Multiple Chronic Conditions Associated With Higher Knowledge but Not Improved Care-Seeking

A cross-sectional survey examining chronic disease management among low-wage male migrant workers in Singapore has revealed that having multiple chronic conditions is associated with higher disease knowledge and more positive attitudes toward treatment, yet does not lead to improved care-seeking behaviour. These three conditions, collectively termed the 3Hs, represent major global health concerns that pose heightened risks to low-wage migrant workers due to sociocultural, economic, and lifestyle factors. Despite these risks, research exploring how this demographic navigates long-term chronic illness in host countries has historically remained limited.

To examine these dynamics, researchers conducted an on-site survey between September and November 2024 at a large clinic serving migrant workers in Singapore. The final study cohort comprised 356 male migrant workers who self-reported a clinical diagnosis of hypertension, hyperlipidaemia, or diabetes. Demographically, 92.4 percent of the participating workers originated from Bangladesh or India. In addition, health assessments demonstrated a considerable multi-morbidity burden within the sample, with more than two-thirds of all participants managing at least two concurrent chronic illnesses. The researchers utilized structured survey instruments alongside descriptive and logistic regression analyses to measure participant understanding of 3H symptoms, associated risk factors, disease management practices, and regular medical follow-up habits.

Overall assessment of disease knowledge revealed that 62.4 percent of the surveyed workers demonstrated a good understanding of 3H complications, risk factors, and symptoms. Nevertheless, the investigators identified critical knowledge deficits that could impair long-term disease control. A substantial proportion of workers struggled to recognize specific physical manifestations of chronic conditions and displayed limited understanding regarding the health risks associated with high dietary salt intake. Furthermore, the analysis uncovered widespread misunderstandings regarding the asymptomatic nature of hypertension, hyperlipidaemia, and diabetes, which frequently misled workers into believing that the absence of observable symptoms indicated an absence of underlying health risk.

Evaluation of participant perspectives revealed a pronounced disparity between general attitudes and daily management practices. More than half of the respondents expressed positive attitudes toward adhering to their prescribed medical regimens and recognized the importance of consistent pharmaceutical treatment. Despite these stated beliefs, 19.7 percent of the cohort reported that they were not taking their prescribed medications at all. Lifestyle modifications showed an even larger gap between medical recommendations and actual behavior, with 52 percent of the surveyed workers reporting that they had made no adjustments to their daily routines, diet, or lifestyle following their chronic disease diagnoses.

The investigation also tracked care-seeking timelines and identified the primary factors influencing whether workers returned for routine clinic visits. Among the 281 participants who successfully attended a medical follow-up visit within one month of their diagnosis or previous appointment, 49.5 percent cited direct reminders from their employers as a primary motivating factor for attending the clinic. Conversely, when workers delayed or missed scheduled follow-up appointments, the most common justification given was the complete absence of noticeable physical symptoms, reinforcing the observational finding that workers frequently equate feeling outwardly well with being clinically healthy.

Statistical modeling via logistic regression provided further insight into the factors shaping knowledge, attitudes, and care-seeking actions. Workers managing multiple conditions had significantly higher odds of demonstrating strong health knowledge (odds ratio [OR] = 1.85, 95% confidence interval [CI] 1.14 to 3.06, p = 0.01) and maintaining positive attitudes toward adherence (OR = 1.95, 95% CI 1.21 to 3.18, p = 0.01). However, this increase in awareness and outlook did not produce a corresponding improvement in action, as multiple diagnoses showed no significant association with improved care-seeking behaviour scores.

Reflecting on these findings, the study authors concluded that positive attitudes toward medication and medical check-ups do not automatically translate into routine healthcare utilization for migrant laborers. Because employer reminders played a pivotal role for nearly half of the workers who achieved timely follow-up, sustained employer involvement represents an essential structural enabler for healthcare access in this population. The researchers emphasized that future public health initiatives must move beyond general awareness campaigns to implement culturally tailored health education programs that specifically address asymptomatic disease progression and dietary risks, paired with formalized workplace support to foster equitable chronic disease management.

Subject of Research: Chronic disease management and care-seeking behaviours among migrant workers

Article Title: Knowledge, attitudes and care-seeking behaviours related to chronic disease management among migrant workers in Singapore: a cross-sectional study

Article References: Aw, V. Z. J., Chan, S.-E. J., Talib, H., Fook-Chong, S., Ong, M. E. H., & Yoon, S. (2026). Knowledge, attitudes and care-seeking behaviours related to chronic disease management among migrant workers in Singapore: a cross-sectional study. BMC Public Health. https://doi.org/10.1186/s12889-026-30119-z

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30119-z

Keywords: Migrant workers, Singapore, Hypertension, Hyperlipidaemia, Diabetes, Chronic disease management, Care-seeking behaviour, Medication adherence, Health knowledge, Follow-up appointments, Cross-sectional survey, Employer reminders, Dietary risks, Salt intake, Asymptomatic conditions, Bangladesh, India, Health education