BACKGROUND: The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to @entity1 in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve @entity101 control in Malaysia. METHODS: A health systems appraisal was undertaken in the capital, Kuala Lumpur, and poorer-resourced rural sites in Peninsular Malaysia and Sabah. Building on two systematic reviews of barriers to @entity101 control, a conceptual framework was developed that guided analysis of survey data, documentary review and semi-structured interviews with key informants, health professionals and @entity1 . The analysis followed the @entity1 as they move through the health system, exploring the main modifiable system-level barriers to effective @entity101 management, and seeking to explain obstacles to improved access and health outcomes. RESULTS: The study highlighted the need for the proposed intervention to take account of how Malaysian @entity1 seek treatment in both the public and private sectors, and from western and various traditional practitioners, with many @entity1 choosing to seek care across different services. @entity1 typically choose private care if they can afford to, while others attend heavily subsidised public clinics. Public @entity101 clinics are often overwhelmed by numbers of @entity1 attending, so health workers have little time to engage effectively with @entity1 . Treatment adherence is poor, with a widespread belief, stemming from concepts of traditional medicine, that @entity101 is a transient disturbance rather than a permanent @entity10094 . Drug supplies can be erratic in rural areas. @entity101 awareness and education material are limited, and what exist are poorly developed and ineffective. CONCLUSION: Despite having a relatively well funded health system offering good access to care, Malaysia's health system still has significant barriers to effective @entity101 management. DISCUSSION: The study uncovered major @entity1 -related barriers to the detection and control of @entity101 which will have an impact on the design and implementation of any @entity101 intervention. Appropriate models of care must take account of the @entity1 modifiable health systems barriers if they are to have any realistic chance of success; these findings are relevant to many countries seeking to effectively control @entity101 despite resource constraints.

Understanding the modifiable health systems barriers to XXXX management in Malaysia: a multi-method health systems appraisal approach.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity10094 :: ('MESH:D058070', 'Disease') :: ['asymptomatic condition'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension', 'Hypertension']
@entity101 :: (MESH:D006973,Disease) :: ['hypertension']
