Iranian Journal of Nursing and Midwifery Research1735-906631420260809677684ENCommunity Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, IranCommunity Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, IranDepartment of Nursing and Midwifery, Instructor of Medical Surgical Nursing, Hormozgan University of Medical Sciences, Hormozgan, Iran2026080820260808<p><strong>Background: </strong>Hypertension is a major public health challenge, and low self‑efficacy undermines adherence to lifestyle change and treatment. Family‑centered empowerment may strengthen self‑efficacy, yet evidence in Iranian patients with hypertension is limited. This study evaluated the effect of a family‑centered empowerment program on self‑efficacy in adults with hypertension. <strong>Materials and Methods: </strong>In this randomized clinical trial (Zahedan, Iran; November 2020–September 2021), 70 patients were randomized 1:1 to intervention (four weekly 60‑min family‑centered empowerment sessions with a primary caregiver) or usual care. The primary outcome was hypertension self‑efficacy (17‑item validated scale) measured at baseline, immediately post‑intervention, 1 month, and 3 months. Repeated‑measures analysis of variance (ANOVA) tested time, group, and time × group effects; partial eta squared (<em>η</em>2<em>p</em>) and Cohen’s <em>d </em>complemented <em>p </em>values. <strong>Results: </strong>Groups were comparable at baseline (<em>all p </em>&gt; 0.05). Repeated‑measures ANOVA showed a significant time × group interaction for total self‑efficacy (<em>F </em>= 148.72, <em>p </em>&lt; 0.001; <em>η</em>2<em>p </em>≈ 0.69). The intervention group improved across all time points, whereas the control group remained largely stable. At 3 months, total self‑efficacy was 53.40 (2.87) (intervention) versus 46.48 (3.64) (control; <em>p </em>&lt; 0.001; Cohen’s <em>d </em>= 2.11). Similar patterns were observed for dietary adherence (32.22 (1.30) vs 28.45 (2.13); <em>p </em>&lt; 0.001; <em>d </em>= 2.14), treatment adherence (12.88 (1.45) vs 11.65 (1.69); <em>p </em>&lt; 0.001; <em>d </em>= 0.78), and disease management (8.28 (0.98) vs 6.37 (1.00); <em>p </em>&lt; 0.001; <em>d </em>= 1.93). <strong>Conclusions: </strong>A structured family‑centered empowerment program meaningfully increased self‑efficacy in patients with hypertension over 3 months, with large effect sizes across total and domain scores. Given its cultural fit and low resource needs, integrating this model into routine nursing practice may enhance hypertension self‑management.</p><p> </p>http://ijnmr.mui.ac.ir/index.php/ijnmr/article/view/2424http://ijnmr.mui.ac.ir/index.php/ijnmr/article/download/2424/70708011