Barriers and facilitators of implementing cardiovascular health assessment in children and adolescents in primary care settings in Malaysia: a qualitative study

Cardiovascular disease (CVD) is the leading cause of death in Malaysia, with risk factors emerging in childhood. The American Heart Association’s Life’s Essential 8 defines cardiovascular health (CVH) through eight factors: diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, cholesterol, and glucose. While CVH assessment in primary care is critical for long-term CVD prevention, insights from low- and middle-income countries, including Malaysia, remain limited. This study aimed to explore the barriers and facilitators of implementing CVH assessment in children and adolescents in the Malaysian primary care settings.

We conducted a qualitative study using semi-structured interviews with policymakers, healthcare professionals (HCPs), adolescents (12–18 years), and parents of children (5–11 years). Data were analysed using directed content analysis guided by the Tailored Implementation for Chronic Diseases (TICD) framework.

Interviews with 51 participants identified multilevel barriers across system, provider, and patient levels. Policymakers and HCPs highlighted limited school health and primary care capacity, resource constraints, insufficient paediatric-specific training, and fragmented care coordination. HCPs perspectives reflected variation in perceived feasibility, with some expressing concerns regarding implementation complexity and competing priorities. Parents and adolescents reported a low perceived need for screening, fear of procedures, and stigma. Facilitators included alignment with existing adolescent health programmes, perceived feasibility when integrated into existing workflows, and opportunities for task-sharing and community engagement, although these were often dependent on local resources and coordination.

Implementation of CVH assessment is shaped by interacting system-, provider-, and patient-level factors within a broader healthcare orientation. Supporting implementation requires enhancing paediatric-specific training, enabling task-shifting, and integrating CVH assessment into routine workflows. Improved referral pathways, care coordination, and integration into existing adolescent health programmes may further facilitate uptake in primary care.