1. Written by: Joseph Muwonge Jr.
Adoption of Healthy Lifestyle Practices in Uganda: A Socio-Ecological Perspective.
Introduction:
Healthy-lifestyle-practices such as increased physical activity, reduced alcohol consumption,
increased fruit and vegetable intake and reduced salt intake can lower the risk of hypertension
(World Health Organization, 2013) also known as high blood pressure. Hypertension is the biggest
contributor to morbidity and mortality(WHO, 2009) causing an estimated 57 million disability-
adjusted life years (DALYs) globally (Mohan et al., 2013).
The prevalence of hypertension in Uganda is estimated to be 24.3%, with many undiagnosed cases
reported(Ministry of Health, 2014), thus, the actual prevalence may be higher. Besides,
hypertension presents a huge economic burden to a country yet to recover from the infectious
disease scourge (Musinguzi G et al., 2015). The newly burdensome condition (hypertension) is
associated with change in lifestyle-practices attributed to urbanization (WHO, 2005, Musinguzi G
and Nuwaha F, 2013). This means that practices that lead to hypertension can be modified to
prevent disease occurrence.
The World Health Organization recommends 90 minutes of moderate-intensity aerobic physical
activity per week for persons aged 5-17years old and 150 minutes per week for persons aged above
18years old, 5 or more servings of fruits and vegetables daily and below 5g of salt per day (WHO,
2010). However, the adoption of these recommendations is still low in Uganda. Current estimates
by the Ministry of Health (2014), indicate that 28.9% of Uganda’s population currently consume
alcohol, 4.3% are physically inactive, 87.8% consume less than 5 servings of fruit or vegetables
per day, and 19.1% are overweight/ obese (above 25kg/m2
). Why the adoption of recommended
healthy-lifestyle-practices is still low, is unclear.
Importantly, UN Human Rights Conventions that Uganda ascribes to, bring to light the
responsibility of states to firstly, protect, respect and fulfill the human right to the ‘highest
attainable standards of physical and mental health’ (UNCHR, 2016). Secondly, to meet goal 3 of
the sustainable development goals (SDGs), ‘ensure healthy lives and promote well-being for all at
all ages’(UN, 2015). In relation to adoption of healthy-lifestyle-practices, the state should ensure
adequate access without discrimination based on gender or social economic class to facilities,

2. information and a suitable environment for all, to make healthy choices. Moreover, health
inequality which can be defined as differences in health status experienced by various groups in
society(WHO, 2016), likely results from unequal distribution of health promoting services and
facilities. This according to the WHO, is not “a ‘natural’ phenomenon but is the result of a toxic
combination of poor social policies and programmes, unfair economic arrangements, and bad
politics”(CSDH, 2008).
Problem statement
Although evidence suggests that people can lower the burden of hypertension by engaging in
healthy-lifestyle-practices, the adoption is low in Uganda. Effort to understand why may ultimately
help improve the adoption of these cost-effective practices to control hypertension.
Research aim:
To assess the socio-ecological factors that influence people to adopt healthy-lifestyle-practices in
Uganda. Specifically, this paper discusses facilitators and barriers that promote or limit the
adoption of healthy-lifestyle-practices based on socio-ecological dimensions of physical
environment, social-cultural environment and individual attributes.
Research questions:
1. What enables people to adopt healthy-lifestyle-practices in Uganda? (facilitators)
2. What hinders people to adopt healthy-lifestyle-practices in Uganda? (barriers)
To answer these questions, this paper will firstly, summarize general facilitators and barriers as
identified from reviewed literature, then focus more on two facilitators and two barriers. Secondly,
relate the factors to specific human rights and sustainable development tenets and health
inequality.
Limitation
There are limited studies on factors that influence the adoption of healthy-lifestyle-practices in
Uganda. Therefore, several studies from other low income contexts/ groups will be utilized to
make comparisons.

3. Analysis and Discussion:
Under this section, the paper discusses socio-ecological factors that facilitate or hinder the
adoption of healthy-lifestyle-practices in Uganda.
Facilitators
This paper identified the following general facilitators; knowledge of health status, access to
information, financial and physical access to health-promoting facilities, positive influence by
family and/or peers, social support, psychological factors such as positive motivation (healthy
ageing and fitness) and self-esteem(Enjezab B et al., 2012, Kelly S et al., 2016, Gerber et al., 2009,
Phalla Doung Keo, 2016, Mayega RW et al., 2014). Specifically, this paper presents a detailed
discussion of knowledge of health status and access to information as facilitators.
Knowledge of Health status: Not only is the early detection of a person’s hypertension status a
key preventive approach in the management of heart disease(World Health Organization, 2013)
but may be important in triggering the uptake of healthy-lifestyle-practices(Bukman et al., 2014)
to halt disease progression. However, this may be dependent on a person’s understanding of the
risks associated with continued unhealthy practices or how much he/she values a good health
status. In their book, Biehl J and Petryna A (2013), discuss the role of expanding diagnosis to risk
factors (overweight) in helping people shift their thinking from, ‘I am well’ to ‘I am not yet ill’.
This change in attitude may help people attach value to their health status and thereby make effort
to adopt healthy-lifestyle-practices. This is supported by a cohort study in Tokyo by Shi et al.
(2004) where men who valued their health participated in more healthy-lifestyle-practices. This
cascade-like process from knowing health status to change in attitude to value attachment to
making effort to change is important in the ultimate adoption of healthy-lifestyle-practices.
Unfortunately, almost all hypertension cases are diagnosed late in Uganda (Kavishe et al., 2015),
which is likely due to irregular monitoring of blood pressure. A study by Mayega RW et al. (2014)
found that limitations to routine health checkups (blood pressure monitoring) were transport costs,
long distances, work commitments, ignorance about health checkups, service charges, fear to
discover presence of disease and possibility of being denied care. It is important to note that
adequate healthcare is inclusive of health promotion and preventive care(Jon Mark Hirshon et al.,
2013). Sadly, limitations to blood pressure monitoring depict a society that doesn’t enjoy full

4. health coverage. Moreover, without a strong social-welfare system in Uganda, the sick suffer huge
out of pocket expenditures for quality care(Ministry of Health, 2014), thus, an economic burden
to the families and societies at large.
Comparatively, as discussed above, it is cost-effective for a person to undergo routine screening
of blood pressure and engage in healthy-lifestyle-practices. Individuals in this category may stay
healthy, lead quality lives, save money and contribute to the development of the country.
Therefore, for Uganda to “ensure healthy lives and promote the wellbeing for all at all ages”, it is
imperative to provide preventive facilities and services like affordable/free monitoring of blood
pressure and blood glucose levels.
Access to information: Access to comprehensive health information facilitates behaviour change
and uptake of healthy-lifestyle-practices. Based on the Health Belief Model (HBM), a commonly
used health behaviour theory (University of Twente, 2016), a person may try to halt unhealthy
behaviour or adopt healthy behaviour because of a feared negative outcome such as heart disease.
This is dependent on a person having access to health information. According to Enjezab B et al.
(2012), women who had access to health promotion information such as in nutrition and physical
activity reported active involvement in healthy-lifestyle-practices.
Nonetheless, for sustainable bevahiour change, access to information should be continuous. As
seen in another lifestyle programme(Lisa Adorno DiMaria, 2015), some participants reported that
after the eight-week programme, they still did not know what healthy foods to include in their diets
and how to cook vegetables. As a solution, routine reminders on Short Messaging services (SMS)
or radio may stimulate daily healthy-lifestyle-practices. For instance, in a weight management
programme, majority of the African-American women who received SMS were reported to take-
part in daily healthy-lifestyle-practices (Gerber et al., 2009).
Notably, the target audience for educational/awareness programmes should have the ability to read
and make use of information e.g. people should be able to read nutrition labels and health warnings
on alcohol and tobacco packs to make informed decisions (Mårtensson and Hensing, 2012, Phalla
Doung Keo, 2016). In the case of Uganda, reports indicate that 27% of adults cannot read and
write, majority of whom are in rural and peri-urban areas(UNICEF, 2013). One may infer that the
low literacy rates contribute to the excessive use of alcohol, commonly associated with such
populations(Ministry of Health, 2014).

5. Significantly, the human right to health depends on the attainment of other rights such as the right
to education(UN, 2016), which is not fully achieved in Uganda especially in lower socioeconomic
groups, hence an inequality. Overall, access to health information is an important determinant of
the adoption of healthy-lifestyle-practices but may be strongly influenced by other underlying
determinants such as literacy levels.
Barriers
This paper identified the following barriers; restrictions in the physical environment, poor
socioeconomic factors such as lack of time due to home and occupational roles, lack of financial
and physical access to facilities, psychological factors such as lack of motivation, low self-esteem
and entrenched behavior (Patel et al., 2012, Enjezab B et al., 2012, Kelly S et al., 2016, Mayega
RW et al., 2014). Specifically, this paper presents a detailed discussion of restrictions in the
physical environment and lack of time as barriers.
Physical environment: Space limitations and safety which are commonly associated with poor
urban infrastructure are presented. In a systematic review study, Kelly S et al. (2016), found among
other factors, that lack of recreational space was a common barrier to adoption of healthy-lifestyle-
practices. For instance, people in well planned cities utilize special lanes for jogging and cycling.
Conversely, poor road safety common in poorly planned urban space, may hinder the adoption of
healthy-lifestyle-practices. According to parents of overweight children aged 5-17 years,
neighbourhood safety in terms of security and road safety were seen as barriers to allowing their
children jog or walk to school(Sonneville et al., 2009). This can be accurately related to Uganda,
since reports indicate that roads are not pedestrian and bicycle friendly (Kayemba Patrick, 2013).
Moreover, people of lower socioeconomic status face restrictions accessing developed facilities
like gyms and recreational space common in well-planned neighbourhoods (Pampel et al., 2010).
Notably, a safe and well planned environment is integral to the full enjoyment of the right to health.
The role of the Ugandan government is to ensure access to safe and affordable transport systems
and create safe and accessible recreational space for all. This not only promotes the right to health
but meets SDG-11-“Make cities inclusive, safe, resilient and sustainable”(UN, 2015).

6. Lack of time: The paper focuses on lack of time due to home and occupational responsibilities as
barriers to active engagement in healthy-lifestyle-practices.
Due to high unemployment rates in Uganda(Republic of Uganda, 2014), people may be forced to
accept low quality jobs that are commonly insecure, low paying and may require working long
hours. Moreover, time after work is demanding as well, as noted by Patel M and colleagues(2012),
time after work comprises of household chores and family roles, thus considered a barrier to
participate in healthy-lifestyle-practices. The lack of time maybe worse among the working-class
married women, who in addition to the long occupational hours are expected to fulfill ‘wife/gender
roles’ like domestic chores, which is a common gender norm in Uganda(CID, 2014).
In such situations, healthy-lifestyle-practices may be surrendered for unhealthy practices. Phalla
Doung Keo (2016) highlights poor choices made due to inadequate time. Firstly, some people may
conveniently buy fast foods instead of shopping and preparing healthy meals. Secondly, due to job
insecurity, people may fail to take time off their jobs to visit health facilities for medical checkup.
Thus, lack of time may hinder both the physical access to healthy choices, and due to home and
occupational ‘pressures’, may affect the cognitive ability to make healthy choices.
Importantly, everyone has the right to conditions that promote their health and wellbeing,
employment conditions being part. Specifically, according to articles 23-24 of the Universal
Declaration of Human Rights(UN, 1948), everyone has the right to favourable conditions of work
including reasonable working hours and rest. Overall, lack of time is a significant barrier to
adoption of healthy-lifestyle-practices and maybe influenced by unfavourable work conditions and
gender norms.
Conclusion:
This paper sought to assess both facilitators and barriers to adoption of healthy-lifestyle-practices
in Uganda. Knowledge of health status and access to health information are key facilitators to the
adoption of healthy-lifestyle-practices while poor physical environment and lack of time are
barriers. This paper also shows how these facilitators and barriers are directly linked to the Human
rights to health and education and SDGs-goals 3 and 11. Furthermore, though not presented in
detail to make scientific inference, the adoption of healthy-lifestyle-practices is influenced by

7. underlying factors such as literacy levels, socioeconomic status and gender roles. These factors
highlight health inequality.
Overall, the adoption of healthy-lifestyle-practices may improve with provision of a safe and
health promoting environment for all. A healthy population is a productive one. Thus, Uganda may
attain middle income status by first ensuring complete health and wellbeing of her population.
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