Background
Case study setting
Methods
Sampling and recruitment
Data collection
Patients’ Characteristics | Malay | Chinese | Total | ||
---|---|---|---|---|---|
Male | Female | Male | Female | ||
Age range | |||||
55–65 | 1 | 1 | 1 | 2 | 5 |
66–75 | 1 | 2 | 1 | 4 | 9 |
75 and above | 0 | 0 | 2 | 4 | 6 |
Marital Status | |||||
Single | 1 | 0 | 1 | 1 | 3 |
Married/ Living with partner | 2 | 2 | 1 | 4 | 9 |
Divorced | 0 | 0 | 0 | 1 | 1 |
Widowed | 1 | 1 | 0 | 3 | 5 |
Not mentioned/ unclear | 0 | 0 | 1 | 1 | 2 |
Living arrangement | |||||
Living alone | 2 | 0 | 1 | 2 | 5 |
Living with partner only | 1 | 2 | 0 | 3 | 6 |
Living with partner and/or other family members (children / grandchildren / siblings) | 0 | 1 | 2 | 2 | 5 |
Living with live-in helpers | 0 | 0 | 0 | 2 | 2 |
Living with other tenants | 0 | 0 | 1 | 1 | 2 |
Employment | |||||
Full time | 0 | 0 | 1 | 0 | 1 |
Part-time | 1 | 0 | 2 | 2 | 5 |
Retired | 1 | 1 | 1 | 3 | 6 |
Unable to work due to physical conditions | 1 | 1 | 0 | 3 | 5 |
Not mentioned/ unclear | 0 | 0 | 0 | 3 | 3 |
Data analysis
Pseudonym | Sex | Ethnic |
---|---|---|
Yeok | Female | Chinese |
Gim | Female | Chinese |
Chun | Female | Chinese |
Eng | Female | Chinese |
Hock | Male | Chinese |
Kam | Female | Chinese |
Ahmad | Male | Malay |
Hapsah | Female | Malay |
Lian | Female | Chinese |
Bee | Female | Chinese |
Halimah | Female | Malay |
Keng | Female | Chinese |
Abdullah | Male | Malay |
Hua | Female | Chinese |
Meng | Male | Chinese |
Kuok | Male | Chinese |
Chuan | Male | Chinese |
Ling | Female | Chinese |
Zaid | Male | Malay |
Latifah | Female | Malay |
Reflexivity
Results
I. INDIVIDUAL LEVEL
Perceived physical and mental wellbeing
Lifestyle modification
Hypertension management
II. COMMUNITY AND INSTITUTIONAL LEVEL
Community support system
Institutional engagement
III. SOCIAL ECONOMIC STATUS
Education level
Employment
Perceived financial ability
IV. SYSTEMS AND POLICY LEVEL
Social support
Built environment
Health system factors
Discussion
Personal factors | Enabling environment | Disabling environment |
---|---|---|
Knowledge and Skills | • Good literacy contributes to better understanding. • Positive community engagement at residential areas enhances patients’ exposure and opportunities to gain knowledge and skills in managing chronic conditions. • Health information on media (Television and radio programmes, social media, and the Internet) facilitate patients’ understanding of chronic conditions. | • Generic and impersonalised health messages provided by healthcare professionals are ineffective in creating awareness. • Illiteracy or low education level may compromise patients’ understanding of their conditions. |
Management of hypertension (Lifestyle, medications, follow-ups) | • Availability of pedestrian pathway and outdoor gym at residential areas facilitate patients’ active lifestyle. • Physical activity sessions organised by NGOs for elderly at residential areas assist patients to lead active lifestyle. • Efficient public transportation system allows physically-abled patients to access care at low costs. • Good availability of polyclinics and appointment system enable patients to access care easily. | • Wheelchair-bound patients struggle to use low-cost public transports, resort to taking more expensive taxis or receiving more expensive mobile services delivered by private practitioners. • Healthcare professionals are not effective in communicating lifestyle information to empower changes. • Mistrust between some patients and healthcare professionals compromises communication, potentially leading to undetected non-adherence of medication • Side effects deter some patients from taking medications. • Some patients lack financial means to adhere to follow-up schedule. |
Financial ability to afford care | • Availability of multi-layer financial protection measure eases most patients’ burden in affording care. • Additional subsidies for chronic conditions and for eligible patients enable participants to mobilise their resources more effectively. • Being able to obtain employment post-retirement has provided some patients with income to afford medical care. | • Costs associated with seeking care, especially for immobile patients, are hindering access to health facilities. • Lack of knowledge or means to navigate available assistance contributes to compromised ability to afford care. • Low income results in low MediSave funds which essentially depletes quickly when patients have co-morbidities. |