Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusions

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

NCDs:

Non-communicable diseases

PHC:

Primary healthcare

LMICs:

Low- and middle-income countries

SMS:

Short message service

CHWs:

Community health workers

PHCCs:

Primary healthcare centers

WHO:

World Health Organization

CLI:

Collaborative for Leadership and Innovations in Health Systems

AUB:

American University of Beirut

MOPH:

Ministry of Public Health

UNRWA:

United Nations Relief and Works Agency

IDRC:

International Development Research Center

BMI:

Body mass index

DB:

Diabetes

FBS:

Fasting Blood Sugar

SBP:

Systolic Blood Pressure

DBP:

Diastolic Blood Pressure

HTN:

Hypertension

WC:

Waist circumference

DSME:

Disease self-management education

OR:

Odds ratio

RR:

Response rate

US:

United States

UK:

United Kingdom

References

  • Amara AH, Aljunid SM (2014) Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need. Global Health 10:1–15. https://doi.org/10.1186/1744-8603-10-24

    Article  Google Scholar 

  • Ammar W (2009) Health reform in Lebanon key achievements at a glance. Ministry of Public Health

  • Anderson RM, Funnell MM (2010) Patient empowerment: myths and misconceptions. Patient Educ Couns 79:277–282

    Article  PubMed  Google Scholar 

  • Balcázar H, Wise S, Rosenthal EL, Ochoa C, Duarte-Gardea M, Rodriguez J, Hastings D, Flores L, Hernandez L (2012) An ecological model using promotores de salud to prevent cardiovascular disease on the US-Mexico border: the HEART project. Prev chRonic Dis 9:110100. https://doi.org/10.5888/pcd9.110100

    PubMed  PubMed Central  Google Scholar 

  • Beaglehole R, Epping-Jordan J, Patel V, Chopra M, Ebrahim S, Kidd M, Haines A (2008) Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. Lancet 372:940–949. https://doi.org/10.1016/S0140-6736(08)61404-X

    Article  PubMed  Google Scholar 

  • Chen B, Cammett M (2012) Informal politics and inequity of access to health care in Lebanon. Int J Equity health 11:1

    Article  Google Scholar 

  • Gamm L, Castillo G, Pittman S (2010) Access to quality health services in rural areas—primary care. Nation 2:3

    Google Scholar 

  • George A, Rubin G (2003) Non-attendance in general practice: a systematic review and its implications for access to primary health care. Fam Pract 20:178–184

    Article  PubMed  Google Scholar 

  • Gray CS, Miller D, Kuluski K, Cott C (2014) Tying eHealth tools to patient needs: exploring the use of ehealth for community-dwelling patients with complex chronic disease and disability. JMIR Res Protoc 3:e67

    Article  Google Scholar 

  • Hogan TP, Wakefield B, Nazi KM, Houston TK, Weaver FM (2011) Promoting access through complementary eHealth technologies: recommendations for VA’s Home Telehealth and personal health record programs. J Gen Intern Med 26:628–635

    Article  PubMed  PubMed Central  Google Scholar 

  • International Diabetes Federation (2015) IDF Diabetes Atlas. IDF Diabetes Atlas—7th edn. http://www.diabetesatlas.org/. Accessed 20 May 2016

  • International Diabetes Federation (2017) Middle East and North Africa. http://www.idf-mena.org/about/diabetes-in-the-region. Accessed 20 May 2016

  • International Society of Hypertension (2015) World Hypertension Day 2015—17 May. http://ish-world.com/new-investigators-news/a/World-Hypertension-Day-2015/. Accessed 20 May 2016

  • Islam SMS, Tabassum R (2015) Implementation of information and communication technologies for health in Bangladesh. Bull World Health Organ 93:806–809

    Article  PubMed  PubMed Central  Google Scholar 

  • Islam SMS, Lechner A, Ferrari U, Froeschl G, Alam DS, Holle R, Seissler J, Niessen LW (2014) Mobile phone intervention for increasing adherence to treatment for type 2 diabetes in an urban area of Bangladesh: protocol for a randomized controlled trial. BMC Health Serv Res 14:1

    Article  Google Scholar 

  • Katz SJ, Moyer CA (2004) The emerging role of online communication between patients and their providers. J Gen Intern Med 19:978–983

    Article  PubMed  PubMed Central  Google Scholar 

  • Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, Zeidan W, Abu-Zayed I, Kochi A, Harries AD, Zachariah R (2014) Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of E-Health over 3 years in Jordan. Tropical Med Int Health 19:219–223

    Article  Google Scholar 

  • Lacy NL, Paulman A, Reuter MD, Lovejoy B (2004) Why we don’t come: patient perceptions on no-shows. Ann Fam Med 2:541–545

    Article  PubMed  PubMed Central  Google Scholar 

  • Maher D, Harries AD, Zachariah R, Enarson D (2009) A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem. BMC Public Health 9:1

    Article  Google Scholar 

  • Maher D, Ford N, Unwin N (2012) Priorities for developing countries in the global response to non-communicable diseases. Global Health 8:1

    Article  Google Scholar 

  • Ministry of Public Health (2016) Non communicable diseases prevention and control plan (NCD-PCP) Lebanon 2016. Republic of Lebanon-Ministry of Public Health

  • Mousa H, Yousef S, Riccardo F, Zeidan W, Sabatinelli G (2010) Hyperglycaemia, hypertension and their risk factors among Palestine refugees served by UNRWA

  • Neal RD, Hussain-Gambles M, Allgar VL, Lawlor DA, Dempsey O (2005) Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records. BMC Fam Prac 6:1

    Article  Google Scholar 

  • Norris SL, Chowdhury FM, Van Le K, Horsley T, Brownstein JN, Zhang X, Jack L, Satterfield DW (2006) Effectiveness of community health workers in the care of persons with diabetes. Diab Med 23:544–556

    Article  CAS  Google Scholar 

  • Ouma S, Herselman M (2008) E-health in rural areas: case of developing countries. Int J Biol Life Sci 4:194–200

    Google Scholar 

  • Oyebode O, Pape UJ, Laverty AA, Lee JT, Bhan N, Millett C (2015) Rural, urban and migrant differences in non-communicable disease risk-factors in middle income countries: a cross-sectional study of WHO-SAGE data. PLoS One 10:e0122747

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Paré G, Jaana M, Sicotte C (2007) Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc 14:269–277

    Article  PubMed  PubMed Central  Google Scholar 

  • Sabatinelli G, Pace-Shanklin S, Riccardo F, Shahin Y (2009) Palestinian refugees outside the occupied Palestinian territory. Lancet 373:1063–1065

    Article  PubMed  Google Scholar 

  • Samb B, Desai N, Nishtar S, Mendis S, Bekedam H, Wright A, Hsu J, Martiniuk A, Celletti F, Patel K, Adshead F, McKee M, Evans T, Alwan A, Etienne C (2010) Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries. Lancet 376:1785–1797. https://doi.org/10.1016/S0140-6736(10)61353-0

    Article  PubMed  Google Scholar 

  • Serocca AB (2008) Personal health record use by patients as perceived by ambulatory care physicians in Nebraska and South Dakota: a cross-sectional study. Perspect Health Inform Manag 5:1

    Google Scholar 

  • Sharp DJ (2001) Non-attendance at general practices and outpatient clinics: local systems are needed to address local problems. BMJ 323:1081–1083

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. Milbank Q 83:457–502

    Article  PubMed  PubMed Central  Google Scholar 

  • United Nations Relief and Works Agency (2011) Palestine refugees: a special case. UNRWA Lebanon

  • Wakerman J, Humphreys JS (2011) Sustainable primary health care services in rural and remote areas: innovation and evidence. Aust J Rural Health 19:118–124

    Article  PubMed  Google Scholar 

  • Wilson N, Couper I, De Vries E, Reid S, Fish T, Marais B (2009) inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health 9:1060

    PubMed  Google Scholar 

  • World Health Organization (2005) Preventing chronic diseases: a vital investment, World Health Organization

  • World Health Organization (2015) Lebanon: WHO statistical profile, 2015. World Health Organization

  • Yamout R, Adib SM, Hamadeh R, Freidi A, Ammar W (2014) Peer reviewed: screening for cardiovascular risk in asymptomatic users of the primary health care network in Lebanon, 2012–2013. Prev Chronic Dis 11:E120

    Article  PubMed  PubMed Central  Google Scholar 

  • Youssef A (2014) Use of short message service reminders to improve attendance at an internal medicine outpatient clinic in Saudi Arabia: a randomized controlled trial/Utilisation de rappels par minimessages afin d’améliorer l’assiduité des patients dans un service de consultations externes en médecine interne en Arabie saoudite: essai contrôlé randomisé. East Mediterr Health J 20:317

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

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.

Funding

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

Author information

Authors and Affiliations

  1. Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon

    Shadi Saleh, Mohamad Alameddine & Angie Farah

  2. Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon

    Shadi Saleh & Nour El Arnaout

  3. College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health Care City, Dubai, UAE

    Mohamad Alameddine

  4. School of Pharmacy, Lebanese American University, Beirut, Lebanon

    Hani Dimassi

  5. Bloomberg Faculty of Nursing, Dalla Lana School of Public Health and Department of Psychiatry, School of Medicine University of Toronto, Suite 381, HSB, 155 College Street, Toronto, ON, M5T 1P8, Canada

    Carles Muntaner

  6. Health Informatics, School of Health Policy and Management, Faculty of Health, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada

    Christo El Morr

Authors
  1. Shadi Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamad Alameddine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angie Farah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nour El Arnaout
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hani Dimassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carles Muntaner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christo El Morr
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Mohamad Alameddine.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saleh, S., Alameddine, M., Farah, A. et al. 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. Int J Public Health 63, 577–588 (2018). https://doi.org/10.1007/s00038-018-1092-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-018-1092-8

Keywords

Search

Navigation