PURPOSE: The main aim of this study was to develop guidelines for prevention of hypertension among adults in Hawassa City, Ethiopia. METHOD: The study used mixed methods approach. In Phase 1, a quantitative community-based comparative cross-sectional survey was used to establish the burden of hypertension and its determinant factors in the urban and peri-urban areas. The survey was meant to describe adult’s knowledge and attitudes regarding hypertension risky behaviour and its prevention. Secondly, in the qualitative phase, focus group discussion (FGD) among health care providers of selected sub-cities of the first phase of the study was conducted to explore their perspectives towards efforts exerted for the prevention of hypertension. Thirdly, based on the findings of the two phases of the study, review of literatures, the researcher’s insights and exploring expertise opinion using a Delphi technique, a guideline for hypertension prevention among adults was developed. RESULTS: The overall prevalence of hypertension was 21.2%, higher in the urban setting (24.5%) than the peri-urban (14.7%) (x2=7.81 and p-value 0.003). Fifty-five (55) of the hypertensive participants were newly screened. In the urban setting age, wealth, use of top added salt on plate, mode of transport, family history of hypertension, ever-told have diabetes and body mass index were significantly association with hypertension. In the peri-urban setting age, sex, vegetable eating habit, performing physical fitness activities and family history of hypertension showed significantly association with hypertension. Regarding knowledge of hypertension risky behaviour and prevention, 46.1% (n=282) of the respondents were with “low”, 37.6% (n=230) with “medium” and 16.3% (n=100) with “high” level of knowledge on hypertension risky behaviour and prevention. The majority of respondents demonstrated positive attitude toward perceived susceptibility and perceived severity whereas the minority had poor attitude toward their perceived benefit of applying hypertension prevention. In the qualitative study, four themes and 12 sub-themes emerged, which explored health care providers’ perspectives regarding efforts exerted for the prevention of hypertension In conclusion prevalence of hypertension is high and has become a public health problem but activities done on the prevention are minimal. Guidelines developed from this research, if utilised, will assist in lessening the burden of hypertension in Ethiopia among adults. / Health Studies / D. Litt. et Phil. (Health Studies)