| 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 | Â | - 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 | Â | - Lack of social support or counselling available for hypertension patients | - Weak civil society |
- High fat and oil diet is cheap and accessible | Â | - Lack of regulation of food and tobacco industry |