Abstract Body: Background: Hypertension is a leading modifiable risk factor for cardiovascular disease globally, with a disproportionate burden in low-and-middle income countries such as Ghana. Despite effective pharmacologic and lifestyle interventions, control rates remain low. Health coaching and home blood pressure (BP) monitoring (HCHBPM) are evidence-based strategies that promote self-management and adherence, yet evidence on their implementation in LMICs is limited. Guided by the Theoretical Domains Framework (TDF) and COM-B model, this study explored multilevel determinants and strategies to support adapted HCHBPM interventions in Ghana.

Methods: We held five workgroup sessions over 9 months with 46 stakeholders, including adults with hypertension (n=15), healthcare professionals (n=16), policymakers (n=6), and community leaders/Civial Society Organization representatives (n=9). Semi-structured discussions and human-centered design activities were used to elicit perspectives on HCHBPM. Transcripts were analyzed using a rapid framework-guided approach, coded to TDF and mapped to COM-B domains to identify barriers, facilitators, and implementation strategies.

Results: Key barriers to implementing HCHBPM in Ghana included low health literacy and fear of diagnosis (knowledge, beliefs, emotion), limited provider capacity for individualized coaching (skills), high cost of BP devices, long waiting times for BP checks (environmental context), and weak follow-up systems (behavioral regulation). Facilitators included trusted community health nurses (CHNs) and faith-based networks (social influence), and the CHPS structure supporting home visits (environmental opportunity). Strategies mapped to COM-B/TDF emphasized training and enablement through standardized CHN-led coaching supported by digital tools with decision-support prompts, educational scripts, and real-time BP data entry, alongside quarterly mentorship for skill reinforcement. Environmental restructuring involved subsidized home BP devices and CHPS integration, while modeling and reinforcement leveraged peer and faith leaders to promote adherence.

Conclusion: Applying TDF and COM-B revealed behavioral, social, and systemic determinants influencing HCHBPM implementation in Ghana. Multi-level strategies emphasizing capacity building, community engagement, and system integration can enhance adoption, fidelity, and sustainability of patient-level hypertension interventions in Ghana and similar LMIC contexts.