Article Text

Download PDFPDF

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
  1. Benjamin Palafox1,
  2. Maureen L Seguin1,
  3. Martin McKee1,
  4. Antonio L Dans2,
  5. Khalid Yusoff3,4,
  6. Christine J Candari2,
  7. Khairuddin Idris5,
  8. Johan Rizwal Ismail4,
  9. Steven Eric Krauss5,
  10. Gideon Lasco6,
  11. Fadhlina A Majid4,
  12. Lia M Palileo-Villanueva2,
  13. Azlina A Razak3,
  14. Alicia Renedo7,
  15. Dina Balabanova1
  1. 1 Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 College of Medicine, University of the Philippines Manila, Manila, Philippines
  3. 3 Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
  4. 4 Centre for Translational Research and Epidemiology, Faculty of Medicine, University Teknologi MARA, Shah Alam, Malaysia
  5. 5 Institute for Social Science Studies, University Putra Malaysia, Serdang, Malaysia
  6. 6 Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
  7. 7 Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Mr Benjamin Palafox; benjamin.palafox{at}


Introduction Hypertension 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 analysis The 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 dissemination Ethical 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.

  • hypertension
  • health systems
  • cardiovascular disease
  • malaysia
  • philippines

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from


  • BP and MLS contributed equally.

  • Contributors BP, MM, DB, AR, ALD and KY conceptualised the study. All authors contributed to the development of study design. They also read, edited and approved the final version. MS and BP contributed equally to the first draft of the manuscript.

  • Funding This study is supported by a grant from the Wellcome Trust/Newton Fund-MRC Humanities & Social Science Collaborative Award scheme (200346/Z/15/Z).

  • Competing interests ALD, KY, JRI, FAM and LMP-V have been and/or are currently involved in clinical trials of antihypertensive medications that receive some funding from industry.

  • Patient consent Not required.

  • Ethics approval The London School of Hygiene and Tropical Medicine Observational Research Ethics Committee, the Ethics Committee for Research Involving Human Subjects—Universiti Putra Malaysia and the University of the Philippines Manila Research Ethics Board Panel 1.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.