Consensus on Values and Priorities on Advancing Women’s Health in Malaysia

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Rapid urbanization and an obesogenic environment have contributed to the steady increase in diabetes, obesity and cancers in Malaysian women. In addition to the rising non communicable diseases, significant knowledge gaps remain for reproductive health in this country with limited data on what would be expected to be common conditions such as endometriosis, pelvic pain, infertility, incontinence and polycystic ovary syndrome. Amidst the growing plethora of topic areas in women’s health, it is unclear which should be prioritised for immediate research investments. The aim of this study was to understand the gaps and opportunities in women’s health translational research in Malaysia. This priority-setting exercise identified the key values, principles and research priorities for women’s health in Malaysia through the engagement of health professionals and women with lived experience through a modified Delphi and Nominal Group Technique. Five principles and values and eight priorities were identified. The highest ranked value and principle for women’s health was community education that addresses health literacy, engagement and empowerment, which uphold the autonomy and dignity of women. The highest-ranked health priority was diabetes, which includes healthy weight and lifestyle. Gaps and opportunities include building intersectoral partnerships, addressing equitable access to reproductive services, integrating data systems to enable access, and strengthening research support services such as biostatistics, health economics, legal, financial and ethical support. Addressing these gaps and opportunities would accelerate progress in women's translational health research in Malaysia. Women’s health Malaysia priority consensus Figures Figure 1 Introduction The ultimate aim of health and social care research is to improve wellbeing, policy and care. It is therefore crucial that research should address questions that are relevant to policy makers, health and social care practitioners and individuals. Malaysia is a Muslim majority, multiethnic country classified as upper middle income with a population of 34.1 million (2023), of whom 48% are women 1 . There has been significant progress in some areas of women’s health in Malaysia, notably in reducing maternal mortality, now one of the lowest in the region, at 26 per 100,000 live births in 2023 2 . This has largely been due to long term investment in developing rural health services, a comprehensive continuum of care starting from pre-pregnancy planning, and the widespread availability of quality obstetric care provided by skilled, trained professionals. These strategic investments in public health infrastructure and services, combined with socioeconomic development and systems for monitoring maternal deaths, have successfully reduced preventable maternal deaths. However, this rate has remained static in recent years 2 . The plateau reflects a combination of persistent rural and geographical disparities, healthcare system limitations, and social and religious barriers such as marginalisation or exclusion of unmarried women, adolescents and gender diverse individuals 3 . Significant gaps remain in the understanding of reproductive health in this country across the life stages, with limited data on what would be expected to be common conditions such as endometriosis, pelvic pain, infertility, incontinence and polycystic ovary syndrome. In addition to these sexual and reproductive health issues, the rising rates of non-communicable diseases pose additional risks to the health of women in Malaysia. Malaysia experienced accelerated urbanisation in recent years, with an estimated 75% of people living in urban areas in 2022 4 . Malaysian women's participation in the labour market has increased but significant gender income inequality remains an issue, with women often occupying lower-paid jobs and industries 5 . Rapid urbanization, along with low health literacy and an obesogenic environment, contributed to the steady increase in the prevalence of diabetes, obesity and cancers in the country 6 . An estimated 15% of women in Malaysia have diabetes 7 , although this is likely an underestimate as up to 40% of those with diabetes are undiagnosed 8 . Data from the National Health and Morbidity Survey 2019, reported that 55% of women in Malaysia experience excess body weight, and females have a 33% increased chance of having excess body weight compared to males 9 . The highest prevalence is seen among those with lower education levels and lower income (B40) groups 8 . Addressing the complex and systemic issues in women’s health exacerbated by high prevalence of these NCDs therefore requires targeted interventions and improved healthcare accessibility for high-risk or underserved groups. Malaysia has a dual-tiered healthcare system: a government-led and funded public sector, and a thriving private sector 10 . The government is committed to the principle of universal healthcare through a public healthcare system that is heavily subsidised by the federal government, accessible through a small contribution by individuals. Women’s health care is included in this model although service gaps exist—gender-based violence support, cancer screening, fertility care and safe abortion are not typically included or are difficult to access. Further, lack of awareness, stigma, religious norms contribute to unequal access to these services 11 , 12 . In recent years, Malaysia has seen an acceleration of research strengths within their local universities and through international campuses in addressing knowledge and implementation gaps in women’s health. There are also initiatives by government and non-government organisations advancing women’s health. However, the strengths and opportunities across these sectors have not been mapped, preventing strategic coordination of effort in tackling the complex issues that underlie women’s health in this country. Therefore, this study aims to identify the gaps and opportunities in women’s health translational research in Malaysia, guiding future directions towards equitable health outcomes for all women in Malaysia. Method Study participants: Steering Committee and Delphi Panellists The composition of the Delphi panel was based on stakeholders, including health service providers and consumer groups, in the translation and implementation of women’s health clinical research. Participants were sought from academics in women’s health, clinicians from the public and private health sectors, representatives from the Malaysian Ministry of Health and consumer advocacy groups in women’s health. All participants provided online consent prior to the first Delphi survey. This study was approved by the Monash University Human Research Ethics Committee (MUHREC 42996). The priority-setting framework A modified Delphi process and Nominal Group Technique were used to determine the values and priorities 13 , 14 . The Australian Policy Prioritisation Framework was used for assessment during the priority setting process. This framework was previously used for the development of Australian national priorities in data-driven healthcare improvement and women’s health 15 . The framework offered nine criteria (9Ps) for priority assessment 15 . Table 1 Priority setting framework (9Ps) 15 Criteria Definition Criteria 1. Prevalence or burden attributable to the proposed problem Consider the prevalence or attributable burden of the problem and its implications/complications. Is the problem a significant issue for the community, health system and key stakeholders? Criteria 2: Prevention Is there potential to prevent the problem, including complications or secondary impacts, in the general population or in a specific vulnerable target cohort? Criteria 3: Position Consider the geographical issues around the problem and the location of services/expertise. Are there inequities that can be improved through this initiative? Is there potential to improve health outcomes for the general population and/or regional populations and/or specific vulnerable target cohorts? Criteria 4: Provision Does the current approach or system align with evidence-based best practice? Is the current approach designed to deliver the best possible community health outcomes and health care system? Is there a clear gap to address in the area proposed? Criteria 5: Potential Is there a strong rationale/evidence base for the potential for improvement in patient outcomes and health system advancement through this initiative? Criteria 6: Participation Is a collaborative approach critical to success? Are there clear drivers for stakeholders to engage and collaborate? Are there existing relationships between stakeholders that can be leveraged to drive improvement and change? Criteria 7: Policy Does the problem or the potential solution align with current policy directions at a local, state, national or international level? Criteria 8: Proposed Strategy Does the proposal align with the women’s health strategy endorsed by the Malaysian Health Coalition, Women’s Aid Organisation and Obstetrical and Gynaecological Society of Malaysia (OGSM)? Criteria 9: Proposed Transformation Will addressing this problem or taking this approach collaboratively support the development of an improved health system and health outcomes? Priority-setting process This study involved a four-step consensus process involving a pre-workshop Delphi survey, a consensus workshop, a post-workshop Delphi survey, and final endorsement. The multi-step process is outlined in Fig. 1 . The initial list of values and research priority areas was derived from the Australian Health Research Alliance and adapted for the Malaysian setting (Supplementary Tables 1 and 2). 16 At the pre-workshop Delphi survey and the consensus workshop, participants had the opportunity to rank, change, or add the principles and priorities. The Delphi surveys were anonymous. Mean ranking scores were calculated for each principle or priority, with lower scores representing higher priority. The results of Delphi Survey 1 were presented at the consensus workshop. During the workshop, participants discussed the relative importance of each item and whether items should be changed, merged or split into further items. The updated list of items was provided in Delphi Survey 2 to be ranked by the participants. The final list was provided to the group for endorsement and minor refinement of wording. Following the priority-setting discussions, the group discussed strategic plans for women’s health research in Malaysia. In small group discussions, participants considered the following topics: current research strengths, challenges and needs and visions for a flourishing women’s health research community in Malaysia. These were reported back to the larger group for further consensus discussion and the final themes were collated. Demographic characteristics of the participants were presented in frequencies and proportions. Rankings were determined as the average of scores (mean) provided by the participants. Quantitative analyses were conducted in Microsoft Excel 2019. Results Characteristics of the Delphi panel The Delphi panel included a diverse group of representatives from a range of disciplines and professions (Table 2 ). Of 26 panellists, 21 (81%) completed Delphi survey 1, all (100%) attended the consensus meeting, and all (100%) completed Delphi survey 2. Table 2 Characteristics of panellists Characteristic Number Gender Male 6 Female 19 Other 1 Group representation Research 11 Public health 5 General practice 2 Obstetrics/gynaecology 5 Nursing/midwifery 3 Policy 2 Psychology/counselling 3 Social care 4 Government 1 NGO 5 Other medical profession 3 Consumer 1 Consumer advocacy 3 Values and principles in Delphi Survey 1, consensus meeting and Delphi Survey 2 For values and principles, Delphi Survey 1 found ‘primary, secondary and tertiary prevention across all research priorities’ being ranked as the highest priority, followed by ‘community education, engagement and empowerment’, and ‘women in their lived environment including social determinants (Supplementary Table 3)’. Health literacy was merged into the Community Education item in the consensus workshop. Empowerment was also expanded to include the promotion and preservation of women’s autonomy and dignity. The concept of social determinants of health was merged with equity for priority and vulnerable populations, with the addition of highlighted populations including those from Indigenous, migrant and refugee backgrounds, gender diverse individuals, those in rural and regional areas, and key life stages of adolescence and ageing. This item was also expanded to include a multilevel approach as a solution. The item on translation and impact was reworded to ‘Implementation, impact and sustainability, including monitoring and evaluation, translation and dissemination. The final consensus on the prioritised values and principles for women’s health in Malaysia is as shown in Table 3 . The highest ranked value and principle was ‘Community education, health literacy, engagement and empowerment (including autonomy and dignity)’, as education, awareness and literacy was seen as the most important gap. The second highest ranked value and principle was prevention of disease, followed by multilevel approaches to address health equity. Table 3 Final consensus of values and principles for women’s health in Malaysia 1. Community education, health literacy, engagement and empowerment (including autonomy and dignity) 2. Primary, secondary and tertiary prevention of disease across all research priorities 3. Multilevel (political, cultural, community, interpersonal, individual) approach to social determinants of health and equity (e.g. priority and vulnerable populations including Indigenous, culturally and linguistically diverse, refugee, gender diverse individuals, and those in rural and regional areas, adolescents and ageing) 4. Implementation, impact and sustainability (include monitoring and evaluation, translation and dissemination) 5. Research processes require partnership, transparency, governance, priority setting, stakeholder engagement and large-scale collaboration Research priorities in Delphi Survey 1, consensus meeting and Delphi Survey 2 For research priorities, Delphi Survey 1 found ‘chronic diseases and preventive health’ being ranked as the highest priority, followed by ‘healthy lifestyle’, and ‘preconception’ (Supplementary Table 3). During the consensus workshop, chronic disease was expanded and split into diabetes and other non-communicable diseases (NCD) together with cancer as separate items. Preconception, pregnancy and postpartum were also merged into a single item for continuity of care with a life course approach. Healthy lifestyle and obesity were merged with diabetes as these were seen as interrelated. Expanding on the life course approach, menopause and aging were suggested as additional items. The final consensus on the prioritized research topics for women’s health in Malaysia is as shown in Table 4 . The highest ranked research priority was ‘diabetes, healthy weight and lifestyle’, due to the rapidly increasing prevalence of diabetes in Malaysia. The second highest ranked priority was other NCD, followed by preconception, pregnancy and postpartum research. Table 4 Final consensus on the research priorities for women’s health in Malaysia 1. Diabetes, healthy weight and lifestyle 2. NCD apart from diabetes (including cancer) 3. Preconception, pregnancy and postpartum 4. Cancer screening and prevention 5. Mental health 6. Sexual and reproductive health 7. Perimenopause, menopause and healthy ageing 8. Violence and abuse Gaps and opportunities in women’s health research and implementation Intersectoral partnerships: The group identified highly motivated and committed leaders in healthcare, health policy and academia to address issues on women’s health research. These leaders, with appropriate systemic support, are able to facilitate the conduct of research that meets stakeholder needs and ensure translation and implementation. There are some established intersectoral partnerships between government ministries (Ministry of Education, Ministry of Health, Ministry of families), government funded and private healthcare, NGOs and universities that can be built upon, and a willingness from these sectors to build engagement in women’s health research. A number of global research funds identified would be well placed to support a middle-income country like Malaysia in women’s health research. Integrating research with government healthcare and data: Government health services collect valuable information to inform health research, evaluation and healthcare. Whilst there are good partnerships between government and clinical and public health research, simplifying systems and processes to access data, to link data and to obtain ethical approval would facilitate the integration of research and improved healthcare. Addressing cultural and religious mores and beliefs: As a Muslim majority country, cultural and religious beliefs play a significant role in reproductive health, particularly in areas such as the provision of contraception and abortion and sexual and reproductive health education. For example, practitioners in government primary healthcare are legally allowed to provide contraception to unmarried women but in reality, this was reported to often be discouraged implicitly or explicitly. There also continues to be increasing recognition of gender-diverse individuals, though societal and legal challenges remain. Research infrastructure and workforce capacity: All attendees expressed the need for research services support including: biostatistics, health economics, legal, financial and ethical support. The need for access to a skilled interpreter workforce was identified to support the undertaking of research with diverse groups of women in Malaysia’s multicultural environment, including those with migrant and refugee experiences. The importance of open access publications was discussed as many researchers are unable to access university journal databases. Conversely, while many would wish to publish their own work in open access publications the significant costs often prohibit this. Additionally, supporting clinicians to upskill in research and to have protected research time along with dedicated research fellows were noted as required to harness the strengths and coordinate effort to progress the women’s health research agenda National research network: There is a need for a national research network bringing together intersectoral partners of academics, clinicians, government and non-governmental organisations to study, plan and deliver on initiatives that address the current gaps in women’s health in Malaysia. Table 5 Vision of possibilities: Recommendations for women’s health research and implementation in Malaysia 2024–2034 Recommendation Description Intersectoral partnerships Intersectoral partnerships between government, NGO and universities are needed to address implementation gaps in women’s health. This could potentially capitalise on innovative advances such as data-driven health systems, precision medicine, digital health, climate change and others. Integrating research with government healthcare and data The establishment and maintenance of key registry databases across women’s health conditions and non communicable diseases are needed for the visibility of women’s health issues in Malaysia to inform healthcare and policy. Addressing cultural and religious mores and beliefs Barriers to women’s health service access are multifactorial, ranging from stigma and taboo, attitudes and practice of healthcare providers, cultural and religious beliefs on women reproductive health issues. Multidisciplinary collaborations are needed to address these complex problems. Research infrastructure and capacity There is a need for greater support in research support services including biostatistics, health economics, legal, financial and ethical support. Develop a national research network A network that brings together women’s health researchers across the nation could help coordinate efforts on advancing women’s health. Discussion This priority-setting exercise for women’s health in Malaysia identified the key values, principles and research priorities through the engagement of health professionals and consumers across various sectors. Five values and eight priorities were identified. The highest ranked value for women’s health was community education, health literacy, engagement and empowerment that uplifts the autonomy and dignity of women. The highest ranked priority was diabetes, healthy weight and lifestyle. Gaps and opportunities include intersectoral partnerships, cultural and religious beliefs, access to health data, and research support services such as biostatistics, health economics, legal, financial and ethical support and building capacity through a national women’s health network. The autonomy and dignity of women, advocated through community engagement and empowerment, were the highest-ranked value and principle. Community-voted priorities often reveal unmet needs 17 . In many reproductive health contexts, such as unwanted pregnancies, women were not the only actors nor do they have complete agency over the circumstances that led to the outcome 18 . Despite this, the responsibility of the pregnancy with its lifetime consequences are borne mostly by girls and women. Reproductive autonomy needs to be recognised as a societal and systemic responsibility. Change is urgently needed as the human cost to inaction is tragic. Currently, there is one abandoned baby every three days with 60% found dead, unsafe abortions contributing to 1 in 5 maternal deaths and 18,000 teenage girls become pregnant each year 19 – 21 . To address the structural and social barriers, there is a need for increased literacy and empowerment of women and girls at every socioecological level, from policy, health system, communities, families to individuals, to ensure that women and girls have the autonomy and dignity to make choices that enable their health and well-being 22 . Education and communication were identified as key health promotion strategies to address non communicable diseases in Malaysia 23 , which would also be applicable to women’s sexual and reproductive health. However, awareness in sexual and reproductive health alone will not be sufficient to bridge the gap. There are prerequisites to the actualisation of autonomy and dignity, such as equitable access to health care, education and the ability to support oneself 22 . Multi-level interventions are needed to address the complex root cause of the under-recognition of autonomy and dignity of women in health. The highest-ranked research priority area was on diabetes which included weight and healthy lifestyle. This priority reflects the stark increase in obesity and chronic diseases in Malaysia, particularly among women. The National Health and Morbidity Survey 2023 reported that over half (54%) of adults in Malaysia are overweight or obese 8 . About 1 in 6 adults in Malaysia has diabetes, and 40% of those with diabetes were undiagnosed 8 . Women have additional sex-specific risk factors for type 2 diabetes, such as gestational diabetes (GDM), which is glucose intolerance first identified during pregnancy. GDM affects one in three pregnancies in Malaysia 24 . Women with prior GDM are at 10 times increased risk of developing T2DM later in life 25 . There is increasing evidence that these pregnancy complications are indicators and accelerators of impaired maternal physiology, and therefore an important population risk marker for prevention 26 . Offspring born of GDM pregnancies are at increased risk of childhood obesity, hyperinsulinemia and metabolic syndrome, perpetuating the risk of cardiometabolic diseases diabetes in high-risk populations intergenerationally 27 . Lifestyle interventions have been shown to reduce the risk of cardiometabolic diseases, but implementation models for low- and middle-income countries such as Malaysia are lacking 28 . Taking a life course approach to non-communicable disease prevention at preconception, pregnancy and postpartum periods has also been prioritised among the top three topics by the current panel. The group voted for a multilevel approach as a value and principle to address the social determinants of women’s health. Barriers to women’s health service access are multifactorial, ranging from stigma and taboo, attitudes and practice of healthcare providers, cultural and religious beliefs on women’s reproductive health issues 29 , 30 . The generation of solutions that are respectful and responsive to all these requires leaders and experts in culture, language and religion; cross-disciplinary expertise including health psychology, medical anthropology, human rights, co-design, digital health, medical humanities; healthcare providers, and women from various backgrounds to be at the table. There is also emphasis on sustainable implementation with impact requiring intersectoral partnerships between government, NGO and university sectors to drive innovations in healthcare. Complex interventions require knowledge on the inner and outer contextual factors, key actors and processes, governance, systems, data systems that are critical to successful implementation. While interventions at all levels are required, solutions targeting systems instead of individuals will produce the greatest impact in a sustainable manner. Seeking solutions through the public-funded government services will also ensure that those experiencing social disadvantage such as the B40 or rural populations will benefit. This is important as they are over-represented in disease burden 8 . However, other solutions will need to be found to support those who are excluded from these services such as refugees. Women’s health research and services in Malaysia are ready for growth. There are local leaders with great calibre and commitment to women’s health, indicating workforce potential in women’s health research, leveraging the growing partnerships of local research institutions and international campuses in Malaysia. The potential of short-medium term gains is considerable: the infrastructure of primary care is well-developed for nation-wide scale-up of initiatives that will provide care to the most socially disadvantaged (B40) in the country, including women in rural areas and those with minimum income. Intersectoral partnerships and health systems innovations including in digital health could place Malaysia as a leading example of women’s health in the region. Conclusion This priority-setting activity places the upholding of women’s autonomy and dignity through community education and the prevention of non-communicable disease such as diabetes at the forefront of women’s health in Malaysia. Intersectoral partnerships, integration of health data and negotiating solutions within religious and cultural beliefs would accelerate the progress towards equitable health outcomes for women in Malaysia. Declarations Ethics approval and consent to participate This study was approved by the Monash University Human Research Ethics Committee (MUHREC 42996), in accordance with the provisions of the National Statement on Ethical Conduct in Human Research 2025. Consent for publication Not applicable. The study did not include any individual identifiable data, images, or personal information requiring consent for publication. Informed consent Informed consent was obtained from all participants prior to their inclusion in the study. Participation was voluntary, and participants were informed about the purpose of the study. Competing interests The authors declare no competing interests. Funding: This project did not receive funds from any funder Author Contribution Lim S and Dominic NA contributed to the main manuscript text, whilst J.A Boyle contributed to the methodology and part of the discussion. The remainder authors reviewed the manuscript. Data Availability Statement Data sharing not applicable to this study as no datasets were generated or analysed during the current study References Malaysia DoS. The Population of Malaysia. Open DOSM. Accessed May 12. 2025, https://open.dosm.gov.my/dashboard/population Bank W. Malaysia. Gender Data Portal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9007481","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627475723,"identity":"cef855d4-7034-41a8-b66b-903c0389e8d5","order_by":0,"name":"NA 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University","correspondingAuthor":false,"prefix":"","firstName":"Siew","middleName":"","lastName":"Lim","suffix":""},{"id":627475725,"identity":"0f7d880d-c7a4-43e6-8efb-c1a199840b6e","order_by":2,"name":"A Kamarulzaman","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"A","middleName":"","lastName":"Kamarulzaman","suffix":""},{"id":627475726,"identity":"3ed1933a-cd9f-4a17-bfbd-e544bd5a5b9c","order_by":3,"name":"VJT Arasoo","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"VJT","middleName":"","lastName":"Arasoo","suffix":""},{"id":627475727,"identity":"9681acdd-873c-48c4-acd4-67b1da2187ba","order_by":4,"name":"R Jeganathan","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"R","middleName":"","lastName":"Jeganathan","suffix":""},{"id":627475728,"identity":"e866e0e9-1bf5-4cfe-a2d4-fbafcadab2ce","order_by":5,"name":"S Verghis","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"S","middleName":"","lastName":"Verghis","suffix":""},{"id":627475729,"identity":"126bec07-549f-4464-9d9e-6d7a69420848","order_by":6,"name":"S Jayaraj","email":"","orcid":"","institution":"Klinik Rakyat PJ and Reproductive Rights Advocacy Alliance Malaysia","correspondingAuthor":false,"prefix":"","firstName":"S","middleName":"","lastName":"Jayaraj","suffix":""},{"id":627475730,"identity":"97c66ea2-1915-4a3b-94c9-b41c0a79319a","order_by":7,"name":"A Gandhi","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"A","middleName":"","lastName":"Gandhi","suffix":""},{"id":627475731,"identity":"106ac549-89c8-4dcd-845e-0b1136f29f8b","order_by":8,"name":"F Jaafar","email":"","orcid":"","institution":"Universiti Kebangsaan Malaysia","correspondingAuthor":false,"prefix":"","firstName":"F","middleName":"","lastName":"Jaafar","suffix":""},{"id":627475732,"identity":"171d275f-f693-4055-80ab-73fd39eef439","order_by":9,"name":"GRL Ramanathan","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"GRL","middleName":"","lastName":"Ramanathan","suffix":""},{"id":627475733,"identity":"f4cf15b8-3286-40b7-a9ae-c432da808f9f","order_by":10,"name":"A Subasinghe","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"A","middleName":"","lastName":"Subasinghe","suffix":""},{"id":627475734,"identity":"8891ccf4-9825-4217-b4ef-ef5921813dd8","order_by":11,"name":"Tomoko Soga","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Tomoko","middleName":"","lastName":"Soga","suffix":""},{"id":627475735,"identity":"d2fbf9da-d459-419a-b200-b4933073c585","order_by":12,"name":"M Sivalingam","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"M","middleName":"","lastName":"Sivalingam","suffix":""},{"id":627475737,"identity":"67b8cc10-ea8a-4380-abf6-464ea878ab30","order_by":13,"name":"R Ibrahim","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"R","middleName":"","lastName":"Ibrahim","suffix":""},{"id":627475738,"identity":"b63577f7-8667-47a5-a3ea-0a9432bdc60a","order_by":14,"name":"D Devi","email":"","orcid":"","institution":"Southern Cross Education Institute","correspondingAuthor":false,"prefix":"","firstName":"D","middleName":"","lastName":"Devi","suffix":""},{"id":627475739,"identity":"3e4161e8-56f5-41bf-a0d3-a57152050d74","order_by":15,"name":"F Dass","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"F","middleName":"","lastName":"Dass","suffix":""},{"id":627475740,"identity":"da8c3eaa-c50c-40d9-af94-01a0dcfd8734","order_by":16,"name":"C Niap","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"C","middleName":"","lastName":"Niap","suffix":""},{"id":627475741,"identity":"4cf81261-aebf-451b-b39a-ea3d57508b09","order_by":17,"name":"AH Abdullah","email":"","orcid":"","institution":"Hospital Sultanah Aminah","correspondingAuthor":false,"prefix":"","firstName":"AH","middleName":"","lastName":"Abdullah","suffix":""},{"id":627475742,"identity":"04ae6b91-37ea-44c1-9300-33b9c760672d","order_by":18,"name":"M Abdullah","email":"","orcid":"","institution":"Hospital Sultanah Aminah","correspondingAuthor":false,"prefix":"","firstName":"M","middleName":"","lastName":"Abdullah","suffix":""},{"id":627475743,"identity":"1ea1e833-45b8-49f0-92d1-d92782b49707","order_by":19,"name":"J Jamaludin","email":"","orcid":"","institution":"Hospital Sultanah Aminah","correspondingAuthor":false,"prefix":"","firstName":"J","middleName":"","lastName":"Jamaludin","suffix":""},{"id":627475744,"identity":"5c919b61-346f-41ca-a42f-cbc91c23993c","order_by":20,"name":"T Maisarah","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"T","middleName":"","lastName":"Maisarah","suffix":""},{"id":627475745,"identity":"994847d9-1720-41e3-a333-c440d29f7588","order_by":21,"name":"K E Kee","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"K","middleName":"E","lastName":"Kee","suffix":""},{"id":627475746,"identity":"847b086e-ac34-46f4-94b8-429d629babc4","order_by":22,"name":"A Kamarudin","email":"","orcid":"","institution":"AQ Mental Health Advisory","correspondingAuthor":false,"prefix":"","firstName":"A","middleName":"","lastName":"Kamarudin","suffix":""},{"id":627475747,"identity":"5a663158-082d-453e-a236-2ba16116be90","order_by":23,"name":"P Olivier","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"P","middleName":"","lastName":"Olivier","suffix":""},{"id":627475748,"identity":"ae912c6b-fc40-439e-9623-6b5b5e0de996","order_by":24,"name":"N Lokman","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"N","middleName":"","lastName":"Lokman","suffix":""},{"id":627475749,"identity":"6ad99374-1e61-43d7-896c-eb987ba4ecba","order_by":25,"name":"A Kukreja","email":"","orcid":"","institution":"University Malaya","correspondingAuthor":false,"prefix":"","firstName":"A","middleName":"","lastName":"Kukreja","suffix":""},{"id":627475750,"identity":"9ef6e849-d308-44ad-bdea-939404a7bc27","order_by":26,"name":"A Mukherjee","email":"","orcid":"","institution":"United Nations University International Institute of Global Health","correspondingAuthor":false,"prefix":"","firstName":"A","middleName":"","lastName":"Mukherjee","suffix":""},{"id":627475751,"identity":"e1a1eae7-9101-40c4-b940-74d0edf0c14f","order_by":27,"name":"SD Karalasingam","email":"","orcid":"","institution":"Cyberjaya University","correspondingAuthor":false,"prefix":"","firstName":"SD","middleName":"","lastName":"Karalasingam","suffix":""},{"id":627475752,"identity":"638a8d81-6681-46a1-8b6b-d3f62ade1076","order_by":28,"name":"J. A. Boyle","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"J.","middleName":"A.","lastName":"Boyle","suffix":""}],"badges":[],"createdAt":"2026-03-02 08:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9007481/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9007481/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107647782,"identity":"dfa27618-dd8e-458a-9d66-e3568a5dfdce","added_by":"auto","created_at":"2026-04-23 14:35:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59395,"visible":true,"origin":"","legend":"\u003cp\u003eThe consensus development process for women’s health priorities in Malaysia\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9007481/v1/06b9b1931849da6f71ed2a35.png"},{"id":107707826,"identity":"530b92ec-5549-47fd-b162-c508df262183","added_by":"auto","created_at":"2026-04-24 09:21:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":320277,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9007481/v1/0955c424-c7ec-4494-b4b0-1af1d388c77a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Consensus on Values and Priorities on Advancing Women’s Health in Malaysia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe ultimate aim of health and social care research is to improve wellbeing, policy and care. It is therefore crucial that research should address questions that are relevant to policy makers, health and social care practitioners and individuals. Malaysia is a Muslim majority, multiethnic country classified as upper middle income with a population of 34.1\u0026nbsp;million (2023), of whom 48% are women \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. There has been significant progress in some areas of women\u0026rsquo;s health in Malaysia, notably in reducing maternal mortality, now one of the lowest in the region, at 26 per 100,000 live births in 2023 \u003csup\u003e2\u003c/sup\u003e. This has largely been due to long term investment in developing rural health services, a comprehensive continuum of care starting from pre-pregnancy planning, and the widespread availability of quality obstetric care provided by skilled, trained professionals. These strategic investments in public health infrastructure and services, combined with socioeconomic development and systems for monitoring maternal deaths, have successfully reduced preventable maternal deaths. However, this rate has remained static in recent years \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The plateau reflects a combination of persistent rural and geographical disparities, healthcare system limitations, and social and religious barriers such as marginalisation or exclusion of unmarried women, adolescents and gender diverse individuals \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Significant gaps remain in the understanding of reproductive health in this country across the life stages, with limited data on what would be expected to be common conditions such as endometriosis, pelvic pain, infertility, incontinence and polycystic ovary syndrome. In addition to these sexual and reproductive health issues, the rising rates of non-communicable diseases pose additional risks to the health of women in Malaysia.\u003c/p\u003e \u003cp\u003eMalaysia experienced accelerated urbanisation in recent years, with an estimated 75% of people living in urban areas in 2022 \u003csup\u003e4\u003c/sup\u003e. Malaysian women's participation in the labour market has increased but significant gender income inequality remains an issue, with women often occupying lower-paid jobs and industries \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Rapid urbanization, along with low health literacy and an obesogenic environment, contributed to the steady increase in the prevalence of diabetes, obesity and cancers in the country \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. An estimated 15% of women in Malaysia have diabetes \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, although this is likely an underestimate as up to 40% of those with diabetes are undiagnosed \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Data from the National Health and Morbidity Survey 2019, reported that 55% of women in Malaysia experience excess body weight, and females have a 33% increased chance of having excess body weight compared to males \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The highest prevalence is seen among those with lower education levels and lower income (B40) groups \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Addressing the complex and systemic issues in women\u0026rsquo;s health exacerbated by high prevalence of these NCDs therefore requires targeted interventions and improved healthcare accessibility for high-risk or underserved groups.\u003c/p\u003e \u003cp\u003eMalaysia has a dual-tiered healthcare system: a government-led and funded public sector, and a thriving private sector \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The government is committed to the principle of universal healthcare through a public healthcare system that is heavily subsidised by the federal government, accessible through a small contribution by individuals. Women\u0026rsquo;s health care is included in this model although service gaps exist\u0026mdash;gender-based violence support, cancer screening, fertility care and safe abortion are not typically included or are difficult to access. Further, lack of awareness, stigma, religious norms contribute to unequal access to these services \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e In recent years, Malaysia has seen an acceleration of research strengths within their local universities and through international campuses in addressing knowledge and implementation gaps in women\u0026rsquo;s health. There are also initiatives by government and non-government organisations advancing women\u0026rsquo;s health. However, the strengths and opportunities across these sectors have not been mapped, preventing strategic coordination of effort in tackling the complex issues that underlie women\u0026rsquo;s health in this country. Therefore, this study aims to identify the gaps and opportunities in women\u0026rsquo;s health translational research in Malaysia, guiding future directions towards equitable health outcomes for all women in Malaysia.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants: Steering Committee and Delphi Panellists\u003c/h2\u003e \u003cp\u003eThe composition of the Delphi panel was based on stakeholders, including health service providers and consumer groups, in the translation and implementation of women\u0026rsquo;s health clinical research. Participants were sought from academics in women\u0026rsquo;s health, clinicians from the public and private health sectors, representatives from the Malaysian Ministry of Health and consumer advocacy groups in women\u0026rsquo;s health. All participants provided online consent prior to the first Delphi survey. This study was approved by the Monash University Human Research Ethics Committee (MUHREC 42996).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe priority-setting framework\u003c/h3\u003e\n\u003cp\u003eA modified Delphi process and Nominal Group Technique were used to determine the values and priorities \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The Australian Policy Prioritisation Framework was used for assessment during the priority setting process. This framework was previously used for the development of Australian national priorities in data-driven healthcare improvement and women\u0026rsquo;s health\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The framework offered nine criteria (9Ps) for priority assessment \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePriority setting framework (9Ps) \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 1. Prevalence or burden attributable to the proposed problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsider the prevalence or attributable burden of the problem and its implications/complications. Is the problem a significant issue for the community, health system and key stakeholders?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 2: Prevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs there potential to prevent the problem, including complications or secondary impacts, in the general population or in a specific vulnerable target cohort?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 3: Position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsider the geographical issues around the problem and the location of services/expertise. Are there inequities that can be improved through this initiative? Is there potential to improve health outcomes for the general population and/or regional populations and/or specific vulnerable target cohorts?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 4: Provision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoes the current approach or system align with evidence-based best practice? Is the current approach designed to deliver the best possible community health outcomes and health care system? Is there a clear gap to address in the area proposed?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 5: Potential\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs there a strong rationale/evidence base for the potential for improvement in patient outcomes and health system advancement through this initiative?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 6: Participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs a collaborative approach critical to success? Are there clear drivers for stakeholders to engage and collaborate? Are there existing relationships between stakeholders that can be leveraged to drive improvement and change?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 7: Policy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoes the problem or the potential solution align with current policy directions at a local, state, national or international level?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 8: Proposed Strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoes the proposal align with the women\u0026rsquo;s health strategy endorsed by the Malaysian Health Coalition, Women\u0026rsquo;s Aid Organisation and Obstetrical and Gynaecological Society of Malaysia (OGSM)?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria 9: Proposed Transformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWill addressing this problem or taking this approach collaboratively support the development of an improved health system and health outcomes?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003ePriority-setting process\u003c/h3\u003e\n\u003cp\u003eThis study involved a four-step consensus process involving a pre-workshop Delphi survey, a consensus workshop, a post-workshop Delphi survey, and final endorsement. The multi-step process is outlined in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe initial list of values and research priority areas was derived from the Australian Health Research Alliance and adapted for the Malaysian setting (Supplementary Tables\u0026nbsp;1 and 2).\u003csup\u003e16\u003c/sup\u003e At the pre-workshop Delphi survey and the consensus workshop, participants had the opportunity to rank, change, or add the principles and priorities. The Delphi surveys were anonymous. Mean ranking scores were calculated for each principle or priority, with lower scores representing higher priority. The results of Delphi Survey 1 were presented at the consensus workshop. During the workshop, participants discussed the relative importance of each item and whether items should be changed, merged or split into further items. The updated list of items was provided in Delphi Survey 2 to be ranked by the participants. The final list was provided to the group for endorsement and minor refinement of wording.\u003c/p\u003e \u003cp\u003eFollowing the priority-setting discussions, the group discussed strategic plans for women\u0026rsquo;s health research in Malaysia. In small group discussions, participants considered the following topics: current research strengths, challenges and needs and visions for a flourishing women\u0026rsquo;s health research community in Malaysia. These were reported back to the larger group for further consensus discussion and the final themes were collated.\u003c/p\u003e \u003cp\u003eDemographic characteristics of the participants were presented in frequencies and proportions. Rankings were determined as the average of scores (mean) provided by the participants. Quantitative analyses were conducted in Microsoft Excel 2019.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the Delphi panel\u003c/h2\u003e \u003cp\u003eThe Delphi panel included a diverse group of representatives from a range of disciplines and professions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of 26 panellists, 21 (81%) completed Delphi survey 1, all (100%) attended the consensus meeting, and all (100%) completed Delphi survey 2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of panellists\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup representation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics/gynaecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing/midwifery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolicy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychology/counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNGO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther medical profession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsumer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsumer advocacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eValues and principles in Delphi Survey 1, consensus meeting and Delphi Survey 2\u003c/h2\u003e \u003cp\u003e For values and principles, Delphi Survey 1 found \u0026lsquo;primary, secondary and tertiary prevention across all research priorities\u0026rsquo; being ranked as the highest priority, followed by \u0026lsquo;community education, engagement and empowerment\u0026rsquo;, and \u0026lsquo;women in their lived environment including social determinants (Supplementary Table\u0026nbsp;3)\u0026rsquo;. Health literacy was merged into the Community Education item in the consensus workshop. Empowerment was also expanded to include the promotion and preservation of women\u0026rsquo;s autonomy and dignity. The concept of social determinants of health was merged with equity for priority and vulnerable populations, with the addition of highlighted populations including those from Indigenous, migrant and refugee backgrounds, gender diverse individuals, those in rural and regional areas, and key life stages of adolescence and ageing. This item was also expanded to include a multilevel approach as a solution. The item on translation and impact was reworded to \u0026lsquo;Implementation, impact and sustainability, including monitoring and evaluation, translation and dissemination.\u003c/p\u003e \u003cp\u003eThe final consensus on the prioritised values and principles for women\u0026rsquo;s health in Malaysia is as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The highest ranked value and principle was \u0026lsquo;Community education, health literacy, engagement and empowerment (including autonomy and dignity)\u0026rsquo;, as education, awareness and literacy was seen as the most important gap. The second highest ranked value and principle was prevention of disease, followed by multilevel approaches to address health equity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal consensus of values and principles for women\u0026rsquo;s health in Malaysia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Community education, health literacy, engagement and empowerment (including autonomy and dignity)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Primary, secondary and tertiary prevention of disease across all research priorities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Multilevel (political, cultural, community, interpersonal, individual) approach to social determinants of health and equity (e.g. priority and vulnerable populations including Indigenous, culturally and linguistically diverse, refugee, gender diverse individuals, and those in rural and regional areas, adolescents and ageing)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Implementation, impact and sustainability (include monitoring and evaluation, translation and dissemination)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Research processes require partnership, transparency, governance, priority setting, stakeholder engagement and large-scale collaboration\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch priorities in Delphi Survey 1, consensus meeting and Delphi Survey 2\u003c/h3\u003e\n\u003cp\u003eFor research priorities, Delphi Survey 1 found \u0026lsquo;chronic diseases and preventive health\u0026rsquo; being ranked as the highest priority, followed by \u0026lsquo;healthy lifestyle\u0026rsquo;, and \u0026lsquo;preconception\u0026rsquo; (Supplementary Table\u0026nbsp;3). During the consensus workshop, chronic disease was expanded and split into diabetes and other non-communicable diseases (NCD) together with cancer as separate items. Preconception, pregnancy and postpartum were also merged into a single item for continuity of care with a life course approach. Healthy lifestyle and obesity were merged with diabetes as these were seen as interrelated. Expanding on the life course approach, menopause and aging were suggested as additional items.\u003c/p\u003e \u003cp\u003eThe final consensus on the prioritized research topics for women\u0026rsquo;s health in Malaysia is as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The highest ranked research priority was \u0026lsquo;diabetes, healthy weight and lifestyle\u0026rsquo;, due to the rapidly increasing prevalence of diabetes in Malaysia. The second highest ranked priority was other NCD, followed by preconception, pregnancy and postpartum research.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal consensus on the research priorities for women\u0026rsquo;s health in Malaysia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Diabetes, healthy weight and lifestyle\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. NCD apart from diabetes (including cancer)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Preconception, pregnancy and postpartum\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Cancer screening and prevention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Mental health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Sexual and reproductive health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Perimenopause, menopause and healthy ageing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Violence and abuse\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eGaps and opportunities in women’s health research and implementation\u003c/h3\u003e\n\u003cp\u003eIntersectoral partnerships: The group identified highly motivated and committed leaders in healthcare, health policy and academia to address issues on women\u0026rsquo;s health research. These leaders, with appropriate systemic support, are able to facilitate the conduct of research that meets stakeholder needs and ensure translation and implementation. There are some established intersectoral partnerships between government ministries (Ministry of Education, Ministry of Health, Ministry of families), government funded and private healthcare, NGOs and universities that can be built upon, and a willingness from these sectors to build engagement in women\u0026rsquo;s health research. A number of global research funds identified would be well placed to support a middle-income country like Malaysia in women\u0026rsquo;s health research.\u003c/p\u003e \u003cp\u003eIntegrating research with government healthcare and data: Government health services collect valuable information to inform health research, evaluation and healthcare. Whilst there are good partnerships between government and clinical and public health research, simplifying systems and processes to access data, to link data and to obtain ethical approval would facilitate the integration of research and improved healthcare.\u003c/p\u003e \u003cp\u003eAddressing cultural and religious mores and beliefs: As a Muslim majority country, cultural and religious beliefs play a significant role in reproductive health, particularly in areas such as the provision of contraception and abortion and sexual and reproductive health education. For example, practitioners in government primary healthcare are legally allowed to provide contraception to unmarried women but in reality, this was reported to often be discouraged implicitly or explicitly. There also continues to be increasing recognition of gender-diverse individuals, though societal and legal challenges remain.\u003c/p\u003e \u003cp\u003eResearch infrastructure and workforce capacity: All attendees expressed the need for research services support including: biostatistics, health economics, legal, financial and ethical support. The need for access to a skilled interpreter workforce was identified to support the undertaking of research with diverse groups of women in Malaysia\u0026rsquo;s multicultural environment, including those with migrant and refugee experiences. The importance of open access publications was discussed as many researchers are unable to access university journal databases. Conversely, while many would wish to publish their own work in open access publications the significant costs often prohibit this. Additionally, supporting clinicians to upskill in research and to have protected research time along with dedicated research fellows were noted as required to harness the strengths and coordinate effort to progress the women\u0026rsquo;s health research agenda\u003c/p\u003e \u003cp\u003eNational research network: There is a need for a national research network bringing together intersectoral partners of academics, clinicians, government and non-governmental organisations to study, plan and deliver on initiatives that address the current gaps in women\u0026rsquo;s health in Malaysia.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVision of possibilities: Recommendations for women\u0026rsquo;s health research and implementation in Malaysia 2024\u0026ndash;2034\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecommendation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntersectoral partnerships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntersectoral partnerships between government, NGO and universities are needed to address implementation gaps in women\u0026rsquo;s health. This could potentially capitalise on innovative advances such as data-driven health systems, precision medicine, digital health, climate change and others.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrating research with government healthcare and data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe establishment and maintenance of key registry databases across women\u0026rsquo;s health conditions and non communicable diseases are needed for the visibility of women\u0026rsquo;s health issues in Malaysia to inform healthcare and policy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAddressing cultural and religious mores and beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBarriers to women\u0026rsquo;s health service access are multifactorial, ranging from stigma and taboo, attitudes and practice of healthcare providers, cultural and religious beliefs on women reproductive health issues. Multidisciplinary collaborations are needed to address these complex problems.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch infrastructure and capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere is a need for greater support in research support services including biostatistics, health economics, legal, financial and ethical support.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevelop a national research network\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA network that brings together women\u0026rsquo;s health researchers across the nation could help coordinate efforts on advancing women\u0026rsquo;s health.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis priority-setting exercise for women\u0026rsquo;s health in Malaysia identified the key values, principles and research priorities through the engagement of health professionals and consumers across various sectors. Five values and eight priorities were identified. The highest ranked value for women\u0026rsquo;s health was community education, health literacy, engagement and empowerment that uplifts the autonomy and dignity of women. The highest ranked priority was diabetes, healthy weight and lifestyle. Gaps and opportunities include intersectoral partnerships, cultural and religious beliefs, access to health data, and research support services such as biostatistics, health economics, legal, financial and ethical support and building capacity through a national women\u0026rsquo;s health network.\u003c/p\u003e \u003cp\u003eThe autonomy and dignity of women, advocated through community engagement and empowerment, were the highest-ranked value and principle. Community-voted priorities often reveal unmet needs \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. In many reproductive health contexts, such as unwanted pregnancies, women were not the only actors nor do they have complete agency over the circumstances that led to the outcome \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Despite this, the responsibility of the pregnancy with its lifetime consequences are borne mostly by girls and women. Reproductive autonomy needs to be recognised as a societal and systemic responsibility. Change is urgently needed as the human cost to inaction is tragic. Currently, there is one abandoned baby every three days with 60% found dead, unsafe abortions contributing to 1 in 5 maternal deaths and 18,000 teenage girls become pregnant each year \u003csup\u003e\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. To address the structural and social barriers, there is a need for increased literacy and empowerment of women and girls at every socioecological level, from policy, health system, communities, families to individuals, to ensure that women and girls have the autonomy and dignity to make choices that enable their health and well-being \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Education and communication were identified as key health promotion strategies to address non communicable diseases in Malaysia \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, which would also be applicable to women\u0026rsquo;s sexual and reproductive health. However, awareness in sexual and reproductive health alone will not be sufficient to bridge the gap. There are prerequisites to the actualisation of autonomy and dignity, such as equitable access to health care, education and the ability to support oneself \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Multi-level interventions are needed to address the complex root cause of the under-recognition of autonomy and dignity of women in health.\u003c/p\u003e \u003cp\u003eThe highest-ranked research priority area was on diabetes which included weight and healthy lifestyle. This priority reflects the stark increase in obesity and chronic diseases in Malaysia, particularly among women. The National Health and Morbidity Survey 2023 reported that over half (54%) of adults in Malaysia are overweight or obese \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. About 1 in 6 adults in Malaysia has diabetes, and 40% of those with diabetes were undiagnosed \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Women have additional sex-specific risk factors for type 2 diabetes, such as gestational diabetes (GDM), which is glucose intolerance first identified during pregnancy. GDM affects one in three pregnancies in Malaysia \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Women with prior GDM are at 10 times increased risk of developing T2DM later in life \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. There is increasing evidence that these pregnancy complications are indicators and accelerators of impaired maternal physiology, and therefore an important population risk marker for prevention \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Offspring born of GDM pregnancies are at increased risk of childhood obesity, hyperinsulinemia and metabolic syndrome, perpetuating the risk of cardiometabolic diseases diabetes in high-risk populations intergenerationally \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Lifestyle interventions have been shown to reduce the risk of cardiometabolic diseases, but implementation models for low- and middle-income countries such as Malaysia are lacking \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Taking a life course approach to non-communicable disease prevention at preconception, pregnancy and postpartum periods has also been prioritised among the top three topics by the current panel.\u003c/p\u003e \u003cp\u003eThe group voted for a multilevel approach as a value and principle to address the social determinants of women\u0026rsquo;s health. Barriers to women\u0026rsquo;s health service access are multifactorial, ranging from stigma and taboo, attitudes and practice of healthcare providers, cultural and religious beliefs on women\u0026rsquo;s reproductive health issues \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. The generation of solutions that are respectful and responsive to all these requires leaders and experts in culture, language and religion; cross-disciplinary expertise including health psychology, medical anthropology, human rights, co-design, digital health, medical humanities; healthcare providers, and women from various backgrounds to be at the table.\u003c/p\u003e \u003cp\u003eThere is also emphasis on sustainable implementation with impact requiring intersectoral partnerships between government, NGO and university sectors to drive innovations in healthcare. Complex interventions require knowledge on the inner and outer contextual factors, key actors and processes, governance, systems, data systems that are critical to successful implementation. While interventions at all levels are required, solutions targeting systems instead of individuals will produce the greatest impact in a sustainable manner. Seeking solutions through the public-funded government services will also ensure that those experiencing social disadvantage such as the B40 or rural populations will benefit. This is important as they are over-represented in disease burden \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. However, other solutions will need to be found to support those who are excluded from these services such as refugees.\u003c/p\u003e \u003cp\u003eWomen\u0026rsquo;s health research and services in Malaysia are ready for growth. There are local leaders with great calibre and commitment to women\u0026rsquo;s health, indicating workforce potential in women\u0026rsquo;s health research, leveraging the growing partnerships of local research institutions and international campuses in Malaysia. The potential of short-medium term gains is considerable: the infrastructure of primary care is well-developed for nation-wide scale-up of initiatives that will provide care to the most socially disadvantaged (B40) in the country, including women in rural areas and those with minimum income. Intersectoral partnerships and health systems innovations including in digital health could place Malaysia as a leading example of women\u0026rsquo;s health in the region.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis priority-setting activity places the upholding of women\u0026rsquo;s autonomy and dignity through community education and the prevention of non-communicable disease such as diabetes at the forefront of women\u0026rsquo;s health in Malaysia. Intersectoral partnerships, integration of health data and negotiating solutions within religious and cultural beliefs would accelerate the progress towards equitable health outcomes for women in Malaysia.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the Monash University Human Research Ethics Committee (MUHREC 42996), in accordance with the provisions of the National Statement on Ethical Conduct in Human Research 2025.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable. The study did not include any individual identifiable data, images, or personal information requiring consent for publication.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all participants prior to their inclusion in the study. Participation was voluntary, and participants were informed about the purpose of the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis project did not receive funds from any funder\u003c/p\u003e \u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLim S and Dominic NA contributed to the main manuscript text, whilst J.A Boyle contributed to the methodology and part of the discussion. The remainder authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability Statement\u003c/h2\u003e \u003cp\u003eData sharing not applicable to this study as no datasets were generated or analysed during the current study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMalaysia DoS. The Population of Malaysia. Open DOSM. Accessed May 12. 2025, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://open.dosm.gov.my/dashboard/population\u003c/span\u003e\u003cspan address=\"https://open.dosm.gov.my/dashboard/population\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBank W. Malaysia. Gender Data Portal. 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Int J Gynaecol Obstet Apr. 2014;125(1):89\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijgo.2014.01.002\u003c/span\u003e\u003cspan address=\"10.1016/j.ijgo.2014.01.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Women’s health, Malaysia, priority, consensus","lastPublishedDoi":"10.21203/rs.3.rs-9007481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9007481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThere has been significant progress in some areas of women\u0026rsquo;s health in Malaysia, notably in reducing maternal mortality but this rate has remained static in recent years. Rapid urbanization and an obesogenic environment have contributed to the steady increase in diabetes, obesity and cancers in Malaysian women. In addition to the rising non communicable diseases, significant knowledge gaps remain for reproductive health in this country with limited data on what would be expected to be common conditions such as endometriosis, pelvic pain, infertility, incontinence and polycystic ovary syndrome. Amidst the growing plethora of topic areas in women\u0026rsquo;s health, it is unclear which should be prioritised for immediate research investments. The aim of this study was to understand the gaps and opportunities in women\u0026rsquo;s health translational research in Malaysia. This priority-setting exercise identified the key values, principles and research priorities for women\u0026rsquo;s health in Malaysia through the engagement of health professionals and women with lived experience through a modified Delphi and Nominal Group Technique. Five principles and values and eight priorities were identified. The highest ranked value and principle for women\u0026rsquo;s health was community education that addresses health literacy, engagement and empowerment, which uphold the autonomy and dignity of women. The highest-ranked health priority was diabetes, which includes healthy weight and lifestyle. Gaps and opportunities include building intersectoral partnerships, addressing equitable access to reproductive services, integrating data systems to enable access, and strengthening research support services such as biostatistics, health economics, legal, financial and ethical support. Addressing these gaps and opportunities would accelerate progress in women's translational health research in Malaysia.\u003c/p\u003e","manuscriptTitle":"Consensus on Values and Priorities on Advancing Women’s Health in Malaysia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 14:35:51","doi":"10.21203/rs.3.rs-9007481/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T13:40:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T13:01:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T07:04:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309379900767608426039306519057757965434","date":"2026-04-19T23:29:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137605469109426036396383227175410916456","date":"2026-04-16T06:22:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T03:00:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-07T09:46:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-04T10:20:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T06:47:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-04-02T05:58:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cf82eb6-f1ef-45ae-b33a-6267c8987736","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-05T13:40:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T13:01:25+00:00","index":61,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T07:04:18+00:00","index":60,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T12:55:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 14:35:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9007481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9007481","identity":"rs-9007481","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}