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Title: The social determinants of chronic disease management: Perspectives of elderly patients with hypertension from low socio-economic background in Singapore
Authors: Tan, S.T 
Quek, R.Y.C 
Haldane, V 
Koh, J.J.K 
Han, E.K.L 
Ong, S.E 
Chuah, F.L.H 
Legido-Quigley, H 
Keywords: adult
attitude to illness
built environment
Chinese (language)
clinical article
community care
educational status
English (language)
environmental factor
ethnic group
financial deficit
health care access
health care need
healthy lifestyle
lifestyle modification
Malay (language)
patient compliance
physical mobility
priority journal
professional-patient relationship
purposive sample
qualitative research
safety net hospital
social behavior
social determinants of health
social status
therapy delay
chronic disease
middle aged
very elderly
Aged, 80 and over
Chronic Disease
Ethnic Groups
Life Style
Middle Aged
Social Determinants of Health
Socioeconomic Factors
Issue Date: 2019
Citation: Tan, S.T, Quek, R.Y.C, Haldane, V, Koh, J.J.K, Han, E.K.L, Ong, S.E, Chuah, F.L.H, Legido-Quigley, H (2019). The social determinants of chronic disease management: Perspectives of elderly patients with hypertension from low socio-economic background in Singapore. International Journal for Equity in Health 18 (1) : 1. ScholarBank@NUS Repository.
Abstract: Background: In Singapore, the burden of hypertension disproportionately falls on the elderly population of low socio-economic status. Despite availability of effective treatment, studies have shown high prevalence of sub-optimal blood pressure control in this group. Poor hypertension management can be attributed to a number of personal factors including awareness, management skills and overall adherence to treatment. However, these factors are also closely linked to a broader range of community and policy factors. This paper explores the perceived social and physical environments of low socio-economic status and elderly patients with hypertension; and how the interplay of factors within these environments influences their ability to mobilise resources for hypertension management. Methods: In-depth interviews were conducted in English, Chinese, Chinese dialects and Malay with 20 hypertensive patients of various ethnic backgrounds. Purposive sampling was adopted for recruitment of participants from a previous community health screening campaign. Interviews were translated into English and transcribed verbatim. We deductively analysed leveraging on the Social Model of Health to identify key themes, while inductive analysis was used simultaneously to allow sub-themes to emerge. Results and discussion: Our finding shows that financing is an overarching topic embedded in most themes. Despite the availability of multiple safety nets, some patients were left out and lacked capital to navigate systems effectively, which resulted in delayed treatment or debt. The built environment played a significant role in enabling patients to access care easily and lead a more active lifestyle. A closer look is needed to enhance the capacity of patients with mobility challenges to enjoy equitable access. Furthermore, the establishment of community based elderly centres has enabled patients to engage in meaningful and healthy social activities. In contrast, participants' descriptions showed that their communication with healthcare professionals remained brief, and that personalised and meaningful interactions that are context and culturally specific are essential to advocate for patients' overall treatment adherence and lifestyle modification. Conclusion: Elderly patients with hypertension from lower socio-economic background have various unmet needs in managing their hypertension and other comorbidities. These needs are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity. © 2019 The Author(s).
Source Title: International Journal for Equity in Health
ISSN: 1475-9276
DOI: 10.1186/s12939-018-0897-7
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