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Table 3 Barriers to hypertension control in Malaysia

From: Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach

 

Community and household level

Health service delivery level

Health sector policy and governance level

Environmental and contextual characteristics

Hypertension clinical management

- Health beliefs leading to non-adherence to drugs

- Lack of routine screening

- Lack of effective public awareness campaigns

- Lack of understanding of access issues from a patient perspective

- Supplementary use of traditional therapies, sometimes leading to discontinuation of Western medication

- Lack of follow-up from community outreach activities

- Lack of incentives for health staff or clinics to improve quality of management or care

- Weak response to risk factors for hypertension, such as food industry regulation

- Patients seeking care across public, private and TCM providers, disrupting continuity of care

- Little time with patients for effective counselling and management

- Lack of continuity of care between and within public and private sector

- Lack of regulation of TCM

- Failure to dispense enough medications to last between check-ups

 

- Lack of evidence for TCM

- Overburdened public health system puts pressure on resources due to private sector dumping

- Clinics are not open out of working hours

External issues

- Access to clinics due to transport or working hours

 

- Lack of social support or counselling available for hypertension patients

- Weak civil society

- High fat and oil diet is cheap and accessible

 

- Lack of regulation of food and tobacco industry

  1. Source: Authors’ assessments, using a structure adapted from Hanson et al., [53]