Hypertension Management and Lifestyle Changes Following Screening for Hypertension in an Asian Low Socioeconomic Status Community: A Prospective Study

Objective: This study investigated the extent to which the efficacy of a hypertension awareness programme in Singapore may differ based on age, gender, race and housing type (as proxy for income). Method: Pre- and post-programme survey responses on blood pressure (BP) knowledge and beliefs from 9,960 grade 5 students were assessed. Post-programme responses from 5,361 adult family members were also evaluated. Results: Female students were more likely to show better BP knowledge and beliefs. As compared to Chinese students, Malay students had lower levels of BP knowledge and attitudes, while Indian students possessed stronger attitudes. Programme efficacy among students in the most affordable housing was the least favourable. In the adult family member sample, Malay and Indian adults had higher self-confidence and intention to measure their BP in the future than the Chinese. Adult respondents in the most affordable housing possessed the least favourable beliefs towards BP measurement. Older adults, men, Malays and residents in affordable housing types had higher odds of being found with hypertension when tested at home. Conclusion: Despite the same hypertension education programme being implemented, disparities in programme impact were apparent in both student and adult sample across race, housing type and, to a lesser extent, gender. Future interventions should consider these disparities when developing health education programmes.

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Disparities in the impact of a community hypertension education programme across age, gender, race and housing type

Lwin

Malik

Kang

et al. 2018

Health Education Journal

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Factors associated with emergency room visits and hospitalisation amongst low-income public rental flat dwellers in Singapore

et al. 2019

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Background In Singapore, a densely urbanised Asian society, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. Staying in a public rental flat is associated with higher hospital readmission rates and poorer access to health services. We sought to examine sociodemographic factors associated with hospital admissions and emergency room visits amongst public rental flat residents. Methods We surveyed all residents aged ≥60 years in a public rental housing precinct in central Singapore in 2016. Residents self-reported their number of emergency room visits, as well as hospitalisations, in the past 6 months. We obtained information on residents’ sociodemographic characteristics, medical, functional and social status via standardised questionnaires. We used chi-square to identify associations between emergency room visits/hospitalisations and sociodemographic characteristics, on univariate analysis; and logistic regression for multivariate analysis. Results Of 1324 contactable residents, 928 participated in the survey, with a response rate of 70.1%. A total of 928 residents participated in our study, of which 59.5% were male (553/928) and 51.2% (476/928) were ≥ 70 years old. Around 9% (83/928) of residents had visited the emergency room in the last 6 months; while 10.5% (100/928) had been admitted to hospital in the past 6 months. On multivariable analysis, being religious (aOR = 0.43, 95%CI = 0.24–0.76) and having seen a primary care practitioner in the last 6 months (aOR = 0.46, 95%CI = 0.27–0.80) were independently associated with lower odds of emergency room visits, whereas loneliness (aOR = 1.96, 95%CI = 1.13–3.43), poorer coping (aOR = 1.72, 95%CI = 1.01–3.03) and better adherence (aOR = 2.23, 95%CI = 1.29–3.83) were independently associated with higher odds of emergency room visits. For hospitalisations, similarly poorer coping (aOR = 1.85, 95%CI = 1.12–3.07), better adherence (aOR = 1.69, 95%CI = 1.04–2.75) and poorer functional status (aOR = 1.85, 95%CI = 1.15–2.98) were all independently associated with higher odds of hospitalisations, whereas those who were religious (aOR = 0.62, 95%CI = 0.37–0.99) and those who were currently employed (aOR = 0.46, 95%CI = 0.37–0.99) had lower odds of being hospitalised. Conclusion In this public rental flat population, functional status, coping and adherence, and having a religion were independently associated with emergency room visits and hospitalisation. Residents who had seen a primary care practitioner in the last 6 months had lower odds of visiting the emergency room.

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Challenges and opportunities in the continuity of care for hypertension: a mixed-methods study embedded in a primary health care intervention in Tajikistan

Chukwuma

Gong

Latypova

et al. 2019

BMC Health Serv Res

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BackgroundHypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of hypertension case detection and retention in care within Tajikistan’s primary health care system, and to identify challenges and appropriate solutions.MethodsOur mixed methods study drew on the cascade of care framework to examine patient progression through the recommended stages of hypertension care. We triangulated data from household surveys and facility registries within Tajikistan’s Health Services Improvement Project (HSIP) to describe the cascade. Focus group discussions with local HSIP stakeholders identified the barriers to and facilitators for care. Drawing on global empirical evidence on effective interventions and stakeholder judgments on the feasibility of implementation, we developed recommendations to improve hypertension service delivery that were informed by our quantitative and qualitative findings.ResultsWe review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about 10% have been diagnosed in Khatlon and only 5% in Sogd. Barriers to case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increase provider supply, and introducing job aids for providers.ConclusionsTranslating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery challenges.

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Hypertension Management and Lifestyle Changes Following Screening for Hypertension in an Asian Low Socioeconomic Status Community: A Prospective Study

Cited by 9 publications

References 26 publications

Disparities in the impact of a community hypertension education programme across age, gender, race and housing type

Disparities in the impact of a community hypertension education programme across age, gender, race and housing type

Factors associated with emergency room visits and hospitalisation amongst low-income public rental flat dwellers in Singapore

Challenges and opportunities in the continuity of care for hypertension: a mixed-methods study embedded in a primary health care intervention in Tajikistan

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