Responsive and Equitable Health Systems—Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines

Abstract

IntroductionHypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients’ sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts.Methods and analysisThe study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24–30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20–25 participants per community 12–18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers).Ethics and disseminationEthical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and ‘digital stories’ coproduced with research participants.

Nasa dugo(‘It’s in the blood’): lay conceptions of hypertension in the Philippines

“…25 We draw on qualitative data gathered in the mixed-method longitudinal Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) project which examines patient pathways and barriers to hypertension care in the Philippines and Malaysia. 26 The Filipino qualitative data consist of 71 semistructured interviews with hypertensive patients (40 initial, 31 follow-up after 12 months) and four FGDs with 33 patients aged 35-70 years old in low-income communities in Valenzuela City (urban) and Quezon Province (rural). Those who signified interest in participating in the qualitative study were gathered from a quantitative database of 620.…”

“…The mixed-method RESPOND project, within which the current paper is situated, actively engaged with stakeholders and community representatives including patient groups, during the project inception phase to identify major challenges faced by poor and hard-to-reach populations, along with cultural considerations which may impact the study. 26 This engagement was maintained and strengthened throughout the field work phase of the project.…”

Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases

“…We propose that a framework drawing on elements from SST may overcome these deficits. The RESPOND study 3 is doing this by applying SST concepts to examine hypertensive patient pathways in Malaysia and the Philippines.…”

“…Representatives for neither patients nor the public were involved in developing this paper. However, they were extensively involved in the wider study, 3 which prompted this review.…”

“… 2 This is the approach taken by the ‘Responsive and Equitable Health Systems—Partnership on Non-communicable Diseases’ (RESPOND) study, which aims to holistically explore pathways of hypertensive patients in Malaysia and the Philippines. 3 Achieving this aim requires a critical analysis of existing frameworks which attempt to capture pathways of patients diagnosed with CVDs.…”