Abstract
<title>Abstract</title> <p> Non-communicable diseases risks are rising among women in Sub-Saharan Africa, yet localized community prevention data remain limited. This community-based, cross-sectional study assessed knowledge, attitudes, and engagement in preventive care practices for diabetes and hypertension among 301 adult women residing in Kilimanjaro, Tanzania. Data was collected using a structured, interviewer-administered questionnaire adapted from validated KAP and WHO-STEPwise instruments. Composite binary scores were constructed for knowledge, attitudes, and preventive practices. Logistic regression analyses were performed using IBM SPSS V27.0 to identify predictors of engagement in preventive care practices. Pearson correlation and linear regression were used as sensitivity analyses. Statistical significance was kept at 0.05. Most participants demonstrated poor knowledge of hypertension (61.5%) and diabetes (54.5%), with knowledge of non-modifiable risk factors and disease complications being particularly limited. Health-seeking behaviors were relatively common, while sustained lifestyle practices such as regular physical activity (36.9%) and avoidance of refined sugar (34.6%) were infrequent. In multivariable analysis, asset ownership was the only independent predictor of engagement in preventive care practices (aOR = 1.71, 95% CI: 1.01–2.89, <italic>P</italic> = 0.046). Interventions need to move beyond health education to integrate structural strategies that address financial barriers, expand healthcare access, and create supportive environments for sustained behavior change. </p>