International Journal of Public Health

, Volume 63, Issue 5, pp 577–588 | Cite as

eHealth as a facilitator of equitable access to primary healthcare: the case of caring for non-communicable diseases in rural and refugee settings in Lebanon

  • Shadi Saleh
  • Mohamad AlameddineEmail author
  • Angie Farah
  • Nour El Arnaout
  • Hani Dimassi
  • Carles Muntaner
  • Christo El Morr
Original Article



Assess the effect of selected low-cost eHealth tools on diabetes/hypertension detection and referrals rates in rural settings and refugee camps in Lebanon and explore the barriers to showing-up to scheduled appointments at Primary Healthcare Centers (PHC).


Community-based screening for diabetes and hypertension was conducted in five rural and three refugee camp PHCs using an eHealth netbook application. Remote referrals were generated based on pre-set criteria. A phone survey was subsequently conducted to assess the rate and causes of no-shows to scheduled appointments. Associations between the independent variables and the outcome of referrals were then tested.


Among 3481 screened individuals, diabetes, hypertension, and comorbidity were detected in 184,356 and 113 per 1000 individuals, respectively. 37.1% of referred individuals reported not showing-up to scheduled appointments, owing to feeling better/symptoms resolved (36.9%) and having another obligation (26.1%). The knowledge of referral reasons and the employment status were significantly associated with appointment show-ups.


Low-cost eHealth netbook application was deemed effective in identifying new cases of NCDs and establishing appropriate referrals in underserved communities.


Primary healthcare eHealth Diabetes Hypertension Referrals Appointment no-show 



Non-communicable diseases


Primary healthcare


Low- and middle-income countries


Short message service


Community health workers


Primary healthcare centers


World Health Organization


Collaborative for Leadership and Innovations in Health Systems


American University of Beirut


Ministry of Public Health


United Nations Relief and Works Agency


International Development Research Center


Body mass index




Fasting Blood Sugar


Systolic Blood Pressure


Diastolic Blood Pressure




Waist circumference


Disease self-management education


Odds ratio


Response rate


United States


United Kingdom



Technical support was provided by the Ministry of Public Health (MOPH) and the United Nations Relief and Works Agency (UNRWA) to ensure the commitment of participating centers. The study authors would like to acknowledge all the CHWs and all data collectors for their efforts.

Author contributions

SS and MA have conceptualized the study. MA and HD advised on the study design and data analysis. SS supported the implementation of the study. HD led the data analysis. SS, MA, AF, and NEA contributed significantly to the interpretation and development of the manuscript. AF, NEA, CEM, and CM made significant contributions to the write-up of the manuscript. All authors read and approved the final manuscript.


The study was funded by the International Development Research Center (IDRC), Canada. The contributions of IDRC staff and the material resources were very supportive to the conduct of this study

Compliance with ethical standards

Ethics approval and consent to participate

Prior to commencing the study, ethical approval was obtained from the Institutional Review Board of AUB. Written informed consent was used at all stages; participation was completely voluntarily and the data collected was completely confidential.

Availability of data and materials

The data sets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  1. 1.Department of Health Management and Policy, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
  2. 2.Global Health InstituteAmerican University of BeirutBeirutLebanon
  3. 3.College of MedicineMohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health Care CityDubaiUAE
  4. 4.School of PharmacyLebanese American UniversityBeirutLebanon
  5. 5.Bloomberg Faculty of Nursing, Dalla Lana School of Public Health and Department of PsychiatrySchool of Medicine University of TorontoTorontoCanada
  6. 6.Health Informatics, School of Health Policy and Management, Faculty of HealthYork UniversityTorontoCanada

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