":"On Chi-Squared Tests for Multiway Contingency Tables with Cell Proportions Estimated from Survey Data","volume":"12","author":"JNK Rao","year":"1984","journal-title":"The Annals of statistics"},{"key":"pone.0271914.ref032","first-page":"15","article-title":"On Simple Adjustments to Chi-Square Tests with Sample Survey Data","author":"JNK Rao","year":"1987","journal-title":"The Annals of Statistics"},{"issue":"1","key":"pone.0271914.ref033","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12877-017-0538-9","article-title":"Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China","volume":"17","author":"X Zhang","year":"2017","journal-title":"BMC Geriatr"},{"issue":"1","key":"pone.0271914.ref034","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/S2468-2667(16)30005-6","article-title":"Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study","volume":"1","author":"AS Venkataramani","year":"2016","journal-title":"Lancet Public Health"},{"key":"pone.0271914.ref035","article-title":"Nudge: Improving decisions about health, wealth, and happiness","author":"RH Thaler","year":"2009","journal-title":"Penguin"},{"key":"pone.0271914.ref036","doi-asserted-by":"crossref","first-page":"j1608","DOI":"10.1136\/bmj.j1608","article-title":"Progress in maternal and child health: how has South Asia fared?","volume":"357","author":"N Akseer","year":"2017","journal-title":"BMJ"},{"journal-title":"Annual health bulletin","year":"2020","author":"Ministry of Health Bhutan","key":"pone.0271914.ref037"},{"journal-title":"Annual health bulletin","year":"1990","author":"Ministry of Health Bhutan","key":"pone.0271914.ref038"},{"issue":"1","key":"pone.0271914.ref039","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s10754-016-9194-4","article-title":"Healthcare utilization, bypass, and multiple visits: the case of Bhutan","volume":"17","author":"K Damrongplasit","year":"2017","journal-title":"International Journal of Health Economics and Management"},{"issue":"6","key":"pone.0271914.ref040","first-page":"731","article-title":"Progress and delivery of health care in Bhutan, the Land of the Thunder Dragon and Gross National Happiness. Tropical Medicine &","volume":"16","author":"T Tobgay","year":"2011","journal-title":"International Health"},{"key":"pone.0271914.ref041","unstructured":"Asia Pacific Observatory on Health System and Policies. The Kingdom of Bhutan Health System Review. Available from http:\/\/maternalnutritionsouthasia.com\/wp-content\/uploads\/the-Kingdom-of-Bhutan-Health-System-Review.pdf"},{"issue":"54","key":"pone.0271914.ref042","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1080\/09688080.2018.1535686","article-title":"Social determinants of health affecting utilisation of routine maternity services in Nepal: a narrative review of the evidence","volume":"26","author":"RB Khatri","year":"2018","journal-title":"Reprod Health Matters"},{"issue":"3","key":"pone.0271914.ref043","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S0277-9536(99)00461-X","article-title":"Gender, socioeconomic development and health-seeking behaviour in Bangladesh","volume":"51","author":"SM Ahmed","year":"2000","journal-title":"Social Science & Medicine"},{"issue":"9","key":"pone.0271914.ref044","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jama.2013.184182","article-title":"Prevalence, Awareness, Treatment, and Control of Hypertension in Rural and Urban Communities in High-, Middle-, and Low-Income Countries","volume":"310","author":"CK Chow","year":"2013","journal-title":"JAMA"},{"issue":"1","key":"pone.0271914.ref045","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/pubmed\/fdh207","article-title":"Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers","volume":"27","author":"BT Shaikh","year":"2004","journal-title":"Journal of Public Health"},{"issue":"4","key":"pone.0271914.ref046","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.cpcardiol.2007.01.002","article-title":"Systemic Hypertension","volume":"32","author":"WJ Elliott","year":"2007","journal-title":"Current Problems in Cardiology"},{"journal-title":"Profile on the occupational health and safety of Bhutan","year":"2012","author":"Department of Labour and WHO, Bhutan Office","key":"pone.0271914.ref047"},{"issue":"2","key":"pone.0271914.ref048","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10198-019-01124-4","article-title":"The company you keep: health behavior among work peers","volume":"21","author":"GJ Pruckner","year":"2020","journal-title":"Eur J Health Econ"},{"issue":"2","key":"pone.0271914.ref049","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1037\/0278-6133.26.2.136","article-title":"Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination","volume":"26","author":"NT Brewer","year":"2007","journal-title":"Health Psychol"},{"issue":"4","key":"pone.0271914.ref050","doi-asserted-by":"crossref","DOI":"10.1111\/j.1468-0009.2005.00425.x","article-title":"Why People Use Health Services","volume":"83","author":"IM Rosenstock","year":"2005","journal-title":"Milbank Q"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0271914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T17:38:57Z","timestamp":1660757937000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0271914"}},"subtitle":[],"editor":[{"given":"Marcelo Arruda","family":"Nakazone","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,8,17]]},"references-count":50,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0271914","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2022,8,17]]}}}