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Seguin M, Mendoza J, Lasco G, Palileo-Villanueva LM, Palafox B, Renedo A, McKee M, Balabanova D. Strong structuration analysis of patterns of adherence to hypertension medication. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531298 PMCID: PMC9748305 DOI: 10.1016/j.ssmqr.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Achieving blood pressure control is among the highest priorities for reducing the burden of cardiovascular diseases globally. Control is poor in the Philippines, especially in socioeconomically marginalised communities. This paper explores long-term adherence to anti-hypertensive medication in these communities, identifying 4 distinct medication adherence patterns. We draw on Strong Structuration Theory to explore motivations of action for those who are consistently adherent, consistently non-adherent, and those who became more or less adherent over time. We employ longitudinal qualitative methods comprising repeat interviews and digital diaries collected over 12 months by 34 participants. Twelve participants were consistently adherent, 9 consistently non-adherent, 9 increasingly adherent, and 4 increasingly non-adherent. For the consistently adherent, positive views about prescribed medication and family support encouraged adherence. Conversely, negative views of medication and lack of family support were notable amongst the consistently non-adherent, along with resistance to accepting a 'sick' label. A shift toward positive views of medication was detected amongst those whose adherence improved, along with worsening health and increased family support. A decrease in financial resources drove some participants to become less adherent, especially if they already held negative views toward medication. This study sheds light on the variety of medication adherence patterns among poor people with hypertension in the Philippines, as well as the complex web of elements influencing their treatment choices. The results point to the potential for measures that address concerns about medicines and increase family support.
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Affiliation(s)
- Maureen Seguin
- The Centre for Global Chronic Conditions, The London School of Hygiene and Tropical Medicine, UK
| | - Jhaki Mendoza
- College of Medicine, University of the Philippines Manila, Philippines
| | - Gideon Lasco
- Development Studies Program, Ateneo de Manila University, Philippines.,Department of Anthropology, University of the Philippines Diliman, Philippines
| | | | - Benjamin Palafox
- The Centre for Global Chronic Conditions, The London School of Hygiene and Tropical Medicine, UK
| | - Alicia Renedo
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, UK
| | - Martin McKee
- The Centre for Global Chronic Conditions, The London School of Hygiene and Tropical Medicine, UK
| | - Dina Balabanova
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK
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Palileo-Villanueva LM, Palafox B, Amit AML, Pepito VCF, Ab-Majid F, Ariffin F, Balabanova D, Isa MR, Mat-Nasir N, My M, Renedo A, Seguin ML, Yusoff K, Dans AL, Mckee M. Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines. BMC Complement Med Ther 2022; 22:252. [PMID: 36180884 PMCID: PMC9526286 DOI: 10.1186/s12906-022-03730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines. METHODS We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension from low-income rural and urban communities in Malaysia (n = 495) and the Philippines (n = 451). We compared the prevalence, characteristics and household expenditure on TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, and five hypertension management outcomes and wellbeing. RESULTS The prevalence of TCAM use to manage hypertension was higher in the Philippines than in Malaysia (18.8% vs 8.8%, p < 0.001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries, mainly as a complement, rather than an alternative to conventional treatment. Households allocated around 10% of health spending to TCAM in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use, while belief in conventional medicine was a negative predictor. TCAM use was not strongly associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country. CONCLUSIONS A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension, despite a general lack of evidence on efficacy and safety of commonly used TCAM modalities. Recognising that their patients may be using TCAM to manage hypertension will enable health care providers to deliver safer, more patient-centred care.
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Affiliation(s)
| | - Benjamin Palafox
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Arianna Maever L Amit
- College of Medicine, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Veincent Christian F Pepito
- College of Medicine, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Fadhlina Ab-Majid
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Farnaza Ariffin
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Dina Balabanova
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mohamad-Rodi Isa
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Nafiza Mat-Nasir
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mazapuspavina My
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Maureen L Seguin
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Khalid Yusoff
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.,Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Antonio L Dans
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Martin Mckee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Lasco G, Renedo A, Mendoza J, Seguin ML, Palafox B, Palileo‐Villanueva LM, Balabanova D, McKee M. 'Doing' hypertension: Experiential knowledge and practice in the self-management of 'high blood' in the Philippines. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1167-1181. [PMID: 35929521 PMCID: PMC9540552 DOI: 10.1111/1467-9566.13503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/15/2022] [Indexed: 05/15/2023]
Abstract
Patients' embodied experiences do not always correspond to the biomedical concepts of particular diseases. Drawing from year-long fieldwork in the Philippines that involved semi-structured interviews, focus group discussions and digital diaries, we examine how individuals 'do' hypertension through their embodied experiences and the knowledge and practice that emerge from them. Drawing inspiration from Annemarie Mol's work on the notion of 'multiplicity' of disease, our analysis was informed by a commitment to privileging patients' embodied experiences and the multiple ontologies of hypertension. We find that for patients diagnosed with hypertension in the Philippines, symptoms enact illness; patients rely on their own embodied knowledge to define their illness' nature (e.g., diagnosis), experience (e.g., frequency of symptoms and non-chronicity) and praxis (e.g., self-care practices). We show how this knowledge gained from having embodied experiences of living with the disease interacts in various ways with biomedical knowledge, other diagnostic labels and clinical practices, to shape how hypertension manifests and is managed by patients. Beyond interrogating the relationship between what counts as a 'disease' and what is considered a 'symptom', our findings underscore the need to pay attention instead to the mutually co-constitutive processes of embodied experiences and disease categories in co-producing patient knowledge.
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Affiliation(s)
- Gideon Lasco
- Department of AnthropologyUniversity of the Philippines DilimanQuezon CityPhilippines
- Development Studies ProgramAteneo de Manila UniversityQuezon CityPhilippines
| | - Alicia Renedo
- Department of Global Health & DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Jhaki Mendoza
- College of MedicineUniversity of the Philippines ManilaManilaPhilippines
| | - Maureen L. Seguin
- Centre for Global Chronic ConditionsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Benjamin Palafox
- Centre for Global Chronic ConditionsLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Dina Balabanova
- Department of Social and Environmental Health ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Martin McKee
- Centre for Global Chronic ConditionsLondon School of Hygiene and Tropical MedicineLondonUK
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Lasco G, Mendoza J, Renedo A, Seguin ML, Palafox B, Palileo-Villanueva LM, Amit AML, Dans AL, Balabanova D, McKee M. Nasa dugo ('It's in the blood'): lay conceptions of hypertension in the Philippines. BMJ Glob Health 2021; 5:bmjgh-2020-002295. [PMID: 32646854 PMCID: PMC7351273 DOI: 10.1136/bmjgh-2020-002295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Understanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management. Methods This is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines. Results Four prominent perceived causes were identified—genetics, heat, stress and diet—for what patients refer to as ‘high blood’. We propose a ‘folk physiology’ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected. Conclusions By understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patient’s beliefs and thus adherence to treatment.
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Affiliation(s)
- Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines .,Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
| | - Jhaki Mendoza
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Alicia Renedo
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Antonio L Dans
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Seguin M, Lasco G, Bin Idris K, Mendoza J, Mohd Kadri NH, Krauss S, D'Silva J, Shaffril HM, Fadzil MF, Palafox B, Renedo A, Nafiza MN, Majid F, Razak AA, Yusoff K, Palileo-Villanueva L, Dans A, Mallari E, Balabanova D, McKee M. Patient pathways for cardiovascular diseases in Malaysia and the Philippines: a systematic review. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16412.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cardiovascular diseases (CVDs) are the leading cause of premature mortality in the world and are a growing public health concern in low- and middle-income countries (LMICs), including those in South East Asia. Their management requires coordinated responses by a range of healthcare providers, which should preferably be based on knowledge of the national context. We systematically review evidence on the pathways followed by patients with CVD in Malaysia and the Philippines to understand patient journeys, along with the barriers at each stage. Methods: We searched seven bibliographic databases and grey literature sources to identify material focused on the pathways followed by patients with CVD in Malaysia and the Philippines, and performed a narrative synthesis. Results: The search yielded 25 articles, 3 focused on the Philippines and 22 on Malaysia. Most articles were quantitative analyses that focused on hypertensive patients. Three examined secondary prevention post myocardial infarction, and one each examined acute myocardial infarction, heart failure, and atrial fibrillation. Reported barriers reflected capability (knowledge of behaviours to achieve control or the capacity to conduct these behaviours), intention (attitudes or motivations toward the behaviours to achieve control), and aspects of the health care system (availability, accessibility, affordability and acceptability of services). Conclusions: There are large gaps in our understanding of patient pathways in Malaysia and the Philippines that limit the development of evidence-based strategies to effectively address the CVD burden in South East Asian countries and in LMICs more broadly. Addressing these evidence gaps will require longitudinal mixed-methods studies following patients from initial diagnosis to long-term management.
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Palafox B, Renedo A, Lasco G, Palileo‐Villanueva L, Balabanova D, McKee M. Maintaining population health in low- and middle-income countries during the COVID-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health 2021; 26:20-22. [PMID: 32985024 PMCID: PMC7537160 DOI: 10.1111/tmi.13498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community health workers in low- and middle-income country primary health care systems are well suited to perform essential functions on the frontlines of Covid-19 pandemic responses. However, clear and coordinated guidance, updated infection control training, and reliable access to personal protective equipment must be ensured in order to deploy them safely and effectively. With these additional responsibilities, community health workers must also be supported to ensure that hard-fought gains in population health, including progress on non-communicable diseases, are sustained throughout the pandemic.
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Affiliation(s)
- Benjamin Palafox
- Faculty of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Alicia Renedo
- Faculty of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Gideon Lasco
- Department of AnthropologyUniversity of the Philippines DilimanQuezon CityPhilippines
| | | | - Dina Balabanova
- Department of Global Health & DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Martin McKee
- Faculty of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
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Balane MA, Palafox B, Palileo-Villanueva LM, McKee M, Balabanova D. Enhancing the use of stakeholder analysis for policy implementation research: towards a novel framing and operationalised measures. BMJ Glob Health 2020; 5:e002661. [PMID: 33158851 PMCID: PMC7651378 DOI: 10.1136/bmjgh-2020-002661] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Policy is shaped and influenced by a diverse set of stakeholders at the global, national and local levels. While stakeholder analysis is a recognised practical tool to assess the positions and engagement of actors relevant to policy, few empirical studies provide details of how complex concepts such as power, interest and position are operationalised and assessed in these types of analyses. This study aims to address this gap by reviewing conceptual approaches underlying stakeholder analyses and by developing a framework that can be applied to policy implementation in low-and-middle income countries. METHODS The framework was developed through a three-step process: a scoping review, peer review by health policy experts and the conduct of an analysis using key informant interviews and a consensus building exercise. Four characteristics were selected for inclusion: levels of knowledge, interest, power and position of stakeholders related to the policy. RESULT The framework development process highlighted the need to revisit how we assess the power of actors, a key issue in stakeholder analyses, and differentiate an actor's potential power, based on resources, and whether they exercise it, based on the actions they take for or against a policy. Exploration of the intersections between characteristics of actors and their level of knowledge can determine interest, which in turn can affect stakeholder position on a policy, showing the importance of analysing these characteristics together. Both top-down and bottom-up approaches in implementation must also be incorporated in the analysis of policy actors, as there are differences in the type of knowledge, interest and sources of power among national, local and frontline stakeholders. CONCLUSION The developed framework contributes to health policy research by offering a practical tool for analysing the characteristics of policy actors and tackling the intricacies of assessing complex concepts embedded in the conduct of stakeholder analyses.
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Affiliation(s)
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina Balabanova
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
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8
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Mallari E, Lasco G, Sayman DJ, Amit AML, Balabanova D, McKee M, Mendoza J, Palileo-Villanueva L, Renedo A, Seguin M, Palafox B. Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines. BMC Health Serv Res 2020; 20:860. [PMID: 32917203 PMCID: PMC7488850 DOI: 10.1186/s12913-020-05699-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC, launching the Barangay (village) Health Worker (BHW) programme in the early 1980s, yet little is known about the factors that motivate and sustain BHWs’ largely voluntary involvement. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines. Methods This cross-sectional qualitative study draws on 23 semi-structured interviews held with BHWs from barangays in Valenzuela City (urban) and Quezon province (rural). A mixed inductive/ deductive approach was taken to generate themes, which were interpreted according to a theoretical framework of community mobilisation to understand how characteristics of the social context in which the BHW programme operates act as facilitators or barriers for community members to volunteer as BHWs. Results Interviewees identified a range of motivating factors to seek and sustain their BHW roles, including a variety of financial and non-financial incentives, gaining technical knowledge and skill, improving the health and wellbeing of community members, and increasing one’s social position. Furthermore, ensuring BHWs have adequate support and resources (e.g. allowances, medicine stocks) to execute their duties, and can contribute to decisions on their role in delivering community health services could increase both community participation and the overall impact of the BHW programme. Conclusions These findings underscore the importance of the symbolic, material and relational factors that influence community members to participate in CHW programmes. The lessons drawn could help to improve the impact and sustainability of similar programmes in other parts of the Philippines and that are currently being developed or strengthened in other LMICs.
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Affiliation(s)
- Eunice Mallari
- College of Medicine, University of the Philippines - Manila, Metro Manila, Philippines
| | - Gideon Lasco
- Department of Anthropology, University of the Philippines - Diliman, Quezon City, Philippines
| | - Don Jervis Sayman
- College of Medicine, University of the Philippines - Manila, Metro Manila, Philippines
| | - Arianna Maever L Amit
- College of Medicine, University of the Philippines - Manila, Metro Manila, Philippines
| | - Dina Balabanova
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Martin McKee
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Jhaki Mendoza
- College of Medicine, University of the Philippines - Manila, Metro Manila, Philippines
| | | | - Alicia Renedo
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Maureen Seguin
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Benjamin Palafox
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Seguin ML, Rangnekar A, Renedo A, Palafox B, McKee M, Balabanova D. Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases. BMJ Glob Health 2020; 5:e002464. [PMID: 32928800 PMCID: PMC7490945 DOI: 10.1136/bmjgh-2020-002464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/04/2022] Open
Abstract
The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks.
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Affiliation(s)
- Maureen L Seguin
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Avanti Rangnekar
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Alicia Renedo
- Social and Environmental Health Research, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Benjamin Palafox
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Dina Balabanova
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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10
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Castillo-Carandang NT, Buenaventura RD, Chia YC, Do Van D, Lee C, Duong NL, Ng CH, Robles YR, Santoso A, Sigua HS, Sukonthasarn A, Tan R, Viora E, Zakaria H, Brizuela GE, Ratnasingham P, Thomas M, Majumdar A. Moving Towards Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations from a Review and Multidisciplinary Expert Panel. Risk Manag Healthc Policy 2020; 13:803-819. [PMID: 32765135 PMCID: PMC7371561 DOI: 10.2147/rmhp.s256165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in the Association of Southeast Asian Nations (ASEAN) member states. Progress has been slow despite the World Health Organization action plan for the prevention and control of NCDs in the region. This paper presents recommendations focused on practical strategies for optimizing NCD management in the ASEAN region. Methods A multidisciplinary group of experts from six ASEAN member states convened for two face-to-face meetings to discuss barriers and possible recommendations for optimizing NCD management, focused on cardiovascular diseases and mental disorders, in the region. Multiple approaches, ie, analysis of insights from the meetings and a review of existing literature on NCD programs in the ASEAN region were followed. The proposed recommendations were also based on selected successful interventions in ASEAN member states, thus providing actionable strategies. Results The gaps identified in NCD management for cardiovascular diseases and mental disorders in the ASEAN region were classified into gaps relating to policies and to clinical and public health practice. The proposed solutions addressing policy gaps include fostering multisectoral public–private partnerships, employing “whole-of-government” and “whole-of-society” approaches and promoting “health-in-all policies approach” to manage issues with financing, accessibility, efficiency and quality of health services. Whereas proposed solutions to bridge clinical and public health practice gaps entail strengthening primary care services, building the capacity of trained healthcare workers and employing collaborative care for holistic management of patients. Conclusion The scale of premature and preventable deaths from NCDs in the ASEAN region remains a serious public health concern and requires a “whole-of-system approach”. The interventions proposed in this paper build on regional collaborations and knowledge sharing to help develop a concerted and targeted response to NCDs.
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Affiliation(s)
- Nina T Castillo-Carandang
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Robert D Buenaventura
- Department of Psychiatry, Manila Theological College - College of Medicine, Manila, Philippines
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dung Do Van
- The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Ngoc Long Duong
- Department of Research, Education and Technology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yolanda R Robles
- College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology, Vascular Medicine, National Cardiovascular Centre - Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Helen S Sigua
- University of the Philippines Open University, Laguna, Philippines
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Roger Tan
- Roger Kidney Clinic, Gleneagles Hospital, Singapore
| | - Eka Viora
- Indonesia Psychiatrist Association, Jakarta, Indonesia
| | - Hazli Zakaria
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Grace E Brizuela
- Research, Development and Medical, Pfizer Upjohn, Manila, Philippines
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