Understanding the multiple health system and contextual barriers to hypertension control: Towards a new framework and its application to the Philippines

Reducing the burden of CVD is critically important, especially among poor individuals in in LMICs, where the treatment gap is widest. In order to address this inequity, evidence is needed on the experiences of economically marginalised individuals in LMICs diagnosed with CVDs. At present, there is little focus on the experiences of such individuals as they make sequential decisions regarding their care over time. Moreover, the evidence base is hampered by the lack of a clear framework encapsulating both individual agency and societal structures in conceptualising this chronology of behaviour. We aim to address this gap by capturing patient pathways of individuals diagnosed with hypertension in Malaysia and the Philippines drawing on a framework informed by strong structuration theory (SST). This lens allows examination of the social, economic and environmental forces that influence accessibility and quality of health services available to low-income residents in LMICs.